The Milwuakee Journal had an excellent 2 part series on nursing homes recently.  They can be found here and here.

The Journal describes how dozens of nursing homes in Wisconsin have been cited for improper care after the deaths of 56 residents since 2005 – a period marked by a dramatic surge in serious violations around the state.  Neglect was noted after hundreds of elderly or disabled nursing home residents were found with bruises, broken bones or pressure ulcers – some so deep they tunneled to the bone.   In hundreds of cases, reports document how inadequate training, lack of supervision and understaffing contributed to a rising number of injuries.

The Journal Sentinel built a database from thousands of pages of nursing home regulatory records over the past 3 1/2 years. Among the findings:

• Health care violations that put patients in jeopardy or resulted in harm spiked 34% the past three years.

• Dozens of homes are cited repeatedly for serious violations.  Many of the homes cited multiple times are owned by out-of-state corporations.

• Deaths and injuries are occurring at a time of significant worker turnover. In one case, a problem home reported nursing staff turnover rates as high as 257% last year while it led the state in serious citations.

• Families are often kept in the dark about citations issued after the deaths of their loved ones. Four families learned from the Journal Sentinel that serious citations had been issued months and even years after their loved ones were buried. 

Uunprecedented growth and profits in the industry is expected to continue. Last year, the federal government spent about $75 billion on nursing home care through the Medicare and Medicaid program.

The ownership and operation of Wisconsin nursing homes has changed dramatically. Locally owned mom-and-pop operations have given way to out-of-state for profit corporations that own clusters of homes. 

Health care experts cite other factors that have affected nursing home care.   The increase in pressure iulcers are a major concern and a leading indicator of neglect.   Pressure ulcers occur when nursing home residents are left in one position too long. The ulcers get worse when people are forced to lie in their own waste which is common in uunderstaffed facilities.  Without immediate attention, the ulcers can be life threatening.

High turnover rate is an major problem.  The aides do not get paid well and are typically asked to do the work of 2 or 3 aides.  Most aides don’t stay at one facility for long. The Journal Sentinel found that turnover for full-time nursing assistants at Wisconsin nursing homes can be as high as 200%, with an average of 42% last year.   Many nursing assistant jobs start at less than $9 an hour.

"It’s a hard job, but it’s better than working at McDonald’s," said Jim Wilson, administrator at Oak Park Nursing and Rehabilitation in Madison.   The turnover of full-time professional nurses who monitor residents’ care is also high. Among the homes cited repeatedly for serious violations, the turnover rate for full-time registered nurses averaged 57% last year with some homes reporting turnover as high as 300%. The state’s average turnover for full-time registered nurses in all nursing homes was 32%.

Staff turnover can directly affect care, said Julie Eisenhardt, a spokeswoman for the union representing nursing assistants. Inspection records back that up.

Sava Senior Care, a Georgia-based corporation, operates 185 homes nationally. Two of its four homes in the state have been cited with serious violations at least three times since 2005.
Even when large fines or other enforcement actions are imposed against nursing homes after serious injuries or deaths, families might never know about them. Neither federal nor state law requires that families be notified.

A Journal Sentinel analysis found that nursing homes in Wisconsin were cited for poor care after the deaths of 56 residents since 2005. But Nursing Home Compare doesn’t offer any details about those deaths.   The Web site also doesn’t mention anything about corporate ownership, meaning that consumers would be unable to determine if the nursing home was owned by an out of state corporation or even one with a history of violations and fines.  "Figuring out who is accountable for poor care can be very difficult," said Alice Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform. "Consumers often don’t know who owns and operates a facility. Unless a facility tells them, there is no public way to find that out."   For consumers, knowing who owns a home is important if they want to determine whether the same problems are showing up in multiple homes owned by the parent corporation.

The number of nurses and aides on staff to help residents is a key factor in determining whether quality care is being provided, according to experts.   "The higher the staffing, the better the quality," said Charlene Harrington, a professor of sociology and nursing at the University of California in San Francisco.   Staffing numbers provided by Nursing Home Compare are merely a two-week snapshot from the most recent inspection – and in an industry that has widespread staff turnover, those numbers can’t always be trusted, Hedt said.

William A. Hyman wrote an article in McKnight’s Long Term Care News on July 24, 2008 about the dangers of bed rails and the problem with entrapment.

