We have numerous cases where a resident suffered horrible painful pressure ulcers because of the lack of preventative treatment.  The nursing homes always claim that the pressure ulcers were "unavoidable" due to the age of the resident.  A new comprehensive study disproves that claim.

This article discusses the purpose and success of preventing pressure ulcers from forming when nursing homes provide preventative care.

The Pressure Ulcer Collaborative project had been aiming for a 25 percent reduction in new occurrences of bedsores by encouraging health workers to use proven strategies to prevent skin deterioration.  Instead, the 150 hospitals, nursing homes and home health care agencies participating reduced new bedsores on average by just over 70 percent between September 2005 and May 2007.

Bedsores, technically known as pressure ulcers, are painful, occasionally deadly skin lesions caused by unrelieved pressure  that can cause infection and destroy tissue, muscle and bone if not properly treated.  They also can trigger depression, affect a patient’s self-image and complicate treatment.

At the beginning of the New Jersey project, 18 percent of newly admitted patients developed a bedsore while receiving care. By the end, the rate had been cut to 5 percent of new patients, Holmes said.

Holmes said the preventive steps started with a prompt evaluation of each new patient, with every square inch of their skin examined and their risk of developing bedsores determined based on a standardized scale.

Hospitals then had to follow strategies to prevent development of bedsores. Options included shifting the patient to a new position every two hours, use of heel cushions and other padding for vulnerable pressure points, even use of special air mattresses that alternately inflate and deflate different areas, spreading pressure around.

Patients not eating or drinking enough water _ a common problem with older patients _ got a nutritional consultation because inadequate caloric intake or protein stores, as well as dehydration, can lead to skin tearing and breaking down.  Frequent follow-up examinations of the skin also were required, along with new ones for patients suddenly bedridden, as after surgery.

 

Choosing a nursing home for a loved one is one of the most emotional and stressful decisions a family will ever face.  With so many nursing homes out there and all of the stories we have heard about under-staffing, sub-standard care and neglect, how does one make an informed decision?  I recently came across an article that offers some really good advice on selecting a nursing home that I hope will help make this decision a little easier.  

First, visit the facilities you are considering.  Go often and unannounced.  Visit at different times during the day such as mealtimes and activities.  This will allow you to get a good idea of how the needs of the residents are addressed in different situations. 

The article also suggests to pay close attention to what your sense of sight and smell are telling you when you visit.  Is the facility clean?  Are the hallways clear and safe or crowded?  Does it smell clean?  If you notice foul odors from feces or urine, chances are residents are not being tended to quickly enough and it could be a sign of neglect. 

Check for resident call bells that go unanswered; that is a major red flag.  Also, talk to the staff.  Do they seem friendly and helpful?  Are they willing to answer your questions?  Are they attentive to the residents?

Hopefully, these tips will assist you in making a more informed decision about a nursing home.  If you are interested in seeing the complete article, visit this link: news.enquirer.com/apps/pbcs.dll/article

Several years ago, I was having dinner with a friend who had at one time worked in the same nursing home I had worked in.  We began talking about staffing and ways to ensure that you had good staff, and ways to hold the staff accountable.  She had recently suggested to the company that she was working for that the way to have consistently good staff was to offer good pay and benefits.  As you can imagine, that wasn’t the solution that the corporate representatives wanted to hear.  However, I agree with her.  If you take care of your staff, you can hold them accountable.  Further, if you take care of your staff, they will often perform better.  I’ve often thought about that conversation when sitting through depositions of overworked and underpaid nursing home staff.

This afternoon I have been looking around at other nursing home blogs, and I stumbled on this tidbit.  The Legal Medicine blog has lots of great posts, but this one in particular caught my eye.  It reminded me of the conversation with my friend . .

It seems that Nursing homes are concerned about immigration reform because it might hurt their staffing.  Think about that for just a minute.  The more immigrants they can hire, the less they have to pay them.  The less immigrants they hire, the more they have to pay.  Does everyone see that this has very little to do with staffing, and everything to do about the bottom line?

Yes, staffing is a problem in nursing homes.  However, often its more related to what the corporation is willing to pay for staff, rather than availability of people to fill staff positions.  And sometimes, you get what you pay for.

 

I saw this article on another website discussing the recent Cornell University study on physical abuse between residents.  Resident on resident abuse is underreported and mismanaged in the nursing home setting and most likely caused

Physical abuse in a nursing home may include staff or other residents.  According to a Cornell University Study, resident-on-resident violence in long-term-care facilities is far more prevalent than previously thought.  The authors of the study admit nursing home abuse is  woefully understudied.

