The website Nursing Home Compare, published by the Centers for Medicare & Medicaid Services, is a resource for researching nursing home options for loved ones. The number of falls that lead to injury are a critical category of concern for nursing home residents, however, a University of Chicago researcher has found that the data used by Nursing Home Compare to report patient safety related to falls is highly inaccurate.

“This is a substantial amount of underreporting and is deeply concerning because without good measurement, we cannot identify nursing homes that may be less safe and in need of improvement,” Sanghavi said.

Falls are a leading cause of death among the over-65 population, and they can lead to other serious injuries. Patients become fearful of walking again for fear of reinjury, yet falls are considered widely preventable. They are a discrete event that is easy to identify and record, compared to other clinical conditions on Nursing Home Compare such as pressure ulcers or infections, so there should be a wealth of reliable data.

“That’s why falls are a patient safety measure on Nursing Home Compare,” Sanghavi said. “They reflect how well a nursing home does at preventing these injuries.”

Nursing Home Compare has faced prior scrutiny for using self-reported data. Sanghavi’s own research was sparked by a 2014 New York Times investigation into serious deficiencies found in nursing homes rated five stars by Nursing Home Compare.

“I found it odd that Nursing Home Compare would use self-reported data,” she said. “Having worked with Medicare claims data, I thought I could use it to study MDS reporting. The Medicare claims we used are hospital bills. They want to get paid and should not have an interest in nursing home public reporting. That’s why they are a more objective source than the self-reported data from nursing homes.”

Based on her results, Sanghavi suggests that the Centers for Medicare & Medicaid Services change their evaluation criteria for falls on Nursing Home Compare.

“They should use an objective source, like claims data,” she said. “It should be relatively easy for them to do, since they already have the data. There are other claims-based measures already used on Nursing Home Compare.”

When Krysten Schmidt visited her grandmother at Premier Genesee Center for Nursing and Rehabilitation nursing home, an aide quietly pulled her aside to share there were maggots on her grandmother’s foot.  Schmidt said that if it hadn’t been for the aide, she might never have known that maggots – fly larva that look like small worms – were infesting her grandmother’s leg wounds at Premier Genesee not only that day but also four days earlier.

Two nurses who responded to Schmidt’s demands for an explanation downplayed the maggots, the granddaughter said.

“My mother had just arrived for the visit and took off the shoe and sock and three or four maggots fell to the floor,” Schmidt said. “They proceeded to tell me the maggots were in her shoe and not her sock. I mean, does it really matter? Are maggots supposed to be anywhere? They were trying to downplay it.”

Later that same day, Schmidt said, she filed a complaint with the state Health Department, which initiated an investigation in early October.  Staff at Premier described the Sept. 25 incident to a state Health Department investigator in graphic terms. On Mary Ellen Sharp’s left foot, there was “something wiggling between her toes,” a nurse’s aide told investigators.  In the state investigation report, the director of nursing told an investigator that the licensed practical nurse who initially discovered the maggots has been banned from working at the facility “for lack of nursing supervision notification.” The licensed practical nurse, however, told the investigator she not only recorded the incident in Sharp’s file, but also informed a registered nurse and tried “many times” to alert the nursing supervisor by phone, pages and texts, but could not reach her. The state cited Premier Genesee for violations but incredibly did not fine the nursing home.

An inadequate pest control program to prevent flies from entering and spreading maggots at the 160-bed nursing home was cited by the Health Department as the culprit.  A maggot infestation on a nursing home resident’s body is a very disturbing violation of minimum care standards.  An adequate pest control program includes making sure screens remain properly fitted in windows and eliminating gaps in doors to block flies from entering, making sure bug light traps are plugged in and that monthly recommendations for repairs from a pest control company are promptly addressed.  The best intervention would be to care for and treat the resident’s wounds every shift.

The state cited other problems:

• An unsanitary situation occurred when a wound doctor, after treating one of Sharp’s wounds, failed to place a dressing on it. For hours, the wound was openly exposed, making it a target for flies.

• Officials at the nursing home failed to comply with a federal regulation requiring they immediately notify a physician and relatives when there has been a change in a resident’s condition.

