A recent editorial from Erin Ninehouser expressed serious concerns about the pay and lack of benefits given to nursing home caretakers.  The nursing home industry made a reported $500 million profit in 2011, yet the homes refuse to pay their workers enough so that they can enjoy a decent standard of living.  Nursing homes are prone to being short-staffed in general, and on nights and weekends they work with a skeleton crew.  Many of the workers are underpaid and overworked, resulting in a bad combination for your loved ones. Because of this, many states, including Pennsylvania are implementing legislation to increase the amount of hands-on care loved ones get, increase access to information for families, and ensure that Medicaid funding goes toward resident care.

The quality of care in Pennsylvania suffers because of the poor practices of the nursing home industry, and you suffer because your loved ones reside in a home that doesn’t meet the standard of care that it should. In addition to not properly caring for your loved ones, you may now have to pay the price for that shoddy care. In a recent ruling, Pennsylvania upheld a filial support law where a man had to pay his mother’s $93,000 nursing home bill even though he had not taken any of her money for himself.  See The Mercury article here.  Alternative methods of payment were not explored, leaving the man holding an almost one hundred thousand dollar bill. One patient’s bill totaled nearly one hundred thousand dollars, yet 81% of caregivers said their nursing homes were sometimes or never adequately staffed. They say that to find the truth you must follow the money. In the case of nursing homes, the money isn’t being paid to the workers, so where is it going?

NPR reported on recent research about strokes or brain attacks.  Not only is the number of strokes rising among younger people, but the risk associated with stroke survivors have been proven to be incrementally higher than expected. In 20 to 55 year olds, 1 in 5 strokes now occur, as compared to the 1 in 8 in the 1990s.

Weight gain resulting in obesity and diabtetes are thought to be contributing factors to the large increase. It was believed by physicians that younger stroke survivors were doing well, but in following their patients through later life, it’s been found that 1 in 5 stroke survivors will die within two decades.

Dr. Frank-Erik de Leeuw who led the study says that doctors should pay these patients more attention. Instead of simply taking an aspirin a day, these patients need to keep their blood pressure and cholesterol under control, maintain a healthy weight, and should avoid smoking. Dr. Leeuw suggests that a stronger emphasis be placed on preventative care rather than after the fact treatment.

The risk of these strokes continues to impact lives for years after the initial stroke occurs. The study shows that even lesser strokes can increase early deaths to 1 in 4. Young people need to be educated about the signs of a stroke so that they can take measures to protect themselves, because once a stroke has occurred, the damage has already been done.

If you’re a fan of the Nanny Cam then you’ll need to keep a lookout for the next great spy invention, the Granny Cam. Legislation was recently passed in Oklahoma that advances a bill that allows cameras to be placed in residents’ rooms. The bill prohibits nursing homes from refusing to admit patients who want cameras recording in their rooms and prohibits the home from removing or obstructing it. The bill states that the camera can be placed in the open, or concealed. The discussion at the Capitol has been going on for 12 plus years.

The cameras are meant to ensure the safety and security of residents, and proponents of the bill make it clear that informed consent is a big factor in implementing these camera. Some residents are hesitant to make use of cameras. However, some family members have found that it is the only way to know the truth of what’s happening when those doors close. Either way, it looks like Oklahoma residents will have one more way available to them to ensure patients are properly cared for.

See articles at KOCO.com and NewsOK.

In Jacksonville, a woman tries desperately to get justice for her mother’s sexual assault at a nursing home. Sandra Banning went before the Senate Judiciary Committee this month to try and improve the way nursing home cases were conducted in the state of Florida.  The Senate is attempting to pass more tort reform that protects nursing homes from accountability and responsibility.   It raises the threshold for those suing nursing homes to seek damages for excessive misconduct, or “punitive damages.”  The bill (SB 1384) would require that before a person seeks punitive damages, a judge must first grant permission and require a detailed hearing to vet evidence used.  In other words, the victim has to disclose his strategy and trial tactics in a mini-trial to convince the judge, and then have another trial in front of the jury.  What a waste of judicial time and money.

