NPR continued their great series about the care of the disabled including this one discussing the growth in population of young people as nursing home residents.  Young people ages 31 to 64 now make up 14 percent of the nursing home population, an analysis of federal data from the Department of Health and Human Services by NPR’s Investigative Unit found. That’s up from 10 percent just 10 years ago.  In the past 10 years, adults ages 31 to 64 have been the fastest-growing population in nursing homes.

According to a study by the AARP Public Policy Institute, the cost of attendant care is about a third the cost of providing care in a nursing home or institution. So as states face record budget gaps, the programs that help people live at home are cut.   Nancy Miller, at the University of Maryland, Baltimore County, thinks that may be one reason the percentage of 31- to 64-year-olds is growing in nursing homes. Miller, an associate professor in the school’s department of public policy, has been studying why young people enter nursing homes and published several reports documenting these data. She has found that it’s also this same group going into nursing homes at higher rates. It’s a trend she has found in almost every state over the past 10 years.

Pat McMurry, who runs a nursing home outside Atlanta, agrees that it’s the availability and funding of state programs that has caused the growth of working-age people in nursing homes.

"I’ve been in this business for almost 50 years now," McMurry said. "And traditionally, nursing homes were the little old men or the little old ladies that either outlived their relatives or had some kind of a fall or a fracture. Now we’re seeing a transition to a younger population, either for psychiatric issues, which once upon a time were addressed in psychiatric state hospitals, which a lot of those have closed. So this is really the only means available that are financially reimbursed."

More than 60 percent of what states spend on long-term care for the elderly and disabled goes to pay for people to live in a nursing home. The amount spent on home-based care has grown slowly, but not enough to meet the need.  Nationwide, there are some 400,000 people on state waiting lists for home-based care, double the number 10 years ago.

The Community Choice Act would end the "institutional bias" in Medicaid and make it mandatory for states to pay for home-based care, just like it is a requirement to pay for nursing home care now.  A pilot program was included in the recent health care overhaul, but it’s voluntary for states. The larger bill has stalled in Congress.  The Congressional Budget Office estimates it would only cost $5 billion a year, and would be offset by the cost savings of caring for people at home.

 See article from The Washington Post about young quadriplegics in nursing homes.

NPR had a series of great articles on the issue of being able to be cared for at home instead of a nursing facility as a civil right.  A growing body of law and federal policy states when the government pays for someone’s care in a nursing home, that person should have the choice to get his care at home. That it’s a civil rights issue.  Often being confined to a facility feels more like prison than home. Some people assume that nursing home residents are too sick to live at home. Yet there are many people who have the same disabilities found in nursing homes, who are able to live in their own homes with assistance from family or home health aides.

NPR’s Investigative Unit looked at this emerging civil right to live at home and found that although it’s been established in law and federal policy, the chance to live at home remains an empty promise for many people.  States especially in the conservative Southeast refuse to create appropriate programs. 

"People with disabilities are segregated just as African-Americans were segregated," says Sue Jamieson, of the Atlanta Legal Aid Society.  The Americans with Disabilities Act — ADA — is a 20-year-old law that bans discrimination on the basis of disability. Eleven years ago, the U.S. Supreme Court ruled in Olmstead v. L.C. that people who live in institutions like state hospitals and nursing homes but could live successfully on their own have a civil right, under the ADA, to get their care at home.

Since then, federal policy was updated in the recent health care overhaul, which says that states need to spend more money on Medicaid programs for people to receive their long-term care at home. Meanwhile, hundreds of thousands of people across the country are waiting for in-home care. 

An NPR analysis of unpublished data on every nursing home in America shows that nursing home residents — and how disabled they are — vary from state to state.  States vary in the portion of Medicaid spending they devote to serving the elderly and disabled.  In Illinois, almost 21 percent of people in nursing homes can walk by themselves, but fewer than 5 percent can in South Carolina.  In Illinois, nearly 27 percent of residents can use the toilet without assistance. But in South Carolina, fewer than 3 percent can.

Numerous studies have shown that over the long run, home-based care is cheaper: One study by the AARP Public Policy Institute found that nearly three people can get care at home for the same cost of one in a nursing home.  Over the past decade, states have steadily increased spending on home-based care — but not nearly enough to meet the need. The number of people on waiting lists has more than doubled, and there are now 400,000 people across the country waiting to get into home-based care.