• Breakdowns in communication among employees, ranging from the nursing staff to maintenance workers.

“What happened is inexcusable and horrifying,” said Lindsay Heckler, supervising attorney at the Center for Elder Law and Justice in Buffalo. “Had staff followed basic standards of care and timely notified the physician, maggots would not have infested the resident’s leg for additional multiple days. Maggots should not have infested her leg on Sept. 21, and the resident should not have been left to suffer from further infestation.”

“You don’t really think it could be true or it could ever happen,” Schmidt said of the maggots. “How would anyone feel having that happen to a loved one?”

 

 

As we all know, abuse and neglect are rampant in the industry.  Skilled nursing facilities are also required to notify federal and state agencies of potential abuse and neglect. Allowing facilities to self-report and then refusing to punish them when they cover up incidents increases the likelihood that abuse and neglect will continue.  Reports of nursing home staff slapping patients, calling them names, and leaving them in their own filth all day are made to law enforcement but are not reported to state and federal agencies obligated to investigate.

NBC26 I-TEAM compared police reports at PruittHealth nursing home with federal reports over the same 12-month period. What they uncovered is reports going to law enforcement are often for “information only” whatever that means. For example, one resident called the police after laying in his own waste and filth for over 9 hours but the report is listed as “info only” and the officer immediately closed the case. It was never investigated as neglect. There was no investigation.

The news is shocking because neglect is a punishable offense like abuse. Staff is required to report those allegations to law enforcement. In fact, a staff member called police after Glenn made a similar complaint about lying in his own waste for too long the previous year. Staff member stated she “wanted the incident documented.” But like the other one, this was listed as information only — not neglect.

We looked 12 months of police reports. In one report, a nurse allegedly hit and slapped a patient with pressure sores. It’s listed as a medical complaint. In another, an employee allegedly berated a patient, calling her “ugly ugly” while taking picture to show her just how ugly she is. It’s information only, too.

More than half of these 28 reports are information only.

Federal complaint investigations were compared with local police reports. None matched each other. This isn’t just a local problem. Last year, the inspector general determined nursing homes across the country aren’t reporting potential neglect and abuse. Nursing homes are graded partially based on these investigations.  Every agency is looking at the other agency to investigate.

Crimes Against the Vulnerable and Elderly (CAVE) made its first nursing home arrest last year. CAVE operates on the Georgia side. South Carolina has no such task force.

 A convicted serial killer who spent nearly 30 years behind bars walked out of a federal prison and will live in Fort Mill, S.C.  Catherine Wood worked as a nurse’s aide at the Old Alpine Manor nursing home in Michigan when she and Gwendolyn Graham, murdered five women ages 60 to 98.  It was reported that the serial killer duo even chose their victims by their last names, wanting to spell out the word murder with their initials.  All of the victims suffered from dementia or Alzheimer’s disease.

The case in 1987 made national headlines, and her victims’ families said her future neighbors in York County should be very worried. They did not mince words, saying they believe Wood may kill again.

“I feel sorry for the people who have to live around her, quite frankly,” said John Engman. His mother-in-law, Mae Mason, was one of those murdered. “I think she is a danger to society. I would certainly think they (authorities) are going to keep an eye on her — at least for two years. But after that, she can go wherever she wants.”

Wood testified that Graham suffocated the victims with washcloths and she acted as a lookout. But investigators believed Wood was more involved, and there could have been as many as a dozen victims.

Graham was serving a life sentence without the possibility of parole, but Wood walked out of a federal prison in Tallahassee, released over the objections of families of the women she helped kill, fearing she’ll kill again. She served nearly 30 years for her second-degree murder conviction.

The parole board had denied Wood’s release eight times before, finding she was a potential danger and wasn’t remorseful.

Retired Walker, Michigan Police Sgt. Roger Kaliniak, who helped investigate the murders at Alpine Manor Nursing Home in 1987, fears the 57-year-old Wood will kill again.

