Lexington Herald-Leader had a story recently about how many families feel compelled to videotape loved ones residing in nursing homes.  I know many State Attorney Generals use surveillance videotaping top prove allegations of abuse and neglect.  There are some concerns about privacy but that is hard to argue if your loved one is being abused and neglected.

The article discusses the family of an 84-year-old resident of a Richmond nursing home owned by Extendicare.  The family hid a video camera in the woman’s room after they discovered dozens of unexplained bruises all over her body and didn’t get answers from the staff. The videotape proved that nursing assistants at Madison Manor physically abused and taunted Armeda Thomas of Irvine.  The tape also proved neglect because the staff often failed to feed and clean her.

The Kentucky Attorney General’s Office is conducting a criminal investigation.  After the criminal investigation began, evidence revealed "injuries of unknown origin" on 17 residents who were cognitively impaired. 

A review of the incidents videotaped between Aug. 17 and Sept. 8 "demonstrated actual incidents of physical abuse and neglect by the staff," the state’s citation said.  The citation said that bruises — which the family first photographed in July — were handprint bruises and not injuries caused by the patient’s own behavior.

The videotape captured the staff "pulling the resident out of bed by her wrists and neck," and "roughly moving the resident from side to side," the investigation showed.  Three days after an incident in which certified nursing assistants handled the resident roughly, X-rays showed fractures in Thomas’ lumbar vertebrae.

The videotape also showed instances where nursing assistants did not clean or feed the woman. And they falsified records about how much she ate. On two occasions, a nursing assistant ate the food herself. One of those times she recorded that Thomas ate all of her food.   At one point, records show, Thomas lost 19 pounds in two weeks. 

The videotape also showed nursing assistants mocking and taunting Thomas. One staff member showed her fist to Thomas after Thomas was combative. In another incident, a nursing assistant danced in front of Thomas while other staff forcibly held the resident down, state records show.

 

The Milwaukee-Wisconsin Journal Sentinel had an interesting article about Bruce Bowman.  He was a resident at a nursing home facility who was given Risperdal, an anti-psychotic medication.  Normally it is used to control agitation and aggression but many nursing homes use it and other medications as a chemical restraint to "quiet" the residents.

Mr. Bowman had adverse reactions to the Risperdal.  These reactions were well known to his health care providers but the nursing home never warned the family of any possible side effects.  Mr. Bowman’s throat swelled up. His body went rigid. He got pneumonia from lack of mobility. The once strong former logger withered away. Two weeks before he died June 19, Bowman weighed only 112 pounds.

Six months before he died, Bowman was given Risperdal by the nursing home. his children insist they were never told by the nursing home staff that Risperdal has a black-box warning that reads: "Increased mortality in elderly patients with dementia-related psychosis." They didn’t know that in clinical trials for Risperdal, most patient deaths occurred from cardiovascular or infectious complications, such as pneumonia. The drug’s listed side effects also include vomiting, weight loss and muscle stiffness, among many others.

"I’d never give any kind of consent for any of that," said Martin Bowman, Bruce’s son, who was the legal guardian of his father’s care and needed to approve any changes in medication.

The black-box warning for Risperdal was issued by the Food and Drug Administration in 2005. The drug is only approved for use in people with schizophrenia, bipolar disorder and some irritability associated with autism. Martin Bowman never saw that warning because the nursing home was using 7-year-old medication consent forms, Public Investigator found.

The old forms didn’t have the paragraphs of warnings about Risperdal because the warnings hadn’t been issued in 2001, when the forms apparently were printed.  The nursing home should have downloaded an updated form from the state Department of Health Services Web site.

Anti-psychotic drugs often are prescribed to elderly patients with dementia to control their agitation and outbursts.  Many researches believe that anti-psychotic drugs are overprescribed to subdue nursing-home patients. The consequences can be deadly.

Many nursing homes use medications as a restraint so they can save money on staff.  The less vocal a resident is or the more they are asleep, the less the staff has to do for them.  Nurses are happy because of less work, and the corporation who owns and operates the facility gets more profit.

 The Syracuse Post Standard had an article recently discussing the (small) fine that a nursing home received for neglecting a resident who died as a result of choking.  How could they levy such a small fine for a preventable death? 

The government fined a Minoa nursing home $13,300 for failing to provide prompt emergency care to a choking resident who died.  The Centers for Medicare & Medicaid Services said The Crossings put residents in immediate jeopardy and provided substandard quality of care, the most serious deficiencies.

