Deseret News had an article about the sentencing of a nursing home employee who molested an 85 year old resident where he was employed.  This is a tragic and preventable situation. Why didn’t anyone supervise this CNA?  How could they have hired this guy?  Why did they allow him to plea to a lesser crime? How could they give him such a light sentence?

Jacob Mut Bolith was charged in July 2007 with first-degree felony rape, second-degree felony forcible sex abuse and class A misdemeanor lewdness. However, in a plea agreement, he pleaded guilty to forcible sex abuse, a second-degree felony, and the other two charges were dropped.  He was only sentenced to serve a one-to-15-year sentence and ordered him to pay restitution.

"To do this to my mother … is unconscionable," one daughter said. Her other daughter said a medical exam showed that the defendant did more than "what he admitted."

The article doesn’t mention if the facility knew or should have known about their employee’s tendencies or if they did a background check or if they recieved prior complaints about his behavior or if the State even investigated the nursing home.

 

The Wall St. Journal had an article recently that made me think about the future of helath care when the baby boomers enter the nursing home industry.  Will there be a revolution in health care?  Will for profit chains dictate how the old and frail among us will conclude their lives? 

A nursing home in California wants to evict Jasmine Nguyen, a 32-year-old dependent on a ventilator to breathe and the facility’s staff for her daily needs, and a dozen other residents in similar situations replacing them with short-term residents that bring more profit.

Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if — like Ms. Nguyen and the other Lodi residents — they depend on Medicaid to pay their bills, the officials and advocates say.

Assisted-living facilities have sprung up as alternatives for those who don’t require nursing-home care but need assistance with things like taking medications or bathing and dressing. Each state regulates the industry differently, so eviction policies vary. But many states simply require facilities to give four- to six-weeks’ notice, with no appeal guaranteed.

In Florida, for example, the state’s 2,400 assisted-living facilities must give residents 45 days’ notice before evicting them, but don’t need to provide a reason or appeal process. 

No national figures on assisted-living evictions exist, but discharge-related complaints recorded by the federal Administration on Aging more than doubled in the decade before 2006, rising 177% — nearly twice the growth for complaints overall.  Some attorneys are turning to federal fair-housing rules and the Americans with Disabilities Act to help assisted-living residents stay in their homes. They argue that those laws require all landlords, including assisted-living companies, to make reasonable accommodations for disabled residents, and prohibit them from evicting residents because their condition worsens.

And evictions may be even more widespread, since some eviction attempts are resolved without formal complaints. Residents may not know they can appeal or may be too ill to do so or fear retribution.  Federal law — enforced by the states — says residents can be discharged involuntarily for just six reasons: if they are well enough to go home; need care only available elsewhere; endanger the health of others; endanger the safety of others; fail to pay their bills; or if a facility closes its doors. Even so, nursing homes must give residents at least 30 days’ notice, explain their appeal rights, and put together a plan to make sure the move doesn’t harm them.

Even an orderly eviction can carry grave risks for the old and ill. Studies suggest "transfer trauma," or relocation-stress syndrome, can spur depression and weight loss and increase the risk of falls.

For example, the nursing home trying to evict Jasmine Nguyen, Lodi Memorial Hospital, told her and a dozen others that they would have to move by June 30 because the nonprofit organization was closing the facility — for renovations.  All 13 residents were "sub-acute" patients, most of them dependent on ventilators or feeding tubes, or with other conditions requiring significant extra care.

Lodi Memorial told the state it planned to replace them with patients recently discharged from its hospital — who typically require shorter-term care covered at a higher daily rate by private insurance or by Medicare. (Medicare pays for up to 100 days in a nursing home following a hospital stay of at least three days.)

In April, after Lodi Memorial sought state approval, administrators were told that they knew when accepting the sub-acute residents that they would need extensive care, probably for many years, and it couldn’t simply stop. Moreover, the state said in a letter, "your facility is not ceasing to operate as you are not surrendering your license."

