Journal Watch had an article about a recent study about falls and risk factors.  Delbaere K et al. Determinants of disparities between perceived and physiological risk of falling among elderly people: Cohort study. BMJ 2010 Aug 20; 341:c4165.  The conclusion of the study that was done that found that, even when the physiological risk of falling may not be high, if an elder has a fear of falling, that alone is a risk factor that needs to be taken seriously by clinicians.

Perceived risk and physiological risk are independent risk factors for falls among elders. Clinicians should take fear of falling seriously even if an elder appears spry.  in practice, identifying patients who fear falling without directly asking them would be difficult. Patients who fear falling should receive advice and interventions on how to avoid falling


About this time every year I start getting the "Stella Awards" email from friends who think the examples cited are outrageous and somehow want me to comment or justify the attack on civil justice that these "Awards" put forth.


If you get the "Stella Awards" in your email, please ,before giving it any credibility or passing it along to your contacts click onto the snopes link  and learn how this is totally false and untruthful.


The only thing worse than making up false damnation’s about our civil justice system is to pass that untruth onto your contacts as if it were true.


The truth is that we are blessed with the best system in the world to determine the truth and protect parties in either our civil or criminal justice system. Many people have sacrificed, which has included giving up their lives, to obtain and preserve our right to trial by jury.


Our state and federal constitutions recognize this rights importance and are written to preserve our basic rights including our right to trial by jury..


We also have a freedom of speech which those same people sacrificed and died to obtain and preserve. It is not the freedom of truthful speech only.  Unfortunately that freedom allows and often protects untruths and distortions to be spread just as easily as the truth.


It is our duty to look with a critical eye when we read things like the "Stella Awards", because while our freedom of speech protects its dissemination it does not guarantee it truthfulness…


Thanks for your consideration in stopping this outrageous attack on our precious right to trial by jury which so many sacrificed to preserve.




We recieved an email from Gary Owens of Tender Care Beds. See website here.  Gary Owens is a full time caregiver for his wife Gina. He wanted to keep the bedroom home-like with all the medical equipment ( home hospital bed, etc ) needed. He made a huge difference by inventing a wood slip-over Head and Footboard that slides over the ends of an ugly hospital bed and turns it into a beautiful piece of furniture. It can be used at home or in a long term care facility. It’s never been done before, therefore people don’t know to ask for it. They just suffer in silence with their sterile, clinical looking rooms. All ages enjoy the home-like look and feel it adds, without losing the function of their hospital bed. Go to for more details.

Gary’s father is a resident in a nursing home. His room was very outdated with an old long term care bed that was very institutional and sterile looking. He created a home-like environment for him as he did for Gina. He created a room that invited a homey warm feeling for everyone, and raised the bar on the level of care.

Gary E. Owens
TenderCare Beds, LLC
Direct Line – 662-862-9419

877-407-4440 x 105

The Consumer Voice Expands its Commitment to Quality Long-Term Care Through New
Three-Year Project 

The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR), also known as the Consumer Voice, announces the launch of a major project, Consumers for Quality Care, No Matter Where, funded through a three-year grant by The Atlantic Philanthropies. Consumers for Quality Care, No Matter Where will expand the organization’s national grassroots advocacy network to focus on health care issues faced by older long-term care consumers in all care settings, activating the consumer voice on long-term care issues and the need for quality, accessible, well-coordinated care wherever the consumer lives.

Additionally, Consumers for Quality Care, No Matter Where will develop models for engaging consumers through state pilot projects, facilitate collaboration with national organizations to implement health reform, result in a report with policy recommendations to respond to the growing long-term care needs of a diverse aging population and offer training and grant opportunities for consumer advocates.

"This is an exciting time for the Consumer Voice and the individuals we represent," said Executive Director Sarah F. Wells, MA. "Our organization has had much success in advancing consumer advocacy for nursing home residents and will continue to move forward on those efforts. Consumers for Quality Care, No Matter Where presents a new opportunity to advance the goals we developed through our strategic business plan, reflecting our commitment to meeting the changing needs of long-term care consumers."

The Consumer Voice is widely recognized as the only national organization bringing consumers’ voices directly to federal policy discussions and was instrumental in passing the 1987 Nursing Home Reform Act, which created the framework for nursing home regulation and consumer protection. The organization was also a leader in the passage of the Nursing Home Transparency and Improvement Act, the Elder Justice Act, and the Patient Safety and Abuse Prevention Act in the health care reform law.

For more information, visit

The National Consumer Voice for Quality Long-Term Care is a 501(c)(3) nonprofit organization founded as the National Citizens’ Coalition for Nursing Home Reform (NCCNHR) in 1975 by Elma Holder. The organization represents the consumer voice at the national level for quality long-term care, services and supports by advocating for public policies that support quality care and quality of life responsive to consumers’ needs in all long-term-care settings; empowering and educating consumers and families with the knowledge and tools they need to advocate for themselves; training and supporting individuals and groups that empower and advocate for consumers of long-term care; and promoting the critical role of direct-care workers and best practices in quality-care delivery.

