Gemma Vale, a fantastic freelance writer, was kind enough to contribute the following article.

 Around the world, there are 36 million people who have Alzheimer ’s disease or a related form of dementia. Dementia is an umbrella term for a group of diseases that cause mental decline and confusion.  It is caused by damage to the nerve cells in the brain. Often, clumps of protein are found in the brains of people with dementia. In some cases, the nerve damage results from trauma or blocked blood vessels in the brain. Blocked vessels cannot deliver oxygen rich blood to the brain effectively and the lack of oxygen causes brain damage.  This type is called vascular dementia.

Initially, your loved one may experience problems with their memory. They might also have difficulties with decision making and abstract thought, display disorientation about what time it is or where they are and behave inappropriately in certain situations. Depression is common in older adults with dementia. As the illness progresses, they could have gait and balance difficulties and loss of communication skills and self-care skills. In the latter stages, they could require round the clock care.

This is why many families are faced with the challenging decision of how best to care for their loved one. If a full time carer isn’t available in the family, a care home may be the only option.

Force Drugging of the Vulnerable Elderly

Unfortunately the term ‘care’ home may only be the title and nothing to do with the practice. The rights and welfare of the elderly may be overlooked in an institutional setting. There are more than 25,000 residents in the USA are being drugged with anti-psychotic drugs to control symptoms of dementia and to make them more docile and compliant towards staff. Most of these prescriptions for ‘off-label’ reasons are not approved by the FDA and are ordered by doctors who haven’t seen any combative behavior in the resident. Instead of providing supportive care and companionship to the elderly, nursing home staff may rely on medications to keep their charges quiet.

Sometimes, drugs are prescribed without the consent of the elderly person or their relatives. Finn Christensen was 85 years old when he was admitted to hospital with confusion. Just a day after his admission he was physically restrained and force medicated with two anti-psychotic drugs. He wasn’t informed before this was done, wasn’t asked for his consent and neither were his family members. Mr Christensen endured a 16 day nightmare as he was drugged repeatedly by three different physicians. When his family complained, the Medical Board refused to investigate, saying the drugs were only low dose and ignoring issues of informed consent and drug safety.

One care home resident dialled 911 when sick from being force medicated with four anti-psychotic drugs and morphine. Reaching out to the emergency services was a desperate plea for help, but instead of helping, her doctor gave her more drugs. She later developed a permanent disability as a result of drug side-effects and her doctor was never prosecuted.

The situation is not unique to America. The forced sedation of seniors is occurring in many first world countries.

Half of all care home residents in British Columbia, Canada, are being given anti-psychotic medication – the highest rate of drugging anywhere in the world.

In the UK, more than 100,000 people living in care homes are given drugs. Of 934 homes, a quarter use medication to control behavior and one home surveyed drugged three quarters of its residents. 82% of prescriptions were completely unnecessary and in the case of some of the homes, not one person prescribed the drugs should have been taking them.

Sick from Psychotropics

Seniors are at special risk from psychotropics. Age related changes affect absorption, kidney function and the immune system, putting the elderly at increased risk from serious drug side-effects such as heavy sedation, psychomotor retardation, cognitive impairment,   tardive dyskinesia and drug induced Parkinson’s disease.  There is also an increased risk of death in elderly people with dementia who take anti-psychotics. Despite the lack of evidence for their safety in this population, doctors and nursing homes continue to force dangerous and unproven medications on the most vulnerable members of society.

Don’t put up with it

If you suspect your loved one is being force medicated, contact Poliakoff and Associates today.  We are a respected law firm with nursing home abuse attorneys who are experienced in lots of issues relating to elder abuse to give a voice to those who need it most.