The nearest nursing home certified to care for patients like Ms. Nguyen is about two hours away with traffic, says Jasmine’s 23-year-old sister, Mary. Their mother, Kim Nguyen, who runs the family nail salon in nearby Stockton, visits Jasmine twice a day.

 

On Seattlepi.com there was an article about the tragic death of Lee Ann Steele caused by the understaffing and neglect of a for profit nursing home.

Lee Ann, who had suffered a stroke,  lived at Aldercrest Health & Rehabilitation Center.  She needed a tracheotomy. The Steele family had felt assured by the facility’s promises of skilled, high quality care, but less than 24 hours after their daughter was admitted, her tracheal tube clogged with mucous, causing oxygen loss and brain damage. Lee Ann Steele, once a vibrant church secretary who had volunteered at a food bank, died a few months later, in January 2007. She was 49.

The family wanted answers so they filed a lawsuit against Exyendicare Homes, Inc., the company that owns and manges the facility.   The complaint, filed in King County, accuses Milwaukee-based Extendicare of violating consumer-protection laws by advertising "quality standards above government regulations" and failing to deliver.

The lawsuit highlights problems regarding Extendicare, one of the largest nursing-home chains in America. The company runs 268 facilities for up to 30,000 residents.  In Washington, two of the company’s homes are on a federal list of troubled facilities that require extra inspections by the U.S. Department of Health and Human Services.

Four of its homes, including Aldercrest, have been barred in the past from accepting new residents. Five have been hit with fines totaling thousands of dollars.  Many complaints, including those alleging wrongful deaths, stemmed from neglect and poor treatment for such conditions as pressure sores and diabetes.

She said the company appeared to have a high turnover in management. She also said the homes routinely accepted more residents — and more acutely sick residents — than staff members could handle. 

On Oct. 5, 2006, the day Steele was admitted, her family found her lying on a sheetless rubber mattress and her tracheal-tube equipment on the floor, unhooked, with no one attending to her for several hours.  Steele  suffered respiratory distress and died soon after.

 

 I have read several articles recently about how some cities like Cincinnati may stop conducting nursing home inspections.  That is fine with me since most inspectors in South Carolina are so overworked and underfunded that the inspectors don’t have the time and resources to properly insure that the nursing home is properly caring for the residents. 

Typically, the nursing homes know when they are coming and improve conditions before the inspectors get there.  We hear countless stories from ex-employees of nursing homes in the area that all repeat the same chorus.  "They increase staff and clean everything when they know the survey team will be coming in". 

I have not seen any complaints substantiated or any fines incurred against any of the for profit nursing homes. The inspectors in South Carolina seem to ignore violations, and the concerns of residents and family members. Instead, they criticize the county run nursing homes or the charitable organizations that run the mom and pop nursing homes.  I can’t tell if it is corruption or incompetence but certainly the inspection program in South Carolina isn’t doing anything to provide better care or oversight for the residents.

Below is a summary of a story by Dan Horn about Cincinnati dropping nursing home inspections

The Cincinnati Health Department is considering whether to drop its inspection program for nursing homes and residential care facilities. Budget cuts and retirements could soon leave the department unable to keep up with annual inspections. Cincinnati is the only city in the state that does its own nursing home inspections, a policy that city officials have said allows the city to react more quickly and aggressively to problems.   He said the program once operated with six inspectors and supervisors, but that number fell to four by the start of this year. Another retirement will drop the total to three employees by this fall.

 

 

 

The Fort Worth Star Telegram had an article about a tragic situation where an abused resident died before the grand jury was able to indict his tormentor. 

Elaine Doores, a retired biology professor diagnosed two years earlier with Alzheimer’s, struggled to find the right words to describe the abuse she survived.   "He has hurt me a lot. Every time he bathes me. He puts things in me.  . . . He had sex with me more than once. It’s all the time in the bath."

The 68-year-old woman’s statement led to the arrest of Donald Gene Shelby, a certified nursing assistant at the James L. West Alzheimer’s Center where Doores had been living.

Her daughter says the district attorney’s office stalled in handling the case.  "They sat on it while the victim got worse," Pitt said. "That’s the disservice they did to my mom and my family."

