The News & Observer of Raleigh has an interseting article about the "new philosophy" of limiting or preventing nursing home residents from being in a wheelchair as long as the resident wants.

The article argues that older people’s health, mobility and self-image can suffer from too much time in wheelchairs. More than 24,000 North Carolina nursing home residents – about two-thirds of the total population – use wheelchairs as their main means of getting around.   

Ways to limit unnecessary wheelchair use are part of a movement that gives priority to the well-being of residents and their caregivers, above the functions of the nursing home or convenience of the staff.

The Midwest-based group called GROW – Get Residents Out of Wheelchairs – has taken up the cause on a national level. The nonprofit urges nursing homes to help residents use regular chairs, couches, recliners when sitting "is considered the norm and socially accepted." That includes for meals, TV watching, socializing with family and friends, and resting when tired.

Advocates acknowledge that wheelchairs have their uses for certain residents at certain times.
Advocates and academics say the downsides to spending too much time in a wheelchair are varied, but specific. They include a greater chance of pressure sores, significant discomfort and physical strain from operating chairs.

In addition, people in wheelchairs can be perceived as less able and are even spoken to differently in what becomes a self-perpetuating cycle of helplessness. Perhaps most importantly, loss of mobility can begin within a few days if someone starts using a wheelchair instead of walking.

Solutions are readily available in concept, but harder in reality. The GROW Coalition wants a requirement that nursing homes carry out a resident assessment before placing anyone in a wheelchair. In addition, lowered staffing ratios would let a center’s caregiver take more time with slow-moving residents.

Easier access to meals and other services should mean that more North Carolina nursing-home residents will be able to stay healthy and mobile.

The family of a Pennsylvania man who died shortly after falling and fracturing his hip at an Oakmont nursing home has filed a lawsuit asking for reasonable compensation from the facility for neglect and causing his death.

The family of Charles Grice filed suit Thursday against Presbyterian SeniorCare over negligent operation of its nursing home, The Willows.  Mr. Grice injured his hip when he fell unassisted out of his wheelchair. He died after surgery to fix his fractured hip. 

The staff of The Willows failed to take necessary precautions with Mr. Grice’s care even though he was assessed as being at high risk for falls. He had entered the nursing home for rehabilitation, and was to return to home.

The Hartford Courant has an article about proposed reforms in nursing homes by the Connecticut Ombudsman’s office.  I wish the South Carolina Ombudsman’s office would play a proactive role in protecting resident’s care and preventing neglect.  Below is a summary of the article.

Connecticut’s long-term care ombudsman is proposing reforms in oversight that would protect residents who complain about poor care from retaliation and encourage state agencies to monitor and evaluate the performance of chains, rather than just individual homes.

The program outlined a dozen reforms, including protections for residents who complain about poor care such as preventing nursing homes from issuing involuntary discharges to people who file complaints for at least a year following the complaint.

The ombudsman’s office also wants the Department of Public Health to impose "significant sanctions" when patient-care deficiencies result in death, and to weigh "common ownership and management" as a factor in imposing penalties against corporate operators. 

The recommendations were prompted by revelations about the troubled record of one of the state’s largest nursing-home chains, Haven Healthcare, which filed for bankruptcy in November and faces a federal fraud investigation. Some of the chain’s 15 Connecticut homes had escaped severe sanctions despite repeated citations for serious patient-care deficiencies resulting in death. The chain also defaulted on millions of dollars in bills for supplies and services, while its owner used corporate assets for personal profit.

Democratic state senators proposed strengthening state oversight of nursing homes and boosting staff levels. 

The ombudsman’s office wants to require more financial "transparency" from nursing-home corporations, including disclosures of detailed information about related business entities. Owners shield excessive profits by diverting money to related ventures without detailing those transactions.

Other proposals call on the state to more carefully review the public-health and financial records of any new owners or managers of nursing homes or assisted-living facilities, and for "improved communication" among state agencies charged with overseeing elderly care.