The new study, funded by the National Institutes of Health (NIH), is only the second published report to look at patient-to-patient violence. Cornell University examined the records of 747 nursing home patients over the course of the study. Of those, 42 where involved in 79 incidents at nursing homes that actually required police intervention. The finding surprised researchers, especially because the study was not even focused on nursing homes. Rather, it looked at overall community crime, and nursing homes where just one area that was examined. 

Many nursing home patients suffer from varying degrees of dementia, and this often plays a factor in the violence.  Common triggers can be unwanted touching or disputes over television.   It is often the byproduct of a neglectful staff. Conflicts are far more likely to escalate to physical violence when patients are unattended. However, attentive staff can take steps to separate feuding patients before the situation deteriorates.

The report also questions the wisdom of housing dementia patients together. This is standard practice in most nursing homes, which generally have a dementia ward. But, because dementia often triggers violence, the report suggests it might be better to incorporate these patients into the general population as much as possible. 

As many as one in 20 nursing home residents are victims of nursing home abuse. Because there is no uniform system for reporting nursing home violence, experts on elder abuse concede that current estimates are probably just the tip of the iceberg.   There is no requirement to report resident-on-resident violence. In fact, the Cornell researchers only looked at cases that involved police calls. There were simply no records available to them detailing physical confrontations between residents that did not escalate to this level of violence.

Here is an article talking about another rape of a resident at a nursing home.  Where is the supervision? Where is the criminal background check? Wher eis the good ol fashioned judgment!?

Salt Lake Police arrested a worker at a nursing home today accused of raping an 85-year-old resident.  Jacob Bolith was arrested on suspicion of rape. The CNA is accused of raping a patient at St. Joseph’s Villa nursing village July 1.

Police said Bolith has worked at various nursing facilities in the Salt Lake Valley over the past decade. Bolith told police that he faced similar accusations in the past, according to a probable cause statement released by the jail.

I do not understand how nursing homes continue to say that they can’t make any money taking care of their residents.  The corporate executives of Manor Care will get more than $200 million for their sale to the Carlyle Group.  See the article here.

The head of America’s biggest nursing-home company is about to get intensive financial treatment. 

Chief Executive Paul Ormond will receive $118 million to $186 million from cashing in his company stock when the deal is completed this year.  Sixteen other top executives and recently retired officers at the firm to be purchased by the Carlyle Group, of Washington, can receive a total of $68 million for their stock.

In total, Manor Care officials stand to receive $200 million or more from their stock holdings.

The amount to be paid by Carlyle, a global private-equity firm that owns stakes in more than 500 companies and real-estate developments, may not be known for weeks.

The buyer said it will purchase Manor Care for $6.3 billion and hopes to complete the deal by the end of the year.

Mr. Ormond, CEO and chairman of the company that had $167 million in profits on $3.6 billion in revenue last year, is typically among the top-compensated corporate CEOs locally each year. Last year, he was compensated $18.8 million, an SEC filing shows.

The biggest chunk of looming stock payouts from Carlyle are to Mr. Ormond, whose 1.8 million company shares will be worth more than $118 million. They could be worth another $68 million if options on another 1.9 million shares he has are exercised for prices ranging from $20 to $53 each.

But the most recent regulatory filings show $55.5 million in stock payments could go to R. Jeffrey Bixler, former vice president and general counsel; Geoffrey Meyers, former executive vice president and chief financial officer; and M. Keith Weikel, former senior executive vice president and chief operating officer.

Company officers, directors, key employees, and some retirees stand to collect about $200 million for their existing stock, and possibly more than $250 million if unexercised stock options can be cashed in, the new SEC filings show.

Manor Care, No. 565 on the Fortune 1,000 list of the largest U.S. corporations, was once part of Owens-Illinois Inc. and started acquiring health-care facilities in the early 1980s. It spun off and became Health Care & Retirement Corp. and in 1998 merged with Manor Care Inc. of Gaithersburg, Md.

Former NY Mayor Ed Koch wrote a great article on the budget cuts to home health that have forced many older citizens into nursing homes.  Below are excerpts of the article:

In the last seven years, while the Medicare budget for nursing home stays has dramatically increased from $13.6 billion to $15.7 billion, home health care has been cut by 25 percent, from $14 billion to $10.5 billion. It is cut further in the Bush administration’s proposed fiscal year 2008 budget, which calls for an "inflation freeze" that would slash $410 million in fiscal 2008 and $9.68 billion over five years.

