This entry is a follow-up to the entry about a resident in Concord, N.C. who was allowed to wander away from the nursing home and fll off a loading dock.  A state investigation shows that a nursing home in Concord made several mistakes, which played a role in the death of a patient.  The 21-page report says that the staff and director of Five Oaks Manor knew that 87-year-old Annie Bell Scarboro was at risk for wandering because she had wandered off before.

State inspectors from the Department of Health and Human Services went into Five Oaks Manor in December after the Alzheimer’s patient died. The report shows Scarboro got through three sets of doors unsupervised.

First, she went through the dining room doors. A worker says those doors hadn’t locked properly for at least eight months. Then, Scarboro went through the kitchen doors and out a back door leading to the loading dock. The back door, according to the report, had no alarm.

Scarboro fell 4 feet off the loading dock .The "merry walker" chair she used to get around landed on top of her. A nurse who found Scarboro told inspectors, "I went out there and saw her blood was running everywhere."

A nursing assistant at Five Oaks told investigators, "Everyone knew that she wandered around. We all knew that she did that. She got out that kitchen door before."  The report shows that on May 22, 2008, Scarboro had exited the building through the same kitchen door.   The solution then was to check on her every 15 minutes.

The state investigation found the nursing home failed to meet several federal standards of care, meaning Five Oaks could be forced to pay a big fine and could lose their funding altogether.

NewsChannel 36 tried to get comment from the director, but he hung up on us.

To view the full 21-page report, click here.   The report does not mention the staffing levels at the time of the incident.
 

McKnight’s had an article about health care spending.  The article states that Federal spending on nursing home and home health accelerated in 2007, even as overall healthcare spending grew at the slowest rate since 1998, according to a new spending report issued by the Centers for Medicare & Medicaid Services.

Freestanding nursing home spending expanded by 4.8% that year, compared with 4.0% in 2006. Meanwhile, spending for freestanding home healthcare services increased to 11.3%.   Overall healthcare spending climbed by 6.1% in 2007 to $2.2 trillion, or $7,421 per person. Total healthcare spending by public programs, such as Medicare and Medicaid, grew 6.4% in 2007, a deceleration from 8.2% 2006.

One of the factors contributing to the overall slower growth in federal healthcare spending was a deceleration in prescription drug spending due to an increased use of generic medication. Retail prescription drug spending grew by 4.9% in 2007, compared with 8.6% growth in 2006, according to the report.

 

The Supreme Court of Missouri in Lawrence v. Beverly Manor affirmed the circuit court decision  that wrongful death claimants were not bound by an arbitration agreement and could bring a court action for their relative’s wrongful death.  

The Missouri Supreme Court in Ward v. National Healthcare Corporation affirmed the circuit court’s decision because the resident’s relative signed the agreement that included an arbitration clause but the relative was not power of attorney or legal guardiand therefore the arbitration clause was not enforceable.

These opinions are very encouraging.  It is ridiculous that nursing homes want residents and their families to agree to waive their right to a jury trial.  Most of the residents don’t even know what they are signing or what arbitration means.

Hopefully, the Arbitration Fairness Act will soon pass and consumers will not need to worry about such unconscionable clauses in the nursing home admissions contracts.

 

Science Daily had an interesting article about how technology can assist in caring for residents at home instead of placing them in nursing homes. Many older adults want to remain active and independent and to live in their own homes and avoid moving to nursing homes. University of Missouri researchers are using sensors, computers and communication systems, along with supportive health care services to monitor the health of older adults who are living at home.

According to the article, motion sensor networks installed in seniors’ homes can detect changes in behavior and physical activity, including walking and sleeping patterns. Early identification of these changes can prompt health care interventions that can delay or prevent serious health events.

As part of the "aging in place" research at MU, integrated sensor networks were installed in apartments of residents at TigerPlace, a retirement community that helps senior residents stay healthy and active to avoid hospitalization and relocation. MU researchers collected data from motion and bed sensors that continuously logged information for more than two years. The researchers identified patterns in the sensor data that can provide clues to predict adverse health events, including falls, emergency room visits and hospitalizations.

"The ‘aging in place’ concept allows older adults to remain in the environment of their choice and receive supportive health services as needed. "Monitoring sensor patterns is an effective and discreet way to ensure the health and privacy of older adults."

In recent evaluations, the sensor networks detected changes in residents’ conditions that were not recognized by traditional health care assessments. MU researchers are perfecting the technology infrastructure so these technologies and supportive health care services can be made available to seniors throughout the country.

"Our goal is to generate automatic alerts that notify caregivers of changes in residents’ conditions that would allow them to intervene and prevent adverse health events," Rantz said. "Additional work is underway to establish these health alerts, improve the reliability and accuracy of the sensor network, implement a video sensor network, and refine a Web-based interface to make it even more user friendly and meaningful to health care providers."

The study, "Using Technology to Enhance Aging in Place," was presented at the 2008 International Conference on Smart homes and health Telematics. It was funded by a grant from the U.S. Administration on Aging and the National Science Foundation ITR grant.
 

