Often when maggotts are found in a resident’s pressure ulcer (normally caused by the lack of proper wound care and cleaning), the nursing home tries to argue to the family that the maggotts are a method of cleaning the wound and that the nursing home intended the maggotts to clean the wound (despite no physician order typically).  Well, that frivolous argument has now been proved wrong.

Reuters had an article about a recent study in the British Medical Journal of the world’s first controlled clinical trial of maggot medicine.  Maggotts may clean wounds quicker than normal treatment but this does not lead to faster healing. Some patients also found so-called "larval therapy" more painful. 

To find out more, researchers at Britain’s University of York recruited 267 patients with venous leg ulcers and treated them either with maggots or hydrogel, a standard wound-cleaning product. They found no significant difference in outcomes or cost.  Larval therapy works because maggots eat only dead and rotting tissue, leaving a clean wound. They do not burrow into healthy flesh, preferring to eat each other when they run out of food. 

 

 

The New york Times had an article explaining the Obama administration’s plan to overhaul financial regulation by subjecting hedge funds and traders of exotic financial instruments to potentially strict new government supervision. Many of these hedge funds and financial instruments own or have a financial stake in numerous nursing homes around the country.  It states that the government would have the power to peer into the inner workings of companies that currently escape most federal supervision, and specifically cites "private equity firms like the Carlyle Group."   

The Carlyle Group bought out Manor Care a couple of years ago and have created sham L.L.C.s to protect themselves from liability while cutting the budgets of the nursing homes that they own.  In fact, two men who worked in the New York State comptroller’s office were arrested recently after it was discovered they took millions of dollars in kickbacks from private equity and hedge funds.  David Loglisci, who was the top investment officer of the state’s $122 billion pension fund, along with Henry Morris, who fund-raised for former comptroller Alan Hevesi, were nailed in a 123-count indictment, which included charges of money laundering, securities fraud and bribery. It was discovered that over 20 transactions made by the pension fund involved kickbacks, with five of those coming from the renowned private equity fund The Carlyle Group. Morris, who was released after posting a $1 million cash bail, allegedly received $13 million from The Carlyle Group, from investments that totaled $730 million.

The administration would require that all standardized derivatives be traded through a regulated clearinghouse. Traders would be required to provide documentation on their collateral and borrowings. They would also be subject to new eligibility requirements, and their trading and settlement practices would be subject to new standards.

 

Keloland.com had an article about the sexual abuse allegations at an elderly home in Hot Springs, S.D.  Many family members are appropriately concerned. The DCI is finally looking into reports dating back to January at the Castle Manor Nursing home.  Hospital officials say they know of more victims. Board President of Castle Manor Rich Nelson knows of at least three victims and has received several other complaints. The suspect is a male nursing assistant.  Family members of the alleged victims claim Fall River Health Services tried to cover up the abuse.

When sisters Sharon Deboer and Gwendolyn Ketterer needed a long-term care facility for their mother two-and-a-half years ago, they had no doubts about the care at Castle Manor. That changed when the 84-year-old dementia patient started acting out of character late last year when a male nursing assistant began taking care of her.

"I just felt that there was something with him that I just couldn’t put my finger on. I couldn’t put my finger on it but I suspected that type of thing. It was just a feeling," Deboer said.  On January 17, Deboer’s suspicions were confirmed.  "One of the staff called me and told me she had to talk to me, that she had something to tell me. She told me right when we met that this CNA, this male CNA, had been molesting my mom," Deboer said.

That was the only type of notification the sisters received from Castle Manor, despite an abuse report filed with the Department of Health three days earlier. The suspect stayed on as an employee for weeks before Manor officials say he was finally let go. That was part of Fall River Health Service’s efforts to cover up the abuse.

How many others suffered abuse silently while Manor staff looked the other way.

 

The Hour had an article about Connecticut Governor M. Jodi Rell announcement that her administration has given the Legislature’s Public Health Committee testimony in support of her bill to provide greater state oversight over nursing home administration and management including ongoing financial monitoring and expanded quality of care reviews of nursing homes.

An Act Concerning Oversight of Nursing Homes would:

1.  identify areas of the state which either need or have a surplus of nursing home beds;

2. create an oversight committee to focus on financial solvency and quality of care issues;

3.  enhance the public’s access to important nursing home data;

4.  provide for greater oversight by the Department of Social Services when there is an application for a change of ownership;

5.  require expanded financial reporting to DSS;

6.   require that nursing homes submit quarterly reports of accounts payable to DSS — as unpaid bills are a key indicator of financial health; and provide state regulatory agencies with expanded subpoena authority.

