Valley News reported on Vermont’s new law that will change the way officials scrutinize nursing home ownership changes after the state’s oversight came under scrutiny last year when the 67-bed Brookside Health and Rehabilitation Center closed because of unaddressed health and safety violations.  The Brookside incident aside, state officials also have been engaged in a more general discussion of changes in the nursing home industry. Those changes include a trend toward large, out-of-state companies buying nursing homes, then breaking up home operations and real estate into separate corporations.  This is done to avoid accountability for abuse and neglect, and to siphon funds to related entities.  Green Mountain Care Board member Jessica Holmes told the House Health Care Committee earlier this year that such companies are “buying up small mom-and-pop nursing homes, operating them at arm’s length and extracting short-term gains.”

The law created an eight-member group to study the ways to improve the state’s oversight of nursing homes. Nursing Home Oversight Working Group is supposed to “examine the oversight of nursing homes in Vermont, including financial stability and licensing criteria, in order to ensure the provision of high-quality services and a safe and stable environment for nursing home residents.”  The working group will look at a wide variety of issues, including the information currently reported by nursing homes and “what types of additional financial data may be necessary to evaluate nursing homes’ ongoing financial stability.”

Also, as of July 1, oversight of nursing home transfers will switch from the Green Mountain Care Board to the Agency of Human Services.  Officials with both entities support the change, saying the care board is ill-suited to regulate the increasingly complex world of nursing home ownership. Human Services Secretary Al Gobeille is pledging to develop “a very thorough, very credible review process” for when his agency takes over.   “I completely agree with the Green Mountain Care Board’s assessment that this is not the work for them,” Gobeille said.

 

 

The Marietta Daily Journal had an article about the prevention and treatment of scabies in nursing homes.  The article explains that members of the Cobb Elder Abuse Task Force met in May to discuss how and why contagious illnesses like scabies occur at senior homes.

Scabies is caused by microscopic mites that burrow into the skin and lay eggs. It can be spread without precautions in place by prolonged skin-to-skin contact and often manifests as an intensely itchy rash.  According to the Centers for Disease Control and Prevention, nursing homes and extended-care facilities are often the sites of scabies outbreaks because they have a large number of people in close contact.

Scabies should not typically be fatal on its own, however untreated scabies can lead to bacterial infections that can be fatal, especially among the elderly.  Nursing homes can be found negligent in failing to recognize the infestation and by allowing the disease to progress so far that it injures the residents. If properly recognized and diagnosed, it can be treated with a simple prescription lotion or cream, according to the CDC.

MyPalmBeachPost reported that Eva Mae Rhodes died a painful wrongful death at age 98 after caregivers at Lakeside Health Center nursing home left her outside unattended where she blistered and baked in Florida’s sun.  Rhodes was transferred to the hospital with a temperature of 103.2 degrees, suffering from heat stroke, severe dehydration and second-degree burns on her shoulders, arms and mouth. An investigator for the Florida Department of Children and Families concluded inadequate supervision was to blame. After Rhodes died two weeks later, the Palm Beach County Medical Examiner listed her cause of death as “hyperthermia” caused by exposure to the sun and heat.

The family filed a lawsuit to make sure that this doesn’t happen to other vulnerable adults.   “The message I want to send is we will not tolerate the abuse of our elderly,” CandaceMcKinley told reporters. “I’m mortified that nothing more has been done.”

Lakeside Health Center is owned and operated by the national for profit nursing home chain Life Care Centers of America.

 

 

New Jersey legislators are introducing a bill that would require nursing homes to increase staffing of certified nurse aides to a safe level. New Jersey requires nursing homes to provide 4.1 hours of care per resident each day, with additional rules for specialty care units. Assembly bill 382 would set a ratio of one CNA for every 8 residents during the day; 1:10 during the evening; and 1:16 overnight.

The proposal was supported by caregivers, consumer advocates, and experts.  The nursing home industry claims that increasing staffing will hurt their profit margins.

The Assembly Human Services Committee advanced a bill to establish specific staff-to-patient ratios. It would enact regulations supporters say are on par with staffing levels already in place in other states. The bill would not affect requirements for LPNs, RNs or other nursing home employees.

