USA Today had an informative article about the dangers of using opiods such as morphine and heroin–overdose deaths from opioids hit a record 28,647, or 78 people a day.  This epidemic is fueled as much by well-meaning doctors as it is by dope pushers. Overdoses of the most popularly prescribed legal painkillers, such as oxycodone and hydrocodone, accounted for more deaths last year than heroin, according to numbers released by the Centers for Disease Control and Prevention (CDC).

Many doctors who are part of the problem have shown little inclination to solve it.  The CDC has proposed guidelines to change physicians’ prescribing habits.  The guidelines suggest that for acute short-term pain — which gradually resolves as tissues heal, such as after surgery or a sprain — doctors prescribe the smallest supply of drugs, for three days.  For chronic long-term pain, CDC suggests physicians first look to other drugs or physical therapy. If they do prescribe opioids, they should start with the lowest possible dosage and continue opioids only if benefits outweigh risks.

Two recent studies demonstrate how much these guidelines are needed. Opioid prescriptions are dominated by general practitioners — the family doctors, internists, nurse practitioners and physician assistants that most patients see for common problems —according to a study published last month by Stanford University researchers.  However, many general practitioners do not understand basic facts about how addictive opioids are and their potentially lethal adverse effects.

Opioid painkillers certainly are indispensable to those with terminal illnesses for whom addiction is not an issue. But these patients are not the CDC’s focus.

For many others, prescription opioids have become a gateway to addiction, to heroin (which can be cheaper and easier to obtain than many of the legal drugs) and even to death. Last year, this category of drugs rivaled guns and auto accidents as major killers of Americans. If the CDC guidelines are defeated, the winners will be the pushers of opioids, legal and illegal alike.

The Intelligencer reported that Christopher Frederici  pleaded guilty to one count each of raping a mentally disabled person, sexual assault, indecent assault of a person with a mental disability and indecent exposure, according to court records. Frederici admitted to rape charges in connection with the sexual assault of a 93-year-old woman with dementia.

 

 

CNBC had an article about the lack of nursing home beds for America’s aging population.

Here are some points you may want to ponder: The Census Bureau reported that in 2006, there were 78.6 million boomers in the U.S. Many of them will turn 70 by 2020. By 2030, about 20 percent of the nation’s population will be 65 and over. That compares with 13 percent right now.

So we are aging, and the problem becomes how we will care for all these people. To that point, from 2000 to 2009 the total number of nursing homes in the U.S. decreased by 9 percent. Additionally, from 2007 to 2011 new construction of nursing-home units decreased by 33 percent.

There were roughly 15,642 nursing facilities in the U.S. in 2010, according to the Kaiser Family Foundation. This may appear to be plenty, but the total number of beds in these facilities stood at about 1.66 million in 2012.  And when we look at the occupancy rate, things get a bit scarier. In 2012, the occupancy rate stood at close to 89 percent, with roughly 1.36 million beds being occupied.

The bottom line is, there simply will not be enough beds to serve an aging population.

Hospital-acquired conditions are a major factor in patient safety. According to the Partnership for Patients, in 2010 adult patients experienced about 4.8 million HACs in 32.8 million hospitalizations. The Agency for Healthcare Research and Quality estimates that the additional cost of HACs ranges from $1,000 for treating a catheter-associated UTI to $17,000 for treating central-line infections and $21,000 to treat surgical-site infections and ventilator-associated pneumonia.

The HAC program uses a composite group of measures and three individual metrics to score hospitals on the prevalence of hospital-acquired conditions, which is a proxy for patient safety. The composite measure is the Patient Safety Indicator (PSI) 90 Composite Index, which includes eight metrics and uses claims data. The mean performance on that index improved this year across all hospitals.

Data on the other measures, for central-line infections, catheter-associated urinary tract infections (UTIs), and surgical-site infections, is derived from chart reviews. The mean national score for central-line infections improved this year, while that for catheter-related UTIs declined. The surgical-site infection measure is new.

Medscape and CMS reported that seven hundred fifty-eight hospitals are losing 1% of their Medicare reimbursement in fiscal year (FY) 2016 because they are in the worst performing quartile in the hospital-acquired conditions (HAC) reduction program.  Hospitals that fell into the lowest quartile this year will forgo about $364 million in Medicare payments during FY 2016, CMS estimated.

