USA Today had an interesting article about a new report on balance and aging. “Loss of balance, it turns out, is not just a problem for the oldest old.  Instead — like strength, agility and muscle mass — balance tends to start declining in midlife.”

As we grow older, all of us lose some of our ability to balance leading to falls.  This knowledge allows us to recognize our limitations and prevent falls.  However, elderly resident who suffer from dementia, delirium, or other cognitive issues may not be aware of their limitations and safety precautions.  That is why nursing homes must supervise, care plan, and monitor the effectiveness of the fall prevention interventions used.

The  new findings, published in Journals of Gerontology: Medical Sciences, shows a decline earlier in life than many might suspect, says Miriam Morey, a researcher at Duke University School of Medicine. While all the scores fell from the youngest to oldest age groups, scores on the balance and sit-and-stand tests were the first to fall, starting in the 50s, say Morey and co-author Katherine Hall, an assistant professor of medicine at Duke.

About one-third of adults over 65 fall each year, according the Centers for Disease Control and Prevention. While there’s less fall data on younger adults, studies suggest that at least one in 10 falls each year. Most are not seriously injured, but broken bones and head injuries from falls land about 700,000 people in hospitals each year, the CDC says.

“Balance is not just a matter of how well the vestibular system of the inner ear is working. Declines in strength, flexibility, vision, touch and mental functioning can all contribute to balance problems, says Peter Wayne, an assistant professor of medicine at Harvard Medical School.”

“Balance is a very complicated process,” he says. But improving it can be simple, the experts say. Here are a few tips:

• Practice standing on one foot, challenging yourself to increase the duration. You can do it on line at the grocery store or while brushing your teeth. If that’s too difficult at first, start by using a chair back or bathroom counter for support. If it’s easy, try raising your foot higher or holding it out to the side. For extra challenge, try standing on a throw pillow or closing your eyes.

• Try heel-to-toe walking, as if on a balance beam.

• Practice getting in and out of a chair without using your hands.

• Exercise while standing on a wobble board or Bosu ball (an inflated rubber disc on a stable platform).

• Try tai chi or yoga. The evidence that tai chi can improve balance is especially strong, and studies show it is quite safe for people of all ages and fitness levels. In a typical class, a series of movements is performed in a slow, graceful flow, accompanied by meditative deep breathing.

 

Four employees of Focus Rehabilitation & Nursing Center were arrested for allegedly leaving a 94-year-old resident alone in a recliner for nearly two days, according to Attorney General Eric T. Schneiderman.  LPN Lorraine Caldwell; LPN Amanda Gus; CNA Sarah Schuyler, and CNA Donna Gray face charges they they each failed to provide care to a 94-year-old resident over the Memorial Day weekend this year.

According to Schneiderman’s press release, charges were brought including falsifying business records, endangering the welfare of an incompetent or physically disabled person in the first degree, as well as the misdemeanor charge of willful violation of health laws.

Surveillance camera footage allegedly shows a resident, identified as “M.P,” was left in a recliner for 41 hours, receiving only one meal, one round of her medications and one change of her briefs.  At the end of the 41-hour period, the resident was removed from the recliner, returned to her room and diagnosed with a pressure sore measuring 4 cm x 2 cm.

“Our healthcare workers have a basic duty to care for their patients, to provide required care, keep them safe and not to injure them,” Attorney General Schneiderman said. “My office will bring to justice caregivers who hurt and neglect patients, who ignore the law and safety protocols, and who falsify records to cover up their crimes.”

For over 41 hours over Memorial Day weekend while she was a resident at Focus, resident M.P. was allegedly left in a recliner and received substandard care.  During this period of time, staff members allegedly failed to administer medications and fulfill basic necessities like providing food and incontinence care with the exception of one meal, one round of medications, and one change of her briefs. All of this was captured by a facility video camera.  At the end of the 41 hour period, the resident was removed from the recliner, returned to her room and diagnosed with a pressure sore measuring 4 cm x 2 cm.

 

 

The New York Times had a great article explaining the new Medicare rule enacted this past Saturday.  Medicare does not pay for nursing home care unless the resident was admitted to the hospital as an inpatient for 3 days immediately prior to admission into the nursing home facility.  Hospitals have been keeping patients in limbo — in “observation status” — for fear of being penalized by Medicare for inappropriate admissions. While under observation, patients can be liable for substantial hospital bills, and Medicare will not pay for subsequent nursing home care unless a person has spent three consecutive days in the hospital as an inpatient.