In her testimony, SEIU vice president Milly Silva told committee members their state ranks 44th in the nation for staff-to-patient ratios.

“These statistics are alarming and should serve as a wakeup call,” she said.

WFAA had an article about the continued use of dangerous medications to chemically restrain nursing home residents.  See Part 5 (See Parts 1, 2, 3 and 4 of WFAA’s continuing investigation of nursing home abuse and neglect.)  Despite the FDA’s warning to stop using anti-psychotics for dementia patients, the majority of nursing homes still uses them — more than 25 percent of the residents continue to take them for uses not approved by the FDA.

The story begins in 1993. Risperdal had just gained FDA approval for use in treating schizophrenia and bipolar disorder. But that’s a relatively small market. Dementia patients, however, comprise about half of nursing home residents.

Federal and state attorneys argued that Johnson & Johnson “developed a scheme to turn the drug into a blockbuster,” court documents show. In testimony, the attorneys claimed Johnson & Johnson used Texas as the “model state” to promote the drug “locally and nationally.”

The goal, according to federal and Texas attorneys: Get doctors to prescribe Risperdal over other drugs and for conditions – like dementia – for which it was not FDA-approved. It’s known as “off-label use.”

An off-label use of a drug is not illegal,” said Michael Elliott, a former assistant U.S. attorney who specialized in health care fraud. “What is inappropriate is for a drug company to market that drug for off-label uses.”

Texas court records and exhibits show Johnson & Johnson recruited influential doctors like Steven Shon, then medical director of the now defunct Texas Department of Mental Health & Mental Retardation. Texas Attorney General attorneys alleged Johnson & Johnson “made a series of illegal payments to Dr. Shon that effectively turned him into a salesman for Risperdal,” court documents show.

Dr. Shon testified in the case that the money did not influence him.  Sure….

The company also paid lucrative fees to a major pharmacy provider to promote the drug in nursing homes, court documents show.

Despite the FDA’s warning that using Risperdal to treat elderly dementia patients was dangerous, business plans in federal court filings show Johnson & Johnson created a sales force they called “ElderCare.”

The alleged objective? Target dementia patients, federal court records show.

From the late 1990’s to 2004, sales reps made thousands of calls promoting the drug “as safe and effective” for treating “behavior problems” in elderly dementia patients, court documents show.

As a result, court exhibits show, domestic sales of Risperdal increased from $892 million to $2 billion per year.

According to Johnson & Johnson’s own market research, as much as “75 percent of the prescriptions for Risperdal were for off-label uses.”

The Indy Channel had a sad story about a 102 year old nursing home resident that suffered a wrongful death after Bethel Pointe Healthcare nursing home removed her safety bed rails allowing her to fall out of bed.  Thelma Pauline Rector would have celebrated her 103rd birthday in March if not for the fall that led to her wrongful death nearly three months earlier.

Rector’s family was pleased with Bethel, until her accident this past November revealed her bed rails had been removed. Dowling says no one bothered to call Thelma’s power of attorney to report their removal or explain the decision.

“She actually fell out of bed and hit the floor – face-first – and that’s when we actually realized that they were gone,” Dowling said. “When we went in to talk to the people at the facility – that’s when they actually told us [about a] new law that you have the right to fall which I could hardly believe.”

“It didn’t go over well with me,” Dowling said. “Somebody is in a facility and that’s why you put them (there), to have 24-hour care and you put them there because we were having trouble keeping them from falling at home. You expect that care to be given to them.”

We’ve published several blogs about pet ownership over the years. Pets have earned a place in our hearts as loyal companions, and dogs specifically have earned the place of man’s best friend. Most people have or have had a pet, and most people (95%) see their pets as family.

Having someone or something to care for can be very beneficial to people, elderly included. That’s in addition to the biological reactions we have to pets (interaction with dogs has been shown to increase feel-good responses in your brain such as endorphins and dopamine, for example).

For more in-depth research into why dogs are good for our mental health, check out this article from dogOwner.