None of this makes common sense. Home care allows the elderly who have become frail to maintain their dignity and independence, sleep in their own beds, use their own kitchens and stay in the house they have long enjoyed (or in the house of a child or relative) – unless their condition deteriorates to the point where moving into an institution is absolutely necessary.

Besides offering a higher quality of life, home care is far cheaper than the alternatives – averaging one-fifth the price of nursing homes and a tiny fraction (3 percent) of the cost of hospitalization. It costs roughly $109 per visit, compared to $499 per day in a skilled nursing facility and $3,838 for hospitalization, according to Medicare statistics.

Starting in 1997, under the Balanced Budget Act, Medicare home health spending was cut by half. This forced the closing of nearly 25 percent of all home health agencies in the United States.

According to the Center for Responsive Politics, "hospitals / nursing homes" gave more than $30 million to candidates in the 2004- 2006 federal election cycles, based on Federal Election Commission data, and they are among the top third of 80 "industries" ranked. Home health does not even rate a mention on the chart.

There are some 1.6 million people in nursing homes today. Sometimes, senior citizens are able to live normal lives and care for themselves, but as people age, many have problems compounded by poor health and need caretakers. They should not be forced into nursing homes for lack of alternatives.

This article is very disturbing.  I cannot believe that the nursing home did not recognize this obvious sociopath.

A Victorian nursing home employee accused of pinning down a 98-year-old dementia patient "like an animal" and raping her was just doing his job, according to his defense lawyer.   Henry Alexander, 35, of Mount Martha, is accused of sexually assaulting four women in their 80s and 90s at a nursing home on the Mornington Peninsula in November 2005.

"Mr. Alexander’s care of these particular residents is based on the fact that what he did was reasonable … and it was all to do with the proper hygienic care of residents who had become incontinent with feces and urine,” Gipp said.

Alexander’s former colleague, Anne Girvasi, who no longer works at the home, said on one occasion she saw him pin a 98-year-old woman to the bed with his legs and digitally penetrate her.

"She was pinned down like an animal,” Girvasi said. "Henry Alexander is an animal and a rapist, okay? What he did was disgusting.”

She said she did not file an incident report about Alexander’s conduct because six-month old reports would pile up in the nurses’ station and no action was taken.   Friend and former colleague Janine Blythe said she tried to make an appointment with Susan Younger, the Director of Nursing, but Younger cancelled.

She said she then submitted an incident report to CEO Heila Brookes, which detailed Alexander’s alleged "inappropriate and rough” touching of an 87-year-old woman on Nov. 4, 2005.

"She just ripped it up – she said it wasn’t done the way it should be.

Blythe was fired from the nursing home for failing to immediately report the incident.

Here is the full article.

I wish South Carolina enforced the nursing home rules and regulations and issue fines when neglect has occurred. To my knowledge, SC has never fined any "for profit" nursing home.

A nursing home was fined $100,000—the most severe penalty under state law—after investigators ruled that poor health care led to the death of a 76-year-old patient.
Pleasant Care Convalescent of Petaluma operates a 54-patient facility where a woman died March 12 from an infection, said Norma Arceo, a spokeswoman for the California Department of Public Health.

The woman developed an infection and died from complications in a hospital eight days later, Arceo said. Records showed the patient had extensive cavities and food debris throughout her mouth, causing large swelling in her neck. 

Here is the full article

The NY Times has an interesting article about how health care providers misuse HIPAA to conceal medical mistakes or neglect from family members.

An emergency room nurse told Gerard Nussbaum he could not stay with his father-in-law while the elderly man was being treated after a stroke. Another nurse threatened Mr. Nussbaum with arrest for scanning his relative’s medical chart to prove to her that she was about to administer a dangerous second round of sedatives.

The nurses who threatened him with eviction and arrest both made the same claim, that access to his father-in-law and his medical information were prohibited under the Health Insurance Portability and Accountability Act, or Hipaa, as the federal law is known.

Mr. Nussbaum, a health care and Hipaa consultant, knew better and stood his ground. Nothing in the law prevented his involvement. But the confrontation drove home the way Hipaa is misunderstood by medical professionals, as well as the frustration — and even peril — that comes in its wake.

Government studies released in the last few months show the frustration is widespread, an unintended consequence of the 1996 law.

Hipaa was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply Hipaa regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information.

Experts say many providers do not understand the law, have not trained their staff members to apply it judiciously, or are fearful of the threat of fines and jail terms — although no penalty has been levied in four years.

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