"Placing a loved one in a nursing home is often a necessary, but difficult decision and family members deserve the peace of mind of knowing that the finances and the quality of care issues of these facilities are closely monitored," Rell said. "When a nursing home goes out of business due to financial issues, both patients and their families must suffer through the turmoil of a new placement.

"Nursing homes are an important part of the network of care and services for Connecticut residents and quality of care issues are paramount to individuals who have a family member in a nursing facility," the governor said. "We must do everything in our power to ensure a standard of care that instills confidence in the people who are entrusting loved ones to a nursing facility."
 

I wish every State especially South Carolina would pass similar legislation.

The Chattanooga Free Times Press had an article about the arrest of a nursing home employee who neglected and caused the death of a nursing home resident.   Walter Small is charged with criminally negligent homicide in the death of Robert A. Young on Nov. 12, 2007.  The nursing home was almost successful covering this crime up.  The arrest was made in connection with the 2007 homicide of a cerebral palsy patient, a case that almost ended with no investigation into the victim’s unexpected death and his burial just days later in a pauper’s grave.

 A timeline of the case reveals it was Mr. Young’s family members who initially questioned the circumstances of his death, which took place while he was living at the Health Center at Standifer Place.  Authorities eventually exhumed Mr. Young’s body last summer, and the autopsy performed one year after his death indicated Mr. Young died of blunt force trauma to the head.

County Medical Examiner Frank King said he did not initially perform an autopsy because of representations made to him that the victim had fallen and fractured his skull as the result of a seizure. But medical records didn’t support that theory, Dr. King said, and Mr. Young’s sister, Rana Reynolds, would end up suing Standifer Place as well as the Tennessee Department of Human Services in November 2008, alleging that both were in “collusion” to “hide the death and burial” of Mr. Young.

According to the two lawsuits filed in Hamilton County Circuit Court, not only did a Standifer Place employee kill Mr. Young, but when family members called to check up on him, employees didn’t even tell the family he was dead for more than a month.  After Mr. Young’s death, “Standifer Place told each person, on each call, that (Mr. Young) was OK, and to come see him,” court documents state.

 

The Lexington Herald-Leader had an article about a recent lawsuit filed against a nursing home with a history of neglect and violations.  The facts behind the lawsuit suggest that the nursing home’s failure to assess the respiratory condition of a 54-year-old man led to his death after a six-day stay.   The Winchester Centre for Health and Rehabilitation has faced numerous state and federal sanctions in the past two years and was threatened with the loss of Medicare and Medicaid funding.

On Jan. 25, 2008, William Baker was admitted to the nursing home.  The facility failed to assess and monitor Baker’s respiratory condition or to suction him. Baker developed breathing problems and was transferred to a Lexington hospital where he died on Jan. 31, 2008.  "The lack of care and attention caused Mr. Baker to suffer in a most traumatic fashion and ultimately die," the lawsuit said.  The lawsuit also the said the facility "established staffing levels that created recklessly high nurse/resident ratios."

The lawsuit is the latest in a series of problems for the facility, which in 2008 received two type A citations — the most serious the state can give. One, in August, was for not calling a doctor when a man lost more than 87 pounds in 19 days. At the end of the 19 days, the man was found unresponsive and was taken to the hospital, according to the citation from the Kentucky Cabinet for Health and Family Services

A second type A citation was issued Jan. 12 after a patient received the wrong dose of an anti-seizure medication for 40 days in November and December, an error that wasn’t discovered until the patient suffered a seizure.  The facility didn’t have a system to make sure that medications were administered properly, according to the Jan. 12 citation.

 

McKnight’s had another article on the Fairness in Nursing Home Arbitration Act.  This bill would prevent nursing homes from using pre-dispute arbitration agreements as a way to take away residents’ rights to a jury trial. The bill is supported by both Republicans and Democrats and should be able to pass without much difficulty. 

Sens. Mel Martinez (R-FL) and Herb Kohl (D-WI) reintroduced their measure in an effort to "restore the original intent of arbitration laws [and] ensure that families will not have to choose between quality care and forgoing their rights within the judicial system."    The version of the bill introduced in the last session of Congress was approved by the Senate Judiciary Committee, but never came to a full floor vote. The bill does not prohibit the use of all arbitration agreements by nursing homes, only pre-dispute agreements.   Arbitration agreements could still be used after a dispute arises, though the bill would make them a voluntary matter.
 

 

The Dallas Morning News had an article about the amount of money Texas provides to nursing home residents who are on Medicaid.  The article emphasizes that the amount of money is directly related to the quality of care and shows how Texas treats its most vulnerable citizens.