The NY Times had a series of great articles examining the struggle to find answers about Alzheimer’s disease.  This article discusses how some facilities comply with the demands of demented residents including allowing resdients to sleep, be bathed and dine whenever they want, even at 2 a.m.  Dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic “nip at night,” said Tena Alonzo, director of research. “Whatever your vice is, we’re your folks,” she said.

Research shows that creating positive emotional experiences for Alzheimer’s patients diminishes distress and behavior problems.  In fact, science is weighing in on many aspects of taking care of dementia patients, applying evidence-based research to what used to be considered subjective and ad hoc.

Caregiving is considered so crucial that several federal and state agencies, including the Department of Veterans Affairs, are adopting research-tested programs to support and train caregivers. Last month, the Senate Special Committee on Aging held a forum about Alzheimer’s caregiving.

The National Institute on Aging and the Administration on Aging are now financing caregiving studies on “things that just kind of make the life of an Alzheimer’s patient and his or her caregiver less burdensome,” said Sidney M. Stahl, chief of the Individual Behavioral Processes branch of the Institute on Aging. “At least initially, these seem to be good nonpharmacological techniques.”

Techniques include using food, scheduling, art, music and exercise to generate positive emotions; engaging patients in activities that salvage fragments of their skills; and helping caregivers be more accepting and competent.

Some efforts involve stopping anti-anxiety or antipsychotic drugs, used to quell hallucinations or aggression, but potentially harmful to dementia patients, who can be especially sensitive to side effects.   

A study in The Journal of the American Medical Association found that brightening lights in dementia facilities decreased depression, cognitive deterioration and loss of functional abilities. Increased light bolsters circadian rhythms and helps patients see better so they can be more active, said Elizabeth C. Brawley, a dementia care design expert not involved in the study, adding, “If I could change one thing in these places it would be the lighting.”

New research suggests emotion persists after cognition deteriorates. In a University of Iowa study, people with brain damage producing Alzheimer’s-like amnesia viewed film clips evoking tears and sadness. 

One program for dementia patients cared for by relatives at home creates specific activities related to something they once enjoyed: arranging flowers, filling photo albums, snapping beans.

In fact, reducing caregiver stress is considered significant enough in dementia care that federal and state health agencies are adopting programs giving caregivers education and emotional support.  The Veterans Affairs Department is adopting another program, Resources for Enhancing Alzheimer’s Caregiver Health, providing 12 counseling sessions and 5 telephone support group sessions. Studies showed that these measures reduced hospital visits and helped family caregivers manage dementia behaviors.

These days, hundreds of Arizona physicians, medical students, and staff members at other nursing homes have received Beatitudes’ training, and several Illinois nursing homes are adopting it. The program, which received an award from an industry association, the American Association of Homes and Services for the Aging, also appears to save money.


The Free Press had an article about the lawsuit filed on behalf of Esther Rannow who died after a CNA dropped her during a transfer. The family also claims staff at the nursing home failed to identify and treat a deadly medical condition.  A urinary tract infection that ultimately led to septic shock contributed to Rannow’s death.  She never regained consciousness after the fall at Benedictine Living Community.  Three days later Rannow was dead.

The Minnesota Department of Health investigated the incident but found no conclusive evidence of intentional neglect.  A jury will determine if the facility was negligent.

 The family is standing by its neglect allegations and believes the infection should have been treated when Rannow started showing symptoms several days before her death.

“It was their denials that got me,” Rannow’s daughter Glamm said. “They denied and denied and denied everything. We were right there when they dropped mom, but they’re denying everything. “If they would have just admitted their wrongs, we wouldn’t be going through all of this.”

Glamm, her sister Sandy Sack and brother Virgil Rannow all say they noticed a downward turn soon after their mother became a resident at the nursing home. A woman who used to walk frequently became dependent on a wheelchair, they said. She also complained about being handled harshly more than once.

“When I walked into the ER, she was screaming with pain,” Glamm said. “I said, ‘What happened, Mom?’ and she said, ‘They dropped me again.’



McKnights and UPI had articles on how MRSA rates vary among facilities.  Susan Huang of the University of California-Irvine Medical Center found a wide variance in nursing home residents who carry the bacteria Methicillin-resistant Staphylococcus aureus.  She says the high overall levels of MRSA are reason for concern but the variation in rates among facilities may be good news.  While nursing homes are considered to be high-risk facilities for the transmission of methicillin-resistant staphylococcus aureus (MRSA) compared to hospitals and ICUs, infection rates vary broadly from facility to facility, according to a study.