About the Atlantic Philanthropies


The Atlantic Philanthropies are dedicated to bringing about lasting changes in the lives of disadvantaged and vulnerable people. Atlantic focuses on four critical social problems: Ageing, Children & Youth, Population and Health, and Reconciliation & Human Rights. Programmes funded by Atlantic operate in Australia, Bermuda, Northern Ireland, the Republic of Ireland, South Africa, the United States and Viet Nam. To learn more, please visit,


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The National Consumer Voice for Quality Long-Term Care | 1828 L Street, NW | Suite 801 | Washington | DC | 20036

I am very pleased to attach a recent decision of the Eleventh District Court of Appeals reversing the trial court’s decision to stop the litigation and ordering the case to binding arbitration.  Arbitration agreements in nursing homes ar einherently unfair and unconscionable; they violate the Constitution and deny victims his or her day in Court.

 The largest nursing home chains in the country do not draft a binding arbitration clause and then insert in every admission agreement for each of its residents’ nationwide, because arbitration benefit the customers.





The Chicago Tribune and KWQC had articles on the investigation into alleged tip offs to facilities before inspections.  State authorities are investigating whether a city Department of Family and Support Services official tipped off a Chicago nursing home to a surprise inspection led by the state attorney general’s office that was designed to protect vulnerable residents at the facility.  Officials and advocates for the elderly and disabled call unannounced inspections the backbone of safety enforcement, but the alleged security breach added to long-held suspicions that some nursing homes have been given advance warning of state inspections.

When a team of law enforcement officials arrived at the Grasmere Place nursing home in Uptown for the surprise "Operation Guardian" sweep on July 22, facility administrator Celeste Jensen was waiting for them in the lobby. "What took you so long?" Jensen asked.  Under questioning by authorities with the state attorney general’s office, Jensen said she had been warned of the impending sweep by a city official whose job was to safeguard elderly and disabled people in nursing homes.

Officials expressed outrage at the alleged leaking of the sweep. Grasmere was fully staffed and bustling with painters and carpenters, said the attorney general’s deputy chief of staff, Cara Smith, and state long-term care ombudsman Sally Petrone, who both took part in the raid.


When officials returned to Grasmere for an unannounced follow-up sweep on the night of Aug. 16, there was less staff and the facility was in less pristine condition, according to Smith. "What we experienced was literally night and day," she said.

One industry executive recently alleged to public health officials and the attorney general that a health department supervisor was providing advance copies of a monthly "master schedule" of inspections to a Chicago-area nursing home executive in return for cash, sports tickets and other gratuities.

The attorney general began sweeping nursing homes in December in response to Tribune reports about residents being assaulted, raped and even murdered by other residents in facilities that house high numbers of felons and sex offenders. The 17 raids have led to 20 arrests of offenders with outstanding arrest warrants, Smith said.

Despite the alleged tipoff of the July 22 sweep, Petrone said authorities still found problems at Grasmere. Going room to room visiting residents, Petrone’s ombudsmen staff found "a lot of them seemed overmedicated," she said.

Authorities are now more closely guarding the schedule of the sweeps and are limiting the number of agencies involved, Smith said. "We have tightened the information loop," she said.

The San Jose Mercury News had an interesting article about recent research into dementia. In 1980, about 2.8 million Americans were diagnosed with Alzheimer’s disease — the most common form of dementia.  But with better recognition, longer life expectancies and advanced treatment for other diseases such as cancer, that figure has nearly doubled in 2010, to 5.3 million, according to Elizabeth Edgerly, a chief program officer with the Alzheimer’s Association, a national advocacy group. In all, 42 percent of people 85 and older will get Alzheimer’s, Edgerly said.

"The ability to recognize dementia has improved over the last 20 years," said Rick Kovar, emergency services manager for the Contra Costa County Sheriff’s Office. "The science behind searching for people with Alzheimer’s has become efficient and scientific."

Dementia affects the brain in several ways. People lose short-term memory, the ability to communicate, express emotions and follow a conversation. They have severe mood shifts, and lose the ability to reason, problem-solve, sense danger and judge visual spacing.

"Wandering is one of the most common behaviors associated with dementia," Edgerly said. Sixty percent of people with dementia will wander at least once. Of those, 20 percent wander repeatedly.

The team studies "lost person behavior," which is different for various groups of people who are lost. For example, an elderly person with dementia behaves differently than a missing hiker or child.  A person with dementia may not recognize objects such as bodies of water or bushes, and walk right into them. They go until they become stuck. When they hit a barrier that blocks their way, they keep running into it until they find a way around, a phenomenon search professionals call "ping-pong." They tend to travel in as straight a line as possible.