The Des Moines Register reported The Centers for Medicare and Medicaid Services refusal to approve Iowa’s so-called “supplemental  payment plan,” a proposal formalized by lawmakers in 2016 without discussion or debate. The plan was just a sleazy windfall for the nursing home industry in Iowa.  Iowa politicians attempted to funnel already scarce Medicaid dollars to privately owned nursing homes that don’t need the money.  Over five years, the plan would have provided 410 nursing homes with an estimated $1 billion in additional taxpayer money. These include homes owned and operated by large, out-of-state, for-profit corporations. Many would have seen their revenue from Medicaid doubled.

The law was written entirely by industry lobbyists, according to Rep. Dave Heaton, R-Mount Pleasant, the bill’s lead sponsor in the Iowa House. It enables county hospitals to hold the licenses of for-profit, independent nursing homes to create the appearance — on paper at least — that the homes are managed by the hospitals.  This hospital “affiliation” would qualify the nursing homes for higher Medicaid payments than they’re currently entitled to collect as independent operators.

For two years, former Gov. Terry Branstad’s privatization of Medicaid has resulted in the loss of care for Iowans and the closing of health facilities. Elected officials at the state and federal level have repeatedly talked about the need to rein in spending on the health insurance program. The last thing public health care dollars should be used for is padding the bottom lines of for-profit nursing homes.

Fox4KC reported on the new Missouri law that requires nursing and other group homes to report sexual assaults to law enforcement. Current law only required reporting to the state agencies involved.  The mandatory reporting requirement for long-term care facilities will prevent cover-ups and increase the quality of supervision by the regulatory agencies.

This law was a result of a sad and tragic story.  Margaret (not her real name) was raped in her Missouri nursing home and died one day later. The facility notified the state but mistakenly thought the Russell family had called police. In fact, the family believed the home had called police, too.  By the time they were notified, detectives said the evidence was no good and no one was ever arrested in the death of the 93 -year-old woman.

“We applaud the Missouri legislature for passing this critical piece of legislation that will provide important protections to long-term care residents,” said Lynn Faunda Donovan, executive director of VOYCE, a long-term care ombudsman program for 21 Missouri counties.

In a statement, the group noted that between 1995 and 2016, there were 128 known cases of elder sexual abuse and assault with only 20 ending in convictions.

VOYCE and Russell believe mandatory reporting will help law enforcement investigate cases before they go cold.

 

ABC reported the horrific neglect suffered by Val Simpson, a nursing home resident at The Tinonee Gardens The Multicultural Village, because of cost-cutting and under-staffing in the facility.  To the facility’s credit, it has acknowledged it failed Simpson, who was in its care before she died last year.  The Australian Aged Care Quality Agency said the home’s failures at the time placed, or may have placed, the safety, health or well-being of residents at risk.

Ms Simpson’s daughter Sharon Dodd said remembering her mother’s last days was almost too hard to bear.  “Just the level of neglect and watching mum being in a bed of urine and faeces … the placement certainly didn’t provide her with the care she deserved,” Ms Dodd said.  Staff at Tinonee have told the ABC incontinence pads were limited to three residents per day and nappy rash cream always needed to be on hand.

Ms Simpson’s lack of oral care was also upsetting. Her mouth was at times dry, cracked and shrivelled with filth.

A close-up of an old woman's dehydrated mouth.
“It was really shrivelled up and she had lots of things that looked like warts on her tongue,” Ms Dodd said.  “She could hardly respond to me because her mouth was so dry.”

Her granddaughter, Kelsey Moss said she had been horrified by what she had seen.  “There was food left in her mouth and she was left to try and swallow on her own … the outcome could have been much worse,” Ms Moss said.  “She was thirsty, wanting to go to the toilet, never hungry, but definitely neglected there.”

Ms Dodd said her mother had been in so much agony, staff put her behaviour down to anger management problems, before giving her a sedative.  “If they knew anything about UTIs and how they change your personality, they would have known she had a UTI, instead of the anger issues,” she said.

Simpson also suffered regular falls while she was at Tinonee, which left her family concerned about unexplained bruising.

She also went missing one cold winter’s night, and was discovered hours later on all fours, disoriented in the home’s garbage collection area.

“It wasn’t until the kitchen staff came out and put the garbage away that they knew Mum was out there, not even knowing how to stand up,” Ms Dodd said.