The study, published in the January issue of Infection Control and Hospital Epidemiology, finds some nursing homes do a better job than others of containing the bacteria once it arrives in their facility. For example, two nursing homes had identical MRSA intake rates of 12 percent, but at one the number of residents carrying the bacteria — but not necessarily sick — was 22 percent, while the other had a rate of 42 percent.

Obviously, there are methods to prevent the spread of MRSA among residents.  Washing hands, proper hygiene, and other infection control procedures need to be in place and implemented in all facilities.

The Louisville Courier-Journal had a great article on the benefits of music to prevent pressure ulcers typically caused by immobility and the staff’s failure to turn and reposition the residents.  Pressure sores or pressure ulcers are damaged areas of skin caused by staying in one position too long. Medical guidelines require patients should be moved at least every two hours but compliance is lacking.  The problem is on the rise nationally.  Pressure ulcers can be a serious problem for the elderly, and may lead to infection, sepsis, and even death.

A University of Cincinnati study is trying to use music to prevent ulcers at Signature HealthCARE facilities in Louisville.  Every two hours, music plays over a loudspeaker, prompting caregivers to stop what they’re doing and make sure residents are re-positioned to keep bedsores from forming.  Researchers from the UC College of Nursing got a two-year, $300,000 grant from the Robert Wood Johnson Foundation to look at whether a simple audio reminder can prompt a nurse-led team to make sure patients move or get moved.

“We love it,” said Kelly Thompson, administrator of Signature HealthCARE of East Louisville, which is part of the study group. “They let you pick your music … and everybody knows it’s time for moving.”

Repositioning people is not something new; what’s new is the prompt,” said Pam Larimore-Skinner, director of nursing at Signature HealthCARE of Trimble County in Bedford, Ky., which also is participating. “I think it makes people more conscious of the two hours because time can get away from you.”


There have been several media outlets following the case of the nurses criminally prosecuted for reporting a doctor.  One of the nurses, Anne Mitchell, was acquitted in February of misuse of official information, a felony, for anonymously reporting Dr. Rolando G. Arafiles Jr. to the state medical board in 2009. Charges against the second nurse, Vickilyn Galle, were dropped shortly before the trial.   Experts on whistle-blower protection laws said the prosecution seemed unprecedented, and the nurses’ cause was taken up by state and national nursing associations that warned of a chilling effect on the reporting of medical misconduct.

They agreed to settle and split a $750,000 payment from Winkler County, Tex., after being fired and criminally prosecuted for reporting allegations of improper medical treatment by Dr. Rolando G. Arafiles Jr at the hospital.

Ms. Mitchell and Ms. Galle, both of whom live in Jal, N.M., have not been able to find work in the field since their dismissals as nursing administrators last year.

Dr. Arafiles, who attended medical school in his native Philippines before training in the United States, was charged in late June by the Texas Medical Board with numerous violations, including “failure to maintain adequate medical records, poor medical judgment, poor decision-making, overbilling, improper coding, nontherapeutic prescribing and/or treatment and intimidation of witnesses.”

The complaint alleges substandard treatment of nine patients in 2008 and 2009. Dr. Arafiles is accused, for instance, of suturing a rubber scissor tip to a patient’s finger, using an unapproved olive oil solution on a patient with a highly resistant bacterial infection, failing to diagnose appendicitis and conducting a skin graft in the emergency room without surgical privileges.

 The nurses, who were responsible for quality assurance and regulatory compliance, said they began having concerns about Dr. Arafiles soon after he was hired in 2008 by the hospital.  Their concerns were ignored.  The nurses, who had a combined 47 years of employment at the hospital, wrote to the state medical board anonymously and referred investigators to cases listed by number but not by patient name.

Dr. Arafiles persuaded his friend the county sheriff, Robert L. Roberts Jr. to formally investigate who had filed the complaint.  Sheriff Roberts abused the process by obtaining a search warrant to seize the nurses’ computers, found the draft on Ms. Mitchell’s hard drive and brought the case to a grand jury.  At trial, prosecutors asserted that Ms. Mitchell had not acted in good faith, as required by state law, when reporting Dr. Arafiles. The jury took less than an hour to find otherwise.

Dr. Rolando G. Arafiles Jr. was then charged by the state attorney general’s office with retaliation and misuse of official information, the latter being the same charge that was leveled against the nurses. Both of the charges against Dr. Arafiles are third-degree felonies that carry a maximum sentence of 10 years in prison and a $10,000 fine.

