Ken Martin from the website Nursing Schools posted an interesting article, "20 Iconic Nurses Every Nursing Student Should Study”.  Many nurses today do not understand the great history behind nursing and the contributions of nurses from the Civil War to 9-11. 


The medical world has long since recognized the high turnover rate of certified nursing assistants, or nurses’ aids, as having a negative impact on long-term care. More than 70 percent of nurses’ aids leave the job in a given year. Research shows that nursing homes with high turnover rates for nurses’ aids also have a poor quality of care.

The high stress levels causing the high turnover rate are caused by inadequate training, little support, poor benefits and minimal respect from management and superiors. Low wages are also a factor, with an average hourly pay of $10.48. In facilities with high turnover rates, most nurses’ aids leave the job within the first three months.

The University of Pittsburgh conducted a study wherein 1,400 nurses’ aids were surveyed in 9 month intervals over the course of 24 months. The survey was designed to explore why the turnover rate is so high. The first wave of results showed that the top reason for aids to leave the job is disrespect from management.

"Better Jobs, Better Care" is a $15.5 million research and demonstration program geared toward changing long-term care policy and practice. The program’s research shows 55 percent of surveyed care workers wanted to leave the job within the next three years. The program also found that residents were more satisfied in facilities where a higher proportion of nurses’ aids were committed to their jobs.

Residents are confused, disoriented and wary when their care givers are constantly rotated with little or no consistency in staff. Surveyed nurses aids’ claim that positive aspects of the job include forming personal relationships with residents and becoming their advocates within a facility. With a high turnover rate, residents do not benefit from having an ongoing relationship with a care giver.

Also, in facilities with low turnover rates for nurses’ aids, there are fewer cases of bed sores, as well as reduced use of restraints and mood-altering drugs. Bed sores are a serious issue in long-term care facilities.

For nursing homes to give compassionate and complete long-term care, the industry needs to focus on changing practices to ensure a familiar, knowledgeable nursing aid staff for their residents.

Article provided by The Perecman Firm, P.L.L.C.
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One of the nursing home workers who physically abused patients in Albert Lea, Minn. learned her punishment last month. Brianna Broitzman was sentenced to only 180 days in jail. She pleaded guilty to the charges in August.   It’s a staggered sentence where she will serve 60 days immediately and was taken directly to jail from the courtroom.  If she does have to serve the entire time, the next 60 days of her sentence would start in May and the last 60 days would start in October 2011. It’s possible she could petition the court not to serve the remaining 120 days.

Broitzman was one of two teens charged as adults in the case. An investigation that dates back to 2008 found that Broitzman was one of six young women at the Good Samaritan Society of Albert Lea who sexually and physically abused residents.  The investigation found the abuse went on for five months. Longer than her sentence if reduced.

She will also be on probation for 2 years, serve 8 days of community service, have to undergo a psychological evaluation and have no contact with vulnerable adults.  Broitzman also has to write letters of apology to victims and their families.
The judge said he was "appalled by her disregard for humanity."

Refer to WCCO for several good articles on this case.

The New York Times’ blog The New Old Age had an interesting article on medical marijuana and nursing homes.  When states began embracing medical marijuana, few anticipated this inevitable scenario: patients using it would grow older, and many would need to enter assisted living and nursing homes. Any patient using medical marijuana breaks federal law.  Marijuana is listed as a Schedule 1 drug, which means the federal government considers it to have no medicinal value.   Substantial evidence contradicts this conclusion.  Pursuant to state law, physicians in 14 states and the District of Columbia are allowed to recommend it.  Legalization of medical marijuana is under consideration in eight additional states this year.

Experts say elderly patients increasingly use medical marijuana to ease their pain. Most facilities receive federal funding through Medicare and indirectly through Medicaid.  Many facility administrators wonder how they can comply with federal law and preserve their reimbursements and at the same time permit residents to medicate with marijuana. At an American Health Care Association conference, Fred Miles, a Colorado lawyer who represents health care providers, gave a presentation called “Medical Marijuana — Are Nursing Homes Going to Pot?”

“What do these health care facilities do? Adopt a ‘don’t ask, don’t tell’ policy? Somebody is using medical marijuana in the residence and you just close your eyes to it? I don’t think that’s going to work very well,” Mr. Miles said in an interview.

Said Maribeth Bersani, senior vice president of public policy for the Assisted Living Federation of America: “Where do they store [marijuana]? Who assists the residents with it? Do they even want to get involved because it still is not legal federally? It’s one of those challenges that we are beginning to confront in the communities.”

