Rowenna Carlet Cann, a nurse’s assistant at the Willows of Wildwood, was recently arrested for an alleged attack on a dementia resident.

Cann’s coworker saw her kick the 81-year-old man who is  “nonverbal,” according to an arrest report from the Wildwood Police Department. The man had tried to get away from Cann, but she pursued and then kicked him. Prior to that she struck him three times on the shoulder.

Last year, a staffer was arrested in an attack on a fellow employee at the Willows of Wildwood. Earlier this year, a staffer was arrested in the theft of pain medication at the assisted living center.  These kind of incidents often happen because of short-staffing and burn-out.

She was arrested on a felony charge of crimes against a person and booked at the Sumter County Detention Center. She was released after posting $2,000 bond.

Kaiser News recently reported that many seniors are so scared of the thought that they will be abused and neglected in nursing homes that some discuss “rational suicide”.  The concept of rational suicide is highly controversial; it runs counter to many societal norms, religious and moral convictions, and the efforts of suicide prevention workers who contend that every life is worth saving. More seniors are weighing the possibility of suicide, experts say, as the baby boomer generation — known for valuing autonomy and self-determination — reaches older age at a time when modern medicine can keep human bodies alive far longer than ever.

Is it better to die on your own terms?  The question itself is taboo. Many want the option to take “preemptive action” before their health declines in their later years, particularly because of dementia. A Kaiser Health News investigation in April found that older Americans — a few hundred per year, at least — are killing themselves while living in or transitioning to long-term care. Many cases KHN reviewed involved depression or mental illness.

Dena Davis is a bioethics professor at Lehigh University who defends “rational suicide” — the idea that suicide can be a well-reasoned decision, not a result of emotional or psychological problems. Davis, 72, has been vocal about her desire to end her life rather than experience a slow decline because of dementia, as her mother did.

Suicide prevention experts contend that while it’s normal to think about death as we age, suicidal ideation is a sign that people need help. They argue that all suicides should be avoided by addressing mental health and helping seniors live a rich and fulfilling life.

Public opinion research has shown shifting opinions among doctors and the general public about hastening death. Nationally, 72 percent of Americans believe that doctors should be allowed by law to end a terminally ill patient’s life if the patient and his or her family request it, according to a 2018 Gallup poll.

If you or someone you know has talked about contemplating suicide, call the National Suicide Prevention Lifeline at 800-273-8255, or use the online Lifeline Crisis Chat, both available 24 hours a day, seven days a week. People 60 and older can call the Institute on Aging’s 24-hour, toll-free Friendship Line at 800-971-0016. IOA also makes ongoing outreach calls to lonely older adults.

An audit of Pennsylvania nursing homes warns that staffing levels are insufficient and on track to get worse.  Residents will get harmed and injured from the short-staffing.  One of the main reasons for the staff shortage is the greed of nursing home owner/operators paired with relatively low pay and the intense physical and emotional demands of these jobs.

“Nursing home direct care workers are currently, and have been historically, underpaid. And that is part, I think, of the reason why people choose to work in other environments and other places,” said Ellen Flaherty, past president of the American Geriatrics Society, and director of Dartmouth Centers for Health and Aging in Hanover, New Hampshire.

“We are facing an eldercare crisis, and we continue to ignore it at our own peril,” said Pennsylvania Auditor General Eugene DePasquale.

“Without family-sustaining wages and benefits, the eldercare workforce will never grow to the size we need to care for aging Pennsylvanians,” said DePasquale. “The number of health care workers is clearly not keeping pace with current demand, and is currently not keeping pace with future demand, which is going to explode rapidly.”

It’s a deliberate decision by many of the owners to not hire adequate staffing,” said Charlene Harrington, a professor emeritus of the University of California San Francisco’s School of Nursing, where she specializes in nursing homes, staffing and scheduling.

Harrington said for-profit nursing homes are able to make “excessive profits” by employing minimal personnel.

The workers can’t get the work done because staffers don’t have enough staff to do it. Patients are neglected and abused,” she said. “Ulcers … falls … weight loss … overuse of anti-psychotic drugs … all the problems found in nursing homes are related to inadequate staffing.”

The Centers for Medicare and Medicaid Services recommends that, at minimum, nursing home residents receive 4.1 hours of direct care.

Voorhees Care and Rehabilitation Center lost its air conditioning on a hot summer day.  While temperatures rose throughout the day placing residents and caregivers, management refused to do anything about the dangerous and oppressive heat.  A worker said many of the lights in the building were off to try to keep the place cool. Nursing home facilities in New Jersey are required to establish a written heat emergency action plan which mandates the procedures to be followed if the indoor air temperature is 82 degrees or higher for a continuous period of four hours or longer, officials said.

Finally, a visitor was so concerned about the community, the police were called as the heat wave sent temperatures outside to triple digits.  Dozens of first responders began arriving to help evacuate more than 100 residents out of the facility.