The Crossings was one of four nursing homes in the region fined for poor care between June 1 and Sept. 19, according to the Long Term Care Community Coalition.   The fine against The Crossings stems from an Oct. 15, 2007, incident involving a resident:  The report said:

The woman was served a dinner of blueberry pancakes and sausage that a nurse aide cut into bite-sized pieces. A short time later, the aide noticed the women’s mouth was open, she was not breathing and her lips were blue.  The aide failed to call a "code blue," an announcement that alerts all staff to an emergency situation and summons them to provide assistance. It also activates the 911 system. The aide also failed to start the Heimlich maneuver.  A licensed practical nurse who came to help did not take these steps, either.  The registered nurse supervisor who arrived on the scene did not immediately call a "code blue" or 911.

I wonder what "a short time later" means?  I am surprised the nursing home did not claim that the resident had a DNR so they did not need to intervene!!

Elise Degrass has written a guest post for our blog.   We appreciate her contribution and look forward to many other posts in the future.

How to Make Sure Your Parents Are Being Treated Right at Their Nursing Home

It can be difficult to accept that one’s parents need assisted living care in order to properly get through the day. While enrolling a parent in a nursing home may be a necessary step in the process, it’s also important to ensure that he or she is receiving proper care.
Selecting the proper care institution and setting up the right structure for care will ensure that the best possible living conditions for one’s parent(s) in a nursing home.

The first step to ensure proper Nursing Home treatment is to choose the right health care provider in the first place. By taking time to do background research on the Nursing Homes in your area, you can save a lot of time in the future. Services such as Consumer Reports provide information about what to expect from various nursing home providers. Unlike hospitals, nursing homes vary widely in terms of their ability to provide basic services, so always inquire whether a given care center can provide the services that your parents need. For many people, Nursing Home costs can be prohibitively expensive, so look for an institution that is covered by Medicare
Services
to help alleviate the cost burden. You should always visit a care center and request the latest state inspection (Form 2567) to see an objective review of the care center.

After taking time to select what seems to be the best possible institution, there are several steps you can take to ensure that quality of care is up to standards. The most direct way of checking in
on care standards is through regular visits at non-standard times –that way you can review the care standards at various times during the day, and you can keep an eye out for any necessary improvements (in terms of care, cleanliness or scheduling.) Always ask you parent(s) directly about the nature of the care, and discuss any possible issues with management in case any issues arise; in fact, scheduling regular meetings with supervisors can provide a constant feedback look to ensure proper care.

Selecting a Nursing Home close to your work or home will make it easier to visit more regularly. In addition to your direct visits, have various members of your family regularly check up on your
parent(s), as well as asking important questions in case issues arise. Always have a contingency plan in case the care falls below standards, so that you can move to an alternative care center. If your parent has serious medical conditions, it is important to take them to regular visits with their family physician so that they can be monitored for progress; if they are not getting their medications regularly or their diet is not sufficient to provide the nutrients they need, a doctor
should be able to provide you with feedback that you can relay to the Nursing Home. By selecting a nursing home that is professionally management with attentive, registered nurses and medical staff, you can provide the best possible environment for long-term care.

This post was submitted by Elise Degrass, a freelance writer primarily
writing about cell phones .

Bamberg County Council has given approval to a contract for the purchase, sale or lease of the Bamberg County Nursing Center to UHS-Pruitt Corp., a Georgia company.

The council, in a meeting Monday with the Hospital and Nursing Center Board, approved first reading of the contract which outlines the "conveyance of nursing home property and assets" to Toccoa, Ga.-based UHS-Pruitt Corp.

The county council at a Nov. 3 meeting approved a letter of intent with UHS-Pruitt to continue negotiations on all of its options in paying for hospital renovations, including the use of funds from the potential sale of the nursing center.  UHS-Pruitt has already applied for a certificate of need from the S.C. Department of Health and Environmental Control.  CON applications provide details about the particular need for a project. UHS-Pruitt is estimating the total cost of the project at $5,076,000.

Sara Maret, health planner for UHS-Pruitt, said state law required the company apply for a certificate of need for the nursing home project. Public notice of the application is also a state DHEC requirement, she said.

"They (Bamberg County) put the Bamberg Nursing Home up for sale because they wanted it to be a separate entity from the hospital," said Maret, noting that the company put the details of its application out so that pricing suggestions could be made and to show why the company "would be the better company" to purchase the nursing center.

Dobson-Elliott said the county itself has not published an amount for which the nursing center could potentially sell.

"It’s a moving target. We’ve pulled all sales of nursing homes and like facilities in the state. When you break it down comparing size and when it was built, the numbers we’re talking about are very good," she said.

The Charleston Gazette out of West Virginia had an article about the tragic and clearly preventable death of a nursing home resident who wandered away from the facility unsupervised and was struck by a train on nearby tracks.  Why didn’t the facility notice he was missing?  Why weren’t they able to prevent him from wandering away from the facility? What was their staffing level on that day?  Did they have a wanderguard on him?

