Among older adults, falls are the leading cause of injury deaths and non-fatal injuries.  Falls account for the highest number of injuries in nursing homes and most of them occur when residents are in their rooms.  There are many ways to prevent falls or minimize the injury related to falls such as alarms, lowering the bed close to the floor, walkers and canes, floor mats, responding to call bells, and proper supervision by staff.  A new one that has been introduced is helping nursing home residents maintain optimal health.  Inside The Guardian House Alzheimer’s facility in Louisiana, each room is equipped with a Samarion Fall Prevention System. Guardian House CEO, Neal Rider said, “We have a ‘smart’ system, which is a computer system that will learn patient movement and activity.“

Each resident has an individual profile that determines the risk for potential falls. If they are categorized as a “fall risk,“ the computer and motion sensor devices will monitor their every move in bed and alert the staff if anything is abnormal.   The most important aspect is to have good staff in adequate numbers to respond to the alerts.  Looking at the computer screen as an alert comes in, Rider said, “You can see the unauthorized bed exit alert is coming in and you can see the individual getting out of the bed. It identifies where the person is in the building and where other individuals and staff are located throughout the building.“  Once the alert comes in, a nurse will immediately speak to the resident through the room television. Oftentimes, a simple reminder to stay in bed will keep a resident from making a potentially dangerous move.
This system takes the first of its kind preventative step in alerting staff before a fall happens. Guardian House Quality Assurance Manager, Kathy Richard said, “Our residents each have an electronic wristband, when they do a bed exit or they move – and the computer has programmed that that’s an unauthorized move, it will alert us.“

Another aspect to the Samarion system is its ability to prevent abuse in nursing homes. The same computer system working to prevent falls also monitors all interaction between residents, staff and visitors.

 

The Philadelphia Inquirer had an article about the heart wrenching death of an Alzheimer’s patient.  Ronald Myers was supposed to being cared for by Alvador Thompson in the hospice unit of the Cambridge Brightfield facility when she poured scalding hot Cream of Wheat down his throat.
Thompson pleaded guilty yesterday to one count of involuntary manslaughter.   The cereal was so hot that it scalded Myers’ mouth and esophagus causing second degree burns. 

The facility let a half-day go by before seeking medical attention.  According to court records, Doris Brake, Myers’ daughter, called Hatfield Township police Oct. 9 to report that her father had been burned.   He was unable to eat any longer, and died two weeks later.  Nursing homes have the duty and responsibility to check and moniter the temperatures of the liquid and food that they provide to residents.

Thompson pleaded guilty to involuntary manslaughter, a misdemeanor of the first degree that carries a maximum penalty of 2 1/2 to five years in prison and a $10,000 fine.

 

 

 

 

 

The LA Times had an interesting and enlightening article discussing how numerous studies have shown that not for profit nursing homes provide better quality of care than for profit nursing homes.

In the United States, two-thirds of nursing homes are investor-owned, for-profit businesses. The results of an analysis published prove that not-for-profit homes provide higher quality care. The paper, published online in the British Medical Journal, examined 82 studies carried out in the United States and Canada between 1965 to 2003.  Forty studies showed significantly better quality in not-for-profit homes. Nursing homes, whether for-profit or not-for-profit, vary substantially in their management styles, motivations and organizational behavior.  However, the analysis found that nursing home residents in the United States would receive 500,000 more hours of nursing care per day if all not-for-profit institutions provided all nursing home care.

Given the costs of nursing home care and the fears families have about the well-being of their loved ones, more research describing the qualities of superior nursing homes might be in order.

 

I am disgusted by all the stories regarding nursing home employees stealing, abusing, or taking advantage of the vulnerable adults under their care.  Here is just a couple of recent articles which shows the type of staffing that for profit corporations use to staff their facilities:

A man whose wife was being abused by nursing home staff hid a video camera in her room, capturing two unprovoked attacks by a worker. Detectives used that evidence Wednesday to file first-degree felony abuse charges against nurse aide Johnetta Dashaw Phillips, a worker at Castle Pines Retirement Home.  The police report stated the wife, who was paralyzed by a stroke years ago and also has dementia, has lived at the home for the past three years. Several months ago the husband said his wife told him she was being abused. An internal investigation at the nursing home was conducted and later closed because his wife was unable to identify her abuser. The husband told police he decided to set up a video camera in his wife’s room, which caught two separate incidents on tape.  During one incident in June, Phillips allegedly forced the wife out of her wheelchair, striking her three times on the arm before slinging her onto her bed. The force of the incident caused the wife to hit her head on the headboard. During another incident recorded in July, Phillips allegedly picked up a doll the wife had in her lap and struck the wife with it in her chest. The nurse aid then wheeled the wife to her bed and "roughly" placed her in it, causing her to hit her head on the headboard.  See article here.

