U.S. News & World Report discussed a pilot program that emphasizes a new type of training in nursing homes which could lead to overall better care. Teamwork, decision making and safety are core values of the training program used by pilots and the aviation community. The core values of TeamSTEPPS were created to decrease accidents resulting from human error.
One big component of that program is communication and teamwork. If nursing homes can engage in better and more frequent communication among staff, doctors, pharmacists, residents, and families, then they could run more efficiently, but also with better safety. The program is a slightly retooled version of a program that was used in hospitals, where it was found to be incredibly beneficial.
The program is based on common sense strategies to help reduce human error and mitigate patient risk. It recommends that all staff meet every morning to discuss care plans, special issues, and safety concerns. Other things the program recommends are double checking patient charts before administering medicines, asking another staff member for assistance or a secondary opinion.
These are all things that make sense to me. Why wouldn’t a doctor, nurse, or other health care professional do any of these things? The truth is that these five second or three minute protocols can add up over time. In an industry where time is the number one shrinking commodity, and there’s never enough of it, taking the time to do these small things can be a big burden. The program’s success seems to account for this by trying to eliminate problems before they happen, trying to decrease unnecessary injury and death, and trying to make sure that the people who are caring for your loved one are able to communicate their concerns effectively.
A young medical student has voluntarily admitted himself to a nursing home so that he can better understand what his future patients will feel. Anthony Pastore, 25, who hopes to become a primary physician, stayed in a nursing home for ten days, living as an 85 yr old man with weakness on his dominant side due to a stroke. His other problems include pneumonia from inhaling food, and limited mobility, which means he’ll be wheelchair bound and have to eat pureed foods for three meals.
Pastore reported feeling overwhelmed, and at times powerless. He documented his stay in the home in a journal, which details sudden bouts of depression. Some days he would go to every activity and others he wouldn’t want to leave his room. However, the experience wasn’t all bad, Pastore did make a few new friends. Though Pastore is younger than all of the other residents, he said that the similarity of his situation helped him to make friends with others. Commiserating about wheelchairs and talking about things that they did before the home made him understand the heavy feeling of loss that can accompany a residency. For more on Pastore’s nursing home adventure, see part 1 of the article here.
The Weatherwood Nursing and Rehabilitation Center in Weatherly, PA has been the subject of two recent investigations. The first occurred in April, when an 85 yr old resident died at the hands of another resident. Margaret Lechleitner’s death was the result of a shove gone awry. Carl Smith, 53, pushed Mrs. Lechleitner during an argument. Lechleitner hit her head on the floor and died as a result of her injuries. Smith was charged with involuntary manslaughter.
The second investigation is the result of a call made to the police regarding an event that took place July 8 where a nurse or nurse’s aide placed a female resident in the recreation room. The nurse/aide then turned off the lights and left the resident in the room, by herself, for hours. Weatherwood management called the police about the incident. The investigation is ongoing and many details are still unclear. See article at Citizen’s Voice.
The San Francisco Chronicle reported Jodi Alexander, an Oklahoma nursing home worker, has been charged in connection with a prescription drug ring. Alexander is accused of stealing prescription medications from patients at the Crescent Care Center where she worked, changing medical records so they wouldn’t reflect a discrepancy. Alexander and Dale Steven Markus, her boyfriend, were charged with distribution of a controlled dangerous substance. She was also charged with larceny.
Australian ABC News had a tragic article about the severe mistreatment of elderly nursing home residents. Families of loved ones who were abused and neglected in nursing homes spoke out. Stories from family members detail shocking abuse and heart wrenching cries for help. Patients who were screaming in agony were accused by staff of being attention-seekers. One staff member told the daughter of a resident that her mom was a whiner. Her mother was crying for help because staff made her walk for five days with an undiagnosed broken leg.
Another woman detailed the story of her grandmother, who had been tortured in a Nazi concentration camp. The woman stated that after learning what her grandmother suffered, she believed she would have been better off in the concentration camp than in the nursing home. Although there are many families represented in Lateline’s video exposé, there is a common underlying theme. All of their loved ones were abused and neglected in their nursing homes, and all died weeks after leaving due to poor treatment. When these families attempted to report the home and complain to a state agency, many of them found that it was a waste of time, because the agency did nothing. Others were bullied and threatened by the homes. One home even threatened to file a defamation suit against a woman for trying to report the home’s abuse of her mother.