Medical marijuana laws don’t address the possibility that elderly patients in care facilities will want to use it except Alaska which explicitly restricts accommodation in any facility monitored by the state’s Department of Administration, which includes assisted-living facilities.

But Michigan, Oregon and Rhode Island do include “agitation of Alzheimer’s” as a qualifying condition for legal use of marijuana. Maine allows for the establishment of dispensaries, and expressly permitted nursing homes and inpatient hospice workers to act as registered medical marijuana caregivers for patients.  In order for a nursing home or inpatient hospice to act as a registered medical marijuana caregiver, the facility must obtain medical marijuana from a dispensary. 

Valerie Corral, director and co-founder of Wo/Men’s Alliance for Medical Marijuana in Santa Cruz, Calif., said that one local long-term care facility tries to accommodate patients by designating a garden patio as a marijuana-smoking area.

“In that courtyard, people are allowed to use their medicine with one of the aides that works at the facility,” Ms. Corral said. (Smoke-free options do exist for marijuana. Some facilities report patients using vaporizers or consuming cannabis baked into desserts, according to Ms. Moorse.)

Oregon’s long-term care ombudsman, Mary Jaeger, believes the emerging controversy highlights the rights of patients to use medical marijuana, whatever the setting.

“Wouldn’t any one of us, in our own homes, feel that we have the right to live our lives by our own values and choices, to preserve our own dignity and, frankly, to live pain-free?” Ms. Jaeger asked. “Because typically, that’s why a patient gets prescribed medical marijuana.”

In January, the National Organization for the Reform of Marijuana Laws, or Norml, plans to introduce the Norml Senior Alliance, which will offer to elderly Americans information about the medical uses of marijuana, according to Allen St. Pierre, executive director of the organization.

California’s Browning Manor Convalescent Hospital in Delano has received an AA citation, the most severe penalty under state law, and a $100,000 fine from the state of California after an investigation concluded that inadequate care led to the death of a resident, the California Department of Public Health announced. State investigators found that the facility failed to protect the health and safety of a 58-year-old male resident who had a history of exhibiting aggressive and combative behavior.  According to the state’s investigation, inadequate supervision and monitoring of the man — in direct violation of the facility’s own policy — resulted in his death when he unbuckled the safety strap on his wheel chair and fell forward onto the floor. He had been known to unbuckle the safety strap in the past, the investigative report indicated but no other safety interventions were attempted.

In the days leading up to the incident, employees reported the resident behaved aggressively, "started to yell at staff, stripping his shirt. Tried to swing at anybody who goes near him…"

Nursing home policy states that residents experiencing behavioral outbursts and physical aggression are to receive one-on-one monitoring, according to the investigation. But the victim was not receiving one-on-one monitoring at the time of his fall.  In addition, a cervical collar was not placed on the patient previous to transport.

 In June of 2009, the Health Department said 58 year old resident fell out of his wheelchair and was taken immediately to a hospital in critical condition with a brain injury and fractured spine.  He died two days later.  Elizabeth Tyler, a representative for the nursing home, said the man left the facility in "good condition" that day.  The Kern County coroner wrote the cause of the resident’s death was a direct result of injuries he suffered.

The Health Department’s report on the incident stated the man had previous episodes of safety and behavior issues.  According to the report, the facility failed to provide one-on-one monitoring consistent with its policy.  Nursing home policy states that residents with aggression should be monitored for at least 72 hours or until the resident calms down.

Browning Manor Convalescent Hospital has appealed the decision.  Seems like they refuse to take responsibility and would rather file frivolous appeals. 

Ruby McDonough, 63, was allegedly sexually assaulted by Kofi Agana, a Ghanaian national who worked as an aide at the home where McDonough was a resident.  In February 2009, McDonough claimed Agana sexually assaulted her at Sudbury Pines Extended Care. Outside the courtroom, she pointed to her genitals, breasts and other areas of her body when Murphy asked her to describe where Agana had touched her.

Agana, 48, then living in Fitchburg, was arrested and charged with two counts of indecent assault and battery on a disabled person older than 60 and one count of assault and battery on a disabled person older than 60.

Ruby was declared incompetent by a Framingham District Court judge in April and then denied a hearing to reverse that ruling.  Wendy Murphy filed a petition yesterday with the Supreme Judicial Court to force Framingham District Court to reverse the incompetency ruling for Ruby McDonough.

