Reuters had an article about a new study showing that two out of every five residents with urinary problems got inappropriate drugs which in turn increased their chance of getting a bacterial infection.  Doctors are only supposed to treat a UTI with antibiotics if the patient meets certain criteria.  Dosa said overuse can lead to drug-resistant bacteria and so increase the risk of hard-to-treat infections.

Over six months, one out of seven people that received UTI antibiotics in the nursing homes came down with Clostridium difficile, a bacterium in the digestive tract that can cause diarrhea, cramps and sometimes life-threatening inflammation of the colon.

Failing to keep residents clean with proper toileting and hygiene prevent most UTIs. UTIs occur when bacteria enters the urethra, then the bladder.  Untreated, they can cause kidney damage or infection, or in rare cases sepsis which is a life-threatening blood infection. According to the researchers, the disease is especially common in nursing homes, affecting nearly half the residents at some point during their stay.

To be treated with antibiotics, patients should have three out of five symptoms described in current UTI guidelines, such as a fever or a burning sensation while urinating.

SOURCE: Achives of Internal Medicine, online March 14, 2011.

 

An Ohio jury awarded the family of Robin Volpe more than $1 million in a wrongful death case against Heather Knoll Retirement Village Inc. for her August 2006 death when she died after a preventable fall at the nursing home.  Volpe had been sent to the nursing home for short term rehabilitation after back surgery in 2006. Her stay at the nursing home was temporary.  Staff members were aware that Volpe was a fall risk and failed to implement an alarm to alert them if she got out of bed.  There was also evidence that staff did not respond to call bells. She fell after she got out of bed, striking her head and fracturing her wrist and hip. She died a week later.

The jury specifically ruled that Heather Knoll was negligent and had violated Ohio’s Patients Bill of Rights.  Although Volpe was required to sign an arbitration agreement upon entering the nursing home that prevented her from suing if something went wrong, the jury found the agreement was unenforceable.

 

 

WAFB had an article about Sherwood Manor Rehab and Nursing Home and the history of mistreatment of residents including Blanche Taylor McGrath.

"There were times I found roaches in her bathroom and in her bed," said Shannon Flores, granddaughter of McGrath. "Covered in food at 10:00 at night when she had been fed at 4:30, 5:00 in the afternoon." Flores claims that she also found her grandmother covered in ants, unable to move or brush the bugs off.  Blanche Taylor McGrath could not properly feed herself and as a result, she would often spill her food.  Family members also claim McGrath’s adult diaper was not changed regularly.  "They would throw dirty cloths just throw them in the bathroom. A lot of times they would be soiled, you know, with feces," said Brandy Rhorer, another one of McGrath’s granddaughters.

"I would walk in there and I would hear her screaming help me. There was nothing I could do. It’s not easy to move an old person. They get comfortable in their surroundings," Flores recalled.

Similar complaints have been filed with the Department of Health and Hospital over the years. The agency reviewed personal care documents and found one resident had no baths documented for an entire month.

Another resident complained she had to wait on the toilet for three and a half hours before someone came to assist her.  DHH documents show repeated complaints about aides not answering the call bells in patients’ rooms.

"I would just run around there trying to find somebody, anybody, that I thought would be higher than somebody else, that would be able to change something or do something," Rhorer explained.

"It’s just really painful to know that the last few years she had left, she was treated like this," said Flores.
 

The Evansville Courier & Press had an article written by Hanns Pieper is professor of sociology and gerontology at the University of Evansville regarding staffing.  He refers to Medicare.gov which contains nationwide nursing home comparison data.

"Staffing time measures are especially important because it’s the staff that actually delivers the care. The data are based on the nursing home’s staffing hours during the two weeks before the inspection and represent the average amount of time available per resident. All other things being equal, the more time per resident the better."

CNA data is the most important since they provide 90-95% of the direct care to residents.  CNAs have the most frequent contact with the residents, so the time they have available is key.  The time available measure is an indicator of staffing adequacy and there often is a significant difference among the different star ratings.

He looked at a list of Indiana nursing homes, and randomly selected a nursing home with a 4-star rating and one with a 1-star rating for staffing.  The 4-star nursing home provided almost an extra hour per day per resident.

There are other important indicators of staffing adequacy that are not presented in the charts such as staff turnover, and call bell response time.   Data that shows how many CNAs who were working on Jan. 1 and still were employed on Dec. 31 should be available.   A CNA’s leaving often has a significant emotional impact on residents. The quality of care is affected. A high turnover rate also may be an indicator of other inadequate conditions in the nursing home.

The time it takes for a staff member to respond to call lights/bells requesting assitance made by a resident is also not presented in the data.  When facilities don’t have an intercom to determine if the situation is an emergency or routine event, a long response time can lead to devastating results. Inrercom systems and electronic recording of alarms and call bells should be standard in most nursing homes.
 

