So its time for another one of my little rants.  There’s money to be made in the nursing home business, just like there’s money to be made in the assisted living business.  However, do you suppose the people actually doing the work are making the money?  If you said "no", you’re right. 

I ran across an article about Atria Senior Living, which is owned by a investment fund affiliated with Lazard, a large Wall Street firm.   Reportedly, the CEO of Lazard earned nearly $23 million in 2006 and is worth more than $2 billion.   Want to know how much the employees on the floor at Atria make?  Try $8 – $10 an hour. 

The employees of several Atria facilities decided to join together to unionize, but Atria and Lazard apparently began threatening and intimidating the workers not to unite.   There are so many victims here – residents that probably don’t get the quality of care they deserve, due to short staffing, or high turnover which leads to inconsistent care; and of course employees who are out there hands on caring for elderly residents and receiving "peanuts" in return.

What’s wrong with this picture?  When do we say 1) the elderly (our mothers, fathers, grandparents) are more important than million dollar salaries and 2) the people that choose to be their caregivers should be adequately compensated for it.

I’m not saying that CEO’s don’t work.  I was raised by one, and he still works hard every day.  I am saying that people deserve to be compensated for caring for our family members.  I am saying that nursing homes and assisted living facilities cost thousands a month to reside there.  A great deal of what you’re paying for is someone to care for you.  Those caregivers should be compensated accordingly.

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Texas Attorney General Greg Abbott has filed a lawsuit against a Fort Worth assisted living center, claiming its manager threatened residents with a hammer, withheld food and locked some of them out of the building at night.  See full article here.

Abbott says the alleged abuse took place at the Oasis Village assisted living facility, located in Fort Worth’s Polytechnic neighborhood. A district judge issued a temporary injunction against the owner of the facility, God’s Intercessory Prayer Warriors Ministries, Inc., and its manager, Bertha McCoy.

According to state inspectors from the Department of Aging and Disability Services, at least five residents at the facility have complained that McCoy abused them. Some residents said she took the mattresses from their beds and forced them to sleep on metal bed frames, as punishment for soiling their sheets. They also said she locked them out of the building overnight. State inspectors also found evidence that McCoy hit several residents and threatened some with a hammer.

Inspectors reportedly found a hammer in McCoy’s office during a recent visit.

The state has filed suit against Oasis Village with the facility facing a punishment of up to $10,000 per penalty.   All of the residents at the facility have been relocated.

Des Moines Register has a great article on Senator Grassley’s comments and complaints about how states investigate nursing home abuse and neglect.  He is calling for a federal investigation into the way states respond to complaints of poor nursing home care.

"I have an obligation to protect Iowans, and all Americans, from substandard nursing care," the Republican senator from Iowa said in a letter Thursday.  Grassley criticized Iowa’s nursing home inspectors for failing to thoroughly investigate a complaint involving Waterloo’s Ravenwood Nursing and Rehabilitation Center.

In August 2006, Maizie Bickley was an 89-year-old resident at Ravenwood. Nurse aide Connie Rust called Bickley’s daughter, Sandra Bickley, one night to report concerns that Maizie Bickley was very ill and wasn’t being properly evaluated or treated by the nurses.  Within hours of Maizie Bickley’s arrival at the hospital, she was diagnosed with a bowel obstruction, an infection and dehydration.

The facility fired Rust, the aide that told the family the truth citing a company policy that prohibits conduct "that results in serious negative public relations." I guess being caught providing substandard care is considered bad for "public relations" but it is worse for the neglected resident!

Sandra Bickley was furious, particularly when the Iowa Department of Inspections and Appeals looked into Ravenwood’s care for her mother and found no problems. She complained to Iowa Citizens’ Aide Ombudsman William Angrick and to Grassley. 

Dean Lerner, who heads the state inspections department, asked the federal Centers for Medicaid and Medicare Services to do its own review of his agency’s work on the case.  That federal review concluded that state inspectors didn’t conduct a thorough investigation of the Bickley case and didn’t interview nurses, ambulance workers or the hospital’s emergency room staff.

Grassley is asking the GAO to examine the nation’s state-run nursing home inspection agencies and the manner in which they respond to complaints. He is also asking the Centers for Medicaid and Medicare Services to give him four years’ worth of investigative reports dealing with state inspections. He wants to know whether the Bickley case is an indicator of a widespread problem.