Journal of Clinical Nursing has an article about a recent study linking the use of sleeping pills containing benzodiazepines to increase falls in nursing homes.
Older patients taking benzodiazepines were 2.9 times more likely to fall   Obviously, patients who fall suffer severe injuries.   Some older patients have impaired cognitive function or limited functional ability and physical strength stemming from chronic physical ailments, increasing their risk of a fall, often when walking or being moved.

In addition, older patients are take multiple medications, whose side effects increase the patients’ chances of a fall.  Physical restraints may be used to decrease the possibility of falling and being injured.

"Even if no physical injury occurs, fall victims may develop a fear of falling again and thus reduce their activities as a result," the authors wrote. "This can lead to unnecessary dependency, loss of function, decreased socialization, and a poor quality of life."

The researchers found that use of sleeping pills containing benzodiazepines was significantly associated with fractures supporting the findings of most previous studies.

Patients using wheelchairs and bed rails were less likely to fall, but neither of the associations reached statistical significance. Nevertheless, "the use of these might be regarded as protective or preventative strategies," the researchers said.

Bed rails can cause injuries if patients climb over them, and physically restraining an already agitated individual can increase fear and worsen behavior, they said.   "In addition, restraints can lead to serious complications, including circulatory obstruction, skin tears, incontinence, fractures, and dislocations," they wrote. "These restraints should be used with care and consideration." 

The Study recognized that restraints cannot completely eliminate falls in nursing homes and that they may not be appropriate in every situation, but concluded that "our results support the hypothesis that they might be protective when used selectively together with fewer sedatives, especially benzodiazepines."

Primary source: Journal of Clinical Nursing
Source reference:
Fonad E, et al "Falls and fall risk among nursing home residents"J Clin Nurs 2008; 17: 126-134.

Studies show a significant decline in quality of nursing home care for blacks compared to whites.
Elderly black Americans in nursing homes get worse care than that enjoyed by their white counterparts.  "If you’re black, you’re much more likely to get your care in a nursing home that’s not so good, relative to nursing homes that are serving predominantly white patients," Dr Vincent Mor, head of the department of community health at Rhode Island-based Brown University’s school of medicine, told AFP on Tuesday.

Mor was a lead author of the study which looked at "racial segregation in US nursing homes and its relationship to racial disparities in the quality of care."  The study cited race data from nursing homes found US nursing homes remain relatively segregated by race.

"Blacks are much more likely than whites to be located in nursing homes that have serious deficiencies, lower staffing ratios, and greater financial vulnerability," the study showed.

Another study led by Brown University researchers and due to be published in June in the Health Services Research medical journal, looked at the rate of hospitalization of nursing home residents.
That study showed that 24.1 percent of black nursing home residents required hospitalization  compared with 18.5 percent white residents.   It found that nursing homes "with high concentrations of blacks had 20 percent higher odds … of hospitalization than residents in nursing homes with no blacks", and linked the quality of care to the reimbursement policies of Medicaid, the US program for those unable to pay for healthcare.

The rate of hospitalization was an indicator of performance, as were "a whole variety of different measures of quality in terms of regulatory compliance, staffing levels, and so on," Mor explained.

"Both studies clearly suggest that nursing homes which have a predominance or much higher proportion of African-American residents perform more poorly," Mor said.

Extending Life, Waiting for Death at Nursing Home in Florida

Review by Dave Shiflett

Jan. 14 (Bloomberg) — Growing old isn’t for sissies. Anyone who doubts that should tune into “Andrew Jenks, Room 335,” which airs on Cinemax tomorrow at 7 p.m. New York time.

The 90-minute film about life and death at a Florida assisted-living facility is depressing and inspiring. It provides a peek into the likely futures of millions of baby boomers, who may want to ditch all those life-stretching diets and exercise regimens when they see what awaits them.

Jenks was 19 when he spent a month at the posh Harbor Place near Port St. Lucie. From the outside, it looks like a fancy hotel. Inside, time has stripped many residents to the bone.

The opening shots show faces familiar to anyone who has ever visited a nursing home: residents snoozing in wing chairs, heads tilted back, eyes closed tight and mouths wide open. The smartest fashion accessory may be a drool bib.

“All your friends die on you,” a resident says. “You miss the people you had so much fun with all your life. They go one by one.”