Another well-known characteristic is patients trying to return to a place that may no longer exist.  Wanderers typically travel up to 2 miles away from their starting point, which is why the initial search perimeter starts at that distance and expands as needed.

Wanderers are more susceptible to becoming victims of crime, and because of their age they may be seriously injured in falls or made ill by poor weather.


The Fifth Circuit of the U.S. Court of Appeals decided Cedar Lake Nursing Home v. U.S. DHHS on February 10, 2010. Petitioner Cedar Lake Nursing Home ("Cedar Lake") challenges a $5,000 per-instance civil monetary penalty levied by the DHHS against Cedar Lake for violations of 42 C.F.R. § 483.25(h) which is part of OBRA that applies to all nursing homes that accept Medicaid or Medicare which is 85% of nursing homes in the United States. Below are excerpts of the decision rejecting Cedar Lake’s appeal

Cedar Lake is a nursing home that participates in the Medicare program. On February 20, 2008, a resident of Cedar Lake designated in the record as "Resident # 10" — a 92 year-old woman suffering from a variety of ailments — wandered away from the facility and was later discovered walking alone along a highway. Witnesses alerted Cedar Lake staff, who returned her to the facility. Cedar Lake’s alarm system, designed to prevent such "elopements" by residents, did not sound when Resident # 10 opened the door to leave the facility. Cedar Lake alleges through witness testimony that the alarm did not sound because an installation contractor responsible for installing a new alarm system disconnected the old system without informing Cedar Lake personnel.

After this incident, surveyors affiliated with the Centers for Medicare and Medicaid Division ("CMS") of the DHHS conducted a survey of Cedar Lake and determined the facility to be in violation of several Medicare-related regulations, including 42 C.F.R. § 483.25(h), which requires a nursing home to "ensure that — (1) the resident environment remains as free of accident hazards as is possible; and (2) each resident receives adequate supervision and assistance devices to prevent accidents." Specifically, the surveyors found that Cedar Lake violated 42 C.F.R. § 483.25(h) with respect to Resident # 10’s elopement incident. In response to these findings, CMS imposed a $5,000 per-instance civil monetary penalty on Cedar Lake for violations of 42 C.F.R. § 483.25(h).

Cedar Lake appealed this decision to an administrative law judge ("ALJ") and requested a hearing. After briefing, CMS moved for summary judgment on the grounds that the undisputed facts presented by the parties showed that Cedar Lake failed to take all reasonable steps to provide Resident # 10 with supervision adequate to prevent her elopement in violation of 42 C.F.R. § 483.25(h).[ 1 ]

In ruling on the motion for summary judgment, the ALJ considered Cedar Lake’s main factual presentation: affidavits by two Cedar Lake employees testifying that the alarm `s failure to sound upon Resident # 10’s departure was unforeseeable because the installation contractor had failed to inform Cedar Lake that the alarm had been disconnected. Accepting this testimony as true, the ALJ concluded that the remainder of the undisputed facts showed that Resident #10’s elopement was foreseeable and that Cedar Lake did not reasonably provide Resident #10 with enough supervision to prevent her wandering from the facility. See Cedar Lake Nursing Home, D.A.B. No. CR1967, at 7-8 (June 24, 2009).

The ALJ’s findings of undisputed fact included the following: that Resident #10 "had a history of wandering, was at high risk for elopement, and repeatedly attempted to leave the facility"; that Cedar Lake’s care plan for Resident #10 required staff to place the resident in an area "where constant observation is possible"; and that the facility’s care plan amendments for Resident # 10 included frequent observation in addition to the use of a door alarm.[ 2 ] Id. at 5-6. On the basis of these undisputed factual findings, the ALJ determined that Cedar Lake failed to take all reasonable steps to prevent Resident # 10’s elopement in violation of 42 C.F.R. § 483.25(h). The ALJ, thus, granted CMS’s motion for summary judgment and upheld the $5,000 per-instance civil monetary fine.

Cedar Lake appealed the ALJ’s grant of summary judgment to the Departmental Appeals Board, which affirmed the ALJ’s decision. Cedar Lake now seeks review in this Court.


Reviewing the findings and conclusions at issue here under the deferential standards of the APA, we do not consider them to be arbitrary, capricious, not in accordance with the law, or unsupported by substantial evidence.

The ALJ determined that Cedar Lake’s actions with respect to Resident # 10 were in violation of 42 C.F.R. § 483.25(h)(1)-(2), which require a nursing facility to ensure that the resident environment remains as free of accident hazards "as is possible" and that each resident receives "adequate supervision and assistance devices to prevent accidents." The standard of care imposed by these "as is possible" and "adequate supervision" regulations has been consistently interpreted by the DHHS and federal courts as a "reasonableness" standard. See Fal-Meridian, 604 F.3d at 449; Crestview, 373 F.3d at 754; Woodstock Care Center v. Thompson, 363 F.3d 589-90 (6th Cir. 2003); see also Kenton Healthcare, LLC, D.A.B. No. CR1666, at 5 (Sept. 28, 2007).