NY Times has a blog called The New Old Age.  Recently, they had an entry by Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions” regarding nursing homes.  The entry begins with a story about Sharon Kenney’s mother, Eunice.  Eunice was waiting, and waiting, for an aide to answer her call bell and help her to the bathroom.  Her daughter stayed on the phone with her for 45 increasingly desperate minutes. Finally Ms. Kenney hung up, called the desk nurse and asked that someone be sent to assist her mother. The ensuing conversation, as she recalls it:

 

Nurse: “We’re really busy and we have a lot of residents here. You’ll have to wait your turn.”

Ms. Kenney (after long pause): “That’s not the answer I was expecting. The answer I was expecting was, ‘I’m so sorry, we’ll send someone right down there.’”

Nurse: “I only have one person on that wing. She needs to wait.”

Ms. Kenney: “Maybe you could go down and help her. Do I have to drive over there and help her myself?”

Ms. Kenney takes meticulous notes of the neglect. Her motto for dealing with the staff: “Be as polite as possible. But relentless.”

Virtually all nursing homes are chronically short-staffed, with too few aides and nurses scurrying to help too many residents, who are more impaired and suffer higher rates of dementia than their peers a couple of decades ago. 

The article goes on to discuss Cynthia Dyer-Bennet. She grew frustrated when the aides caring for her mother in a dementia facility outside San Francisco seemed to routinely neglect brushing her teeth. “I could tell because her toothbrush was always bone-dry,” Ms. Dyer-Bennet said. The staff denied any problem. “They’d say, ‘We did brush her teeth.’ I’d say, ‘No, look, here’s her toothbrush — it’s dry at 9:30 in the morning.’ They’d lie to me.” She understood that with three aides caring for 27 residents, the staff was doing its best. She knew, firsthand, that with an Alzheimer’s patient, brushing teeth can take 20 minutes. But she persisted, citing what she saw as broken promises about diet and activities, as well as oral hygiene. “It reached the point where the caregivers didn’t want to see me because I was waving a toothbrush, and the administrators didn’t want to see me because they didn’t want to hear complaints,” Ms. Dyer-Bennet said. She eventually moved her mother elsewhere.

Family members who perceive conflict with staff have significantly higher levels of depression, according to a 2007 study conducted in 20 upstate New York nursing homes. And interviews with nearly 700 nursing home nurses and nursing assistants revealed that conflict with family members increases staff burnout and lowers job satisfaction, which contributes to the sky-high staff turnover rates that already plague many nursing homes.

 

L.A. Times had an article about the obvious importance of staffing in providing quality care in nursing homes.  The cornerstone to quality care in a nursing home is staffing.  Those with larger staffs tend to have less turnover, more stability and are more likely to meet the needs of all the residents.

"There is some very persuasive data showing staff simply can’t perform all of the responsibilities they have unless there is an adequate ratio of staff to residents," says Janet Wells, policy director for the National Citizen’s Coalition for Nursing Home Reform, a reform-activist-advocacy organization.  Homes should be staffed to provide at least 3 1/2 to four hours of care per resident in a 24-hour period, says Larry Minnix, chief executive of the American Assn. of Homes and Services for the Aging, a nonprofit organization that represents not-for-profit elder-care facilities. Some may need to offer four to five hours daily depending on the conditions of the residents.

To assess staffing levels, Pat McGinnis, executive director of California Advocates for Nursing Home Reform, recommends visiting at a time when a facility is most likely to have maximum staff on duty (like at lunch, the biggest meal of the day).  Telltale signs of understaffing include diners with food trays who are not eating because they are not receiving necessary assistance, residents sitting idly in common areas or their rooms with nothing to hold their attention, call buttons going unanswered, and development of pressure ulvers.

Visiting during mealtime is also a good way to gauge food quality. Weight loss can be dangerous to the elderly, so food should look and smell appetizing.  Some of the more progressive homes have buffet lines rather than the "school lunchroom program," in which residents shuffle through with trays, Minnix says. "Food is the most looked-forward-to institution for many people, especially those confined to a home," he says. "You should ask about snacks and what kind of weight loss-weight gain program they have."

 

The Times Union had an article about a nursing home failing to respond to call bells leading to residents soiling themselves and losing their dignity, or trying to get up unassisted and increasing the chances of falling.  Residents at Glendale Home were forced to wait to use the bathroom, sometimes so long that they relieved themselves in their beds or on the floor, because of a shortage of workers. The nursing home received a $20,800 federal fine.

In September 2008, six residents of the Glendale Home recounted for Health Department interviewers how they felt humiliated when no one answered their call bells for help getting to the toilet.

"We definitely had that deficiency in that period of time," said Schenectady County spokesman Joseph McQueen. He said the facility in Scotia redeployed staff to handle the workload after a study that helped determine when call-bell use was highest.  Additionally, he said, staff attended "dignity" training and the nursing home surveyed residents to ensure the bathroom problem had been addressed. No additional workers were hired.

Certified nurse aides and other employees admitted that on certain days the facility was short-staffed, sometimes to the point that residents were also not turned in their beds increasing the risk of pressure ulcers, and not bathed frequently enough.  Inspectors learned about problems encountered by one resident who had lived at the nursing home for only a month and needed the assistance of two staff members and a mechanical lift to get out of bed.

