Jose Jorge Gonzales was allegedly dropped twice by staff at the New Orleans Home for the Incurables and is suing the home for neglect, pain and suffering, and medical expenses. Gonzales is a quadriplegic, and was dropped while he was being transferred to his wheelchair. The first fall, on August 25, 2011, resulted in a broken leg. On September 1, one week later, he was dropped again. That fall resulted in serious injury to his lower back and spinal area. The suit also claims that the home failed to provide a safe environment and maintain proper equipment.

See article at The Louisiana Record.

The possible answer: Both.

In an article in the Chicago Tribune, the question of whether bedrails are a safety precaution or a threat to the elderly is explored. Since 1985, the Food and Drug Administration “has received 901 reports of patients caught, trapped, entangled, or strangled in hospital bed rails, including 531 deaths.” Some say that the rails provide support, and prevent falling. Others note that falls do not increase without the rails, and that the rails can often provide obstacles which increase injuries from falls.

In addition, rails used as restraints, with the maximum number of siderails, two at the top and two at the bottom, can be incredibly dangerous to the elderly. Elderly persons are often small and frail, and they can become trapped between the rail and the mattress, which compresses their lungs, suffocating them, and it can break bones in the neck. Many times, the person can’t even scream because their lungs are being compressed. Child bedrails and elderly bedrails don’t have the same safety standards. Child bedrails are safer by far, but there is a growing advocacy movement for safer elderly bedrails. As a result, ASTM International will create voluntary guidelines for adult bed rails. Officials say that if these voluntary guidelines do not decrease deaths, then other steps will be looked into.

Researchers at Carnegie Mellon University have developed a complex algorithm which could be used to help facilities monitor residents. The multi-camera, multi-object tracking system was tested in a nursing home. This system seemed destined to meet the same low percentage as other algorithms, as it has relatively few cameras, which was a problem for the other algorithms.  To achieve comprehensive coverage of residents, it was thought that there had to be an extensive number of cameras, covering every hallway, and every area.  However, this system utilizes the complex algorithm to render full camera coverage unnecessary.

Using the algorithm, this system can track residents to a meter of their actual location with an 88% success rate. The system, which could help facilities monitor residents for changes in activity and could help identify patterns indicating a mental status change, uses facial recognition to pinpoint residents. The system isn’t perfect, as the researchers are looking for ways to increase privacy protection, but it is a step forward in the journey for an indoor monitoring system. The researchers will present their findings June 27 at the Computer Vision and Pattern Recognition Conference in Portland, OR.

See full article at Mcknight’s.

Market Watch reported that EarlySense, the market leader in Proactive Patient Care Solutions™, announced the results of a multi-center clinical study demonstrating that the EarlySense system helps medical teams at rehabilitation centers to reduce patient falls as well as the number of patients transferred back to the hospital. The clinical data was collected from The Hebrew Home at Riverdale, NY and Dorot Medical Center in Israel. The data was presented today at the 2013 Annual Scientific Meeting of the American Geriatrics Society (AGS) by Hebrew Home medical director and study principal investigator Dr. Zachary J. Palace in a poster titled The Effect of a Continuous Patient Monitoring System on Reducing Hospitalization and Falls in Skilled Nursing Facilities.   For additional information, please visit http://www.earlysense.com.

Dr. Palace said, "The implementation of EarlySense on the post-acute care units has demonstrated a significant decrease in the total number of falls and a trend towards reduction in the readmission rate back to hospitals, thus improving the overall quality of care for the elderly. The system also alerted regarding early warning signs of patient deterioration which enabled our medical team to proactively respond and literally save four lives. As clinicians we are always on the lookout for better ways to provide safer, more effective care for our patients."

Dr. Palace continued, "Patient falls and subsequent hospital transfers are an ongoing challenge for most rehabilitation centers. The EarlySense system is the first technology to help us more effectively and proactively respond to early warning signs of deterioration and potential falls to secure better patient outcomes. We’ve experienced success and look forward to continuing this trend."

Dorot Medical Center principal investigator Dr. Gad Mendelson said, "As the population ages, we are seeing a growing need to provide safer, smarter care without increasing our staffing level. In this clinical trial, we saw that the continuous monitoring nature of the EarlySense system and its low level of false alarms allowed our team to reach deteriorating patients earlier without creating alarm fatigue."

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Alarms to prevent falls is standard in the nursing home industry since the federal government limited the use of physical restraints in the early 1990s.  Many nursing homes rely on alarms to warn them if a resident who is at risk for falls is getting up.  However, a new trend is emerging for alarm free facilities.  Many nursing homes now claim that alarms are not effective to prevent falls.  A study last year in the Annals of Internal Medicine that was based at a Tennessee hospital found that alarms did not statistically reduce fall rates.  The most effective safety measure is adequate staffing and supervision.  Connecticut’s The Day had an interesting article on this controversial issue.

"Kimberly Hall South is among a handful of nursing homes in Connecticut that have gone "alarm-free," meaning residents at risk of injury, usually from falls, are no longer outfitted with detectors on their mattresses, chair pads and clothing that emit a warning signal when they try to get up and move around."

Most experts say alarms are an important fall-prevention measure, especially for residents with dementia or poor safety awareness who may try to get out of bed at night unsupervised. The alarms remind the residents that they should not move, while also summoning staff to assist.   Nursing staff must be more diligent in monitoring patients but the lack of noisy alarms lowers anxiety for residents, especially those with cognitive problems, and improves the quality of thier life.