Bed-rail entrapments and deaths continue to occur in nursing homes, other facilities and in the home because rail and bed designs that are clearly dangerous continue to be used. Such rails may be in your inventory, or in the inventory of your rental supplier.

The U.S. Food and Drug Administration has recognized and reported on the problem of lethal entrapments for over 10 years, but it has not ordered recalls. Some manufacturers have designed safer rails yet not replaced those already in use. And despite the publicity efforts of the FDA, The Joint Commission published articles and others, there continues to be a lack of practical understanding of the nature of this hazard and how to recognize a dangerous bed.

The time to end lethal bed-rail entrapments is now, and the way to do it is to remove from the inventory those bed-rail systems that are unreasonably dangerous, and to insist that suppliers provide beds that at least meet current guidelines.

It is now 13 years since the FDA’s Safety Alert on the dangers of entrapment in bed rails, and other parts of hospital and nursing home beds (1). This alert was directed to Home Healthcare Agencies, Hospices, and Nursing Homes, among others. It was based, in part, on already published work and reports to the FDA of deaths and injuries associated with beds and bed rails, the latter going back to publicly available data since 1985. The FDA alert triggered a number of related reports and announcements in the clinical literature (2- 4).

Read More →

S.C. to post Medicaid payments to doctors, nursing homes online 

South Carolina is now posting how much the local nursing home or doctor gets in Mediciad reimbursements.

"We are pleased to be able to offer the public a way to track how their money is spent in the Medicaid program," Emma Forkner, director of the state Department of Health and Human Services, said in a statement. "This kind of spending transparency is key to ensuring accountability from government agencies and those who get paid by them."

The move by DHHS, which administers the $5.4 billion Medicaid program, will help DHHS locate "unusual billing patterns"  and hopefully detect fraud.  

The site also provides information about dentists, hospitals and any of the other nearly 30,000 health care providers in South Carolina who participate in the Medicaid program. It includes their reimbursements as well as the number of patients they saw. More than 800,000 South Carolinians receive Medicaid, the health insurance program for the poor and disabled.

To access the data, go to http://www.dhhs.state.sc.us/dhhsnew/Transparency.asp and click on Medicaid Transparency Database.

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Pearce Adams wrote an article for the Independent Anderson Mail about an administrator of an assisted living facility stealing from his residents.  He was arrested on Wednesday and charged with exploitation of a vulnerable adult.

Robert Dunmoyer, 57, was allowed to post a $25,000 bond in Anderson Municipal Court the attorney general’s office made the recommendation, citing Robert Dunmoyer’s "cooperation" with the investigation.   Dunmoyer, former administrator with the Magnolia Residential Care center in Anderson, tricked a 75-year-old resident to give Dunmoyer power of attorney for the man. That step gave Dunmoyer legal authority to handle the man’s bank accounts and investments.

Supposedly, Dunmoyer took responsibility for his actions after he got caught.  He made excuses for his behavior stating that he was having personal problems from a divorce that “created the state of mind” that allowed him to steal and take advantage of his resident. 

Dunmoyer had taken “approximately $100,000 from (the elderly man’s) account with them,” and charged the man $9,500 to handle his stocks, the report states.

Ken Moore, representing the state unit that investigates nursing home and assisted living home crimes, testified that between July 2007 and April, Dunmoyer withdrew $60,000 without the consent of the elderly man.

The discrepancy between the amount mentioned in court and that listed in the incident report was not addressed. Moore said Dunmoyer “told us what he did and why he did it” and was cooperating with authorities.

I stumbled across this article from the New York Times which I found interesting regarding violence against nurses being a serious issue – especially in terms of workplace violence.  It reminded me that in all the talking we do about abuse and neglect of patients, we sometimes forget that nurses and aides, and really anyone providing "front-line" care to patients in a health care setting, are at risk for abuses as well.

The article points out that workplace violence is 12% higher in for nurses and personal care aides than in the private sector, which may not sound like a lot, but certainly seems like a high risk if you work in this field.  The article goes on to say that the most dangerous setting is psychiatric facilities and nursing homes due in part to patient confusion.  However, the author also points out that part of the problem in these settings is the long wait time for services in places like nursing homes and emergency rooms.  This is made worse still by the nursing shortage.

"Nurses say the persistent nationwide nursing shortage is making matters worse, because understaffing increases the risk of violent incidents. And nurses cite the fear of assault as a reason for low morale, especially if they feel that management does not share their concern."