“She’s a serial killer and she could do it again, and most of them do,” he said. “I believe that Cathy Wood was the mastermind, she was the one that was pulling strings on Gwendolyn Graham. Gwendolyn Graham handled the dirty work and Cathy Wood was the brains behind it. ”

The South Carolina parole board said the terms of Wood’s parole will keep her away from the elderly, children and vulnerable adults. But her parole ends in June 2021.

“My fear is that she will find some old person, old people, incorporate herself into their family, take their property, take their lives and move on and do it again,” Engman said.

Graham and Wood, dubbed “The Lethal Lovers,” worked together to smother the five patients as part of a lover’s pact, according to the New York Times. It’s those salacious details that led to the case being featured on Oxygen’s “Killer Couples” in 2014. The channel provided an episode description saying, “A pair of female serial killers turn a nursing home into a hotbed of sex, scandal, and murder.”

Two years later, Graham and Woods were the inspiration behind a 2016 episode of “American Horror Story,” where two fictional nurses named Miranda and Bridget decide to kill their patients.

The case was also the basis of the 1992 true crime novel, “Forever and Five Days: The Chilling True Story of Love, Betrayal and Serial Murder in Grand Rapids Michigan” by Lowell Cauffiel.

An overview of the book reads in part, “Wood and her lover, Gwen Graham, make a pact to kill those whom they were hired to care for. No one notices when an elderly person dies a quiet death, but as these two slip deeper into their plan, the terrible secret becomes unbearable.”

The website Skillednursing News.com had a conversation with a nursing home therapist about the new reimbursement model Patient-Driven Payment Model (PDPM). The early takeaway from PDPM is the effect of therapists who work at skilled nursing facilities.

Almost instantly after the PDPM shift on October 1, Skilled Nursing News received a flurry of e-mails from therapists who were laid off or saw their hours reduced as providers adapted to the new system — which bases reimbursements on resident acuity, and not the volume of services provided.

The federal government framed the shift as a way to reduce the unnecessary provision of therapy minutes for financial gain, which officials asserted was all too prevalent under the previous Resource Utilization Group (RUG) system. But experts, consumer advocates, and therapists claim that operators are cutting therapy services to the detriment of resident outcomes.

One of the therapists who sent in concerns to SNN’s inbox agreed to take part in our regular Confessions series, a Q&A feature that offers players in the post-acute and long-term care space an anonymous platform to express their opinions.

Tell me about your experience with the PDPM shift.

I’ve worked mainly the past 10 years in nursing homes — primarily the same nursing home, basically. But in 10 years, even though I’ve been in the same nursing home, one, two, three, four different employers have come and taken over the therapy. I think that seems to be common with with therapy departments —they lose contracts with national companies, or they go in-house, and it just switches around.

There’s always changes with Medicare; over the past 10 years, there’s been Medicare changes, but it’s been sort of a gradual decline. We haven’t had a pay raise since 2011.

The company has changed, like I said, four different times. So there’s been a deterioration — you’re not going to get a raise, but we still want you to do more. And then there’s obviously been some big changes — PDPM, and there’s probably more to come.

People have been laid off as the companies changed. People have lost their jobs — like a few here, and then a few in the next round of changes, and then I lost my job with PDPM.

How many other people lost their jobs, or had their status change?

I think it was just me this time. When we changed, some people left on their own, and with PDPM, we had one person elect to leave because PDPM also coincided with the change of company again. It was kind of: Two things happened at the same time. This all happened the beginning of October.

Walk me through how your bosses conducted the PDPM transition from your perspective — over the last 18 months, a lot of leaders told me about their plans for the change, but what did it functionally look like on the ground?

From my perspective, we started 2019 with the big national company, and they were preparing us with webinars, and then they’d do teleconferences. [It was] mandatory — everyone would sit around the phone and listen on about what changes they were going to make.

But then, in the springtime, that’s when we went in-house. And once we went in-house, they didn’t prepare us. They just didn’t have any in-services for us, or tell us anything about it. And then I guess it was around October when we were no longer in-house; another company took us over, a smaller company. At that point, they just told us to do group.