Texas’ Medicaid program only reimburses nursing homes an average of $112.79 per patient per day – less than 48 other states.  Texas remains 30 percent below the national average of $163.27 per day.  Patient advocates and industry experts say Texas’ 49th-place ranking means that nursing homes can’t pay employees competitive wages. That in turn leads to high staff turnover, which hurts residents’ care.  It is no surprise that 28 percent of Texas’ 1,100 nursing homes received the worst rating and only 10 percent scored the best when Medicare announced its new nursing home ratings late last year.

The reimbursements now don’t even cover nursing homes’ actual costs and would need to increase to at least $125 a day for facilities to break even.  Skilled nursing care costs tens of thousands of dollars a year, so many nursing home residents eventually exhaust their personal assets and qualify for Medicaid, the federal-state health care program for the poor.

Nursing homes have tried to hold the line on their labor costs, but that leads to high staff turnover. It’s difficult to compete with hospitals, which pay better, so nursing homes routinely lose registered nurses, licensed vocational nurses and nurses’ aides.  "The average annual turnover rate is 87 percent for certified nurses’ aides," said Pearl Merritt, who leads a center task force on long-term care. "It’s a challenge to maintain high-quality care in a revolving-door environment."

Nurses’ aides can work at a McDonald’s for more than what Texas nursing homes are willing to pay them.

 

 

The Edmond Sun had a recent article about a 131 page investigative report that supports complaints against a nursing home in Oklahoma.  One of the complaints includes a lack of an effective system for investigating and reporting abuse and failure to consult with a resident’s physician when there was an injury.  The investigation was triggered by a Sept. 16, 2008, incident at Grace Living Center. On that day, a resident, Lester Pendergraft, allegedly sexually assaulted a 67-year-old resident.   Pendergraft has been charged with one count of rape by instrumentation.

A meager $10,000 penalty resulting from the investigation has been proposed by the Centers for Medicare and Medicaid Services. 

Documentation showed the victim’s daughter was notified at 8:45 a.m., 1 hour and 35 minutes after the incident occurred at 7:10 a.m. Edmond Police arrived shortly after they were notified, at about 9 a.m. The victim’s doctor was called between 8:15-8:25 a.m., shortly after he arrived at his office.

On Sept. 25, the detective assigned to the case said, “The facility did a poor job of protecting the evidence.” He said facility staff threw away evidence and washed the victim’s bed linens and clothing and Pendergraft’s clothing.   Why would the facility do that unless they were trying to cover up what happened?

According to the report, the facility’s staff should immediately notify the director of nurses and the doctor, get the resident out of harm’s way and assess the resident whenthere is an allegation of abuse or neglect.  “The resident was not assessed timely after the incident,” the report stated.

The detective said someone in charge said to another officer that he felt  “The situation was being blown out of proportion.”

Citizen advocate Wes Bledsoe, founder of A Perfect Cause, an advocacy organization for disability and elder rights, said when he read the report he was “deeply disturbed."  Bledsoe said what was most shocking was that the incident happened in the first place, that evidence was destroyed with either intent or by incompetence and that a staff member voiced concern about police blowing the situation out of proportion.  Furthermore, there were warning signs before the incident that Pendergraft posed a threat to residents. Pendergraft was entering rooms of residents without reason or explanation who could not call out for help.

According to the report, a certified nurse aide reported before the Sept. 16 incident that she observed Pendergraft touch another resident who was dependent on staff for assistance. The same day, Pendergraft was seen pulling up the shirt of still another resident who was dependent on staff for assistance.

 

The Pittsburgh Tribune Review had an article about the recent jury trial against a nursing home in a wrongful death lawsuit in which the family of a woman claims the nursing home was negligent in her care and caused her death.  The family of Olive Shaffer contends she received inadequate care during her stay at Harmon House in Mt. Pleasant.   Shaffer fell several times while living in the nursing home and died July 22, 2003, from injuries she sustained in her falls.

Jurors were given evidence that workers at the nursing home falsified records, violated internal policies which make up the standard of care, and were negligent in supervising Shaffer.   The Shaffer family contends that Shaffer fell several times in the nursing home in June, and the staff made insufficient efforts to prevent her from taking more tumbles.

The nursing home had a management company (Grane Healthcare Co) that was responsible for implementing policies and procedures and training staff on fall prevention. In the lawsuit, the family said Shaffer fell twice on July 15, 2003, and she suffered catastrophic injuries, including brain swelling. She died from her injuries a week later, according to the suit.

The nursing home’s defense is 1) Old people fall  2)  Falls happen and 3) Falls are not preventable. The only way to prevent it is to tie them up.

I hope the jury listens to the evidence and the defense’s frivolous and misleading arguments and awards substantial damages.