Based on specific, undisputed findings of fact, the ALJ determined and the Departmental Appeals Board affirmed that Cedar Lake’s actions with respect to Resident # 10 were not reasonable under the standard of 42 C.F.R. § 483.25(h), in that Cedar Lake did not take all reasonable steps to prevent her from wandering out of the facility. The A LJ’s undisputed findings of fact in support of this determination include not only the February 20, 2008 incident in which Resident # 10 wandered away from the facility, but also Resident # 10’s history of wandering, Cedar Lake’s prior knowledge of Resident # 10’s propensity to wander, and Cedar Lake’s previous development of a care plan that involved frequent observation and other measures designed to prevent Resident # 10 from wandering. See Cedar Lake Nursing Home, D.A.B. No. CR1967, at 7-8 (June 24, 2009).

Moreover, the primary facts presented by Cedar Lake, even when taken as true by the ALJ, failed to alter these core factual findings. Indeed, the ALJ accepted as true Cedar Lake’s main factual presentation— affidavits by employees testifying to the effect that the installation contractor did not inform Cedar Lake that the alarm was to be turned off— but held that such facts did not show that Resident #10’s elopement was unforeseeable nor demonstrate that Cedar Lake’s actions were reasonable under 42 C.F.R. § 483.25(h). Id. at 7-8.

These findings and conclusions of the ALJ and the Departmental Appeals Board with regard to the unreasonableness of Cedar Lake’s safety and supervision measures under 42 C.F.R. § 483.25(h) are not arbitrary, capricious, not in accordance to the law, or unsupported by substantial evidence. Therefore, this petition for review is DISMISSED.

This copy provided by Leagle, Inc.

The Times-Union had an article about the arrests of nine workers at the Northwoods Rehabilitation and Extended Care Facility in NY.  The nine nurses have been named in a 175-count indictment charging them with neglecting an incapacitated patient and falsifying records to make it appear they did.  The investigation, conducted by the office of state Attorney General Andrew Cuomo, produced surveillance video collected over a six-week period showing the alleged neglect.

Authorities allege the resident was often left in the same position throughout an entire shift. Nursing staff members are accused of failing to administer medications, as well not treating the resident’s bedsores and failing to check the resident for incontinence or change undergarments for long periods of time.

The following people were named in the 173-page state attorney general’s indictment handed up in Rensselaer County Court:

Physician assistant Julia Roske; certified nursing assistants Jessica Tremper, and Sharon John;  and licensed practical nurses Gail Klein, Linda Vogt, Leslie Mayo, Alicia Smith; and Lisa Sousie and Kathleen Osgood.  The defendants each face counts of falsifying business records, a felony; endangering the welfare of an incompetent or physically disabled person, a misdemeanor; and willful violation of health laws, an unclassified misdemeanor.

This isn’t the first report of trouble at Northwoods, located at 100 New Turnpike Road in the hamlet of Pleasantdale.  The facility declared Chapter 11 bankruptcy in 2007, and federal officials last summer barred it from receiving Medicaid or Medicare payments for new residents after complaints that workers routinely ignored the buzzer system used by patients in need of assistance.

In January, a male nurse’s aide at Northwoods pleaded guilty to sexually abusing a 78-year-old female resident in a 2008 incident.


Representative Tom Burch from Kentucky has proposed a bill that would mandate that nursing homes be required to call a coroner after any death at their facility. The proposal could help crackdown on abuse and neglect in nursing homes. Tom Burch is chairman of the House Health and Welfare committee.  The legislation is also being backed by the Attorney General’s Office. The Attorney General’s Office wants to be on top of every case that might involve neglect and abuse in nursing homes.

Coroners around the state will receive training to recognize signs of elder abuse. The Attorney General’s Office is also calling for stricter punishments and the development of new teams of investigators.

 In South Carolina, a new state law passed to notify families of those who die within 24 hours of hospital admittance and invasive surgery.  I am not sure why nursing homes ar enot included

The Ann S. Perdue Independent Autopsy Fairness Act was named for a Chesterfield County woman who died in 2004 due to negligence.  Perdue’s family — including her nephew, State Rep. Ted Vick — championed the bill, which requires county coroners or medical examiners to be notified if a patient dies within 24 hours after being admitted to a hospital and within 24 hours following an invasive surgical procedure.

The coroner or medical examiner then opens an inquiry into the death, interviews medical staff and family members and advises the family of their option to have an autopsy performed at their expense. If the family wishes to pursue an autopsy, it is performed at another medical facility than where their loved one died.