And then they also said to do concurrent. This has been the main push, that you have to do groups, and they want you to do concurrent. We used to do that 10 years ago — we were doing that, and then we were told not to do it, and now we’re being told to do it again.

What sort of justification is being given for these shifts? In theory, PDPM is supposed to allow therapists to tailor their services more closely to residents’ needs, but I have heard anecdotal stories about therapists being told to hit certain thresholds.

It seems to be that we just need to do it and we’re not told why. Ten years ago, we did groups because we just had a lot of patients. We didn’t have a lot of therapists, and I suppose it was an economic factor.

We do groups in rehab, because the focus is more that it’s socialization, and you’re going to have a topic, and it’s very well planned — whereas skilled nursing has always been difficult. You can’t always schedule your day; it’s hard to schedule a group sometimes, because people don’t want to do it all, you know, at 11 o’clock. They’re not ready.

It’s just now we don’t have as much time to schedule our patients as you do in acute rehab.

From your standpoint, do you think PDPM will achieve the goals that the government has laid out for it? For me, it’s hard to reconcile the two main opposing forces: the government saying the old system encouraged fraud, and the many therapists reaching out to me saying the new system is just making it worse in different ways.

I agree that the RUG system was just taking minutes. Fortunately, the facility I’ve been in the past 10 years, we didn’t keep people 100 days just to keep them. I mean, there was pressure, if it was the last day of their ARD and they couldn’t get their minutes, you might be asked to go back because they would lose out on money that they’d been working on for weeks up until that point. There was pressure like that.

But PDPM should be a good thing because they’re running out of money, and we don’t want to be giving services [that people don’t need]. And I know there are nursing homes that just keep people 100 days and give them lots of minutes of therapy when it’s not appropriate.

So I think it’s a good thing, but my concern is that because the money is running out, it’s our problem. It becomes our professional problem, because I think nurses are getting raises — and they’re working within the Medicare system. And the CNA is getting a raise. But because therapy is not making money, we get directly affected in our salary. There’s less emphasis on in-servicing about patient care, and more in-servicing about which code to use — and telling us that we need to do more of the administrative [work].

We don’t have a rehab tech, so we have to scan our documents and do all this extra [work] because they don’t have money, I guess, to pay for a tech to help us to transport or to do these things. We used to have a tech — 10 years ago, we had two of them.

So yeah, I think PDPM is good, but it’s bad how the companies are reacting — and they just take everything out on us. I don’t think they’ve had a pay cut, whoever is the director of the companies, or the director of the nursing home; they’re getting a cost-of-living increase, or they’re probably getting a raise, but we’re not.

It’s all the small little things that make you feel like you just are being erased, and you’re not valuable to them because you’re not making money anymore.

In the wake of the change, there’s been a sort of feeling that layoffs were inevitable, or that companies should have cut even more jobs just based on the math — but even more so than in other industries, you are dealing with people’s lives.

I’ve worked in health care enough to know that you have to change. They’re always changing their focus in rehab to where the money might be.

Twenty years ago, I was in acute rehab, and they all of a sudden started a vent unit because I think it was going to be something they could get money from. The focus wasn’t: “Oh, we have a lot of people on ventilators that need to be weaned.”

Maybe I’m cynical, but it has to be driven by: “Can we make money off this type of care?”

Is there anything else that you want leaders in the space to understand about your experience and the state of therapy today?

Residents and family are seemingly unaware of the changes. They don’t seem to know that they’re in a group because there’s been changes to Medicare and their length of stay is going to be shorter.

If the executives have any plans of educating Medicare recipients and family so they don’t expect their mom to get, you know, an hour of therapy — they might get 30 minutes — not to make big promises anymore about therapy, because we’re stretched too thin.

I saw an interesting story that raises moral, ethical, and legal issues related to dying with dignity and chocie.  What do you think?

On April 5, 2018, Andy Jurtschenko went into surgery at Newark Beth Israel Medical Center in New Jersey.  He needed a new heart but instead Andy suffered extensive brain damage due to a lack of oxygen during the heart procedure.