A total of 3308 hospitals were subject to the HAC program for the measurement period from October 1, 2015, to September 30, 2016. In FY 2015, 724 hospitals were subject to the HAC penalty. But they weren’t necessarily the same hospitals as those penalized in FY 2016: only about 54% of those facilities were in the penalty box last year.

The HAC program, which was authorized by the Affordable Care Act, is the latest in CMS’ efforts to increase patient safety in hospitals and reduce the amount of needless complications that generate additional costs for Medicare. Since 2009, CMS has no longer assigned patients to higher diagnosis-related groups for billing purposes when they develop hospital-acquired conditions. And, since FY 2015, hospital data on the PSI-90 composite patient safety index has been part of payment determinations under the Inpatient Quality Reporting program.

 

The Palos Patch reported the lawsuit filed against the national for-profit chain HCR Manor Care for the tragic and preventable choking death of resident Gerald McNamara.  McNamara choked on food he was served at Manor Care of Palos Heights in Dec. 2013. His children Helen G. and David Cardwell claim caregivers did not cut his food into small pieces, and did not supervise him while he ate, according to the Cook County Record.

Helen G. and David Cardwell filed a personal injury lawsuit Nov. 23 in Cook County Circuit Court, naming Manor Care of Palos Heights (West) Illinois, Manorcare Health Services-Palos Heights West, HCR IV Healthcare, and Manor Care of Palos Heights Illinois. Also named are Paul Ormond, Caitlyn Casey, HCR Manor Care, Dr. Rathna Yallapragada, Susan Kio, Ngozi Uwadiale, Jill Catherine Hickey, and MLP1, an unnamed nursing home employee.

 

The Albuquerque Journal had an article about a new project involving Fundamental Long Term Care, now known as Hunt Valley Holdings.  Construction is expected to begin on a 68,000-square-foot, 130-bed skilled nursing facility in the Renaissance area, introducing a new type of development to the mix of commercial and apartment uses near the Montaño and Interstate 25 interchange.

The project is being developed by AS Realty Investors of Culver City, Calif., which has developed a small portfolio of medical buildings, and will be operated by Sparks, Md.-based Fundamental Long Term Care, which currently operates four health care facilities in New Mexico.  Fundamental operates about 80 health care facilities in 13 states, including nursing homes, convalescent and rehabilitation centers.

AS Realty and Fundamental did not respond to requests for information, but the city of Albuquerque recently issued a building permit for the roughly $12 million project at 1610 Renaissance NE. The AS Realty website has basic information on the project, which is designed by architect Mark Bixler of Genoa, Ark.

In New Mexico, Fundamental operates the 26-bed Central Desert Behavioral Health Center  in Albuquerque, 117-bed Casa Arena Blanca Nursing Center in Alamogordo, 118-bed Casa Maria Health Care Center and 52-bed Sunset Villa Care Center in Roswell, according to its website.

New Hampshire Attorney General Joseph Foster announced that CNA Timothy Morrissey has been indicted by a Hillsborough County grand jury on charges of simple assault and abuse of a facility patient, elderly Alzheimer’s patient. Both charges are misdemeanors and carry sentences of 2 to 5 years in state prison.

The indictments allege that Morrissey, while working at Bel-Air Nursing Home in Goffstown, “knowingly caused unprivileged physical contact to a 79-year-old resident with dementia” on Oct. 31.  A co-worker allegedly walked in on Morrissey assaulting the elderly resident on the morning of Oct. 31, according to Board of Nursing documents released by the attorney general. The co-worker told Morrissey to stop, and Morrissey reportedly responded by saying, “This is the most embarrassing thing in my life.”

The incident was then reported to a supervisor, who met with Morrissey. He allegedly admitted to the accusations and said, “I know it’s sick – I need help.

WSBTV reported that a hidden camera, installed at Northeast Atlanta Health and Rehabilitation Center, shows World War II veteran James Dempsey’s repeated calls for help were ignored.  Tim Demsey says his father, James Dempsey, was nervous about spending the night at the facility, so the family installed a nanny camera facing the man’s bed. Only his family and his father knew the camera existed, according to Dempsey.

The family of the 89-year-old says he was supposed to be at the assisted living facility for a short time. He died at the facility in February 2014.