Although certified nurse aides have relatively little training compared with registered nurses, it’s the aides who provide most of the hands-on care in nursing homes. But they typically are prohibited from sharing concerns about quality of care with residents’ family members.

"But the problems with nursing homes are widespread," she said. "We’re basically just warehousing our senior citizens in this country. Too many homes are owned by corporations, and for them the bottom line is profit."

Jay Cameron whose mother died in a California nursing home filed a lawsuit against the facility saying it caused his mother’s death by reducing staff to save money. 

Cameron alleges the home committed elder abuse, fraud, wrongful death, negligence and violated patient rights. He is asking for an undetermined amount of money and reimbursement for attorneys’ fees. 

Cameron’s mother, Margaret Williams, was a resident at Mission View before being transferred to French Hospital Medical Center where she died.  Williams fell three times at the facility, suffered a hip fracture and developed pneumoniacausing her death.

Compass Health and administrators at Mission View are trying to increase profits by reducing staff and employing people who were not properly trained or qualified, leading to Williams’ death.

Attorneys for Cameron, Greg Coates and Michael Thamer, argue that the nursing facility took short cuts in care that resulted in unsanitary and hazardous living conditions and left residents unsuper vised. They also said there was an increase in accidents and injuries suffered by residents and nursing staff and other signs of inadequate care.

State records for 2006-07 show the state Department of Public Health issued three citations against the home in 2006 for patient care and fined the facility $2,800, spokeswoman Lea Brooks said.   In April 2007, during a recertification survey, state investigators found deficiencies at the home, Brooks said.

Here is an article about a nursing home in Arizona losing its Medicare and Medicaid funding because of patient neglect.   This action is the only one the multi-chain corporation understand.  Government oversight must be increased and serious consequences of neglect must be felt by the corporations.

Some Evergreen Foothills Health and Rehabilitation Center residents would have to be relocated to a facility capable of providing good care. The state is working to move those patients.

Arizona Department of Health Services records paint a disturbing picture. Problems cited include: failing to investigate injuries to rule out abuse; failing to provide regular catheter cleansing for one patient; and failing to notice when one patient had three broken ribs.

Evergreen’s corporate defense attorney stressed that, although Medicare and Medicaid funding will officially be cut next month, the state is allowing the center to remain open for now.  I am sure that is a relief to the neglected residents who remain.

The Courier-Journal in Kentucky has a great article about the necessity to increase staffing at nursing homes, and how the nursing home industry lobbyists are fighting against it so their profits remain large despite the poor care that is guaranteed with low levels of staff.  Please read the entire article and the Comments from other interested people.  Below is a summary of the article.

Lois Pemble said she once found her mother alone, sprawled on the floor of her nursing home room, where she’d fallen.   On other occasions, Pemble found her mother with her clothes soaked in urine, waiting for help to get to the bathroom.   She has joined with Kentuckians for Nursing Home Reform in pushing a bill that would require Kentucky to join 37 other states in setting minimum standards for the number of caregivers in nursing homes.

House Bill 109 would require nursing homes to have one nurse’s aide for every nine residents during the day shift; one aide per 13 residents during the evening shift; and one aide for every 19 at night.   The bill also would increase the number of RNs required to be on duty — currently the law requires only that one RN be on duty for only eight hours a day and that one licensed practical nurse be on duty the rest of the time.

The bill would require one nurse for every 21 residents in the day; one for every 29 on the evening shift; and one for every 42 residents overnight.

Other than requiring that a nurse be on duty, Kentucky law now says only that a "sufficient" number of staff be on hand to care for residents, but it does not define "sufficient." 

The reasonable measure already has encountered opposition from the industry, which has contributed more than $110,000 to lawmakers’ campaigns, according to records from the Kentucky Registry for Election Finance.  The political action committee of the Kentucky Association for Health Care Facilities has donated $114,150 to lawmakers, and many of the recipients were on key committees or in leadership roles.

The children of 94-year-old Alice Limbrick claim their mother’s legs had to be amputated  because of negligent care during her stay at the Green Acres Parkdale nursing home.

The trial of Roy Limbrick vs. Mariner Health Care Inc. (Green Acres) began Jan. 23.  The defense will attempt to convince the jury that the amputating Alice Limbrick’s legs had to be taken because of Alice’s medical conditions and old age.