According to data from the U.S. Centers for Disease Control and Prevention, about 1,800 elderly nursing home residents die each year from injuries sustained in falls. Thousands more suffer serious injuries, such as broken hips. In Connecticut, nursing homes overall report that 3.1 percent of long-stay residents experience one or more falls with major injury, slightly lower than the national average.

Other preventative measures include frequent checks on residents who are at risk of falls; additional staffing, safety vests, lap cushions, siderails, hip protectors, detailed assessments of residents’ needs, to identify when and why they get up and try to walk, including their toileting needs; and consistent assignments of nursing staff to particular patients.

 

 

 

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The Sacramento Bee reported the maximum fine of $100,000 against Lincoln Meadows for causing the death of a resident when the staff overmedicated him with a dangerous blood thinner. 
The partially paralyzed patient fell from his wheelchair on May 26, 2011, hitting his head and leaving him with a black eye and facial bruises.  He should have been immediately hospitalized after his fall.  The staff ignored his injuries and failed to properly assess.
At his daughter’s insistence, the man was hospitalized four days later and found to have a subdural hematoma, low blood pressure and multiple organ failure, and hospital admission records indicate his Coumadin levels were 18 times normal levels.  He died on June 4, 2011.
When the patient died, Herman said, the nursing home was owned by Horizon West Healthcare, which in 2010 was hit with $29.1 million in elder abuse damages in connection with the death of a patient at another of its facilities.

 

The Winston-Salem Journal reported that Liberty Commons Nursing and Rehabilitation Center faces the termination of Medicare reimbursement payments for being out of compliance with standards.  According to a DHHS report, the noncompliance includes failing to prevent a fall with injury for an unnamed female resident who was dependent on staff for daily living activities.

"Such a decision would mean that Medicare would no longer make payments to the center for new inpatient services after that date. It would make payments for up to 30 days for patients admitted before Feb. 3, but all payment for current services would end by March 5."

On March 26, the resident was injured on her forehead as the result of rolling out of bed while being given a bed bath. She fell about two feet and landed on a concrete floor.   There was no documentation of a neurological assessment being done after the incident. 

According to Medicare’s Nursing Home Compare website, the center has an overall rating of two out of five stars, with five being the highest. A two-star rating is considered as being “below average.”

 

Elizabeth Street, a wheelchair bound resident of Country Cottage Assisted Living in Georgia, suffered a horrific and preventable accident when her chair brakes were not set and her chair rolled down a hill and into a ditch of water. The woman, died of pneumonia a few days.   According to a report by the U.S. Centers for Disease Control and Prevention (CDC), approximately 1,800 elderly people residing in nursing homes die every year due to falls. Between 10 and 20 percent of nursing home falls result in serious injury; between 2 and 6 percent of injury falls result in a broken bone injury. Even when the fall does not cause death, it can result in permanent physical disability.  Falls are a major cause of depression, anxiety, social isolation, and reduced mobility. 

Medical Express reported: "More than one in four older veterans residing in U.S. Department of Veterans Affairs (VA) Community Living Centers received antipsychotic medications, and more than 40 percent of those veterans had no documented evidence-based reason for use, according to new research from the University of Pittsburgh and VA Pittsburgh Medical Center."

The study, the first to address this topic in VA nursing homes, finds similar rates of antipsychotic use as studies in non-VA nursing homes. The findings will be published in the November issue of the journal Medical Care and currently are available online.

"Our study adds to the growing evidence base that antipsychotics have been overused in nursing homes, and the VA is not immune to this problem," said lead author Walid Gellad, M.D., M.P.H., an assistant professor in Pitt’s School of Medicine and the Graduate School of Public Health’s Department of Health Policy and Management. "Behavioral symptoms in dementia patients are difficult to treat, and, in most cases, nursing home staff are doing what they can to keep patients comfortable and safe. We have to find better ways to do this, though."

Antipsychotics have limited efficacy in alleviating behavioral problems in dementia patients, and several studies associate their use with an increased risk of mortality.

 

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The Journal News/LoHud.com reported that the family of an elderly woman discovered both the circumstances and the culprits behind her mysterious death. They did not discover that she had died from more than mere natural circumstances until the day of the funeral when they opened the casket and were shocked to see how battered her body was. 

The woman, Sinia Malone, 86 years old and a former resident of the Tarrytown Hall Care Center in Sleepy Hollow, NY, died as a result of injuries sustained when she was dropped by one of the nursing home aides on February 15.  The aide, Maureen Flowers, was arrested, as well as another aide named Donna Pagan, who is accused of helping coverup the incident.  Flowers was accused of attempting to move Malone from her bed to a wheelchair without any assistance or without using a mechanical lift, both of which were mandatory.  Malone fell during the transfer, “fracturing her spine and right leg and suffering a broken nose.”   Flowers did not call for help right away; instead, she approached Donna Pagan, asking to lie and say that she assisted in the transfer. After she agreed, Flowers sought medical attention for Malone. 

Unfortunately, it was too late and she died just two hours later at the Westchester Medical Center in Valhalla.  The family was worried and suspicious about the way Malone died, but did not know who was responsible until a relative read a news story reporting the arrest of the two aides.  Whereupon they pieced together the story, and their “worst fears were realized”. Malone’s niece, Lella Oates Jones, rightly stated that “‘no one deserves to die like that.’” She considered the prosecution of the two aides to be a just way of preventing the occurrence of further similar incidents.