"She stated that sometimes staff would become angry with her for calling out when they were so busy and tell her she would have to wait," the inspector reported after speaking with the resident and her daughter. "She also stated that when she was waiting for help she would be in pain from the urgency of needing to void. The resident said that on several occasions she had wet herself while waiting for the staff and that she was mortified and embarrassed that she wet her bed."

The state inspectors said they observed another resident who was unclothed from the waist down as he tried to use a bed pan. The resident later said he was yelling out for someone to close the door to his room, the report said.

 

Chicoer.com reported the filing of a lawsuit against Windsor Chico Creek Care and Rehabilitation Center for negligence and the wrongful death of a Geraldine Pavcik.  Pavcik was admitted to the facility on June 17 for short term rehab after a minor back injury.

Because Pavcik was at risk of falling, her doctor had ordered bed-rail restraints, a lowered bed, an alarm system, and that she be closely attended to.   All are standard preventative measures available in most nursing homes but they depend on proper supervision and a quick response time to call bells and alarms which, of course, depends on adequate staffing.  Most residents fall because the nursing home chose to be understaffed and that leads to falls.

These measure were not in place on "multiple occasions" while Pavcik was in the nursing home.  On July 3, Pavcik was left unattended and without bed rails and a bed alarm.  At 7 a.m. that day, she fell out of bed, severly fracturing her left hip.  Although her hip was X-rayed at the facility at 2:45 p.m., she wasn’t transferred to an acute-care hospital until after 9 p.m.

Pavcik had surgery for her fractured hip, but the operation affected her mental condition, and she was no longer able to eat or drink effectively.   As a result, she contracted "aspiration pneumonia," a type of pneumonia that can develop in people who inhale liquid or bits of food. The woman died of respiratory failure as a result of pneumonia.

Among the accusations against the nursing home are that its administrators failed to hire enough staff to keep Pavcik safe, that her doctor’s orders were not followed, that she wasn’t transferred to an acute-care hospital when she needed to be, and that her doctor was not notified as her condition declined before she died.

 

Nate Taylor wrote an article for The Coloradoan about a recent verdict for a family against nursing home involving a resident who fell because the nursing home refused to respond to the resident’s call light.   The fall led to her untimely death.  This happens all the time in nursing homes and is a result of understaffing.  The nursing home does not want to pay for adequate and competent staff because it will hurt their profit margins.  The staff becomes overworked and fails to respond to call lights.

While the family says her 87-year-old mother Doris Wolfe’s November 2007 death was the hardest thing she’s had to live through, a close second was the lawsuit her family endured suing Spring Creek Healthcare Center.  "We’re just a little tiny family of four against this huge corporation of nursing homes," Johnson said, referring to Spring Creek Healthcare Center’s parent company, Sava Senior Care. "You would never, ever, ever go through (a lawsuit) for any reason other than somebody had been harmed and you felt like you had to fight that fight. It was brutal."

Sava Senior Care owns at least 185 nursing homes across the country, including Spring Creek and Fort Collins Health Care Center.  They are represented by Lori Proctor.  We had a case against them last November when a resident fell three times in a 24 hour period.  The jury awarded us $200,000 in actual damages and $600,000 in punitive damages. 

Johnson said her mother stayed at Spring Creek for 17 days to rehabilitate following back surgery at Poudre Valley Hospital. Wolfe broke her ankle the day she was supposed to be sent home.

According to an investigation by the Colorado Department of Public Health and Environment, Wolfe may have turned on her call light to request help to go to the bathroom. When Wolfe thought an "extended amount of time passed" and no one answered her request, she opted to try to walk toward her walker on her own and fell and broke her ankle.  Jay Reinan, a Denver lawyer who represented the Wolfe family, said Doris Wolfe did push the button.

"As a result of staffing deficiencies, Mrs. Wolfe was left to decide between soiling herself or attempting to go to the bathroom on her own, and that eventually led to her death," Reinan said. "With a lot of older folks, dignity is important, and that’s what happened to Mrs. Wolfe."

The health department investigation also indicated that Spring Creek X-rayed Wolfe’s ankle and found no fracture, but a family physician looked at the X-ray results and determined it was fractured in two places.

Johnson said she hopes the jury’s decision will lead to changes at the nursing home. "As scary and intimidating as it was, that’s why we did this – for change," Johnson said.

 

Northwest Arkansas Times had an article about a resident who died only 6 days after getting admitted to a nursing home. She was only 63 years old.  Why did they agree to accept her if they couldn’t take care of her?

Donna Fay Snow dislodged her catheter line, entered the bathroom and fell. She bled to death while lying on the bathroom floor before she was found at 5: 35 a. m.   Many times the resident needs to go to the bathroom and hits the call light/bell but gets no response so they try to go to the bathroom without assistance.  In this case, the call light was not operating properly.

"It appears that the cord to her nursing call light was missing," the lawsuit states.

Snow had a port placement for dialysis in her upper left jugular vein that she was prone to pick, according to the complaint.  The nursing home and its staff knew about Snow’s medical condition and should have taken steps to care for her needs, the lawsuit alleges.