Alice Limbrick was admitted to Green Acres for long-term care with multiple health problems.  During her residency, Alice fell fracturing her left hip.

The plaintiffs say Limbrick was admitted to the hospital as a result of the preventable fall where she developed pressure ulcers (bed sores) and eight blisters on both heels and left leg. She was in stable condition and was discharged back to Green Acres.

A week later, she was readmitted to the hospital with gangrene on both heels.   The decubitus ulcers to her heels and left leg continued to deteriorate.  Limbrick’s legs were amputated below her knees. 

In the suit, the plaintiffs allege that Green Acres’ nurses were negligent in the following ways:

Failing to properly monitor, treat and care for the decubitus ulcers, which progressed and worsened while Alice was a resident;

Failing to properly assess Alice’s risk level in the progression of pressure ulcers;

Failing to prevent the progression of Alice’s decubitus ulcers;

And by failing to prevent infection in Alice’s decubitus ulcers.

There is an article in an Ohio newspaper that discusses an alleged rape of a male resident at a nursing home.

After visiting her fiancé Saturday night at Concord Care and Rehabilitation Center, Linda Monegan knew something was wrong.  Unable to talk or see after suffering a stroke, her 55-year-old fiance nodded his head to signify he was in pain. He had been sexually assaulted by a nurse.

Concord Care night-shift nurse John R. Riems, 49, 100 block of W. Cedarwood, was arrested Monday on felony charges of rape and gross sexual imposition. During questioning Riems recalled abusing nearly 100 patients during his more than 20-year career.  Riems, who obtained his registered nursing license in 1985 through Providence Hospital’s nursing school, has worked at several nursing homes.

Concord Care director Jessica Short refused to answer any questions. Instead, she handed over a four-sentence typed statement, closed her office door and called police. The statement indicated an employee accused of "inappropriately touching" a resident was fired.

After she told police about the incident, Monegan said she was ordered by a nurse not to return to Concord Care, and now fears for her beloved’s life.

Many of Reims’ victims were elderly or disabled and unable to report the abuse.

The family is calling for justice to be served not only on Riems, but the entire nursing staff, who they say are responsible for patient neglect.   Besides the sexual abuse, Monegan said her fiancé suffered from burns to his legs, dehydration, bed sores and an unkempt trachea tube while staying at Concord Care since October 2007.

"What if that was your family member?" Monegan said. "What if that was your loved one?"

Clark Kauffman, staff writer for DesMoines Register wrote the following review of recent nursing home fines in Iowa.

Clearview Home, Mount Ayr:
A nurse aide was improperly transferring a resident who had a long-standing, serious head injury when the two lost their balance and the resident fell face-first to the floor. The resident was treated at a hospital for broken teeth and facial lacerations, then returned to the home. The resident died the next day. The home was fined $10,000.

Denison Care Center, Denison:
A resident was injured while being transferred, suffering spiral fractures in both legs, but was not taken to a hospital for three days. At the time of the accident, the resident told workers, "You broke my leg." The resident died at the hospital. A physician concluded the accident and injuries were the cause of the resident’s death. The home was fined $10,000.

Eldora Nursing Home, Eldora:
A resident with a history of respiratory problems was found dead on a floor one morning. Employees said they had not checked on the man for at least nine hours, even though the resident was to have been checked every two hours. The home was fined $10,000 for failing to provide a safe environment. Three months later, the home was fined $300 for the same type of violation. In that instance, a resident had been physically attacking and threatening other residents for several months. Five months later, the home was again cited for failing to provide a safe environment.

The Manor, Malvern:
A physician was to be contacted if a resident with end-stage liver disease became drowsy or lethargic. Nurses documented that the resident was "noticeably lethargic" and napping in the lobby, but they did not contact the doctor. A nurse allegedly told a concerned co-worker that the resident was "going to die anyway." Several hours later, an employee noted that the resident was still in the lobby and was dead. A doctor told inspectors the resident might have lived had he been contacted. The home was fined $10,000.