Banning told the tragic story of how her mother was raped in a nursing home when a man used his wheelchair to block the door.  Sandra Banning was awarded a $750,000 judgment but it was never paid by the nursing home corporation. Florida has a state trust fund where 50% of punitive damages are required to go into this fund to assist with reform. However, since that bill was enacted in 2001, there have been zero successful punitive damages claims brought against nursing homes. The bill has two more stops before the Senate can completely come to a decision on it.  See article at the Florida Times-Union.

Another nursing home employee is accused of attempting to steal $10,200 from a resident.   Stephanie Benodin, who was hired to assist the elderly woman in day to day activities at the Tuttle Center, a Port Washington nursing home, was caught when she attempted to deposit a stolen check into her mother’s bank account. The victim went into the hospital, leaving her purse in her room at the Tuttle Center. Benodin made a check out to her mother and then attempted to deposit it. The bank informed the woman’s family that the check had been returned for insufficient funds. The woman’s daughter turned this information over to the police, who then arrested the Benodin. Police reported that she had admitted to stealing the check during an interrogation. She pled not guilty in court though.  See article at The Examiner.

Thefts from nursing home residents seems to have increeased dramatically lately.  A manager at a St. Petersburg home in Florida stole $800 from five residents. She was charged with grand theft and released $2000 bail.  In addition, a Connecticut nursing home employee pled guilty to stealing $140,000 from a patient fund. The former employee pled guilty to the estimated amount, but it’s unsure whether that amount is accurate, or a conservative estimate.  See articles at Tampa Bay Times and Republican American.

These three nursing home employees represent the type of threat that faces nursing home residents. Your loved ones are vulnerable when they’re surrounded by people like these. It would seem that hiring practices need to be based on stricter guidelines and that family members should be cautious and alert with regards to nursing home residents’ finances.

Hundreds of Pennsylvania nursing home workers recently gathered in the State Capital to support three proposed bills that would increase standards.  Pennsylvania Senate bills 624, 625 and 626 would require nursing homes to meet a minimum level of nurse aide staffing, report turnover and staffing levels to the Department of Health, and spend a minimum amount of their Medicaid resident care per diem rate.

An analysis by the workers show nearly 30 percent of Pennsylvania facilities did not spend at least 95 percent of their resident care Medicaid component amount on resident care costs in fiscal year 2011 while nursing homes generated more than $500 million in profits in 2011, with a total margin near the national level of 4.7 percent.  The report also said that 54 percent of survey workers said their facility is only sometimes adequately staffed, and 27 percent say their facility is never adequately staffed.  A 2012 survey of nursing home workers across the state showed that 12 percent of employees work more than one job and 11 percent receive public assistance. 

 

DOJ announced a $12 million settlement with Hospice of Arizona along with American Hospice Management, LLC, and their parent corporation, American Hospice Management Holdings, LLC, for claims involving Medicare fraud and the False Claims Act.  The allegations involved submitting or causing the submission of claims to the Medicare program for ineligible hospice services provided by Hospice of Arizona.   The government alleges that Hospice of Arizona and its related entities engaged in certain practices that resulted in the submission of false claims, including pressuring staff to meet admissions and census targets, adopting procedures that delayed and discouraged discharges of ineligible patients, and failing to timely implement an adequate compliance program.
"The Medicare hospice benefit is available for patients who elect palliative treatment (medical care focused on providing patients with relief from the symptoms, pain and stress of a serious illness) for a terminal illness, and have a life expectancy of six months or less if their disease runs its normal course. Today’s settlement resolves allegations that Hospice of Arizona and its related entities submitted or caused the submission of false Medicare claims between September 1, 2002 and December 31, 2010 for Hospice of Arizona patients that did not have a terminal prognosis of six months or less, or that did but were not eligible for the level of care billed."

