You may have seen this heartbreaking photo on Facebook. The woman pictured is 80-year-old Esther Brown, a resident of Altercare Nobles Pond in Ohio.

It has been shared more than 40,000 times and it’s causing concern about the woman pictured.  Julia Wiggins, the family’s pastor, posted on Facebook. “After being inquisitive we approached the subject only to find out that it was Mother Esther Brown face down into a soft pillow gasping for breath and strangling on her own saliva,” Wiggins shared in the post.

Her son’s reaction was almost as heartbreaking as their discovery, as Wiggins writes, “Her son began to cry out that’s my momma and we hurried to her and upon hearing her son’s voice she tried with all her might to raise her head!”

Wiggins claimed they were yelling for help for five to 10 minutes before someone came to assist them.

Her son, James Brown, said they have filed a complaint with the facility about the care his mother is receiving.  The Ohio Department of Health and The Ohio Department of Aging have been notified and are both looking into the situation.

It’s tough enough leaving your loved ones alone. It’s even more difficult learning they’re not being treated the way you’d hoped.

In her Facebook post, Wiggins urged people with family members in nursing homes to keep tabs on them often.

“People please keep a close check on any of your loved ones if they are in these places,”  she wrote.

 

 

The South Carolina House Judiciary committee has introduced a bill called The Vulnerable Adult Maltreatment Registry Act which would require South Carolina Law Enforcement Division and the Department of Social Services to establish a registry of abuse, neglect, or exploitation of vulnerable adults.  Hopefully, this will create accountability and deter the abusive conduct we see so often.

The problem will be funding and maintaining the lists.  SLED and DSS already have their hands full and do not have the resources to properly investigate, corroborate, and resolve issues involving vulnerable adults.

 

The Skilled Nursing News reported a new development from The Centers for Medicare & Medicaid Services (CMS) which recently announced new standards for its consumer-facing nursing home ratings, including a lower threshold for staffing penalties and new separate ratings for short-term and long-term stays.

Starting April 24, CMS will automatically hand out one-star staffing ratings to buildings that have four or more days in a quarter with no registered nurse on site, down from the current seven-day standard.

Nurse staffing has the greatest impact on the quality of care nursing homes deliver, which is why CMS analyzed the relationship between staffing levels and outcomes,” the agency said announcing the new rules for the Five-Star Quality Rating System. “CMS found that as staffing levels increase, quality increases.”

 Staffing issues took center stage in the public discourse around Nursing Home Compare last summer, when the New York Times and Kaiser Health News published an expose on the widespread inflation of nursing home staffing coverage in CMS’s data. In response, CMS slapped nearly 1,400 nursing homes with a one-star rating in the staffing category because they had seven or more days per quarter with no RN hours.

The federal agency also announced in November that it would begin using Payroll-Based Journal data — which replaced nursing homes’ previously self-reported staffing information — to direct state-level inspections of properties deemed to have insufficient staffing.

In addition to these new requirements, CMS will also develop separate quality ratings for short-stay and long-stay residents, and adjust the star thresholds “to better identify the differences in quality among nursing homes, making it easier for consumers to find the right information needed to make decisions.”

While every nursing home resident has their own individual needs and goals, the overarching goal of the short-stay residents is typically aimed at improving their health status so they can return to their previous setting,” CMS wrote in its extended guidance on the new rules. “Conversely, the main goal of long-stay residents is typically aimed at maintaining or attaining their highest practicable well-being while residing long term in the facility.”

 

The family of a sexual assault victim is suing the employee and facility over the horrific incident. The woman and her daughter filed a lawsuit  against Ronald Whisman Jr, Continuing Healthcare of Cuyahoga Falls and the nursing home’s parent company, Continuing Healthcare Solutions Inc. of Middleburg Heights. They are seeking compensatory and punitive damages, as well as attorneys’ fees.

Whisman Jr. was working at Continuing Healthcare of Cuyahoga Falls in June when he had “sexual conduct” with a 68-year-old female patient, according to a Cuyahoga Falls police report.  Another employee told police she opened the patient’s door and saw Whisman’s pants down around his ankles, apparently engaging in a sexual act with the woman.  Whisman originally denied the allegations, claiming he was changing the patient’s diaper.