New Homestead Care Center, Guthrie Center:
Six workers reported to managers and supervisors that a male employee had committed multiple acts of abuse and neglect against residents. Managers did not act on those concerns, which allowed the abuse to continue. In one instance, the man allegedly put a chair against the door of a female resident’s room while he was inside. Another worker forced her way in and saw the employee bent over the mentally disabled resident, who was partially undressed and bleeding from her vagina. The man turned his back on the other worker and claimed he was cleaning the resident, but he had no washcloths, towels or other supplies. The home was fined $7,000. Eleven months later, inspectors returned to the home and filed a 64-page report of violations.

Park Place, Glenwood:
Four workers noted that a mentally retarded female resident was moaning and groaning in pain one night after having refused food and medication for days. The workers repeatedly asked the nurse on duty to check on the woman, expressing concern that the woman was dying and in serious pain. The nurse did not respond or contact a doctor. Hours later, the woman was found dead, face down at the foot of her bed. Two workers alleged the nurse was often talking on her cell phone or text-messaging her boyfriend. The home was fined $10,000.

Risen Son Christian Village, Council Bluffs:
A resident was placed in a bed with a broken side rail and fell to the floor, suffering a broken leg. The resident was taken to a hospital and died. The fall was the underlying cause of death. Several workers were aware the side rails on the bed were not working properly. The home was fined $10,000.

Scottish Rite Park, Des Moines:
A female resident fell in a shower, causing a serious, overlapping break in the bones of one leg. At the time, the woman told workers, "I guarantee you my leg is broken," but none of the employees notified the woman’s family or doctor, or ordered an X-ray, until the next day. Three workers told inspectors they were fearful of losing their jobs or state licenses. The resident later died, and the home’s medical director told inspectors the death was directly related to the fall. The home was fined $10,000.

Windmill Manor, Coralville:
A resident was entering other residents’ rooms, blocking their exit and then hitting and threatening them. One of the victims tearfully told inspectors she was afraid of the man and wished she could live somewhere else. The director of nursing told inspectors she was aware of the attacker’s history but said the victim who complained was "over-dramatic." While inspectors were at the home, they noticed the attacker was sleeping in the nurses’ station. A worker explained that is where the man stayed, otherwise he would enter the rooms of other residents and "make them scream." The home was fined $500. Two weeks later, inspectors were back at the home investigating a death. A resident had been admitted to the home after a leg amputation. While at the home, the resident’s skin deteriorated. The director of nursing never looked at the wounds. Eventually, the resident was hospitalized and doctors alleged the home had failed to treat a large, open sore. The resident was diagnosed with an infection, developed complications and died. The home was fined $10,000.

Clark Kauffman also has an excellent article about how the nursing home lobbyists have limited the amount of fines for neglect and abuse to a maximum of $10,000.  Continue reading for a brief summary.

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The News & Observer of Raleigh has an interseting article about the "new philosophy" of limiting or preventing nursing home residents from being in a wheelchair as long as the resident wants.

The article argues that older people’s health, mobility and self-image can suffer from too much time in wheelchairs. More than 24,000 North Carolina nursing home residents – about two-thirds of the total population – use wheelchairs as their main means of getting around.   

Ways to limit unnecessary wheelchair use are part of a movement that gives priority to the well-being of residents and their caregivers, above the functions of the nursing home or convenience of the staff.

The Midwest-based group called GROW – Get Residents Out of Wheelchairs – has taken up the cause on a national level. The nonprofit urges nursing homes to help residents use regular chairs, couches, recliners when sitting "is considered the norm and socially accepted." That includes for meals, TV watching, socializing with family and friends, and resting when tired.

Advocates acknowledge that wheelchairs have their uses for certain residents at certain times.
Advocates and academics say the downsides to spending too much time in a wheelchair are varied, but specific. They include a greater chance of pressure sores, significant discomfort and physical strain from operating chairs.

In addition, people in wheelchairs can be perceived as less able and are even spoken to differently in what becomes a self-perpetuating cycle of helplessness. Perhaps most importantly, loss of mobility can begin within a few days if someone starts using a wheelchair instead of walking.

Solutions are readily available in concept, but harder in reality. The GROW Coalition wants a requirement that nursing homes carry out a resident assessment before placing anyone in a wheelchair. In addition, lowered staffing ratios would let a center’s caregiver take more time with slow-moving residents.

Easier access to meals and other services should mean that more North Carolina nursing-home residents will be able to stay healthy and mobile.