We have to remember that often times, our clients, our family members, our patients (whatever angle you look from) are quite often not the only victims in these situations.  Many times, too many times, the people who provide the care are victims as well – if they don’t have enough support, then they effectively have an increased risk of being harmed.  Interesting, isn’t it – without enough staff, we know the care of the resident’s suffers, but we forget that short staffing affects the staff as well.

I, myself, when working at a nursing home, have been cornered in my office by an elderly lady who was furiously swinging at me.  I was a social worker, the resident was in my office because she had been disruptive all day and the nurse’s simply couldn’t watch after her anymore.  I realized right quick that part of the fear is that they might injure you (its amazing what sort of strength a demented, angry 95 pound woman can have), and part of the fear becomes that you might injure them in trying to protect yourself.

I don’t know what the solution is, but I am reminded again, as I often am, about a discussion with a friend about one way to keep plenty of good staff is to pay them well – pay them to continue to care, pay them to be accountable for the care they provide.  Of course, I know that money is not the absolute solution, but Management types should certainly know that if they have good staff, they should pay them to stay – and while thy’re there, they have to listen to and support them emotionally.  If Management sees their front line staff as just another warm body, then eventually morale becomes such that you have just that, another warm body.

It takes a certain, special kind of person to care for patients of all kinds, nursing home residents included.  The article reminded me that we have to remember that caregivers are sometimes victims as well, and often through no fault of their own.  And, like the residents they care for, they should have some measure of safety as well.  Thoughts?

Online Nursing Home Resource Provided by IQ Nursing Homes.  IQ Nursing Homes announces the launch of their new website, a comprehensive online research tool for nursing home residents and concerned family members.

(EMAILWIRE.COM, July 17, 2008 ) New York – IQ Nursing Homes announces the launch of their new website, a comprehensive online research tool for nursing home residents and concerned family members. A national nursing home directory, up-to-date nursing home news, nursing home deficiency reports, and legal resources for victims of nursing home abuse and elder neglect cases are now just a click away on one easy to navigate site.

With increased life expectancies in today’s society leading to higher numbers of nursing home residents, IQ Nursing Homes recognized the need to create a free, complete online nursing home resource. Careful research is imperative to ensure that the nursing home to which you entrust your loved one’s care is reputable and safe. When you visit IQ Nursing Home’s national directory to locate elder care facilities in your area, you can also check nursing home deficiency reports to make sure the facility you choose provides the best care possible to its residents.

In addition to directories and information, IQ Nursing Homes provides a way for nursing home employees, residents, and their families to combat elder abuse and neglect. These are serious, prevalent problems that can result in physical and emotional suffering. Painful bed sores, broken hips, and even death are among the afflictions the nursing home residents face at the hands of negligent or abusive caregivers. Resources to help individuals recognize and report these problems are available on the IQ Nursing Homes website, including signs and symptoms of abuse and neglect and an anonymous abuse report form.

If abuse is suspected, a free nursing home abuse case evaluation is also available on the site. IQ Nursing Homes has partnered with expert nursing home lawyers and law firms throughout the country with the goal of putting a stop to the victimization of the elderly. By holding negligent and abusive staff members accountable for their actions and making it financially devastating for nursing homes to allow abuse and neglect to occur, this epidemic can be put to an end.

Be IQ Smart. Visit http://www.iqnursinghomes.com/ to learn more.

This press release was issued through GroupWeb EmailWire.Com. For more information on unlimited press release distribution service, go to http://www.emailwire.com

House subcommittee passes nursing home arbitration bill (07/17/08 McKnight’s Long Term Care News)

The House Judiciary Subcommittee on Commercial Law and Administrative Law Tuesday approved the Fairness in Nursing Home Arbitration Act, which would outlaw signing an arbitration agreement as a prerequisite to admission in a nursing home.

Republicans on the subcommittee voted against the measure but came up short in a 5-4 vote. Some members tried to add amendments that would remove some of the sting for nursing homes. Rep. Chris Cannon (R-UT) tried to add language that would exclude physicians and providers in nursing homes from the bill, ensure the bill would not be retroactive, as well as other provisions. All these amendments were shouted down in voice votes.

The subcommittee’s approval moves the bill one step closer to becoming law. Long-term care advocates oppose the legislation, arguing that arbitration agreements allow them to channel limited Medicare and Medicaid resources to providing quality care instead of funding lengthy court trials.  