Dr. Arafiles used his position to get medical information and gave it to the Winkler County Sheriff.  Sheriff Robert Roberts told CBS 7 crews today that he believes he will be arrested next.

See articles from New York Times here and here, and CBS here

The Reno Gazette-Journal had an article about the wrongful death settlement between Hearthstone of Northern Nevada nursing home involving Dorothy Schweitzer, a patient who died of severe dehydration, infection and other complications caused by the lack of care at the facility.  Her two daughters sued the nursing home, which was unable to provide documentation that Schweitzer received any nursing care between March 23, 2008, and March 27, 2008, when she was rushed to Northern Nevada Medical Center in critical condition.  Hearthstone later produced fraudulent notes on Schweitzer’s case, but the notes showed the patient was entertaining guests at the nursing home at the time she was dying at the hospital and was being turned in her bed every two hours at the Sparks facility the day after she died at the hospital.

Nevada’s Bureau of Health Care Quality and Compliance concluded Hearthstone’s treatment of Dorothy Schweitzer, 87, had resulted in "actual harm" to the patient.

The lawsuit was settled in August. The amount of the settlement remains confidential, but the Schweitzer family rejected Hearthstone’s demand that the circumstances of the case also be kept secret.

"We were going out of town because of a death in the family, and I got a call (March 27) asking if they should make my mom comfortable. It took me a while to understand they were saying she was dying " We’ve been lied to. They killed our mother and tried to cover it up."

"We found out (nursing home officials) lied to cover themselves, to cover up a death by neglect, but so what?" Noriega asked. "Yes, we settled the suit, but are civil suits the only recourse for families?

Stott said staff members told her the nursing home was "shorthanded" and her usual caregiver had been reassigned as a driver. She said that over the next two months, her mother was dirty when family visited, and in February 2008, they saw she had bedsores, deep wounds caused by remaining in the same position in a bed.

"She had these terrible sores on her hips, but we were told (by staff) it was just a reaction to (adhesive) tape," Stott said.  On March 3, 2008, Schweitzer was taken to Northern Nevada Medical Center suffering from cellulitis, a skin infection caused by bacteria which can spread to the blood or lymph nodes and be deadly. The doctor at the hospital confirmed her wounds were bedsores and not marks from adhesive tape, Noriega said.

Schweitzer returned to Hearthstone on March 6, 2008, and her medical records show she developed a fever by March 18. Family members last visited her five days later, March 23, the day her chart ends.

The investigation concluded Schweitzer had received no nursing care other than her regular medications for 88 hours until she was rushed to the hospital March 27, 2008. The report stated there was no evidence Schweitzer’s temperature was taken or that she was "monitored in any way" during the four-day period.

Her causes of death were listed as severe dehydration; infection that had spread throughout her body causing overall inflamation; pneumonia; extremely low blood pressure and Alzheimer’s dementia.

The nursing home later produced notes indicating Schweitzer was turned in her nursing home bed every two hours on March 27, 2008, when she was actually at the hospital, and on March 29, 2008, the day after she died. Notes also indicate she was doing needlework and entertaining guests in her room at the nursing home March 27, 2008, when she was dying at the hospital.


State records show no fines or other sanctions were levied against Hearthstone related to Schweitzer’s case. The facility had no state sanctions at all in 2008, records show.


Marguerite Warren claims she was injured after Valley View Skilled Nursing Center nursing home employees slathered her with slippery ointment as a "prank" on the next shift, who would have to care for her.   Four nursing assistants coated seven dementia patients with slippery ointment from head to foot, and two others failed to report it; all six were fired and charged with misdemeanors, according to press reports.
The facilitiy’s corporate parent is Horizon West Healthcare of California.  I wonder how much they spend on training.

"Warren suffered from various physical and mental conditions and she was completely dependent on defendants to provide necessary care and assistance to her," according to the complaint in Mendocino County Court.
She says the "defendants committed battery by touching plaintiff in a manner intended to harm or offend plaintiff, namely, by covering plaintiff’s body with a slippery ointment as part of a prank directed at other employees of defendant skilled nursing facility," who would be handling her.
She seeks damages for elder abuse, battery, negligence, intentional infliction of emotional distress, conspiracy, aiding and abetting and violation of the California Health and Safety Code.
Warren also claims she was not protected from falls, and accidents were not reported to her family.