Sources:

Madhusoodanan S et al, Pharmacological treatment of the psychosis of Alzheimer’s disease: what is the best approach? CNS Drugs. 2007;21(2):101-15, accessedDecember 8, 2014, http://www.ncbi.nlm.nih.gov/pubmed/17284093/

Pamela L Lindsey, Psychotropic Medication Use among Older Adults: What All Nurses Need to Know, J Gerontol Nurs. Sep 2009; 35(9): 28–38, accessed December 8, 2014, doi:  10.3928/00989134-20090731-01, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128509/

Pitkala KH et al, Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards, Int Psychogeriatr. 2004 Mar;16(1):61-74, accessed December 8, 2014, http://www.ncbi.nlm.nih.gov/pubmed/15190997/

Crisis Behind Closed Doors: Antipsychotic Drugging of Canada Seniors, Mind Freedom, accessed December 8, 2014, http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/seniors/canada-seniors-antipsychotic

 

 

An investigation conducted by the Wood 8 News Station, an NBC affiliate in the central Michigan area, illustrated a common travesty that occurs in the nursing home industry.  Sharon DeWitt, a great-grandmother, was at MagnumCare of Hastings to rehabilitate a broken hip.  Dewitt had the forethought to inform the nursing home ahead of time in writing that CPR was to be done and an ambulance was to be called in the event that she had a heart attack.  Terri DeWitt, the daughter-in-law of Sharon DeWitt told Target 8 news station that:  “She wanted anything and everything done to keep her alive” and “She was very adamant about that.  She did not want to die, and whatever it took to keep her alive, she wanted it done.”  Despite DeWitt writing down exactly what the facility should do if she had health complications, state records show that the nursing home took none of those life-saving steps when her heart failed, and as a result, she unfortunately died.

Years after DeWitt’s death, relatives believe that they were “left in the dark” by both the state and the facility itself.  Although the state issued one of its’ largest fines to MagnumCare of Hastings, the family says that they only found out about the details of the incident when the news station conducted an investigation about Sharon DeWitt’s death.  For example, in June of 2011, a nurse found that Dewitt was not breathing and did not have a pulse.  This discovery should have triggered a full, life-saving response but instead, no action was taken.  Terri Dewitt says that the nursing home facility never released those details to her or any other family members.

At one point, a nursing home worker suggested that the family should demand a state investigation.  The family requested an investigation but the state never got back to them and never mentioned the fact that it had fined the home $85,000.  A state spokesman, Jason Moon, mentioned that it was someone else, not Terri DeWitt who filed the complaint and that the facility reported the incident as well.  The original complainant’s name was not released in order to protect privacy.

Unfortunately, the DeWitt family is not alone, as the issue has manifested to another resident within the same facility.  The state recently fined the same home $5,818 in the death of Alfie Vincent for a seven hour delay for not getting him proper medical attention.  Records show that his medical guardian reported the death to the state, but not MagnumCare of Hastings.  The news station stopped at MagnumCare of Hastings to request an interview and, not surprisingly, no one responded to the calls for a discussion of the facilities recent headline making fallacies.

It is rather troubling when a resident is not assisted during times of extreme medical distress, it is even more disturbing when the same level of neglect is repeated in a consecutive manner, almost suggesting that this facility and probably others are operating independent of local, state, federal, and most importantly, moral guidelines.

The Wall Street Journal: New Medicare Rules Aim To Reduce Abuse
The Obama administration last week strengthened Medicare’s authority to kick doctors and other medical providers out of the federal program for abusively billing the government. The move represents a significant shift in how the government tackles waste in Medicare, the insurance program for the elderly and disabled. The Centers for Medicare and Medicaid Services estimates that for the fiscal year ended Sept. 30, the main part of Medicare issued $45.8 billion in improper payments, representing nearly 13% of its total spending. (Adamy, 12/3)

Kaiser Health News: Growth In U.S. Health Spending In 2013 Is Lowest Since 1960

Kaiser Health News staff writer Mary Agnes Carey reports: “National health spending grew 3.6 percent in 2013, the lowest annual increase since the Centers for Medicare and Medicaid Services (CMS) began tracking the statistic in 1960, officials said Wednesday. Spending slowed for private health insurance, Medicare, hospitals, physicians and clinical services and out-of-pocket spending by consumers. However, it accelerated for Medicaid and for prescription drugs, according to the report, published online by the journal Health Affairs.” (Carey, 12/3)

The New York Times: Health Spending Rises Only Modestly

Spending on health care in the United States grew in 2013 at the lowest rate since the federal government began tracking it in 1960, the Obama administration said Wednesday. It was the fifth straight year of exceptionally small increases in the closely watched indicator. The data defied critics who had said such slow growth would not continue for long once the recession ended in mid-2009. (Pear, 12/3)