Of course, no Medicaid or Medicare money actually goes to defending lawsuits since insurance companies pay for the defense of the claim.  What is really needed is a bill that mandates minimum amounts of insurance for each facility–something in the amount of 10% of gross revenues.

I know I’m about a week behind on this one, but I think it’s important.  Jane Gross wrote a piece for one of the New York Times blogs about all the decisions that needed to be made for her mother towards the end of her life.  In the piece titled What I Wish I’d Done Differently, Ms. Gross talks about everything from having a geriatrician to selling her mother’s house, and all the uncertainties in between.

She points out, quite correctly that there’s no way to be without uncertainties in situations like this, but that she would have liked to known prior to making some decisions that ultimately limited the choices they had later in regards to her mother’s care.

Something to think about this afternoon . . .

Article about lawsuit over husband’s fall at nursing home by David Yates, writer for The Southeast Texas Record. 

The nursing home staff found him in a pool of his own blood two years ago.  Clifford Ozen has suffered from seizures and decreased mobility sinc ethat fall.  The Senior Rehabilitation and Skilled Nursing Center in Port Arthur allowed Mr. Ozen to fall from his bed.  His wife, Sharon Ozen, filed suit against the healthcare provider July 9 in Jefferson County District Court.

On July 28, 2006, Sharon Ozen visited her husband at the 199-bed rehabilitation facility.   After leaving the center, Sharon received a call and was advised that her husband was being rushed to the hospital.   "According to Mr. Ozen’s chart, an aide called a nurse because he was found on the floor with his head lying against the frame of the bedside table," the lawsuit said. "Defendant’s staff observed blood on the floor in a puddle, as well as a contusion and laceration to the top of Mr. Ozen’s head."

Since the fall, Clifford Ozen has suffered from seizures and has been bedridden. Upon his admission to the nursing home in January 2006, Clifford was diagnosed with dementia, confusion, wandering and an unsteady gait.   All risk factors for falling.  Nursing home was on notice that he could fall but did nothing to try to prevent him from injuring himself even though his wife consented to the use of restraints and safety devicesto protect him.

"The only safety precautions being utilized for Mr. Ozen were side rails on his bed and geriatric chair," the suit says. "These precautions were used only intermittently. Further, during his stay, he was unable to ambulate himself and had an impaired safety awareness."

Sharon alleges she informed the nursing home staff of her concerns, but the healthcare provider negligently failed to assess her husband’s risk for falling.  The nursing home also allegedly "failed to adequately protect him from falling in light of his confusion, agitation and impaired safety awareness."

Senior Rehabilitation and Skilled Nursing Center is owned by Victoria, Texas-based Regency Nursing & Rehabilitation Centers, Inc.

The New Jersey Courier Post online had an article about how nursing homes’ populations are getting younger.  Below is an excerpt from the article:

At 45, John Eickmeyer is the youngest resident of the New Jersey Veterans Memorial Home on North West Boulevard.  His roommate is 86 and has advanced Alzheimer’s disease. That disparity isn’t unique to the veterans home.

Eickmeyer is one of a growing number of younger residents in long-term care facilities traditionally viewed as places for the elderly.   At the veterans home, the average age of residents is 81.

But, 24 of the home’s 290 residents — or roughly 7 percent — are under age 65.   In December 2003, 12.4 percent of New Jersey nursing-home residents were under age 65, according to the Centers for Medicare & Medicaid Services. In December, 14.3 percent were 65 or younger.
Across the country, 12.3 percent of nursing-home residents were under age 65 in December 2003. Last year, that number increased to 13.9 percent. In all instances, the vast majority of those residents were over age 30.

Health-care experts said the number of younger residents in nursing homes and assisted-living facilities will continue to grow, creating new challenges for administrators who must find ways to provide quality of life for residents who might be a half-century apart in age.

At first, Eickmeyer found it hard to adjust to being lumped in with an older crowd.

"It was culture shock," said Eickmeyer, who grew up in Waterford and lived in Hammonton before moving in to the veterans home.   He and some of the older residents disagreed on things as simple as room temperature.  But, Eickmeyer eventually saw an upside to living with people old enough to be his grandparents.

"Thrown into an environment like that, you listen first," he said. "I figured I could learn a multitude of information from older people, and I did."

"Within the next 10 to 15 years, there will be more of an influx of those who served in Vietnam, Desert Storm and more recent conflicts," he said.

Reach Tim Zatzariny Jr. at tzatzariny@thedailyjournal.com