He later pleaded guilty in November to two felony counts of sexual battery and a felony count of gross sexual imposition and is serving a five-year sentence at Lorain Correctional Institution, according to Summit County Common Pleas Court and Ohio Department of Rehabilitation and Correction records. A first-degree felony rape charge was dismissed when he pleaded guilty to the other charges.  He’ll also be required to register as a Tier III sex offender, meaning once he is released from prison, he will have to register with the local sheriff every 90 days for the rest of his life.

The lawsuit alleges Whisman “was negligent, reckless, willful and/or wanton in sexually assaulting and abusing resident … and defendant Continuing Healthcare, and its employees and/or agents, were negligent, reckless, willful and/or wanton in permitting the sexual assault of [the patient].”

According to the suit, the patient “has been forced to suffer various injuries and damages, pain and suffering, emotional distress, mental trauma, permanent injury, significant and ongoing medical treatment and expenses, and loss of the enjoyment of life.” The suit cites the Ohio Nursing Home Patients’ Bill of Rights, stating the patient had the right to a safe living environment and appropriate medical treatment and nursing care “and to be free from abuse.”

The suit also alleges Continuing Healthcare and its employees “negligently, recklessly, willfully and/or wantonly ignored warnings and complaints, failed to provide adequate supervision, training, guidance, evaluation, discipline and/or monitoring of their employees,” including Whisman.

 

The embattled administrator of Veterans Victory House nursing home resigned.  Sandra Ferguson stepped down and has been replaced with Greg McNeil.  The infractions and fines against Veterans Victory House are in a report by the Centers for Medicare and Medicaid Services.

According to the document, the Veterans Victory House was not in compliance with the Medicare and Medicaid guidelines.  According to regulations, conditions at the nursing home were likely to cause serious injury, harm, impairment or death to a resident or patient.

The report also says Veterans Victory House will not be paid any Medicare or Medicaid claims for newly admitted residents. The federal government is giving the facility until Jun. 14 to comply with the guidelines or face the total loss of Medicare and Medicaid funding.
Veterans Victory House filed 29 reports of adverse incidents at the facility in February alone, according to new data from the Department of Health and Environmental Control.  (Nursing homes are required to file a report when there is a serious injury at the facility although often times many do not get reported).  DHEC sometimes even requires two reports to be submitted for every incident–a 24-hour report and a 5-day report.

The reports for Veterans Victory House list several cases that fall under the category “neglect or exploitation, suspected or confirmed abuse.”

Reports filed by Veterans Victory House staff in February also include two instances with a category that uses terms like “severe burns,” “lacerations,” or “severe injuries that could include medical equipment malfunction or misuse.”

The Dayton Daily News reported a horrific story of a sexual predator in nursing homes for 18 years.  Michael W. Schneider was charged with rape accused of raping a non-verbal, bed-ridden nursing home patient more than 18 years ago.  Documents obtained by the Dayton Daily News allege the accused man told his girlfriend he committed the same crimes against at least two other women during the same time period.

Schneider’s girlfriend told Detective Levi Wells that “Schneider recently confided in her that while he was a nurse’s aide at Cedar Village about 20 years ago, he sexually assaulted three, separate, elderly women,” Wells said in the affidavit.  Wells then located two police reports “from that time frame outlining abuse of patients directly under Schneider’s care, one of which had the same condition Schneider had disclosed” to his girlfriend.

Schneider remains in jail charged with two counts of rape involving one patient at the Cedar Village Retirement Community in July 2000.  According to an affidavit filed with the search warrant, Schneider was arrested on Feb. 27 after Mason police investigated “a tip from the FBI about a confession of a health-care worker who admitted to sexually assaulting three women at a facility in Mason about 20 years ago.”

In the affidavit, Wells said he also obtained a recording of Schneider admitting to the sex crimes.

“On the recording, he also admits to wanting to have sex with children,” Wells said in the affidavit.

 

Phyllis Ayman worked as a speech-language pathologist in more than 40 skilled nursing facilities. She has a certificate as a dementia practitioner and consults with individuals and families seeking nursing home placement for themselves or their loved ones. Her website is www.voiceforeldercare.com.  She recently had an article for McKnight’s about decreasing the use of anti-psychotics medications as a way to treat dementia. The article considers the underlying causes of the behaviors presented and alternative methods of management.

“An April 2018 article by Lois Bowers in McKnight’s Senior Living titled “Antipsychotic drug use increasing in assisted living, AARP says” cited the growing off-label use of antipsychotic medications for individuals with Alzheimer’s disease and dementia who reside in assisted living communities or in the greater community. The percentage of people aged 65 or more years who were prescribed antipsychotic drugs increased by more than 6%, from 12.6% to 13.4%, between 2012 and 2015.