The Galax Department of Social Services received an anonymous complaint that employees of Waddell Nursing and Rehabilitation had taken photos of patients without their consent. The photographs were described as pornographic.  Sharon Ann Walker of Fries was charged with two counts of knowingly and intentionally videotaping or photographing a non-consenting person who was 18 years of age or older when such person was nude or in a state of undress without the person permission. Walker allegedly shared the pictures with other people.  Chief Clark says the crime involved more than one patient at the nursing home and is believed to have happened between April 1, 2009 and July 15, 2009.  See article here.

Wiynnona Nelson was indicted today on charges that she took $4,000 from a resident of the Arlington Heights nursing home where she worked.  She was charged with financial exploitation of the elderly and aggravated identification theft.   $4,008 had been withdrawn electronically from the woman’s bank account over a period of several months. Police tracked the thefts to Nelson, who had worked at the Moorings nursing home until December.   See article here.

Douglas A. Harris has been arrested by the Tennessee Bureau of Investigation for allegedly exploiting a dependent resident of Brookhaven Manor.  Harris was employed as a social work director for the nursing home.  Harris is accused of unlawfully obtaining a $20,000 check, additional money in cash, and an Econoline van from a resident.   A statement from a TBI spokesman reads, "Harris was employed as the director of social work at Brookhaven nursing home located in Kingsport Tennessee when he obtained property and cash from a resident of the facility who was incapable of making financial decisions."  See article here.

 

 

There have been reports of an investigation of neglect and abuse in a nursing home in Virginia.  See links here and here.  Interestingly, there is not much information or detail in the articles except that the Galax Police Department and Galax Department of Social Services are investigating multiple allegations of abuse at the Waddell Nursing & Rehab Center. Arrests will be made soon.

Jim Wooddell, the nursing home administrator, says no residents were actually physically abused, but admits their rights were violated. Two employees have been terminated.

 

The Orange County Register reported an incident where a nursing home (Tustin Care Center) was fined $50,000 for the choking death of a resident.  has been fined $50,000 by state health officials in the choking death of a nursing home resident.

The unidentified man died in March after choking on his lunch. The report says staff noticed the man had been growing weaker and needed additional supervision while eating.  The facility allowed him to eat regular meals on his own.  On the day of his death,  the man was eating when he began struggling to breathe.  A nurse allegedly started the Heimlich maneuver but could not dislodge the food.  The man died later that day in a hospital. An autopsy found food completely blocking his trachea. The state report concludes that the nursing home failed to assess his ability to eat, which was a direct cause of his death.

 

 

Alex Nussbaum of Bloomberg had a great article about health care spending and the lack of need for tort reform. Some highlights from the article are below:

Annual jury awards and legal settlements involving doctors amounts to “a drop in the bucket” in a country that spends $2.3 trillion annually on health care, said Amitabh Chandra, a Harvard University economist. Chandra estimated the cost at $12 per person in the U.S., or about $3.6 billion, in a 2005 study. Insurer WellPoint Inc. said last month that liability wasn’t driving premiums.

“Medical malpractice dollars are a red herring,” Chandra said in a telephone interview. “No serious economist thinks that saving money in med mal is the way to improve productivity in the system. There’s so many other sources of inefficiency.”

About 10 percent of the cost of medical services is linked to malpractice lawsuits and more intensive diagnostic testing due to defensive medicine, according to a January 2006 report prepared by PricewaterhouseCoopers LLP for the insurers’ group America’s Health Insurance Plans.  The figures were taken from a March 2003 study by the U.S. Department of Health and Human Services that estimated the direct cost of medical malpractice was 2 percent of the nation’s health-care spending and said "defensive" medical practices accounted for 5 percent to 9 percent of the overall expense.

A 2004 report by the Congressional Budget Office also pegged medical malpractice costs at 2 percent of U.S. health spending and “even significant reductions” would do little to reduce the growth of health-care expenses.

The proportion of medical malpractice verdicts among the top jury awards in the U.S. has declined during the past 20 years, according to data compiled by Bloomberg. Of the top 25 awards so far this year, only one was a malpractice case. At least 30 states cap damages in medical suits, primarily for “pain and suffering” awards.

The development of new drugs and medical procedures, and their growth in price, has been a bigger factor in costs, said Chandra, citing his research and that of other economists. Studies haven’t found a link between increasing procedures, such as Caesarian-section births, and areas with rising malpractice damages, he said.

Medical malpractice is “not a major driver” of spending trends in recent years, Indianapolis-based WellPoint, the largest U.S. insurer by enrollment, said in May 27 report. The report cited advances in medical technology, increasing regulation and rising obesity as more significant reasons for rising costs.

The U.S. Institute of Medicine found a decade ago that medical errors kill 98,000 Americans a year, said Les Weisbrod, president of the lawyers’ association. “By taking away the rights of people to hold wrongdoers accountable, the quality of health care will suffer tremendously,” he said.

 

Arizona Daily Star had an article about a ridiculously small fine issued against a nursing home for severe neglect of their residents.  Devon Gables has agreed to pay a state fine of only $1,450 after an investigation found several civil violations, including nearly a month’s delay in getting a resident treatment for a skin problem that turned into a serious pressure sore.  State investigators found a total of 16 violations of state and federal rules and regulations governing long-term care at Devon Gables.