As one of the top 20 programs statistically across the nation, Jurtschenko felt safe in Newark Beth Israel’s hands especially Dr. Mark Zucker, and the main surgeon, Dr. Margarita Camacho. The program is nationally known for maintaining a high success rate while taking on the sicker and riskier patients, operating on older, overweight, and those who have had regular visits to the intensive care unit because of their hearts.

For a single heart transplant, a hospital usually bills insurers around $1.4 million, and the better survival rates look to the public, the more patients that will choose to receive treatment at the facility. This business mindset forces transplant teams to look at patients not as humans, but as “percentages” and “numbers”.

A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating.  A DNR order is created, or set up, before an emergency occurs. A DNR order allows you to choose whether or not you want CPR in an emergency. It is specific about CPR. It does not have instructions for other treatments, such as pain medicine, other medicines, or nutrition. The doctor writes the order only after talking about it with the patient (if possible), the proxy, or the patient’s family. Families order DNRs for multiple reasons. Sometimes a DNR is the obvious choice. It would preserve a patient’s dignity and reduce the amount of suffering the patient and the family will have to endure throughout the process.

Before a heart transplant surgery, a patient is not able to have a DNR in their file because the new heart may require stimulation to begin to pump, but after surgery, a patient or surrogate can ask for a DNR at any time and it must be sign by the physician and placed in their medical record.  It is a numbers game rather than a moral dilemma.  So when the Jurtschenko family requested a DNR for Andy, the doctors refused to sign.  On the morning of Oct. 31, 2018, Andy Jurtschenko passed away from a weakened heart after a long six month unnecessary battle between his value as a statistic and his doctors in the Newark Beth Israel’s hospital over his request for a DNR.

In the case of Andy Jurtschenko, a DNR could have reduced the suffering he and his family experience, but because his death would lower the program’s one-year survival rate, it could be assumed that doctors convinced the family that he would make a full recovery in the future.  It was not until Andy Jurtschenko was admitted into a nursing home where they caught the mistake that he was not supposed to be resuscitated, meaning the hospital never placed the DNR request in his record.

 

 

 

 

 

EHR systems can track a patient’s vital signs, prescriptions, and health records, forcing the medical profession into a new era of electronic healthcare. With the advancement of technology, major medical corporations are starting to switch over to an electronic healthcare record (EHR) system that may increase efficiency in the health care market but several issues have been raised in cases where the new system has failed resulting in death. This often happens in nursing home cases that we prosecute.

In reviewing state and federal court filings about EHR wrongdoing, Kaiser Health News (KHN) and Fortune found around 24 cases of safety and installation concerns. In the case of Midwest Regional Medical Center in Oklahoma, doctors were finding the device unable to accurately track specific drug prescriptions and dosages correctly, creating the possibility for a major health and safety concern with their patients. This suit claimed that the hospital chain based out of Tennessee gained millions of dollars in the promised government subsidies by fraudulently covering up and ignoring flaws in the EHR systems from the Oklahoma hospital. Other suits claimed that corporations knowingly falsified government-mandated reviews, put in place to ensure the patient’s safety, just to receive federal subsidies. KHN found that nearly 28% of doctors and 5% of hospitals who claimed to have met government standards failed later audits to the system.

These systems were created and encouraged by the health care industry to eliminate medical errors that are caused by stupid mistakes or false documentation. Congress, in 2009, granted subsidies from $44,000 to $64,000 if they switched to this new electronic system and completed an “open book test” on the program. In order to receive the funding promised, doctors and vendors have turned towards “doctoring” their programs in order to receive certification. And this is only the start of the fraudulent system.

Corporations such as Community Health Systems (CHS), Medhost, and eClinicalWorks deny any allegations brought to court, reaching million dollar settlements without admitting any wrongdoing.

It’s a new era of health care fraud. Hospitals and doctors going unchecked and are putting their patient’s lives at risk for a big payout. In the end, the ones suffering from this fraud are patients, and it is up to whistleblowers and federal offices to enlighten the world on the abuse of power from doctors, hospitals, and corporations alike.