In a lawsuit filed in Kanawha Circuit Court, George W. King Sr.’s children, Sharon Milam and George W. King Jr., allege that Heartland of Charleston, a subsidiary of Health Care and Retirement Corp. of America, LLC, failed to properly monitor the 73-year-old former owner of Pineview Cemetery in Orgas.  "George King Sr. could not care for himself or be allowed to walk outside the facility and the staff of the facility at Heartland of Charleston was aware of this fact," the suit reads.

Workers at the facility failed to follow the company’s established protocols for missing residents and failed to adequately supervise King.  "The staff of Heartland of Charleston failed to keep him secure in the facility, failed to immediately discover that he had left the facility, searched for him in the wrong area (because they confused him with a different person who had left the facility on a prior date), failed to use the exterior security cameras to identify the direction in which he left the facility and failed to utilize all available resources to locate him quickly [such as a search dog team]," the suit states.

 

The Chicago Tribune recently had an article about how politicians are bought off by the nursing home lobbyists and their substantial campaign contributions.  This is one of the reasons why health care should not be a for profit business.  Lawmakers receive thousands of dollars in contributions every year from the nursing home industry.  In return, the industry makes sure that staffing is kept low, no insurance is necessary, and no oversight  by the State is effective.

Among the contributors is Tim Boyle, the owner of Grinnell’s Friendship Manor, who serves as the president of the board of the Iowa Healthcare Association, a lobbying organization that represents nursing homes.  There were 12 legislative fundraisers during one week last year that were held by the Iowa Healthcare Association.  11 of the fundraisers were held at Iowa nursing homes.   The other was held at Boyle’s South Dakota home, and was for Rep. Christopher Rants, R-Sioux City, then the minority leader of the Iowa House. Rants collected 15 checks totaling $3,090, according to state records.

Boyle, whose Friendship Manor is facing a $112,650 federal fine for alleged neglect of an elderly woman, has complained to lawmakers that the Iowa Department of Inspections and Appeals is "overly aggressive" in policing the state’s nursing home industry.

The newspaper reported that the Iowa Healthcare Association in March provided Iowa’s care facility administrators with a fill-in-the-blank letter that could be given to residents forward to lawmakers.

It read, in part:

“(NAME OF FACILITY) is dedicated to providing the best care. … Increasing fines by the Iowa Department of Inspections and Appeals (DIA) are cutting into the funds that nursing homes have to put toward providing care. … (NAME OF FACILITY) will either be forced to close or increase my rates. I do not want to be forced to move into another nursing home. …”

Of course, this letter is an outright lie. The nursing home industry makes plenty of money. Just look at their stock prices.  Demand is high and supply is low.  Nursing homes are certainly making enough profit to waste thousands of dollars on lobbying politicians every year.

Andrea Pitzer wrote a great article about PACE for USA TODAY.  Program of All-Inclusive Care for the Elderly (PACE) tries to keep people who are eligible for nursing home care living independently in the community.  PACE patients at the center — almost all of whom qualify for both Medicare and Medicaid–are supported by a coordinated medical team that the federal government hopes will cut costs and improve life for the elderly.

According to the National PACE Association, there are 16,000 patients in PACE nationwide. The average client is 80 and takes eight prescription medications. Participants have to be 55 or older, certified by their state to need nursing home care and be able to live safely in the community.

Each program receives a fixed amount per person from a patient’s state Medicaid program — usually 85% to 90% of estimated nursing home costs. Medicare funds come through a risk-adjusted formula in which the program receives more for sicker enrollees.

PACE becomes both the patient’s insurer and care provider and is obliged to pay for all of the patient’s medical care from the point of enrollment forward.

PACE’s dual role allows for flexibility in using the money from the federal government.  Part of the idea is that thorough preventive care can prevent more serious conditions and reduce hospitalizations.

Started in the 1970s as a community project to keep elders in their homes, today PACE provides a ride back and forth to its centers for day-care activities and medical appointments. Along with the nutritionist, social worker, psychologist, activity director, nurses’ aides, nurse practitioner, doctor and others, the driver is a part of the health care team that meets daily. The clinical staff members also hold group meetings at least twice a year with each patient.

Because the amount received for an individual is fixed, says Shawn Bloom of the National PACE Association, the program has every incentive to keep patients as healthy as possible. "If we provide good care," Bloom says, "we control costs."