Vermont’s WCAX.com had an article about another employee of a nursing home stealing resident’s pills.  There seems to be an epidemic of nurses stealing narcotics and other medications to ingest or sell on the black market.  Should they routinely drug test nursing home workers? 

Dawn Ash was indicted for possession and theft of the narcotics. She worked as a nurse at a New London, N.H., nursing home.   Investigators suspect her of stealing Percocet and Vicodin from residents at the William P. Clough Center. It’s a 58-bed nursing home attached to New London Hospital.

Last April, shortly before she was hired at the Clough Center, the state of Vermont suspended Ash’s nursing license. She was accused in Vermont of illegally obtaining regulated substances with false prescriptions.
 

How in the world was she hired at a nursing home? Why didn’t the nursing home check to make sure she had a license?  I wonder how many residents had to suffer in pain because this nurse took their pain medication.  I hope they throw the book at her.

On Jan. 9, 2009, Trans Healthcare, Inc. filed for bankruptcy and entered into a recievership.  It seems to apply only to facilities located in Ohio and Maryland.  Trans Healthcare, Inc. is a subsidiary to THI Holdings, L.L.C. and a "sister" company to THI of Baltimore, Inc.   I would imagine the next step will be bankruptcy for THI of Baltimore, Inc. 

 

On Jan. 9, 2009, Trans Healthcare, Inc. filed for bankruptcy and entered into a receivership.  It seems to apply only to facilities located in Ohio and Maryland.  Trans Healthcare, Inc. is a subsidiary to THI Holdings, L.L.C. and a "sister" company to THI of Baltimore, Inc.   I would imagine the next step will be bankruptcy for THI of Baltimore, Inc. 

 

Washington Post had an article recently about the epidemic of diabetes in nursing homes.  The article states that more and more people with diabetes are living to older ages but nursing homes are not ready for the additional challenges that come with treating patients with diabetes.

"We need to spend appropriate time to think of a way to successfully provide care for people with diabetes as they enter their elder years, and we’re just beginning to understand how to do that," said Dr. Paul Strumph, vice president and chief medical officer for the Juvenile Diabetes Research Foundation.   Although about one in four nursing home residents has diabetes, not all are getting care that meets the American Diabetes Association’s goals for community-dwelling adults, according to a recent study.

The study, published in Diabetes Care, found that while 98 percent of nursing home residents with diabetes had their blood glucose levels monitored, only 38 percent met short-term glucose goals.

"One of the key differences in managing diabetes in a nursing home is that it’s often not the condition of primary importance," said Helaine Resnick, director of research at the Institute for the Future of Aging Services for the American Association of Homes and Services for the Aging.

Resnick said one of the concerns she had with the study findings was that no one has yet to come up with specific guidelines for caring for elderly people with diabetes. Glucose control goals for someone who’s 40 and living at home may well be different than for someone who’s 85, cognitively impaired, and living in a long-term care facility, she said.

"Someone in a nursing home could pull out a pump site and not know. In that case, you may want to be on a longer-acting insulin instead. We haven’t yet defined what the ideal insulin [regimen] is for someone in a facility with a fairly predictable schedule," Strumph said.

"Families need to become more actively involved in working with care teams, and that’s true for diabetes and for other conditions. Ensure that the facility understands the family’s and the resident’s preferences. Is your mother more interested in keeping her blood glucose control tight and risk [low blood sugar]? Or is it better for her to ease up on glucose control and work more on quality-of-life issues? Resnick said.

SOURCES: Paul Strumph, M.D., vice president, chief medical officer, Juvenile Diabetes Research Foundation, New York City; Helaine Resnick, Ph.D., M.P.H., director of research, Institute for the Future of Aging Services, American Association of Homes and Services for the Aging, Washington D.C.; June 2007, Diabetes Care

 

The Honolulu Advisor had a terrible story about a nursing home resident evicted and left at the emergency room of a hospital days before Christmas.  The 81-year-old woman was confined to a wheelchair wearing only a hospital gown.

Florence Ko told The Advertiser she had no idea what was happening and where she would be staying when she was taken from Nu’uanu Hale, where she had lived since July 2007.  "I wish someone (at the nursing home) had the courage to tell me what was going on," Ko said in a brief interview last week from her bed at the ‘Aiea facility.

When she was left at Straub, Ko had no personal belongings except her purse, which contained less than $3 and her cell phone — but not the charger, according to members of her church who have been helping her.

The Department of Human Services, the agency that investigates elder abuse, called Nu’uanu Hale’s actions inappropriate and was referring the matter to the Department of Health, which licenses Hawai’i nursing homes.

Nu’uanu Hale was one of six Hawai’i nursing homes last month to receive the poorest rating possible from the federal government in a newly created system for publicly assessing quality of care at the nation’s roughly 16,000 homes. The nursing home received a single star out of a possible five.

First Unitarian members, who have been helping Ko in recent years as she became increasingly less mobile because of polio-related ailments, and the family have been trying to get Medicaid to cover Ko’s long-term-care bills, just as the government insurance program does to some degree for income-eligible seniors, the church members said. Ko’s application, however, has twice been rejected, they said. Even though she received regular income from Social Security and an annuity, the amount wasn’t enough to cover her nursing-home tab. 