The new rule requires hospitals to notify patients that they may incur huge out-of-pocket costs if they stay more than 24 hours without being formally admitted. Because of the Notice Act, passed by Congress last year with broad bipartisan support, patients can expect to start receiving the warnings in January.
Under the new law, the notice must be provided to “each individual who receives observation services as an outpatient” at a hospital for more than 24 hours. Medicare officials estimate that hospitals will have to issue 1.4 million notices a year.
The median cost for a private room in a nursing home is roughly $92,000 a year, according to a survey by Genworth Financial, an insurance company. Medicare covers up to 100 days of skilled nursing home care at a time.
The text of the standard “Medicare outpatient observation notice” is subject to approval by the White House Office of Management and Budget. In its current form, the notice to beneficiaries says: “You’re a hospital outpatient receiving observation services. You are not an inpatient.” And it explains that Medicare will cover care in a skilled nursing home only if the beneficiary has had an inpatient hospital stay of at least three days.  Patients can then consult their doctors and may ask to be reclassified as inpatients.

The Senate Finance Committee explained the reason for the law this way:

“The number of Medicare beneficiaries receiving outpatient observation care over the last several years has been steadily increasing. Some beneficiaries are surprised to learn that although having received treatment overnight in a hospital bed, the beneficiary was never formally admitted as an inpatient but was instead a hospital outpatient.”

 “Medicare beneficiaries are spending more and more time in the hospital without being formally admitted,” said Joyce A. Rogers, a senior vice president of AARP, the lobby for older Americans, adding that this “can expose beneficiaries to unexpectedly high out-of-pocket costs amounting to thousands of dollars.”

The Washington Examiner reported on the recent push to increase the quality of care and safety at nursing homes by increasing direct care staffing.

A group of 32 Democratic lawmakers wrote to the Obama administration calls on the Centers for Medicare and Medicaid Services to boost staffing levels. CMS should require a nursing home to be staffed with at least one nurse around the clock.  Nursing homes also should have a minimum standard of at least 4.1 hours of direct care nursing time per resident per day. The lawmakers point to a government study that showed harm to residents is unavoidable below that level.

They also want to eliminate mandatory arbitration agreements in admission paperwork.  CMS’ proposed language about pre-dispute arbitration agreements in the regulations will “legitimize and institutionalize a process which is heavily biased against nursing facility residents.”

“Arbitration companies are chosen by nursing facilities, creating a financial incentive for them to side with facilities since they, not residents or their families, are likely to be repeat customers,” the letter said.

Northwest Arkansas Democratic Gazette reported the disturbing influence of Arkansas nursing home owner and operator Michael Morton and the Arkansas Health Care Association which represents the financial interests of the for profit industry.

The nursing homes industry and apologists are pushing to amend the Arkansas Constitution on the Nov. 8 general-election ballot. The proposal would limit trial attorneys to one-third of any damages won in lawsuits against health-care providers and set an arbitrary limit of $250,000 for noneconomic damages such as pain and suffering in lawsuits filed against health-care providers.

They are pouring money into the effort to arbitrarily and unconstitutionally limit monetary awards in nursing home abuse and neglect lawsuits.  Morton through his 31 nursing homes spent at least $125,000 toward the campaign.  Morton did not make any contributions under his own name.  AHCA has given at least $330,000.

The Committee to Protect AR Families opposes the unconstitutional effort.  Martha Deaver, a director on the opposing committee, is also president of Arkansas Advocates for Nursing Home Residents. Deaver said that nursing homes “are spending thousands of dollars in an attempt to take away nursing-home residents’ ‘right’ to hold them fully accountable when they abuse and neglect our most frail and vulnerable citizens.”  Deaver said nursing-home residents, not the industry, are the ones needing protection.

In 2013, Morton’s Greenbrier nursing home lost a negligence lawsuit over the 2008 death of Martha Bull, 76, of Perryville. A Faulkner County jury awarded $5.2 million to Bull’s family, but on July 10, 2013, the presiding circuit judge, Michael Maggio, cut the award to $1 million.  Maggio later was removed from office.  A corruption lawsuit pending accuses Morton and lobbyist Gilbert Baker of conspiring to funnel contributions to Maggio’s judicial campaign in exchange for Maggio’s reducing the $5.2 million judgment.  In January 2015, Maggio pleaded guilty to a federal bribery charge and implicated two other people, a nursing-home owner and a political fundraiser.