In April, Framingham District Court Judge Paul Healy Jr. ruled that McDonough was incompetent to testify against Kofi Agana. Agana, a nursing home aide, was accused of sexually assaulting McDonough in February in a Sudbury nursing home. McDonough has expressive aphasia, which affects her ability to communicate through speech or writing.

A court psychiatrist said McDonough was competent, but Healy would not let McDonough testify in a hearing to determine if she was competent with the help of an interpretive aide. He ruled she was incompetent. Murphy appealed that ruling, and the SJC ruled that Healy erred by not letting McDonough have an aide during the hearing. It sent the matter back to district court.

McDonough’s attorney, Wendy Murphy, argued her client has the right to have the incompetency ruling against her overturned. In a heated exchange with Greco, Murphy said the court illegally ruled her client incompetent to testify because it did not provide accommodations for her disability.

Murphy asked the SJC to order a Framingham District Court judge to either vacate the "illegal competency ruling" or to hold a new competency hearing so McDonough can "demonstrate that she is mentally competent and has legal capacity to give expression to her experiences in a court of law," Murphy said.

A hearing was scheduled for Oct. 28, when McDonough was going to testify with an aide. But Judge Robert Greco ruled the matter was moot because Agana is in federal custody and is most likely going to be deported because he was in the country illegally from Ghana.

Murphy wrote in her petition that Greco should be ordered to hold a hearing because his not holding the Oct. 28 hearing denied McDonough’s "request for restoration of her dignity as a presumptively competent person."


The decision regarding McDonough’s ability to testify comes after conflicting decisions set forth last year. Another judge had initially declared her incompetent to testify, a ruling struck down by the Massachusetts Supreme Judicial Court on the grounds that the decision constituted a violation of her rights.

The most recent decision found that McDonough was in fact competent but that a disability would prevent her from answering questions in a courtroom setting. The source reports that McDonough suffers from expressive aphasia, a condition that limits her verbal ability to give answers to anything more complicated than a yes or no question.

The new decision may ultimately be moot, as Agana is currently in the custody of U.S. Immigration and Customs Enforcement and is likely to be deported. 


McDonough, who has a condition called expressive aphasia, can answer yes or no to questions, but she cannot give longer accounts of the attack, Murphy said. She can also express herself through gestures, Murphy said.  In response to yes or no questions asked by Murphy, McDonough indicated she was upset she wouldn’t be able to testify. In a rare full sentence, she also said, "I can tell you about him," referring to Agana.

McDonough is a competent witness, said Murphy, who insisted she and her client were in court primarily to see the incompetency ruling overturned.

See articles here, here, and here.

The Madison-St. Clair Record had an article about the recent lawsuit filed against The Lincoln Home Inc. and Weiss Management Group Inc..  The Lincoln Home is a long-term care facility in Belleville. Weiss Management is responsible for overseeing the day-to-day operations at the nursing home.

Lillie Avant accuses Defendants of breaking her leg multiple times and then failing to do anything about it.  Avant says the incident began the morning of May 31, when Lincoln Home staff members attempted to turn and reposition her onto her right side in bed. At least three employees allegedly heard loud popping sounds and saw Avant immediately grab her leg and cry out in pain during the move.  Avant says the popping was the sound made by her femur and knee fracturing as staff repositioned her. Despite the obvious signs of broken bones and her complaints of severe pain, Avant says no one notified her doctor or her legal representative about the incident.

Avant’s son arrived at Lincoln Home later that afternoon and saw his mother "moaning and groaning in pain." Avant’s daughter went to the nursing home about five hours later but found that her mother had still not received any medical care for her leg.

Avant says an order for x-rays on her hip and leg were received late that night. The next morning, the woman says she refused to go to her kidney dialysis treatment because she was in so much pain. Despite her continued complaints about pain in her leg, Lincoln Home staff allegedly gave her pain medication and noted she got "no relief" from them.

According to the complaint, Avant was transferred from Lincoln Home to Memorial Hospital the night of June 1 to be treated for multiple leg and knee fractures. On the same evening, a representative from Lincoln Home allegedly sent a representative to Avant’s hospital room to get her to sign a statement about the incident at a time when the patient was heavily medicated.

Avant accuses Lincoln Home and Weiss Management of more than 20 negligent acts and violations of the IIllinois Nursing Home Care Act. She is asking for more than $50,000 from both defendants.