“We would have just thought it was natural causes and everything was done that should have been done and he passed away in his sleep,” Dempsey told Channel 2’s Rachel Stockman.  Dempsey says he got the real story when he took the hidden camera home and reviewed the video.

On six occasions in the video from the morning he died, Dempsey can be seen pressing the “call/help light button from his bed.”

He can also be seen yelling, “help, help, help,” and appears to be pointing to his heart.
 
At one point a nurse on the video says, “you gotta stop putting the light on. What do you want now?”
 
A nurse also tells him, “you’re having anxiety that’s all, you just need to calm down.”
 
“You would never thought that people would just let a person die,” Dempsey said.
 
About two hours after the initial call light, the nurses are seen administering CPR for several minutes and then the video shows the paramedics arriving – by then it is too late.
 
“The biggest problem to me is the attempt to cover it up,” said Michael Prieto, who represents the Dempsey family.  The son filed a lawsuit against the facility, which is owned by one of the largest nursing home operators in the country, Atlanta-based Sava Senior care.

“If they made a mistake then a person of integrity stands up and says I made mistake and you deal with the consequences that certainly hasn’t happened in this case,” Prieto said.

NJ.com reported the legislation to improve the treatment and safety inside New Jersey’s nursing homes by setting minimum staffing standards for certified nursing assistants.  Nursing homes would have to require one nursing assistant be on duty for every eight residents on the day shift, for every 10 on the late day shift, and one for every 16 residents on the overnight shift.  The bill targets the caregivers who residents rely on the most to meet their basic needs — from eating, bathing, dressing and administering medications.

 

“Mandating specific certified nursing assistant-to-resident ratios will create more precise, enforceable standards,” said Assemblyman Joseph Lagana, (D-Bergen), one of the bill’s sponsors. “Ultimately, this will raise the bar for the standard of care throughout nursing homes in New Jersey.”

Paulette Johnson, a former certified nursing assistant who is now a nurse, urged the committee to pass the bill because she has seen how patients suffer staffing is short.

“There is no time for casual exchange of thoughts or words of good cheer. They are fed in a hurry, taken to the bathroom in a hurry, and even put to bed in a hurry,” said Johnson. “They either get depressed, get combative or refuse to eat or sleep.”

Human Services Committee Chairman Valerie Vainieri Huttle (D-Bergen), one of the bill’s sponsors, agreed. “Countless studies have shown that higher staffing levels result in higher quality of care in nursing homes,” Huttle said. “This leads to lower mortality rates, improved functioning, less infections, lower hospitalization rates and an overall improvement in quality of life, which is what we all want for our loved ones.”

According to the U.S. Bureau of Labor Statistics, there were 1.4 million certified nursing assistants nationwide whose median salary was $25,000 last year, although some made as little as $18,790. Generally, a nursing aide is only required to have 75 hours of training. Annual turnover in the field is among the highest in any industry – exceeding 100 percent in some years because the work is difficult and pay isn’t competitive,according to a 2004 report by the U.S. Department of Health and Human Services.

 

LOHud had an article on Elant Inc. settlement with NY.  Elant agreed to pay $600,000 after senior managers admitted directing administrators to delay the release of short-term residents to bilk Medicare and Medicaid out of hundreds of thousands of dollars, according to authorities.  Elant admitted that it postponed the release of short-term residents who were clinically ready to leave its facilities between 2008 and 2011. The nursing home chain did this by either holding the residents against their will, or not informing them or their families.

Elant administrators and staff openly discussed ways to delay the release of residents and kept daily resident counts for each nursing home as high as possible, the investigation found. Elant admitted that delaying the release of residents was for financial reasons, and that those with Medicare or Medicaid coverage were primarily targeted, the AG said.

Elant also prolonged short-term stays by giving residents that were kept in its nursing homes additional services that were not clinically necessary, and delayed the completion of discharge paperwork, among other things.

In addition, the nursing home chain orchestrated the transfer of long-term residents to a financially-strapped facility in Westchester County to shore up its finances, the attorney general said. Elant targeted residents with Medicaid coverage for transfer to the facility, previously known as Brandywine.

The investigation into the nursing home chain was conducted by the Attorney General’s Medicaid Fraud Control Unit and New York State Department of Health.

Elant will also enter into a Corporate Integrity Agreement with the Office of the Medicaid Inspector General, which will require an outside monitor to oversee the nursing homes’ activities for several years, the AG said.