This growth is in direct conflict with the National Center for Assisted Living’s goal to reduce off-label antipsychotic use by 15% between 2012 and 2013 as well as between 2015 and 2018.”

“As we know, Alzheimer’s disease is progressive and manifests itself in decline in several areas: behavior, communication and physical abilities. We may be able to view it on a kind of bell curve in which the decline in function begins with the last-learned, highest-level behaviors or abilities and regresses to those that are first learned.”

“It may help us understand the frustration an individual may be experiencing with decline or loss of communication ability in Alzheimer’s disease and dementia if we draw an analogy to any person experiencing a paucity or loss of language, whether it be developmental or the result of a disease process or sudden onset. The stroke or brain-injured resident who is at a loss for words due to aphasia, the child who has not developed sufficient language to express himself or herself or is unable to interpret his or her own behaviors sufficiently to put them into words.”

“Continuing this way of thinking, the same communication strategies we apply to those children or other populations experiencing loss of language may benefit the adult who is exhibiting behavioral or communication issues associated with Alzheimer’s disease or dementia. We should be responding to what we think is the need or emotion behind the behavior, rather than the behavior or the words that we are seeing or hearing. In doing so, we could adjust our response to meet the person at his or her level. This may include a combination of physical, gestural and verbal strategies.”

“As with any other person, child or adult, with reduced language, it may take several attempts to determine the underlying cause(s) of the behavior being exhibited.”

“Areas for consideration:

  • What are the antecedents of those behaviors?
  • What environmental or social factors are reinforcing or prompting the behavior?
  • How is the environment structured, and what role is that playing in the behavior?
  • What are the consequences to that behavior, or what effect might they have on perpetuating or continuing the behavior?”

Strategies that may be needed to address behaviors, depending on the behavior and the person’s cognitive level of functioning:

Communication: This may include adjusting the tone of voice, volume or intensity of voice. In addition, explanations or questions are best understood if they are short and simple. This actually serves a twofold purpose. Firstly, too much information and long sentences can be overwhelming and add to the person’s sense of confusion and frustration.  Secondly, in the event the information has to be repeated, it can save the caregiver time and energy. Repeating the same information over and over can be exhausting. Save yourself, and the listener. Redirecting attention to another activity or idea can also be helpful. The use of music can be a great tool for the individual to facilitate communication, engage with the environment and calm behaviors. Consider contacting musicandmemory.org which is a non-profit organization that provides training for using the Music and Memory program.

Physical: Physical comfort, a tender touch of the hand or hug, a gentle smile or kiss, looking a person in the eye and reassuring them you love or care about them can go a long way in helping an individual feel more calm or relaxed. Sometimes something as basic as providing something to eat or drink goes a long way in quieting or soothing behaviors. Note that as the disease process progresses, in many cases there is a preference for sweeter food items. Behaviors may also be a signal that a person is cold or hot; consider offering a sweater or blanket or removing particular articles of clothing.

Environmental: Changing the individual’s immediate surrounding. For example, going for a walk down a corridor, looking at the trees, birds or the weather outside may have a calming effect. It is also important to observe the environment for sudden changes: disruptive or intrusive behaviors from others, a sudden loud noise, etc. A feeling of boredom can be addressed by engaging the person in a familiar every day chore or activity that they used to do to give them a sense of purpose or usefulness. Music also plays a large role here. Too much, too loud, or music not suited to an individual’s interest or cognitive level can be jarring.

Setting expectations

What is the standard of behavior that we are expecting? If we continue to provide the same environments for individuals with Alzheimer’s disease or dementia, then why would we expect to get a different result?

Consider the example of many workplace environments that are designed to maximize the desired level of productivity or behavior while creating a happy and satisfied workforce. Thus, the physical environment is an essential ingredient to attempting to determine the underlying causes of particular behaviors.

Memory books

Memory books can serve an important purpose. Spending time with the person’s family and friends, as well as the individual, in finding out what is relevant to the person, and then spending time creating it, can be a valuable tool for the individual to reminisce and find comfort in familiar at those times when the person feels uneasy or confused in the surroundings. It helps him or her connect with the friends, family members, activities, places, accomplishments, he or she used to enjoy.

Memory books can be created by speech-language pathologists or recreation specialists or in consult with family members. Doing so can be especially valuable to those who no longer are in the comfortable surroundings of their own home environment.