She believes that prosecutors dealing with victims who have dementia or Alzheimer’s should try to present the case to a grand jury without delay.

Elaine Doores was placed in a nursing home Jan. 23, 2007, two years after being diagnosed with Alzheimer’s.  Pitt said Doores had difficulty speaking and performing motor skills but recognized relatives.

Pitt said that on Feb. 18, Shelby told her that her mother was upset the day before because the pajamas that she wanted to wear were dirty. Pitt said she was puzzled because her mother had never seemed to care what she wore.  Later, during the same visit, Pitt said that when she suggested getting "Donald" to help Doores go to the bathroom, her mother became agitated. When questioned, Doores told her daughter that Shelby was "bad" and had done something "wrong."

Pitt said she sought the help of a floor nurse, who asked Doores whether Shelby had touched her. Doores answered, "Yes." When the nurse asked where, Doores replied, "Everywhere," Pitt said.

Pitt went home and told her husband, Deven Pitt, a Fort Worth police detective. At his suggestion, the two contacted Detective S.L. Schloeman, the on-duty investigator with the sex crimes unit, and filed a police report.

Afterward, Doores provided a statement to Schloeman, a copy of which Pitt gave to the Star-Telegram. Doores described Shelby as "scary" and said she was afraid of him. She said he made threats and told her not to tell anyone what he had done.

Schloeman, now a sergeant in patrol, said that to determine Doores’ mental state, she had asked Doores questions, including some about her daughter’s birth date, the current year and where she lived. Doores answered every question correctly, Schloeman said.

"She displayed symptoms of having just a minor case of Alzheimer’s," Schloeman said. "She was able to give me a clear, concise description of what had happened to her. She was able to identify the suspect in a photo spread and identify him by first name."

On March 2, 2007, Schloeman obtained an arrest warrant for Shelby on suspicion of aggravated sexual assault. The next day, Shelby surrendered at the Tarrant County Jail and was released after posting $50,000 bail.

Tarrant County court records show that Shelby was indicted in March 1987 on a charge of indecency/fondling. The state dismissed that case in January 1988 after the accuser, a male minor, committed suicide. 

How could he get a job at a nursing home when he had been arrested for abusing a vulnerable person?  Did the nursing home do a criminal background check?

 

 

 

The Post-Tribune had an article written by Mark Taylor about the negligent care provided to a resident in a hospital.  The article described the resident, Donna Durham, as an active, energetic widow with sparkling green eyes and silver hair who worked as a top real estate agent and home appraiser until June 12, the day she arrived at  the hospital for surgery. 

Prior to the surgery, the Dunham family had apprised hospital staff of their mother’s allergy to codeine and morphine.  It was entered in her medical chart.  It was identified on the red tag she wore on her wrist. And in the final presurgery meeting with physicians, Dunham’s children say they reminded anesthesiologist Dr. Nageswar Yelavarthi that their mother was allergic to morphine.

In spite of those warnings he allegedly ordered a nurse to administer the potent narcotic to which Dunham was allergic, according to Pinnacle medical records obtained by Dunham family attorney George Galanos. Yelavarthi allegedly told the nurse that he and the staff could deal with the expected allergic reactions, such as nausea and vomiting, a nurse’s note states.

By 12:08 p.m., Dunham was in respiratory arrest and having difficulty breathing.  Medical records indicate Pinnacle staff attempted to stabilize Dunham and around 12:30 p.m. began attempts to transfer her to an acute-care hospital. 

Dunham’s doctor, Dr. Kucharzyk,  did not complete a spine fellowship and does not have the additional training required to perform spinal procedures.  According to the Patient Compensation Fund of the Indiana Department of Insurance, Kucharzyk has been named in at least 14 medical malpractice lawsuits.  Kucharzyk never disclosed this information to the family.

Nonetheless, Kucharzyk held surgical privileges in back surgery at Pinnacle.

After Dunham went into respiratory distress at 12:08 pm., Pinnacle staff connected her to a ventilator to breathe for her.   Anesthesiologist Yelavarthi gave her an antidote to the morphine, but it didn’t work.