The New Yorker had an interesting article about the lack of evidence to support the theory that brain games slow or prevent dementia.   Researchers who study the effects of computerized brain training have published a consensus statement that says playing brain games only really helps one’s skill in the game. “No studies have demonstrated that playing brain games prevent of reverse Alzheimer’s disease or other forms of dementia.”  The Federal Trade Commission fined Lumosity, a website that has brain games, for claiming to improve cognition.

The Advanced Cognitive Training for the Independent and Vital Elderly (ACTIVE) performed a study with almost three thousand participants and $23.6 million in funding from the National Institute on Aging and $10.2 million from the National Institute of Nursing Research. The participants had an average age of 73.6 and they got separated into four groups, randomly. The first group received no brain training and was the control. The second and third group got 10 hours of classroom instruction for improving memory and reasoning. The fourth had speed-of-processing training.

After ten years researchers remained in contact with almost all of the participants, giving some four hours of additional training and they were followed and re-tested, occasionally. After ten years, more than 300 met the criteria for dementia, with the odds varying on which group they had been assigned to. Fourteen percent of those who had not been given training met the criteria for dementia. The speed-of-processing was at 12.1%. Those who got additional training were at 8.2%. The researched concluded that those who had some additional sessions were 48% less likely to be diagnosed with dementia after ten years.

Jerri Edwards, lead author of the new study, has been investigating speed-of-processing for over twenty years at the University of Alabama at Birmingham. These findings are causing the Alzheimer’s Association to change its position. Along with healthy diet and lifelong learning, brain training could prevent dementia although, Edwards’s findings may not be able to be recreated by others.

Below is a great editorial from the New York Times about forced arbitration in nursing home abuse and neglect cases:

“People entering nursing homes need to know that all reasonable safeguards are in place to ensure quality care. But federal rules to be finalized soon fail to hold nursing homes truly accountable to patients, their families or the law.

At issue are arbitration clauses in nursing home contracts that require consumers to settle any disputes that arise over products or services through private arbitration rather than through lawsuits. Corporations of all sorts love forced arbitration because it overwhelmingly tilts in their favor and shields them from liability. But in the process, it denies justice to consumers, investors, patients and others who find they have no legal recourse when wronged.

Forced arbitration is especially problematic in nursing home disputes, which are generally about care, not money. (Medicare and Medicaid pay many nursing home bills.) Typical claims involve neglect or abuse leading to broken limbs, dehydration and untreated pain.

 The proposals, by the Centers for Medicare and Medicaid Services, should have banned pre-dispute arbitration clauses in nursing home contracts. Instead, they basically condone them as long as these homes take some legalistic steps to explain and disclose the clauses and do not make signing them a condition of admission. Those provisions skirt the real problem. Prospective patients do not have the necessary information to make a decision about signing the clauses. How could they before a dispute even arises? In essence, families are being asked to anticipate the likelihood of grievous harm and legal ramifications. A nursing home admission is stressful and confusing enough without your being asked to sign away your right to sue.
 The proposed rule acknowledges “concerns” about forced arbitration and notes that regulators solicited comment on whether the clauses should be banned. A ban is needed — and if nursing home regulators won’t impose one, the White House Office of Management and Budget, which will review the rule before its scheduled release in September, needs to ask for a revision.  If the industry wants to seek private arbitration it should be allowed to do so, but only after a dispute arises, not before.”

ABCNEWS4 reported the tragic wandering death of resident Marie Duddy because of a defective and malfunctioning warning system.  Duddy’s body was found two miles from the assisted living facility May 21 — 28 hours after she was reported missing.  Duddy was allowed to wander away from Savannah Place and was found dead in the marsh on James Island.  The Department of Health and Environmental Control released a report citing major violations at Savannah Place.

One of the citations against Savannah Place noted the facility’s alarm system wasn’t working the day Duddy wandered off the property.

“If you have an alarm system you’re gonna have a regular routine for maintenance to make sure it’s working and apparently it hadn’t been working for some period of time and corrected only after this incident,” family attorney Stephan Futerol said.  “They weren’t able to keep proper supervision of her and of course we all know the rest and how tragically that all turned out,” he said.