The Associated Press: Growth For US Health Tab May Have Hit Bottom
U.S. health care spending grew by the slowest rate in more than a half-century last year, government analysts said Wednesday. But a speed-up is coming as the economy gets traction and the new health care law covers more people. (12/3)

Los Angeles Times: Health Spending Grew 3.6% In 2013, Slowest Pace On Record, U.S. Says
Health spending in the U.S. grew in 2013 at the slowest rate ever recorded, a new government study indicates, marking the extension of a historic slowdown in medical spending that began after the last recession. Total spending on healthcare increased just 3.6% last year to $2.9 trillion, according to the study from independent analysts at the Department of Health and Human Services. That is down from 4.1% in 2012 and way down from 2002, when health spending increased by nearly 10%. (Levey, 12/3)

USA Today: Health Care Spending Grows At Lowest-Ever Rate
Health care spending in the U.S. grew last year at the lowest rate ever recorded, due in part to the Affordable Care Act, the Centers for Medicare and Medicaid Services said Wednesday. The slowing growth in health care spending to 3.6% from 4.1% in 2012 was attributed to factors including relatively slow economic growth and more gradual increases in private health insurance and Medicare spending, the CMS said. (Ungar and O’Donnell, 12/3)

 

 

 

 

 

 

 

 

 

 

The Atlantic had a fascinating article on a Dutch “village” for residents suffering from dementia.  Van Amerongen was working as a staff member at a traditional Dutch nursing home when she became committed to making nursing homes more livable and less of a departure from reality for their residents. She envisioned a setup as far away as possible from the nondescript buildings and polished floors of her workplace, where everything carried the scent of a dentist’s medical cabinet. Over the next 20 years, she worked to secure the funding she’d need to make the idea a reality.

Today, the isolated village of Hogewey lies on the outskirts of Amsterdam in the small town of Wheesp. Dubbed “Dementia Village” by CNN, Hogewey is a cutting-edge elderly-care facility—roughly the size of 10 football fields—where residents are given the chance to live seemingly normal lives. With only 152 inhabitants, it’s run like a more benevolent version of The Truman Show, if The Truman Show were about dementia and Alzheimer’s patients. Like most small villages, it has its own town square, theater, garden, and post office. Unlike typical villages, however, this one has cameras monitoring residents every hour of every day, caretakers posing in street clothes, and only one door in and out of town, all part of a security system designed to keep the community safe. Friends and family are encouraged to visit. Some come every day. Last year, CNN reported that residents at Hogewey require fewer medications, eat better, live longer, and appear more joyful than those in standard elderly-care facilities.

Residents are only admitted if they’re categorized as having “severe cases of dementia or Alzheimer’s disease.” Vacancies are rare, given that a spot only opens when a current resident passes away, and the village has operated virtually at full capacity since it opened in 2009. Hogewey was primarily funded by the Dutch government and cost slightly more than $25 million to build. The cost of care is nearly $8,000 per month, but the Dutch government subsidizes the residents—all of whom receive private rooms—to varying degrees; the amount each family pays is based on income, but never exceeds $3,600.

To put it into perspective, a private room at a U.S. nursing home cost an average of $248 per day in 2012, or more than $90,500 annually—a figure that’s even more staggering when applied to the rapid increase in dementia patients globally. By 2030, the number of people suffering from dementia around the world is expected to hit 76 million, which some estimate will cause an 85 percent increase in dementia-related healthcare costs worldwide. By 2050, the U.S. alone will pay a projected $1.2 trillion.

Often, nursing homes are linked to poor quality of life for their residents: Issues of patient mistreatment and low levels of morale have plagued U.S. assisted-living facilities.  The act of engaging in community isn’t just about promoting better healthcare; it’s about developing a more personable and comprehensive way of treating disease. Often those with the most severe mental-health issues end up being isolated, so that less complicated cases can benefit from institutional resources. However, a study from the journal Nature Neuroscience found that isolation actually reduces the production of myelin—a fiber that maintains our nerve cells—meaning these segregating treatments may only make mental illness worse. The countless studies reinforcing how many dementia patients feel lonely or isolated, juxtaposed with Hogewey’s considerable success with these residents, call into question how much of dementia is a result of disease, and how much is a result of how we treat it.