Kucharzyk was enlisted to attempt to transfer Dunham to Methodist or Saint Anthony. But he said he did not hold full privileges at Methodist or Saint Anthony and wasn’t successful in arranging a transfer. Kucharzyk soon after told Pinnacle staff, “He would not be following the patient,” according to Dunham’s medical records.

Khalid contacted Methodist to alert staff there about Dunham’s condition and the sequence of events, and at 1:01 p.m. Superior Ambulance arrived at Pinnacle to transport Dunham to Methodist.  Again at 1:20 p.m., Pinnacle staff contacted Methodist and were told that Methodist could not accept Dunham until case management reviewed her insurance “to make sure she was not a (patient) ‘dump’,” hospital slang for a patient unable to pay, according to Pinnacle records.

Patient dumping is when a hospital transfers a patient to another health-care facility because of the person’s inability to pay. It’s a practice that is illegal, as is delaying care while considering payment or insurance information.

The Pinnacle staff continued working on Dunham even as they attempted to transfer her to Methodist, a hospital with an intensive-care unit better equipped to handle such emergencies.

Finally at 2:30 p.m., nearly 150 minutes after Dunham had gone into respiratory distress, Superior transported her to Methodist.  Dunham arrived at Methodist still in distress and deteriorated rapidly.

Methodist’s ER staff worked on her until 3:30 p.m., when she was pronounced dead of heart failure.  A Methodist ER nurse asked the family if Pinnacle ever explained their mother’s condition when it transferred her.

Cheryl Harrell said Kucharzyk phoned that evening.   “He asked what happened and acted like he didn’t know anything had gone wrong,” she said. “He said when he left she was fine.”

 

Okay – I think I’d be filing a lawsuit too.  Actually, I think I’d have been raising all sorts of hell prior to filing this lawsuit.  I don’t have much information on this other than the Complaint, which doesn’t have a lot of details (probably because its not required), but I cannot imagine how this happened.  The injuries cited are "including but not limited to cellulitis in his scrotum and penis and gangrene in his penis which required the removal of his left testicle."  This complaint is against an Eldercare facility in Illinois.  My first question (and this is an unusual stance for me) is how on earth did this gentleman not complain long before he had gangrene?  And if he did complain, how on earth did no one do anything about it?  And of course, what could have been done?  What causes something like this?

Honestly, I think answers to those questions are far more than I truly want to know, but those are my first thoughts. 

Bottom line is, this gentleman was in a nursing facility, presumably because he needed nursing care – presumably because he needed assistance with activities of daily living, like bathing, dressing and using the bathroom.  What on earth were the employees doing (or not doing) that they could miss something like gangrene . . .

It boggles the mind.

David Krough wrote, for Portland’s kgw.com, an article stating that a nurse assistant at a nursing home was arrested for stealing narcotics from residents in other nursing homes.  Nursing assistants provide about 85-90 percent of all the care to residents.

The article is informative but does not provide key information such as prior arrests, employment history, knowledge of the mangement of the nursing homes regarding the missing narcotics or her conduct.  How could she get hired?  Was she a user or a pusher?  What safeguards do they hav ein place to make sure this doesn’t happen?  Below is a summary of the article.

Surveillance cameras caught a woman on camera, posing as a resident’s granddaughter, then as an employee. Administrators there said the woman snuck in and spent at least three evenings with one of their residents.

Theresa Smith was a nursing assistant who worked at nursing homes in the Portland Metro area.  Police listed Smith as a person of interest after a report of theft of Fentanyl patches at the Laurelhurst Village Nursing Home on SW Stark Street.  She was accused of stealing Fentanyl pain patches from nursing home residents while the residents were wearing the patches. Detectives said she stole from several patients at area nursing homes.

Detectives arrested Smith Wednesday while she was working at the Care Center East Nursing Home on NE Wielder Street.  Smith was charged with burglary, criminal mistreatment, possession of a controlled substance and theft. Police said she may face more charges.
 

