Quality Assurance and Performance Improvement Program reports are not privileged or protected from discovery according to a West Virginia court.  The court said HCR ManorCare LLC must provide nurse consultant reports, also called Center Visit Summaries, as part of a wrongful death lawsuit brought by a resident’s family member against Heartland of Charleston. ManorCare claimed the reports were meant solely for the company’s Quality Assurance and Performance Improvement Program, and were excluded from discovery.  Plaintiffs’ attorneys wanted the consultant reports to argue against a defense claim that it didn’t operate or manage any nursing homes.

 

Click 2 Houston reported that Lajuanita A. Lister, a housekeeper at Lampstand Health and Rehabilitation Center, had bags of cocaine falling out of her clothes when police went to investigate claims she allegedly stole money and patients’ personal things, according to federal prosecutors.

Police, who were on hand while staff searched, said Lister acted nervously and kept reaching into her pockets and “fidgeting with her waistband, as if searching for something, and twisting her left foot onto the ground.”  When Lister walked back to the building, police noticed a bag with white powder on the ground where Lister has just stood.  Lister allegedly claimed “she forgot she had hidden this other bag in her shirt.”  Police say they found a total of 29.6 grams of white powder that field-tested positive for crack cocaine.

 

4029TV reported that after a power surge caused the alarm bells at Countryside Assisted Living to malfunction, it took staff 30 minutes to realize that resident Velma Hull had gone missing. They searched for the 88 year-old for two hours before notifying the police of her elopement. When she was finally found, Ms. Hull had been missing from the facility for 13 hours in almost freezing temperatures. According to Sean Ellis, Huntsville’s emergency manager, she appeared to have tripped and fallen and her skin was discolored from the cold temperatures.

 

 

At the White House Conference on Aging, the Centers for Medicare and Medicaid (CMS) proposed new rules to improve the care of approximately 1.5 million elderly who reside in more than 15,000 long-term care (LTC) facilities nationwide.

The proposal aims to reduce unnecessary hospital readmissions and infections, improve quality care, and strengthen safety measures for these Medicare and Medicaid beneficiaries, according to statement from the Department of Health and Human Services (HHS).

The proposal includes a requirement that a pharmacist review a LTC resident’s medical chart at least every 6 months, at the time the resident is new to the facility, when a prior resident returns or is transferred from a hospital or other facility, and during each monthly drug regimen review when a psychotropic drug or antibiotic is prescribed.  The pharmacist must document in a written report any irregularities during the drug review and share this information with the attending physician and the facility’s medical director and nursing director. The attending doctor must document the review of the identified irregularity in the resident’s medical chart.

In addition, CMS wants to limit the use of psychotropic drugs. If a resident is not using psychotropic medicine, that resident should not be given psychotropic drugs unless it is medically necessary. CMS also wants residents who are using these drugs to receive gradual dose reductions and behavioral intervention, eventually eliminating the need for these medications.

Psychotropic drugs prescribed as PRN—as needed—should be limited to 48 hours, according to the CMS proposal. “Orders could not be continued beyond that time unless the primary care provider reviewed the need for medication prior to renewal of the order, and documented the rationale for the order in the resident’s clinical record,” CMS noted.

For more information, download the proposed rule.

Video surveillance footage obtained by the Daily News prove a trio of nursing home caregivers abused a disabled patient at Peninsula Nursing and Rehabilitation Center and neglected to treat him as he lay on the floor bleeding from his head for more than 20 minutes.  One is seen heartlessly dragging the patient across a floor and at least one nurse failing to lift a finger to help.

Funmilol Taiwo, Eshe Agbonkpolor, and Emmanuael Ufot were arrested for their callous treatment of the helpless 51-year-old man, officials said.  When the vulnerable patient, who suffers from mental and physical disabilities, fell on his back in a hallway next to a nurses’ station, no one rushed to help him, officials said.  The video shows him writhing on the floor, struggling to get to his feet as his blood-soaked hospital gown appears to be torn and twisted around his neck.

The gotcha surveillance video showed Ufot putting on rubber gloves, grabbing the victim by his arm and dragging him back into his room.  About 25 minutes later, the victim emerged from the room bleeding from his head and his jaw, authorities said. In the footage, Ufot grabs the man again, this time by the back of his gown, and tries to drag him back to his room.  The man suffered injuries to his head and neck and was taken to a hospital for emergency treatment, according to sources.

 

Max Mitchell wrote an excellent article on Tuomi v. Extendicare for The Legal Intelligencer.  The Pennsylvania Superior Court has ruled that a plaintiff’s wrongful-death and survival actions against a nursing home facility will not need to be bifurcated so one claim can go to a jury trial and the other to arbitration.  The Court will allow the plaintiff’s claims to be consolidated for trial. The case stems from a patient’s death after she stayed at an Extendicare nursing facility.