 

In the years since Hogewey’s founding, dementia experts from the United States, United Kingdom, Ireland, Germany, Japan, Norway, Switzerland, and Australia have all flocked to the unassuming Dutch town in the hopes of finding a blueprint for handling the global problem. While dementia-only living facilities have been created outside the Netherlands, none of them have offered the amenities or level of care per patient that Hogeway provides. Last year, inspired by Hogewey, a nursing home in Fartown, England, built a 1950s village for its residents; a similar project is underway in Wiedlisbach, Switzerland.

Sometimes it truly does take a village.

The Washington Times reported that disgraced Rep. Eric Turner submitted his resignation from the Legislature.  Turner made no mention of the ethics scandal which removed him as House speaker pro tem.  An Associated Press investigation earlier this year uncovered Turner’s major financial stake in his family nursing home business, Mainstreet Property Group.  Internal Mainstreet documents showed that Turner and other direct stakeholders made millions of dollars every time they built a new home and then sold it to another, affiliated company incorporated in Canada.

Turner worked in private meetings of House Republicans in the last session to defeat legislation that would have banned the construction of new nursing homes. The Republican dominated House Ethics Committee determined that Turner did not “technically violate” House ethics rules barring lawmakers from using the office for their own self-interest.  Shortly after Mainstreet announced it was being sold to another nursing home investor for $2.4 billion.

 

McKnights reported on the Department of Health and Human Services’ Office of Inspector General new list of challenges facing the department when ensuring nursing home quality of care. On this list is nursing home oversight, which has risen from its spot as the No. 7 priority in 2013 to No. 5 this year. According to the OIG, nursing home oversight is defined as the challenge of “ensuring quality in nursing home, hospice, home – and community – based care.” This comes as a change from last year’s list, where hospice was not specifically mentioned.

This change aims to accommodate all of the challenges faced by the OIG when working to improve nursing home oversight, which are adverse events in skilled nursing facilities and inadequate monitoring of hospice surveys. Much has already been done to help ensure the high quality of care in nursing homes that would improve oversight, including the IMPACT Act and the Protecting Access to Medicare act of 2014, which mandate hospice surveys every 36 months and create payments for incentives for high-performing nursing homes, respectively.

Other challenges faced by the HHS OIG include fighting waste and fraud in Medicare, and efficient and secure use of electronic health information. These challenges, all vital to the ensuring of quality care for elderly individuals in nursing homes, could lead to increased oversight by the OIG as well as enforcement actions against long-term care providers.

The New York Times reported another adjournment in the rape case of a 64-year-old woman with dementia.  This is the sixth time the case was postponed. This time the trial adjourns until February, during which time the Bronx District Attorney’s office will continue its investigation into the case and attempt to reach a plea deal with the accused rapist.

The alleged rape occurred on Feb. 18 at the Manhattanville Healthcare Center when an aide caught Nanic Aidasani on top of the victim.  Aidasani, a 42-year-old Yonkers resident, worked at the home as a nurse and provided care for the victim who was in the nursing home after losing the ability to speak because of a stroke.

Following the recent hearing, Aidasani’s attorney, Alberto Ebanks, requested a psychological evaluation for his client who is free on a $20,000 bail. Jessica Blake, a lawyer representing the victim’s family, says that any evaluation done on Aidasani today would not reflect his mental state at the time of the incident. Ebanks and his client did not comment on the request.

Attending the hearing was the victim’s daughter as well as dozens of friends and relatives. The victim’s daughter, Loida Rivera, found facing her mother’s accused rapist difficult. “It’s another trip to court without any closure. It’s horrible,” she said. Other members of the community were present to support the victim, including Sen. Ruben Diaz Sr. and members of the New York Hispanic Clergy Organization. “Again, one more time we are disappointed,” Sen. Diaz said after his appearance at the brief hearing. “Adjournment after adjournment after adjournment.”

Blake, the family’s attorney, said the family plans on filing a civil suit against the nursing home following the trial. “This is just a tedious process,” Rivera said. “We are tired of waiting and watching games being played. We just want justice for our mother.”

Think Progress had a great article on how nursing homes restrict access to the Court to prevent justice for abuse and neglect at their facilities.  They used the tragic case of one Arkansas resident who was severely neglected.  Evan Press’ father was in a nursing home for only three months when he died. Press said he had a bed sore the size of his fist, and that an attendant says he was so dehydrated that he appeared not to have been given any liquid or food for four or five days, according to a report from local news station KARK.