 

The shortage of nursing home workers is caused by low pay, the working conditions at many nursing homes, and the lack of benefits especially health insurance. Nursing home work is harder than most; it involves lifting, bathing, cleaning up after our elders who can’t manage on their own so well anymore. Another reason is that workers have plenty of other options to work for minimum wage. Nationally, just 3.5% of the workforce is unemployed, the lowest in roughly 50 years.

Nursing homes are desperate for staff at all levels, from registered nurse to certified nursing assistant, a job that doesn’t necessarily even require a high school diploma.  For nurses, it’s scary to have so few of them on each shift, and many flee to work at places that aren’t so understaffed.

The economy will decline and shift in favor of nursing home employers, but demographics will exacerbate this particular staff shortage for at least a decade or two. Soon, the huge generation of Americans born in the baby boom after World War II will start entering nursing homes. The later generations that make up the work force are smaller, and therefore the ratio of people of nursing home worker age (18 to 64) to senior citizens (65 and older) has shrunk rapidly.

Meanwhile, lobbyists are pushing a bill that would require “safe staffing” levels at all nursing homes.  Most experts and consumer advocates contend that a minimum of 4.1 is needed for safe staffing.

 

 

Hidden cameras should be allowed in nursing homes to protect residents; prevent fraud; and to monitor the effectiveness of treatments. Recently, I read a tragic story about the abuse and neglect suffered by Skip MacNally, a resident of Peak Resources nursing home.

Her daughter, Renee Herwin, had suspicions about the care her 86-year-old mother, Skip MacNally, was getting at the nursing home in Cherryville, N.C. So, she decided to install a hidden camera to find out. She immediately discovered disturbing video of staff at the nursing home abusing her mother.

“I put the camera in on August 28. On August 29 I had a video of abuse,” she said. She had a second video within 24 hours of installing the camera.

The first video shows a nursing assistant yelling at MacNally—who is blind and suffers from Alzheimer’s disease—while changing her. In the video, you see the nursing assistant go from yelling at MacNally to violently moving her across the bed while changing her. MacNally cries out in pain several times over the course of the video.

“Have I done something?” MacNally asks the nursing assistant towards the end of the video.

“Devil’s wife,” the nursing assistant responds.

Herwin expected the hidden camera to capture evidence of her mother not being properly fed or going long periods of time without being checked on. She didn’t expect to find her mom being violently abused by staff.

A DSS report shows a social worker confirmed MacNally was abused but indicates the social worker didn’t even open an investigation. Fortunately, the police investigated and a detective wanted to press charges. But then the unthinkable happened.

“Well, he called me about four days later, told me the (assistant district attorney) was not going to file charges. I didn’t understand,” Herwin said.

To date, no charges have been filed against the employees in the video.

Herwin called WBTV in hopes the story of what happened to her mother would draw attention to a system that has lax regulation and little oversight.

“They need to have consequences for their actions! If you don’t have any consequences, it’s just going to continue to get worse,” she said.

 

How can you trust numbers when they are self-reported and directly affect the rating of the nursing home?  A new study proves that nursing homes do not report quality measures such as falls. University of Chicago researchers found 150,828 major-injury falls that occurred at nursing homes were reported in hospital claims. Just 57.5% of those were reported on the MDS item (J1900C) used by Nursing Home Compare.   Falls data used by the Nursing Home Compare website “may be highly inaccurate,” says researchers whose new study shows that nursing homes fail to report major-injury falls.

The study assessed the accuracy of nursing home self-reporting of major injury falls on the MDS. Researchers used data from Medicare claims between 2011 and 2015 for the investigation. The data was then compared to MDS 3.0 assessments submitted by providers during those same years.

About 62.9% of major-injury falls were reported for long-stay residents on the MDS item, while 47.2% were reported for short-stay residents. Findings also showed that major-injury falls in white residents were reported at a higher rate than non-white residents — 64.5% compared to 37.4%.

“Our study indicates an urgent need to assess the value and limits of patient safety measurement that is based on the MDS. Given the amount of research that has been based on the MDS, it may be important to revisit some of our understanding of nursing home quality of care,” the authors wrote.

Full findings were published in Health Services Research.