 

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A Sumter, SC man named Isaac Wilson has been accused of causing the death of his bedridden wife by neglecting her.  His wife is 78 year old Louise Wilson who had pressure sores on her back.  Wilson was taken to a hospital but died a week later. Her husband, 74-year-old Isaac Wilson, has been charged with neglect of a vulnerable adult resulting in death.  This happens everyday in nursing homes but no one ever gets arrested. 

 

The Hartford Courant had a great editorial recently about the off label use of antipsychotics in nursing homes.  Below are excerpts.

Antipsychotic drugs are prescribed too frequently in Connecticut nursing homes to keep patients who have dementia or mental illness under control.

Lisa Chedekel of the nonprofit Connecticut Health Investigative Team has reported that some nursing homes in this state significantly exceed the national rate of administering such drugs to long-stay residents. At some facilities, the rate is more than double the already high state average. At one nursing home, 68 percent of long-stay residents were getting antipsychotics.

Antipsychotic drugs are supposed to be given only to patients diagnosed as having a psychosis or related condition. But in many nursing homes, they are prescribed for those who are difficult to manage, regardless of whether there’s a diagnosis of a mental illness.

 

That’s not good for patients, and ought to be curbed. The U.S. Health and Human Services Department has urged taking action against inappropriate prescription. The state Department of Public Health is trying to develop ways to reduce the use of antipsychotic medications.

Critics say that nursing homes are tempted to overmedicate because agitated patients are easier to deal with when sedated. But there can be serious, perhaps fatal, side effects to giving these drugs to elderly people with dementia.

Many residents of long-term-care facilities are neither elderly nor frail, but mentally ill. In 1995, the state closed two of its three mental institutions — Fairfield Hills and Norwich State Hospital — and some residents ended up in nursing homes. They may need to be treated with antipsychotic drugs. Still, that doesn’t excuse prescribing medication without a proper diagnosis, as some nursing homes do. That must stop.

Increasing staff and training has been suggested as a way to lower the need to use medication — but those are expensive, and for facilities that rely on Medicaid reimbursement, the funding may not be adequate. This problem, as so many in health care, is linked to money.

Long-term solutions to overmedication should involve alternative ways to care for those with mental illness, perhaps in supervised group homes.

 

Alarms to prevent falls is standard in the nursing home industry since the federal government limited the use of physical restraints in the early 1990s.  Many nursing homes rely on alarms to warn them if a resident who is at risk for falls is getting up.  However, a new trend is emerging for alarm free facilities.  Many nursing homes now claim that alarms are not effective to prevent falls.  A study last year in the Annals of Internal Medicine that was based at a Tennessee hospital found that alarms did not statistically reduce fall rates.  The most effective safety measure is adequate staffing and supervision.  Connecticut’s The Day had an interesting article on this controversial issue.

“Kimberly Hall South is among a handful of nursing homes in Connecticut that have gone “alarm-free,” meaning residents at risk of injury, usually from falls, are no longer outfitted with detectors on their mattresses, chair pads and clothing that emit a warning signal when they try to get up and move around.”

Most experts say alarms are an important fall-prevention measure, especially for residents with dementia or poor safety awareness who may try to get out of bed at night unsupervised. The alarms remind the residents that they should not move, while also summoning staff to assist.   Nursing staff must be more diligent in monitoring patients but the lack of noisy alarms lowers anxiety for residents, especially those with cognitive problems, and improves the quality of thier life.

According to data from the U.S. Centers for Disease Control and Prevention, about 1,800 elderly nursing home residents die each year from injuries sustained in falls. Thousands more suffer serious injuries, such as broken hips. In Connecticut, nursing homes overall report that 3.1 percent of long-stay residents experience one or more falls with major injury, slightly lower than the national average.

Other preventative measures include frequent checks on residents who are at risk of falls; additional staffing, safety vests, lap cushions, siderails, hip protectors, detailed assessments of residents’ needs, to identify when and why they get up and try to walk, including their toileting needs; and consistent assignments of nursing staff to particular patients.

 

 

 

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