Attorney Paul W. Johnson of Belleville is representing Avant. They demand a jury trial.


News 8 Austin reported the arrest of Mario Rojas Lara accused of sexually assaulting a Pflugerville nursing home resident at Pflugerville Nursing Home and Rehabilitation Center. Mario Rojas Lara is charged with aggravated sexual assault and forgery. Police say Rojas used false documents to gain employment at the Pflugerville Nursing Home and Rehabilitation Center in April.

According to investigators, the assault happened in September. Lara was fired for an unrelated matter later that month. Police say he worked as a caregiver at the center and that the victim was a patient.

"You take a person who is entrusted to provide medical care for somebody who needs it, who can’t provide it for themselves and they abuse that position and that authority,” Officer Jim McLean said. “As a result of that, we had a person sexually assaulted that shouldn’t have occurred."


ABC Action News reported that CNA Yesenia Matilde Surillo was arrested for allegedly stealing from elderly patients at nursing home Baypoint Village Assisted Living Facility. Surillo is accused of stealing jewelry and cash from her patients at the Baypoint Village Assisted Living Facility on State Road 52 in Hudson. The victims’ ages ranged from the 70’s to 98-years-old.

Surillo would enter patients’ rooms and remove cash and jewelry, detectives said. She would then allegedly pawn the jewelry for cash. Surillo admitted to the crimes after she was presented with evidence from the pawn shop transactions, authorities said.

There was about $17,000 in cash and jewelry stolen in 18 reported thefts. The crimes started in May. The suspect collected $8,400 in 14 separate pawn shop transactions, according to investigators. Some of the jewelry was recovered in the suspect’s car and some jewelry is still missing.


The Republican American reported the arrest of  Meghan Cleary, the director of nursing at Wolcott View Manor Health & Rehabilitation Center with drunken driving and possession of narcotics, including five different types of prescription painkillers.

Police say Meghan M. Cleary, parked her car behind a police cruiser in Vernon, walked up to officers who were conducting a traffic stop and asked for directions to Interstate 84. Police "quickly realized" that she was intoxicated, according to Officer Daniel Champagne, a spokesman for Vernon Police Department. Officers searched her Toyota FJ Cruiser and found an open can of beer.

In her purse, they found 16 opiate-based pills, which are typically prescribed as analgesics. She’s also charged with failure to keep prescription narcotics in their original container, improper parking and possession of alcohol in public.




Claims of neglect, loss of dignity, and resident endangerment are surfacing at several New York nursing homes owned and operated by Legacy Health Care.  The group operates numerous facilities including, Ridge View Manor, Williamsville Manor Nursing home and Sheridan Manor.

News 4 learned of a class-action lawsuit.  See video here.




Detroit Free Press had an interesting and informative article about the different coverages that Medicare provides.  Medicare is a federal insurance plan that provides basic coverage for medical care to seniors and people with certain physical disabilities. 
There are different types of Medicare policies. Two are basic plans:

Part A: Coverage for hospital care, limited nursing home stays and some home health care. Most people who have been employed get Part A coverage without having to pay a monthly premium. Recipients, however, do have out-of-pocket expenses, such as co-pays.

Part B: Coverage many seniors purchase from Medicare for other physician and outpatient services, some home health care and some medical equipment. Enrollment typically is automatic once you qualify for Medicare. Recipients pay a monthly premium plus a typical 20% co-pay and other out-of-pocket costs.

In addition to the plans above, you can purchase the following policies from insurance companies on your own:

Part C: Also known as Medicare Advantage, these are plans that usually provide more comprehensive coverage for prescription and generic drugs and sometimes dental and vision care, contributions towards gym memberships and diet-related programs and other care. Medicare Advantage plans include all Part A and B coverage, so you don’t need the two basic plans if you have a Medicare Advantage policy.

Part D: Also known as a stand-alone prescription drug plan, these policies pay for outpatient prescription and generic drug coverage. If you don’t sign up immediately for one of these plans when you reach age 65, you face penalities ranging from a few dollars to more than a $100 a month.

Medigap: Also known as Supplemental Medicare, these plans pay for additional physician and outpatient care services, but often not prescription coverage, necessitating the purchase of a Part D plan. While these plans typically have not required a co-pay, new plans being offered in 2011 are introducing small co-pays such as $2 to $50 for a doctor’s or emergency room visit, a trend likely to continue in the future.