Times Record-Herald had an article about a resident who wandered away from an adult home and froze to death.  These kinds of incidents are preventable if the home has well-trained and competent number of staff members supervising the residents.  A death from wandering is a sure sign that understaffing, inadequate training, and a lack of supervision exists in that nursing home.

The article mentions that Karen Preston walked away from the Roscoe Manor Adult Home. She stumbled into the woods about a mile away. She fell repeatedly. She walked in circles. She curled up under a pine tree. And that’s where police found her frozen body two days later – her socks next to her body, no shoes on her feet. A medical examiner ruled that she died of hypothermia.

Karen Preston was 54 years old and suffered from severe schizophrenia. She had lived in Roscoe Manor because she needed help with daily activities and supervion that an adult home is supposed to provide.

Preston’s tragic death underscores the deplorable conditions at many nursing homes.  The Times Record-Herald reviewed inspections at 22 licensed adult homes in Ulster, Sullivan and Orange counties from 2001-07 and turned up 846 violations deemed to directly affect the safety or well-being of residents – with two-thirds of those citations recorded at the seven adult homes operated in Sullivan County.

A year after Preston disappeared, another Roscoe Manor resident, Ella Maye, walked away from the home.  Maye, 78, had dementia and heart disease. State police believe she suffered a fatal heart arrhythmia while walking on Rockland Road early on Feb. 23. They believe she was trying to crawl back to Roscoe Manor when she collapsed on a neighbor’s front lawn and died.

The adult home was supposed to do hourly bed checks, but Roscoe Manor owner Charles Benson said at the time that an employee had failed to do so.  No one noticed Ella Maye was missing.

Adult home inspection reports and history documented by state agencies make it clear: Residents of some Hudson Valley adult homes are at a significant risk of illness, injury or even death due to carelessness or negligence on the part of the homes’ operators and staff.

Despite reforms over the past few years, state oversight has been ineffective in regulating these homes, which house a vulnerable population of the elderly, infirm and mentally ill. And anyone can end up in an adult home. All it takes is a medical crisis that renders someone unable to live on their own.

State documents paint a disturbing picture of homes where residents are left to sit in soiled clothing, are subjected to physically or verbally abusive staffers and repeated instances of mismanaged medications.

 

Sunrise Senior Living faces another neglect and negligence lawsuit (08/20/08 Orange County Register).  Sunrise was ordered to pay $2 million in damages after the death of a resident in May.  The family of Therese Sperry is suing Virginia-based Sunrise Senior Living which owns and operates Villa Valencia Health Care Center.

Sperry spent two weeks in Villa Valencia’s skilled nursing unit in January 2007. She developed avoidable pressure ulcers on her feet that were neglected and went untreated.  The lawsuit alleges negligence by Sunrise Senior Living and says the nursing home failed to provide adequate medical staff for ailing residents – despite five health and safety citations in the last decade by state health regulators.   The most recent violations, from last year, include sexual molestation of a patient during a bath and failure to change a patient’s catheter often enough to prevent infection.

After a brief hospital stay, she was sent to Villa Valencia for a week to gain strength.  Four days after her admission, she had redness on both heels, which later developed into ulcers that spread to her muscle and bone. Sperry’s family immediately transferred to a different nursing home, where she was properly treated for wounds.  She endured debilitating pain until her death.

The suit argues that the facility "carried out a scheme to place ‘profits over people’ … (and) intentionally underfunded and understaffed the facility in order to decrease expenses and increase profits."  Proof of understaffing arose in the trial over the death of Mary Kathleen Adams, who also developed pressure ulcers while at the center in February 2005. She died two months later.  In May, a jury ordered Sunrise to pay $2 million to Adams’ family for negligence and punitive damages.

"Big corporations like Sunrise cut down on costs and staffing at the expense of patients," said Kim Valentine, one of the lawyers representing the Sperry family, and who also represented Adams.  Valentine also said court testimony showed employees were quitting because of the poor quality of care – a finding reflected in a report by the independent California Nursing Home Search. The agency found that nursing staff turnover at Villa Valencia was 82 percent in 2006, much higher than the state average of 67 percent.