“My bones are like lace,” says another.

Yet many residents still have some fire in their bellies, even if their eyes, ears and bladders aren’t fully dependable.

Bill, a gruff 80-year-old Army vet, is fond of Hawaiian shirts, twisting arms and playing the tough guy. Yet he walks over a mile each day to buy chocolate bars that he shares with his less-mobile companions.

Pig Latin

Then there’s Tammy, a spry and chirpy 95-year-old who is scared of elevators and wields a sharp tongue. “I can’t understand that pig Latin you use,” she tells one pal. Tammy keeps her spirits up even after a bum heart lands her in the hospital.

A sense of resignation seems to prevail, though Jenks does find an undercurrent of resentment. When he asks Tammy why there are no blacks or Hispanics at the facility, she insists those ethnic groups take care of their elderly members at home.

“Years ago, nobody ever got sent to a place like this,” she says. “This generation can’t be bothered.”

The long days are punctuated by bingo games and watching “Jeopardy.” One resident tries to play “Edelweiss” on the piano, but her efforts are doomed by all the sour notes.

Death is never far away. We see a shriveled woman named Dotty, who has no immediate family, gasping for air in a hospital bed with a few friends and a priest hovering nearby.

At one point, Jenks tells Dotty he would like to say a prayer. Suddenly, she lifts her ancient hands and clasps them. Dotty died soon thereafter.

Jenks was clearly moved by his month at Harbor Place.

“We’re all going to grow old at some point,” he notes. “Does this mean we’re going to be neglected, too?”

Here’s the lesson I learned: Longevity, like most other things, should be taken in moderation.

(Dave Shiflett is a critic for Bloomberg News. The opinions expressed are his own.)

Woman admits stealing from Hyde Park nursing home January 14, 2008  See full article here.

A former employee of a nursing home faces prison after admitting in court today she stole more than $8,000 from a resident of the home.  Melissa Johnson acknowledged she had stolen the money by using the woman’s debit card between February and August 2006. 

Johnson had been placed on probation in May of 2006 on an unrelated conviction on a felony forgery charge. She admitted today she had violated the terms of her probationary sentence by carrying out the thefts from the woman at the nursing home.

Family of man who disappeared sues Gooding nursing home.  The family of a man who allegedly wandered away from the Idaho nursing home five years ago has sued thecorporation that operates the facility.

In the lawsuit filed on behalf of Magic Valley Manor resident John Henry Davis allege the home and Northwest Bec-Corp didn’t supervise him or keep him safe and free from harm.

Wendell, who suffered from Alzheimer’s disease, disappeared in July 2002.

Indiana Court awarded damages to nursing home whistleblower.  A whistleblower who claimed she was fired in retaliation for reporting an employee who was sexually abusing a patient at Heritage Manor Nursing Home in Colfax recieved $17,000.

Earlier the state fined Heritage for failing to report the suspected abuse to the state public health department.  Judge Charles Reynard awarded $10,0000 in pain and suffering to whistleblower Michele Bolster. He pointed out the widow had nine children, including six adopted with special needs, and that Bolster’s firing left her with the uncertainty of having medical insurance. Judge Reynard called it, "particularly excruciating."

Heritage Enterprises issued a statement calling Bolster a disgruntled employee who has used numerous avenues to accuse the company of wrongdoing but says her allegations have been proven false.

See full article here.

Dothan, Alabama police have arrested a 68-year-old man and charged him with molesting a woman at the nursing home where he lived last month. See full article here.

Aaron Howell is a convicted sex offender.  Howell violated the state community notification act when he moved into Westside Terrace Health and Rehabilitation Center on Nov. 30.  During the month of December he sexually abused an adult female employee there.

The violation to the state community notification act was discovered after an employee at the rehabilitation center viewed the sex offender Web site.  Thursday, Dothan police investigators charged Howell with felony first-degree sex abuse, and two felony violations of the community notification act.

Howell faces the new sexual assault charges nearly 15 years after he was convicted of molesting a 6-year-old girl in February 1993. Howell pleaded guilty in 1993 to first-degree sex abuse after Houston County investigators charged him when he lived in Cottonwood.