Movie explores love, life and Alzheimer’s Disease in nursing home setting.

A new movie, “Away From Her,” is set in a nursing home and examines a couple’s struggle with Alzheimer’s Disease as well as love within the context of life and aging.   An Ontario couple who has been married for over 40 years decides to seek nursing home placement for the wife (played by Julie Christie) after she wanders away from home.

For the first time in the five decades of their relationship, they are forced to undergo a long separation since the nursing home has a “no-visitors” policy for the first 30 days of a resident’s stay so they can adjust to their new surroundings. When the husband visits after the adjustment period, he is devastated to find out that not only has his wife seemingly forgotten him, she has transferred her affections to another man. The other man, also a nursing home resident, is mute and wheelchair-bound. The husband then starts spending time with the male resident’s wife, played by Olympia Dukakis. Dukakis’ own mother had Alzheimer’s Disease.

Source: www.npr.org, May 16, 2007; http://www.imdb.com/title/tt0491747/

People with Alzheimer’s disease experience an acceleration in the rate of cognitive decline after being placed in a nursing home according to a new study by the Rush Alzheimer’s Disease Center. The observational study involved 432 older persons with Alzheimer’s disease.  

On average, cognition declined at a gradually increasing rate for all participants. During the study period, 155 persons were placed in a nursing home, and placement was associated with a lower level of cognition and more rapid cognitive decline.

"The findings suggest that experience in day care may help individuals with Alzheimer’s disease make the transition from the community to institutional residence," said study author Robert S. Wilson, PhD, a neuropsychologist at the Rush Alzheimer’s Disease Center.

The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer’s disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.

"The findings suggest that the transition from the community to a nursing home is particularly difficult for people with Alzheimer’s disease and that those planning for their care should consider the possibility that experience in adult day care programs may help prepare affected persons for institutional living," said Wilson.

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A former nursing aide who admitted raping and impregnating a profoundly disabled and defenseless woman at a Bloomingdale nursing home three years ago was sentenced Wednesday to 25 years in prison.

Reynaldo Brucal Jr., 20, pleaded guilty in November to aggravated criminal sexual assault of the then-23-year-old woman, who has cerebral palsy, is brain-damaged and has the mental capacity of a 3-year-old. She was in his care at Alden Village Health Facility for Children and Young Adults when the attack occurred in 2004.

Brucal, who is not a U.S. citizen, has been in DuPage County Jail since his 2005 arrest. 
After serving his sentence, he will be deported to his native Philippines.

Staff at the nursing home, where the victim and her twin sister had lived for 13 years, discovered she was expecting in June 2005 when she was more than 28 weeks’ pregnant. A baby girl was delivered by Caesarean section in July 2005.

The twins, who cannot speak or function independently, have been moved to another area nursing facility, and their family has filed a civil lawsuit against Alden that is pending.

The facility also has been fined $10,000 by the Illinois Department of Public Health for lack of oversight and mishandling of the investigation.

According to the probation department’s pre-sentencing report, Brucal admitted assaulting the woman because he was "bored."

But Brucal, who began working at Alden in September 2004 and was 17 at the time of the attack, "didn’t believe he did anything wrong," Berlin said.

Initially, Brucal denied sexual contact but was arrested in November 2005 after admitting such contact, claiming a latex glove he used as a condom had failed.

See article here

States that set high staffing standards for elder care in nursing homes are the only ones that come close to having enough staff nurses to prevent serious safety violations, according to a new study by a professor in the UCSF School of Nursing.

The majority of the nation’s elderly and disabled in nursing homes remain in situations where staffing is well below national recommendations for safe care, the study found. While no states have ideal nursing levels, those states with higher Medicaid reimbursements or higher mandated nursing levels have come closer to meeting the recommendations, according to the analysis published in the June issue of the journal "Health Services Research."

The study’s initial objective was to examine the relationship between Medicaid reimbursement rates, which many states have cut under their cost-containment efforts, and nurse staffing levels in US nursing homes, according to Charlene Harrington, PhD, RN, UCSF professor of sociology and nursing and lead author of the report.

She said previous studies have shown a direct correlation between staffing levels and higher Medicaid reimbursement for nursing homes, but this is the first to show that states with higher mandated staffing standards had substantially higher staffing as well.

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 At a hearing this month concerning the state of the nursing home industry 20 years after the landmark Nursing Home Reform Act (better known as OBRA ‘87), Senate Special Committee on Aging Chairman Herb Kohl (D-WI) addressed the deficiencies of a system that has allowed some poorly performing nursing homes to escape penalties.

Testimony by the Government Accountability Office (GAO) presented at the hearing concludes that many nursing homes shown to be providing substandard care are still not being subjected to any sanctions, and are therefore not be motivated to make the lasting improvements necessary to protect the health and safety of residents.

According to the GAO, in 2006 nearly one in five nursing homes nationwide was cited for poor care or, more specifically, care that can cause actual harm to residents.