Press will never be able to go to court because his contract contained a boilerplate arbitration clause.  Nursing homes are one of a number of industries in which arbitration clauses have become a standard for those pages-long contracts that customers and employees believe they have no choice but to sign. What they do is bind customers to take their case to a private arbitrator, rather than to the constitutionally mandated trial by jury.  A Consumer Financial Protection Bureau study found that arbitration clauses are even worse than they seemed. Because even though companies claim going to arbitration is easier and faster than filing a lawsuit, almost nobody goes to arbitration.

The arbitration hearing is private, so the nursing home won’t receive public reprisal for its actions and consumers will not know about the neglect.  Clauses like this give companies such as a nursing home significantly less incentive to quash bad behavior. The arbitrator is not a government service, and has to be paid by somebody.  One arbitrator may be paid to handle a nursing home chains’ entire roster of cases, which could be one of several explanations for why arbitrators overwhelmingly side with these companies. Even when arbitrators do side with individuals, they are likely to get a much lower judgment than they would in court. And arbitration doesn’t come with any of the procedural protections that exist in court, including the right to appeal. So whatever they come up with is binding.

Unfortunately for Press, the U.S. Supreme Court has been one of the greatest friends to these clauses. California tried to make its own state law saying some arbitration clauses are unconscionable and should not be enforced. The Roberts Court struck it down. Even small businesses tried to challenge an an arbitration clause that prevented them from challenging the alleged monopolistic practices of American Express. The Roberts Court struck that, too, over a dissent by Justice Elena Kagan that called the ruling a “betrayal of our precedents, and of federal statutes.”

Congress could have reformed arbitration clauses with a bill known as the Arbitration Fairness Act. But that bill is even less likely to go anywhere in a Republican-controlled Congress.  There’s one other avenue for reform. Another bill already passed by Congress, the Dodd-Frank Act, directs the Securities and Exchange Commission and the CFPB to limit or even ban use of the clauses — at least for entities subject to the CFPB’s jurisdiction — after studying the issue, they find that it is “in the public interest and for the protection of consumers.”

 

NBC News reported a disturbing finding based on a study published by The Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C.  The study found that since 2009, hundreds of nursing homes nationwide have received a combined total of nearly $2 billion in low-cost mortgages guaranteed by the Department of Housing and Urban Development even after receiving the lowest possible quality rating from the federal government, a Center for Public Integrity investigation has found.  Because HUD guarantees the mortgages, the public pays when one of these nursing home defaults.  Click here to read the full Center for Public Integrity version of this story.

U.S. Representative Jan Schakowsky (D-Ill.), a leading legislator on senior issues, called the findings “outrageous.” And Charlene Harrington, a retired nursing professor from the University of California at San Francisco, says that the pattern of poorly rated homes receiving federally guaranteed mortgages raises serious questions about the allocation of public resources, communication between agencies and what she called a shocking lack of supervision.

Costs include the original loan amount, premium payment requirements and recoveries from the sale of notes and properties, according to a 1995 report by the Government Accountability Office.  The report said that HUD data showed that losses of about $187 million, adjusted for inflation, had been incurred since the nursing home program’s inception.  As of August 2014 more than 2,000, or about 13 percent, of all nursing homes held HUD-insured mortgages. The mortgages HUD backed had an average interest rate of 4.2 percent and a combined worth of more than $16 billion.

The Department of Health and Human Services ranks nursing homes on an overall five-star quality scale in an effort to assist consumers trying to choose a home for a family member. The overall quality mark is determined by rankings on health inspections and staffing levels, among other metrics. A one –star rating, HHS says, indicates that the care provided is “much below average.”  For dozens of facilities, the poor quality of care was also not limited to a single inspection cycle, either.

For-profit corporations were over-represented among the ranks of one-star homes with the low-cost mortgage loans guaranteed by HUD. Corporations owned a little more than half of all nursing homes, but more than two-thirds of poorly-rated HUD-guaranteed mortgage recipients — a trend criticized by Harrington of USCF.  “I think [the HUD-guaranteed mortgages] should be restricted to only doing nonprofits,” she said. “There’s certainly no reason the government should be financing for-profit corporations.”