Church members said they were told Ko was taken to Straub to get treatment for an anxiety problem. While she was there, she used her cell phone, clearly upset about not knowing what was happening. But the line abruptly cut off during their conversation and the lay minister couldn’t reach her friend after that.

Ko, an articulate, feisty woman with a head full of white hair and an occasional memory lapse, said she had thought her financial situation with Nu’uanu Hale was going to be resolved. Yet when she returned to her room after physical therapy on Dec. 17, her personal belongings had been piled on a gurney and people were cleaning her room, she said.

"To just kind of toss you out — that’s it," she said. Later that day, Ko’s belongings were placed under a tarp outside Nu’uanu Hale, where church members later retrieved them.

Because Ko’s finances apparently did not allow her to qualify for Medicaid but were too little to cover her nursing-home tab, she is part of a growing "gap group" that increasingly will have a tough time affording the long-term care they need as they enter their 70s, 80s and 90s, experts say. 

 

Providence Business News at PBN.com had an inspirational article about a group called Nursing Home of the Future.  They are a team of professionals who are trying to understand the difficulties of living in a nursing home and recommending changes to how we care for our vulnerable adults.

The members of the Nursing Home of the Future team spent whole days with residents of the Tockwotton Home, hearing their stories, watching them in their rooms, in the dining area, in exercise class, at the card table.  They saw how hard it is for seniors on walkers to use the bathroom. Realized how they might just stay in their wheelchairs for hours just because moving is too difficult. Noticed that even with all the activities on the calendar, there’s really very little to do all day.  They saw how institutional, rigid and unhomelike life can sometimes be.

This project aims to change the situation.  Armed with reams of information gathered through site visits, interviews and research, and helped by partners from health care and academia to industrial design, the team hopes to reinvent long-term care for a generation of baby boomers.

“The Nursing Home of the Future is exactly the reason we created the Business Innovation Factory,” BIF founder, Chairman and “Chief Catalyst” Saul Kaplan said in a recent interview. “To bring a community of innovators together to come up with solutions to an issue we all face.”

The goal is to ensure older Americans get “the kind of experience as they age that they deserve.” “We want to create a series of laboratories where we can roll up our sleeves and come up with solutions,” said Kaplan.  “We want to work in health care, education, in the consumer space, in the citizen space, looking at public safety solutions.”

The nursing home project began in the spring, as a collaboration between BIF, Tockwotton and a diverse group of experts, including the MIT AgeLab, Brown University and Rhode Island School of Design faculty, Quality Partners of Rhode Island and the design firm Tellart. 

For Phase I, which started in early summer and cost about $160,000, Kaplan, project director Melissa Withers and 14 others set out to document every aspect of life at Tockwotton, a 30-bed assisted living center and 42-bed skilled nursing facility in Providence’s Fox Point neighborhood.

They had group discussions and one-on-one interviews with the Tockwotton staff, residents and family members. They learned how everything is done – how meals are served, medications dispensed and transportation arranged. They watched the staff give manicures, style hair and do makeup; they sat in on exercise sessions, games and TV time.

And they learned about life as a frail elder, watching seniors struggle on walkers and in wheelchairs, and nurses’ aides feeding residents when they couldn’t feed themselves, carrying them in and out of bed and escorting them to the toilet and the shower.

Team member Allan Tear analyzed every part of the bathrooms, quickly identifying design flaws such as the toilet paper’s placement behind the seat, where it would be hard to reach, and the sink so far and inconvenient that many seniors on walkers don’t even try to use it.

“I sat in the shower chair, where the PVC piping of the structure, the medical green synthetic backing fibers and the jammed wheels it rested on, along with the toilet seat for a chair, did nothing to make me relax,” she wrote. “I tried to imagine sitting there naked as someone washed me … I felt ill at ease and exposed.”

Speaking with the seniors was especially instructive, the team found.

How do you take all this knowledge and translate it into better nursing homes?  That is the challenge for Phase II.  That’s when active experimentation will begin, guided by an “opportunity map” the team used to set priorities in different areas.

To better care for seniors’ bodies and minds, they want to create stimulating games and activities; design special furniture and technologies to maximize comfort and reduce pain; and come up with innovative low-risk physical activities, among other ideas.  They want to re-design bathrooms – toilets, sinks, shower areas – to make them easier to use, more welcoming and much safer, not just in the nursing home, but in assisted-living homes and for seniors’ own homes, so accidents that lead to institutionalization are prevented.

They want to use assistive technologies for a wide range of purposes, from remote monitoring of bathroom visits and wireless biometric monitoring, to communications devices and medication reminders for seniors who might forget their pills.

Indeed, the cost and logistics of caring for the baby boomers as they age is a big incentive to make big, dramatic changes in elder care, the team members stressed. Already, there are more than 15,000 nursing homes in America, and $125 billion was spent in nursing home care in 2006. But with the boomers, the elderly population will more than double.

Nursing home “culture change,” a movement within the industry that aims to make facilities more homelike, is making a difference, but not enough, team members said. Seniors can stay up late if they want, for example, but Tockwotton feels eerily quiet and dark at night.