Savannah Place knew that Duddy was known to wander and that they needed to supervise her.  If the assisted living facility cannot provide the care and supervision needed to keep her safe, they had an affirmative duty to transfer to a skilled nursing facility that could meet her safety needs.

Section 801., Regulation 61-84, Standards for Licensing Community Residential Care Facilities,
list requirements for individuals eligible for admission and retention in community residential
care facilities.

Section 801.B., states, “The facility shall admit and retain only those persons whose needs can be met by the accommodations and services provided.”

Section 801.C.3., states, “Persons not eligible for admission/retention are: Any person needing hospitalization or
nursing care.”

Section 801.D., states, “Residents whose condition changes to a degree that nursing home care may be required, … shall be examined by physician or other authorized healthcare provider regarding the possible necessity for transfer to a facility where the resident’s eligibility for admission is appropriate.”

Section 801.C.4., states, “Anyone needing the continuous daily attention of a facility staff licensed nurse.”

Section 801.E. states, “When the provision of care/services in the facility, combined with other appropriately licensed services, in accordance with facility policy, e.g., hospice, home health, as may be ordered by a physician or other authorized health care provider, does not meet the needs of the resident, or if any resident becomes in need of continuous medical or nursing supervision, or the facility does not have the capability to provide necessary  care/services, the resident shall be transferred within 30 days to a location which shall meet those
needs.

 

ABC reported the horrible abuse recorded by secret video at Mitcham Residential Care Facility in Australia.  Noleen Hausler had been suspicious about her father’s bruises but lacked proof to back her complaints that he was being abused in his nursing home.  The tiny spy camera she covertly placed in her father’s private room recorded disturbing acts of abuse in just two days.

“I thought I wasn’t being heard and I was suspicious of a certain staff member,” Ms Hausler told 7.30 in an exclusive interview.

“I thought long and hard about how I could actually get the evidence and the only way I could do that was to put in a video camera and film what was going on.”

In the video, Corey Lyle Lucas, Mr Hausler’s caregiver employed by the facility, appeared to violently force-feed Mr Hausler with a spoon, sneeze on him, eat Mr Hausler’s food using his cutlery, flick his nose and pin Mr Hausler’s arms down when he resisted.  The video also appeared to show Lucas attempting to suffocate Mr Hausler with a large napkin.

The abuse she recorded led to Lucas’ conviction for aggravated assault.

Mitcham Residential Care’s response when South Australian Police detectives showed the secret footage to management was to forbid Ms Hausler from any further recordings.

“Instead of offering Noleen empathy, they instead sent her a letter to cease and desist from filming, as if she was the problem,” Adair Donaldson, lawyer for the Hauslers, told 7.30.

 

90-year-old nursing home resident Bonnie Walker was reported missing last Wednesday from the Brookdale Therapy nursing home in Charleston.  The Charleston County Coroner Rae Wooten said on Friday the cause of death of 90-year-old Bonnie Walker was “multiple sharp and blunt force injuries” and an alligator was involved.  Her dead body was found hours later from a retention pond behind the facility that Brookdale knew contained alligators. (There are signs at the pond warning there are gators.) Wooten said Walker’s injuries are consistent with those which could be inflicted by an alligator.

There has been no explanation how the frail vulnerable resident was able to leave the facility unattended and unsupervised.

Earlier on Friday, a spokesman for DNR said a gator was pulled early Friday morning from a retention bond behind Brookdale Therapy.  Sam Chappelear with DNR said officers pulled the gator from the pond.

“We opened it up and we were sure we had the right gator,” Chappelear said. “Any splashing in the water is going to attract a gator, that’s what they go to, they’ll go investigate. They’re an opportunistic feeder.”

According to DHEC officials, they have received four complaints about the Brookdale facility in the past two years.

DHEC released the following statement on Wednesday:

Brookdale Charleston has notified us of a serious incident that occurred at the facility this morning and we have initiated an investigation.

When a serious incident occurs at a facility that we regulate, we initiate an investigation into the incident to see if the facility violated any licensing standards and regulations. After DHEC inspectors complete their investigation, we make our findings available to the public.

We have received four complaints about this facility in the past two years. Those complaints involved allegations of under-staffing, poor sanitation, and abuse. Three of those complaints were investigated. The most recent complaint was received this month and is scheduled to be investigated as well.