Nursing home owners and operators declined to say why they did not alert anyone to the crisis, or what went wrong with their air conditioning system.

The nursing home is rated at the bottom for its quality of care, ranked “much below average,” according to the most recent report by the U.S. Centers for Medicare & Medicaid Services. That report in April 2018 concluded the facility had failed to maintain a clean and sanitary environment that was in good repair.  According to state health officials, the department was never notified by the facility about the deteriorating conditions, and was not involved in the evacuation.

Inside the facility’s lobby, though, it still felt muggy in the early afternoon. A portable air conditioning unit sat on the floor near the entrance, an exhaust tube snaking into the ceiling.

Reuters had an interesting article on a recent study found in JAMA Internal Medicine.  Numerous nursing home residents develop preventable health problems after they are returned from the hospital in stable condition, a new study shows.  More than half of the complications were related to poor residential care resulting in preventable conditions like pressure ulcers, skin tears and falls, the study found.  Another 28% of adverse events involved infections. A total of 38% of the complications were serious.  7.4% were life-threatening. 2.1% were fatal.  About 70% of the adverse events were preventable, researchers report in JAMA Internal Medicine.

“Adverse events are occurring due to transition related issues (such as being released from the hospital too soon as well as deconditioning requiring increased support from nursing home staff including monitoring to prevent falls, turning in bed to prevent/heal pressure ulcers, and gentler handling to prevent skin tears,” said

“Families should advocate for their loved ones and make sure they do not leave the hospital too early,” Dr. Alok Kapoor, lead author of the study and a researcher at the University of Massachusetts Medical School in Worcester said by email.

“It is important to realize that a nursing home patient who was recently hospitalized is at very high risk for problems over the next several weeks,” Bhatt said by email. “So don’t think they are out of the woods yet.”

Landon Terrel has been convicted of elder neglect for his actions against  91-year-old Adam Bennett who died last year. On Aug. 15, 2017, Bennett was found in his room at Sunrise Assisted Living Center with a bruised lip. Bennett told a day-shift caregiver: “He punched me,” while motioning to his face, chest, and groin. Soon after, Bennett became unresponsive.

Caregivers at the facility called for an ambulance. He was rushed to WellStar Kennestone Hospital, where his injuries included facial bruising, multiple rib fractures, and a collapsed lung. He never regained consciousness and died on Aug. 18. Cobb’s Chief Medical Examiner, Dr. Christopher Gulledge, ruled Mr. Bennett’s death resulted from blunt force trauma as a result of assault.

Evidence collected by police showed that Terrel was the only male working the overnight shift at Sunrise that night. Terrel denied hitting Bennett and insisted he saw no facial bruising when he last checked on Bennett just before his shift ended at 6 am. But he told investigators he “caught” Bennett as he fell out of bed the previous evening and Bennett had banged his chest into the bed. Terrel said he checked on Bennett hourly throughout the night and that Bennett repeatedly complained of pain. Terrel admitted he used “poor judgment” in repeatedly ignoring those complaints.

After a week long trial and about three days of deliberations, a Cobb jury convicted Terrel of elder neglect and found him not guilty of two counts of elder abuse and one count of felony murder based on abuse. The jury was unable to reach a unanimous verdict on the charge of felony murder based on neglect. Terrel faces up to 20 years in prison.

Katie Louise Boll, a nursing home employee, has been charged with allegedly diverting drugs from residents for her own use, according to information filed in federal court.  A grand jury returned an indictment charging Boll with acquiring a controlled substance by deception and tampering with consumer products in Iowa.

At least 13 patients were affected.  She allegedly injured one of the patients when she took part of the patient’s oral morphine sulfate solution and diluted it with mouthwash on Dec. 24, 2018. Later that week, on Dec. 29, 2018, she allegedly used her position to swap codeine, hydrocodone oxycodone, morphine and tramadol medications for at least 10 patients with Tylenol and other medicine.

Boll worked as a nurse at the Good Neighbor Society in Manchester, and between September 2018 and January 2019 she took about 50 hydrocodone pills.  What a waste.  I hope she gets the help she needs, and those poor residents get the justice they deserve.

 

 

The website Claims Journal reported on a study published in the July issue of Health Affairs where researchers analyzed payroll-based staffing data for U.S. nursing homes.  Researchers discovered large daily staffing fluctuations, low weekend staffing and daily staffing levels that often fall well below the expectations/standards of the Centers for Medicare and Medicaid Services (CMS).  The situation dramatically increases the risk of adverse events for residents.

The study paints a picture of the staffing levels of nurses and direct care staff at nursing homes based on a new CMS data resource, the Payroll-Based Journal (PBJ). CMS has been collecting data from nursing homes since 2016, and PBJ data have been used in the federal Five-Star Quality Rating System for Nursing Homes. CMS compares nursing homes’ reported staffing to expected levels based on the acuity of residents in the facility.