The video is a powerful and shocking tale of abuse and neglect, pain and suffering, and a government that doesn’t care to help.
U.S. News & World Report had an article on a new study that found nursing home residents with multiple hospitalizations are at higher risk for death. This study utilized metadata from staff assessments of all nursing home residents in the country from January 2000 to December 2008. Among patients with moderate to severe mental decline, the overall survival after an assessment was 476 days, which varied depending on illnesses, as well as repeat hospitalizations for issues of infection, dehydration, malnutrition, or pneumonia. Those patients died on average within 150 days of the assessment.
The implications of these results aren’t yet known. More research needs to be conducted in order to determine why there is such a large discrepancy between the two numbers. The gap could be due to financial variance, poor communication, or a lack of diagnostic care in nursing homes.
Jose Jorge Gonzales was allegedly dropped twice by staff at the New Orleans Home for the Incurables and is suing the home for neglect, pain and suffering, and medical expenses. Gonzales is a quadriplegic, and was dropped while he was being transferred to his wheelchair. The first fall, on August 25, 2011, resulted in a broken leg. On September 1, one week later, he was dropped again. That fall resulted in serious injury to his lower back and spinal area. The suit also claims that the home failed to provide a safe environment and maintain proper equipment.
See article at The Louisiana Record.
Laura Siano, former director of nursing at Kirkwood House Nursing Home, allegedly stole $16,000 from a 75 yr old resident’s account. In addition, Siano made numerous personal purchases for decorative items, cat supplies and a laptop using the resident’s credit card. The investigation occurred as the result of a complaint to the Department of Public Health. She has been charged with larceny over $250. See article at Wicked Local Wakefield.
The Charlesgate Nursing Center in Rhode Island was the home of a death which may be related to a heat wave in July. The Department of Health is investigating the death of a resident who didn’t have air conditioning in her room. The temperature for that day was 95. The home claims that they provide residents with ice pops, fans, and make sure they have access to air conditioned rooms. There were two air conditioned common rooms, but the resident who died didn’t leave her bedroom on that Saturday. So far, the home has cooperated with investigators and reporters. They too say that the resident’s death was sudden and unexpected. See article at Turn to 10.
Antipsychotic medications have been used as a form of chemical restraint in many nursing homes, with some reporting as high as 37% of residents. These drugs are often used in nursing homes to make residents more calm and easier to handle. This type of chemical restraint is often the result of understaffing and not enough training. When prescribed to patients that don’t need them, they can have a long list of side effects, which include agitation, fatigue, and loss of awareness and speech.
An alternative to chemical restraint is redirection, but critics say it can be time consuming. When a patient becomes agitated, instead of giving that patient a drug which will make them become drooling, incontinent, or out of it, the nurse or aide can redirect the patient. This involves finding out about the patient, what they liked, what they used to do. In many cases, a patient becomes agitated because they are in unfamiliar surroundings and cannot do things that they have done all their lives, like take walks, or sleep in. It can be helpful to learn more about a patient than simply their medical history because it can allow caregivers to form a bond with the patient which can help them feel familiar. Utilizing permanent staff for residents is a key part of building trust with that resident. Unfortunately, permanent staff requires that staff stay at a facility, and many homes have high turnover rates because of their working and operating conditions.
Critics say that in addition to being time consuming and sometimes impossible, taking time to redirect residents and forge bonds with them is simply not feasible or practical. In an industry where costs are constantly being cut, with Medicare and Medicaid being reduced at every turn, staff are decreasing, budgets for activities are decreasing, and there’s been a direct connection to federal cuts and the increase of these medications.
Overmedication of residents is a common occurrence because the systems don’t encourage caregivers to take time with residents. To have a nursing home where chemical restraints aren’t used unless necessary requires a timely, if not necessarily costly, overhaul of the entire home. The system that’s in place isn’t friendly to these changes, and until caregivers have the time to spend with residents, chemical restraint is going to be an accepted if hushed practice in nursing homes across the globe.
See articles here and here.