The Federal Arbitration Act did not preempt state statutes on the issue. The trial court relied on the Superior Court’s 2013 decision in Pisano v. Extendicare Homes, which held that wrongful-death claimants who were nonsignatories to arbitration agreements could not be compelled to arbitration.

 

WKYT reported that nursing home Administrator Kelly Goodin was arrested for stealing residents’ medications and sold them to someone on the streets.  Goodin was the Administrator at Mountain View Nursing and Rehabilitation Center.  She was arrested on 12 charges of trafficking in a controlled substance.  The drugs included oxycodone, hydrocodone, fentanyl, and others, in the form of 549 pills, 13 patches, and a bottle of liquid morphine.

“During the course of the arrest, we were able to seize a large number of very potent drugs that would’ve wound up on the street if we hadn’t been able to intercept them,” said Tom Busic, with Middlesboro Police.

 

News-Medical reported on a study explaining that nursing home residents with dementia are less likely to be apathetic if they live in an appropriately stimulating environment, according to nursing researchers.  Apathy is one of the most common neurobehavioral symptoms in dementia, with about 90 percent of older adults with dementia experiencing it. Those with mild dementia will decline more quickly into severe dementia if they also suffer from apathy, making it important to help them stay engaged.

Five characteristics in particular were studied: environmental stimulation, ambiance, crowding, staff familiarity and light and sounds. Of the five, clear and strong environmental stimulation was the most significantly associated with a lower apathy level in the residents.

‘Interestingly, our results showed that clear and strong environmental stimulation is related to lower apathy, while no stimulation or an overwhelming environment with no single clear stimulation is related to higher apathy,’ the researchers said.

Clear stimulus is found in an environment without competing background noise, and with a single straightforward stimulus. A good example of this is a therapist leading a music therapy program for residents in an otherwise quiet room.

The strength of the stimulus depends on how intense, persistent, interesting and out of the ordinary it is. Routine activities, such as a regular conversation or meal, are considered moderate stimulation, while a birthday party is considered strong simulation.

 

NPR had a great article on the new CMS rules applicable to nursing homes that receive taxpayer money through Medicare and Medicaid.  After nearly 30 years, CMS will modernize the standards nursing homes must follow to qualify for Medicare and Medicaid payments.  The hundreds of pages of proposed changes cover everything from meal times to use of antipsychotic drugs to staffing. The proposed regulations include a section on electronic health records and measures to better ensure that patients or their families are involved in care planning and in the discharge process. The rules also would strengthen infection control, minimize the use of antibiotic and antipsychotic drugs and reduce hospital readmissions.

“The existing regulations don’t even conceive of electronic communications the way they exist today,” said Dr. Shari Ling, Medicare’s deputy chief medical officer. “Also there have been significant advances in the science and delivery of health care that just weren’t imagined at the time the rules were originally written. For example, the risks of antipsychotic medications and overuse of antibiotics are now clearly known, when previously they were thought to be harmless.”

Consumer advocates are disappointed that officials are not including recommendations to set a federal nurse-to-resident ratio.  Nursing homes will be required to report staffing levels, which Medicare officials said they will review for adequacy.  Advocates for nursing home residents argue that because of inadequate staffing, residents with dementia are often inappropriately given antipsychotic drugs, even though that can be dangerous for them. The new rules would help control the use of these drugs by requiring the facility’s pharmacist to monitor drugs that are prescribed for excessive periods of time or other irregularities and require the resident’s physician to address the problem or explain in the resident’s medical record why the medication is necessary.

“We don’t have enough nursing staff,” Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, said before the rules were released. Federal law requires only one registered nurse on the day shift for a 20-bed facility or as much as a 500-bed facility, licensed practical nurses around the clock and sufficient staff to meet residents’ needs, she said.

“The biggest problem is that the rules we have now are not enforced,” said Edelman. “We have a very weak and timid enforcement system that does everything it can to cajole facilities into compliance instead of imposing penalties for noncompliance.”  A report by the Center for Medicare Advocacy last year found that some serious violations often were not penalized.

 

KRQE reported the neglect of Saint Anthony’s Rehabilitation Center when a disoriented woman wandered away over a week ago and staff did not know she was missing. The woman in her 90’s knocked on Matthew Aragon’s door around 6 a.m. last week.  When the woman went to leave, Aragon and other neighbors jumped in to help and called police.

Aragon walked across the street to Saint Anthony’s Rehabilitation Center to see if they were missing any residents. When he asked the nursing home if they were missing any residents they told him they were not. However,  when Aragon told them her name, staff rushed outside to get the woman.