Among other things, Devon Gables staff did not immediately consult a physician about a resident’s dark and reddened skin, which was rubbing against a wheelchair pedal. The resident ended up developing an infection that was serious enough to require hospitalization.  The state, which found several more violations during an inspection in April, gave the nursing home a state quality rating of "A" — the highest level, which denotes "excellent."

The Arizona Department of Health Services, which licenses nursing homes in the state, can only fine facilities a maximum of $500 per day for violations.

Other incidents cited in the state’s report:
• The staff gave a narcotic drug to a resident who was documented as being allergic to narcotics.
• Investigators say the nursing home failed to develop a post-discharge plan for a resident who was released to an "unsafe environment" — a home with no electricity, and with dirt and mouse droppings on "counters and floors in virtually every room."
• Did not report to the state an allegation of abuse involving one resident. The allegation did not turn out to be substantiated, but state rules require any allegation of abuse be reported to the state within five days.
• Failed to document nursing assessments before and after three residents with end-stage renal disease went for dialysis.

Devon Gables is also the subject of three pending lawsuits in Pima County Superior Court alleging negligence, violations of the Arizona Adult Protective Services Act, and wrongful death in two of the cases. 

 
 

The State Journal-Register had an interesting article about how Illinois is challenging a decision by a Sangamon County Judge Zappa that puts a $10,000 limit on nursing home fines, but the ruling already has affected dozens of cases statewide.  Zappa issued his ruling in a case involving Peoria’s Rosewood Care Center, which had appealed a $25,000 fine stemming from the death of 95-year-old Katherine Martin in 2006.  Zappa found that the department violated state law and bypassed administrative rules when it began to impose fines of more than $10,000 several years ago. He barred the department from enforcing fines of more than $10,000 in past cases that remained pending and any future cases.

Public Health officials believe state law allowed them to boost fines to $50,000 whenever they determined that bad care directly caused a resident’s death. The department in 2006 also began issuing fines of at least $20,000 when residents sustained serious injuries connected with bad care.  High fines rightly punish and deter bad behavior, and promote better care.

Fines involving 40 Illinois nursing homes have been reduced, with the facilities agreeing to pay $10,000 or less, since the Feb. 13 decision.  I bet the facilities jumped at the chance to pay less than $10,000.   State officials are considering reducing individual fines that exceed $10,000 in more than 80 other cases going back to 2006.

The Department of Public Health hasn’t decided yet how to proceed in a pending case against Woodstock Residence, now known as Crossroads Care Center, in which the Woodstock nursing home was fined $300,000 — a record level — in May 2008. State regulators have investigated five suspicious deaths there, as well as a former employee who allegedly used drug cocktails on residents.

The article cited a few examples of cases in which fines against nursing homes have been reduced to $10,000 by the Illinois Department of Public Health because of Sangamon County Judge Leo Zappa’s order in February. These cases remain pending, and a final amount to be paid hasn’t been negotiated:

* Maryville Manor, Maryville: Original fine was $40,000, stemming from an Aug. 6, 2007, inspection that detailed a range of problems including multiple bedsores and pressure sores on residents, a lack of recreational activities and a situation in which a nurse’s aide resigned after injectable anti-anxiety medicine prescribed for a resident was found in the aide’s possession.

* Evergreen Nursing and Rehab Center, Effingham: Original fine was $25,000, stemming from a March 22, 2006, investigation into the June 22, 2005, death of an 84-year-old resident who suffocated after becoming caught in a bedrail that had a piece missing.

* Dearborn Court, Kankakee: Original fine was $30,000, stemming from a Sept. 4, 2007, investigation into the alleged physical assault of a 64-year-old female resident by two employees of the nursing home on Aug. 15, 2007. The employees allegedly hit the resident with plastic hangers, tied her up with a belt, punched her in the head and stomach and tried to choke her.

* Peachtree Estates, Jonesboro: Original fine was $20,000, stemming from a July 15, 2008, inspection that said the facility failed to obtain prompt medical attention for a 73-year-old female resident who fell and sustained a head injury June 19, 2008. About a month before that injury, the resident had fallen and broken her left arm; she also fell on June 20, 2008.

 

Montana’s News Station had an article about a nursing home employee accused and charged with elder abuse, six felony counts of possession of dangerous drugs and six counts of misdemeanor theft.  Just the type of person who should be working in a facility full of vulnerable adults.

Keiko Douglas is accused of taking prescription medication from a resident of Park Place Health Care Center.   Douglas admitted to police that she removed a prescription medication patch from a resident’s arm. It happened six times since June 27th.

Despite increasing the number of checks on the patient, nurses noticed her patch continued to disappear. Douglas was seen leaving the patient’s room yesterday morning and the patch was again missing.  The nursing director said that as a laundry worker, Douglas had no reason to be in the room.