Finally, the need to understand the causes that trigger behaviors and to provide the appropriate environment and training, including empathy and communication strategies, should be considered essential as we continue to care for individuals with Alzheimer’s disease or dementia in any setting. These could be enormously helpful in reducing the use of antipsychotic drugs whether in assisted living communities or skilled nursing facilities or the greater community.

 A hearing was held April 2 in the Senate Judiciary Committee. The Republican majority called for the hearing, representing an important step in demonstrating to the American public the ubiquity of forced arbitration clauses.

The victims who attended represent those who are discriminated against for taking leave of employment to serve in the U.S. Reserve Forces; sexually assaulted at work; small business owners trying to dispute charges with financial service corporations; or defrauded by for-profit student universities, among others.

Below, you’ll find a short compilation of remarks from Senators Graham (SC); Booker (NJ); Ernst (IA); Durbin (IL); and Klobuchar (MN); plus, remarks from Navy Reservist Kevin Ziober and Professor Myriam Gilles (Benjamin N. Cardozo School of Law).

The legislation to end forced arbitration, called the Forced Arbitration Injustice Repeal (FAIR) Act, has been introduced in each chamber of Congress. Currently, there are 177 House cosponsors and 35 Senate cosponsors.  Please use this link to email your member of Congress to support the FAIR Act. I encourage you to also watch and share the forced arbitration video, which is posted on the AAJ Facebook page, www.Facebook.com/JusticeDotOrg.

Massachusetts Attorney General Maura Healey announced settlements with seven nursing homes over systemic failures that led to five residents’ deaths and several injuries.  The failures identified by Healey’s office include allegations of staff ignoring serious injuries that led to two residents bleeding to death. They also include a fatal medication error, failure to treat residents with histories of substance abuse, and allowing a resident with a history of wandering to escape from a locked, supposedly secure unit.

Healey’s office said it weighed the evidence and determined civil enforcement was the best way to improve safety and quality in these nursing homes.  The settlements impose fines on the nursing homes ranging from $30,000 to $200,000. Five of them will be required to upgrade staff training and policies, conduct annual audits of their progress, and report that progress to the attorney general’s office for three years.

One company, Synergy Health Centers, has been banned from operating any taxpayer-funded nursing homes in Massachusetts for seven years.  Synergy is a troubled New Jersey company that started buying Massachusetts nursing homes in 2012 and quickly ran into problems with serious patient injuries as it bought 10 more facilities.

Candi Hitchcock, whose mother, Betsy Crane, died in one of the cases, said she is still grieving her mother’s horrific death. Crane, a resident at Beaumont Rehabilitation and Skilled Nursing Center, fell at least 19 times because staff failed to adequately intervene. She died after the 20th fall. “She was my best friend, and our family had to watch her bleed out from head trauma over 10 days and die an unnecessarily painful death,” Hitchcock said.

Hitchcock said she discovered her mother bleeding from her head hours after that fall in late July 2015. Hitchcock said she pleaded with nurses for help, and eventually one applied a Band-Aid. But the 89-year-old woman complained of not feeling well and staff eventually sent her to the hospital. By then it was too late. The internal bleeding was too great.

 

The Sentinel & Enterprise reported on patient acuity in Massachusetts but the issue is nationwide.  Nursing homes in Massachusetts are caring for residents with more complex medical needs while patients who used to be admitted to facilities are instead being cared for in their own homes or at an assisted living facility.  However, the trend creates staffing problems because nursing homes are losing “less complex” residents and treating residents with “much more complex” medical needs that require additional resources including staffing in nursing homes.

At the Joint Ways and Means Committee budget hearing, Health Policy Commission Executive Director David Seltz said patients released from hospitals who previously would have been admitted to nursing homes or rehabilitation facilities are instead being treated in their homes. One in four nursing homes have occupancy rates of 80 percent or less, which is “not sustainable,” and the average occupancy rate is 86 percent.

“That’s a good, positive trend because it’s treating people in the most appropriate setting and using technology and visiting nurses to do this,” Seltz said.

Industry officials say nursing homes are “facing a crisis,” as Damian Dell’Anno, co-founder and CEO of Next Step Healthcare, put it in a Feb. 26 op-ed.  The industry is facing severe financial and demographic challenges that have led to “cutting corners” and shortages in staffing or substandard training that is affecting the level of care seniors receive.