 

Read More →

The Morning Call had a story about another nursing home employee stealing narcotics from the residents.  State police in Pennsylvania have arrested a Bethlehem woman named Heather L. wolters for stealing drugs from a nursing home where she worked. She was employed as a nurse at the Lehigh Center nursing home in Lower Macungie Township when police say she stole 10 vials of injectible Hydromorphone from a computerized medication dispensing system.

A derivative of morphine, Hydromorphone is used as an alternative to morphine in cases of analgesia, and as a cough suppressant. Wolters was charged with numerous counts of possession of a controlled substance, theft by unlawful taking or disposition, theft by deception and receiving stolen property.

 

How could this happen?  Doesn’t the nursing home conduct a narcotics count after every shift?  If so, one or more of the residents are not getting their medication.  If not, they are negligent in dispensing medications.

The Denver Post had an interesting article about new developments in elder care.  Facilities are trying to move away from institutional settings and make resident’s stay feel more like home.

The article states that "a generation of retirees resists the fate of nursing homes they’ve grown to dread, supporters of a cultural revolution say they are reforming an industry long tainted by images of neglected patients languishing on soiled sheets".

Reforms will likely quicken in the next year as Colorado begins sending higher Medicaid payments to homes that make changes ranging from reducing bed sores to giving residents a peanut-butter sandwich on demand.   Critics of traditional nursing- home care are not ready to declare lasting success. Reforms at a given home too often depend on the energy and dedication of a few key staff members, and those changes are difficult to replicate in more than 16,000 nursing homes nationwide.

"In general, the quality of nursing-home care is really bad," said Charlene Harrington, a professor of sociology and nursing at the University of California at San Francisco who has studied national reforms. Truly improving care almost always requires increasing staff, she said.

"There’s some basic merits to the idea of the culture-change movement," Harrington said. But "the nursing-home industry is trying to promote the idea you don’t need the staff; you just change the culture. That’s why I’m skeptical of the whole effort."

"The heart of it is just treating people the way you want to be treated," said Barbara Moore, administrator of Bruce McCandless Colorado State Veterans Nursing Home in Florence. Once entrenched in a notorious state nursing system, McCandless has won kudos for trying everything from consistently matching staff with the same patients to parking a Patton tank outside for grandkids to climb on.

Promotion of culture change or comparable reforms is vital for baby boomers who want to avoid mass warehousing in the coming decades. The U.S. population 65 and older will jump from 40 million in 2010 to 55 million in 2020, according to the federal Administration on Aging.

The vulnerable population 85 and older, meanwhile, will need many new care beds, with the population in that oldest group rising from 6.1 million to 7.3 million that same decade.
By all accounts, they want to avoid the nursing homes of their parents’ day.

Another Medicare and Medicaid report in September said that more than 90 percent of U.S. nursing homes were cited for violating federal standards in the past three years, but those transgressions can range from improper food storage to acute medical problems.
Caring for the elderly, meanwhile, consumes a good share of the state budget.

In Colorado and across the country, nursing-home occupancy rates are flat or dropping even as the population ages. More families are keeping aging relatives at home, hiring home-health aides, or choosing newer and smaller assisted-living sites for patients who don’t need extensive medical care.

Culture change can be as varied as adopting a cow for a pet or building a $1 million adapted home from the ground up to house only six residents — but the basic tenets across the country are consistent:

• Breaking from institutional schedules and rules in which residents must eat at common times or take showers at a rigid hour set by the staff.

• Training staff in resident-centered care and reassigning employees to more-consistent jobs.

• Some attempt to alter the physical monotony of nursing-home settings dominated by institutional 1960s and ’70s architecture. Larger homes may parcel themselves into "neighborhoods;" others renovate with resident input on colors and materials; still more add gardens, meditation rooms or restaurant-style dining areas.

A national survey of the transformation of nursing-home culture found that 31 percent of homes had adopted significant portions of the movement. The results "indicate a hopeful picture about the potential for deep, systemic change within the industry," according to the Commonwealth Fund.

Proponents believe the new state reimbursement system for Medicaid will eliminate any reason not to participate in the changes being made.  Culture change is not more expensive in the long run — it can save on staff turnover, food costs and expensive acute care. But for managers concerned about immediate costs, the state program to come on line next summer offers immediate financial rewards.

Nursing homes will earn points for quality of medical care, satisfaction of patients and their families, and culture-change tenets like consistent staffing and resident-controlled decisions. A home that scores 100 points will receive $4 more per Medicaid patient per day (on top of the current Medicaid rate of about $178 a day).

Medicaid pays for about 63 percent of nursing-home residents; the new payment system will mean, for example, that a high-scoring home with 70 Medicaid patients could earn an extra $8,400 a month. The first year of the program will cost $4 million, half coming from the federal government and half from a new fee charged to all nursing homes.