“Without question, the Nursing Home Reform Act improved nursing home care in this country. Today, many of the nation’s 16,000 nursing homes are providing adequate or excellent care. But shamefully, quite a few nursing homes are getting away with providing a lot less, putting a good number of the seniors living in long-term care facilities at risk. This is unacceptable, and raises questions about how and why our enforcement system is failing,” said Chairman Kohl. “This committee has a long history of closely scrutinizing the quality of nursing home care, and we intend to reaffirm that commitment.”

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The owner and manager of a Palmetto nursing home has been arrested on a charge of neglecting an elderly person in connection with a large lesion found on the face of a resident there.

According to reports, 85-year-old Ronald Larsen began living at the Palmetto Guest House in June, 2005. Jacqueline Dorelien took over the home in July of the following year.

The lesion was present when Dorelien took charge, but grew during the next few months, eventually rupturing into a large open wound.  The report says Dorelien failed to get medical help for the man, despite the advice of doctors.

The arrest came two days after the state agency that oversees nursing homes started action to revoke the Palmetto Guest House’s license for allegedly failing to provide adequate care.

The Florida Agency for Health Care Administration issued the complaint Wednesday.

In it, the agency accused the facility of:

• Failing to provide care and services appropriate to the residents’ needs.

• Failing to arrange for necessary physician appointments.

• Violating the Assisted Living Facility residents’ bill of rights by failing to provide "adequate and appropriate" health care.

"A facility’s first priority should be the safety and well-being of its residents," AHCA Secretary Andrew Agwunobi said in a statement issued with the complaint. "It is unacceptable when the management of a facility does not take this responsibility seriously. Our action in revoking their license is necessary to protect this most vulnerable population. The agency will continue to monitor this facility during the administrative complaint process to ensure the safety of its residents."

Protecting Loved Ones from Nursing Home Abuse

Solomon & Relihan’s Phoenix based law firm has recently launched NursingHomeAdvocates.com. NursingHomeAdvocates.com is a resource portal designed to assist both family members of nursing home residents, and the patients themselves, who suspect neglect, malpractice, or abuse.

In the United States alone, nursing home malpractice has become a significant problem with growing numbers. Investigations done by the US Government have shown that approximately 30% of nursing home facilities in the US have neglected or abused their patients, resulting in significant harm. Studies also show that nursing home malpractice has resulted in over 4,000 deaths due to malnutrition, dehydration, and bedsores.

Check out the website.

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North Carolina officials say a federal grant will help about 550 older and disabled North Carolinians stay home instead of being placed in nursing homes and hospitals.

The nearly $$17 million grant is part of a larger 5-year federal project that will pay for caregivers to provide services in homes. Officials say one goal is to save money — for example, a nursing home can easily cost $$50,000 a year.

The other goal is to allow people to live at home as they age, which is a growing desire among older people. The program is being designed now. The benefit is expected to be available to people next year.

Hopefully, South Carolina will be able to get funds to help citizens of this State avoid nursing homes.

 I saw this story and thought of all the residents who suffered pain as a result of his intentional act. This is why supervision of nursing home employees is crucial.

A 40-year-old nurse who pleaded guilty to switching out painkillers meant for nursing home patients has been sentenced to just over five years in prison.

Michael Paul Smith of Falmouth was charged with tampering consumer products and health care fraud.  Smith may face mandatory exclusion from working in any federal health care program.

Prosecutors say he removed pills containing oxycodone and morphine by separating the cardboard backing from blistercards and substituted the pills for similar-looking medication nearly two years ago.

He was employed at the Odd Fellows Nursing Home in Worcester at the time.

I just read this article about staffing at night in hospitals.  It starts and ends with a particular incident at the Medical University of South Carolina’s children’s hospital.  This is a truly terrifying account of the lack of staffing in hospitals on night shift. 

Now take this same idea of less staffing to a nursing home setting.  In nursing homes, often the residents can’t speak for themselves, or they can’t make sense out of what’s going on around them – maybe they no longer know how or when to call for help.  And maybe they don’t know the difference when no one comes.  Add to that the number of residents that have no family to check on them during the day, much less at night.

As an example, we recently talked to a gentleman who was in a nursing home for a short time for rehab.  He said that night time was the worst part of it all.  He said that patients call for help half the night, and no one comes.  He said you can hear staff members talking and laughing, but they wait for hours to respond to call bells.  The fact of the matter is, there is no real supervision on night shift, and often the staff does whatever they want.  I know that this is not the case with all nursing homes, but I’ve heard that same story more than once, about more than one facility. 

In the article, a child died  – in large part because there was not good staffing at night.  This child died with his mother sitting beside him, unable to get help.

Put yourself in the position of a nursing home patient, who has no one sitting beside them trying to get help.  The staff is all they have.  That’s why staffing is such an important issue in medical facilities – and its not just about the quantity, its also the quality.

This article is worth reading, if for no other reason than to educate yourself about the dangers of night staffing in medical facilities.  We may all be there one day, or we may be able to help someone that is.