Using PBJ data from more than 15,000 nursing homes, the research team discovered that only 54% of facilities met the expected level of staffing less than 20% of the time during the one-year study period. For registered nurse staffing, 91% of facilities met the expected staffing level less than 60% of the time.

Relative to weekday staffing, the PBJ data showed a large drop in weekend staffing in every staffing category. On average, weekend staffing time per resident day was just 17 minutes for RNs, nine minutes for LPNs and 12 minutes for nurse aides (NAs).

Staffing in the nursing home is one of the most tangible and important elements to ensure high quality care,” said study co-author David Stevenson, PhD, a Health Policy professor at Vanderbilt University Medical Center. “Anyone who has ever set foot in a nursing home knows how important it is to have sufficient staffing, something the research literature has affirmed again and again. As soon as these new data became available, researchers and journalists started investigating them, and the government now uses the PBJ data in its quality rating system.”

“We found that the newer payroll data showed lower staffing levels than the previous self-reported data,” said Grabowski. “The lower levels in the PBJ data likely reflect both the fact that they are based on payroll records as opposed to self-report, and also that staffing levels were abnormally high around the time of the inspection. In fact, the PBJ data clearly show this bump, followed by a return to normal after inspectors leave.”

The new PBJ data offer a more transparent and accurate view of nursing home staffing, and Grabowski is hopeful future research will be better positioned to understand the implications of staffing fluctuations on residents’ well-being. Further, he noted that “these new staffing data also offer tools for regulators and other oversight agencies to monitor what nursing homes are doing day in and day out.”

WFMZ reported that a lawsuit was filed over the preventable death of a nursing home resident at Cedarbrook Nursing Home caused by a staffing shortage, a federal lawsuit claims. The suit claims the county-owned facility was “intentionally and grossly understaffed” when resident Shirley Liebenguth fell and later died in 2017.

On July 5, 2017, Liebenguth was being moved by a certified nursing assistant when she was dropped, hitting her face and knees and causing major injury, the lawsuit says.  She needed extensive assistance for all activities of daily living including transfers and bed mobility. Cedarbrook medical records note Liebenguth “rolled out of bed while she was being changed,” but the suit says her fall was “due to the CNA’s lack of training, instruction, supervision…”

She was hospitalized with femur fractures and other injuries, but ultimately died nearly 10 hours later after suffering cardiac arrest and being resuscitated several times, the suit says.

The suit claims Cedarbrook was “intentionally and grossly understaffed” causing a “significant decrease in care that should have been provided” in the two years that Liebenguth was a patient.

 

NJ.com had an article about the lack of staff at nursing homes and how that directly affects the quality of care provided to the residents.  The short-staffing prevents supervision to prevent falls and resident to resident altercations.  The lack of staff prevents residents from being repositioned to avoid pressure injures or bedsores.  The under-staffing makes it impossible for the caregivers to spend the time with the residents to feed them or participate in social activities.  It is the key reason for the neglect suffered by nursing home residents.  And everybody knows it.

“Anyone who has spent any time in a nursing home has a story to tell. About a loved one suffered while waiting for help to go to the bathroom. Or someone who went hungry because there was no one to feed them. A call bell that went unanswered for hours.”

It takes time and staff to regularly turn a patient every two and a half hours, which is what needs to be done to avert pressure ulcers. When bed sores develop, it is a direct consequence of not having enough staff to prevent it.

Federal data shows N.J. nursing homes are understaffed. One-in-four of the more than 360 nursing homes in the state had staffing issues, according to reports issued this year by the Centers for Medicare & Medicaid Services.

They revealed 25 percent were rated “below average” or “much below average” in the number of nursing personnel available to take care of residents — a ranking that takes into account that some nursing homes have sicker residents and may therefore need more staff than other nursing homes whose residents aren’t as sick.  Half of those same facilities had poor health inspection reports as well.

At the same time, those self-reported numbers by the nursing homes themselves may not true.  It is well known that nursing homes inflate their staffing numbers to get a better star rating on Nursing Home Compare.  However, new payroll data being collected by the government will provide a more accurate picture of the number of staff on duty.

Families for Better Care, a non-profit advocacy organization, said the state ranked 45 nationwide in the amount of direct care service hours provided per resident. In its own analysis, the Texas-based group said nursing home residents here received 34 minutes less direct care daily, when compared to the country’s top-ranked states, or an average 2.27 hours of direct care staffing hours per resident.  The state minimum in New Jersey is 2.5 hours, according to the Department of Health.

“They like to keep the profits close to the vest — to give it back to shareholders instead of staff,” Lee said.  New Jersey is the seventh most expensive state for nursing home care, according to a study, by SeniorLiving.org, based on the most recent data from the 2018 Genworth Cost of Care Survey. The average cost of a semi-private room in New Jersey is $10,646 per month or $127,752 per year, the study found. That compares to the national average of $7,441 per month or $89,297 per year.