A lawsuit was filed against Glenwood Care and Rehabilitation nursing home for failing to monitor and supervise Mark Billiter who was allowed to wander away from the facility and was found frozen to death next to a dumpster.  Billiter was only 56 years old.  Billiter had suffered from heart-attack induced dementia, which required medical attention and constant supervision in a secured medical treatment facility.  Billiter wandered away between 7 and 8 p.m. April 15. The facility failed to report the man as missing to his family or police for nearly 12 hours, the filing says.  He was found dead two days later beside a dumpster at a self-serve gas station about four miles from the facility.

Attorney Tracey Laslo is representing the plaintiff.

“This is a tragedy that could have been prevented if the facility had followed its own policies and procedures,” Laslo said Monday afternoon. “The family is distraught because it was preventable.”

Billiter had been a patient and resident there for years. His incapacity was well known to the Glenwood staff, the complaint alleges.

When Billiter wandered out of the secured area, he “was ushered out … of Glenwood’s facility by an unknown member of (staff) while following another patient’s visitor,” the plaintiff contends in court records.

The Stark County Coroner’s Office performed an autopsy and ruled the cause of death to be “environmental (cold) exposure.” The report specifically noted “prolonged exposure to cold environmental elements with wet/insufficient clothing.”

“Had (Billiter) been reported missing soon after he left the facility, he would have been found and safely returned,” the lawsuit contends. “Instead, because of the defendant’s wrongful actions, he slowly froze to death while curled on the ground beside a dumpster.”

McKnight’s had an article about Congressional leaders concerned over the off label and unsafe use of anti-psychotic medications in nursing homes. Rep. Richard Neal (D-MA) sent a letter to the Centers for Medicare & Medicaid last month, asking for explanation on how SNFs and Medicare plans are acting to address such prescriptions. He wants the agency to specify how many Medicare dollars go toward adverse events stemming from inappropriate prescribing, and any links they might have to nursing home staffing levels.

The latest CMS data shows that nursing homes are making minimal progress in decreasing anti-psychotic prescribing. At the end of 2011, almost 24% of residents received an anti-psychotic medication. Since then, there has been a decrease to a national prevalence of 14.6% in the second quarter of 2018, the agency reported.

“Unfortunately, CMS’ data are still extremely disappointing, showing that progress reducing inappropriate use of anti-psychotics in nursing homes has slowed,” he wrote. “Moreover, I am concerned that the ‘improvement’ is not the result of changed prescribing behavior but, instead, stems from some nursing homes falsifying psychosis diagnoses, making incidence of this contra-indicated prescribing appear improved when it is, in fact, not.”

 

CTVNews reported the tragic death of the mother of former Canadian politician Gilles Duceppe who froze to death just outside of her Montreal seniors’ residence early one Sunday morning. She had frozen to death after mistakenly heeding a fire alarm from a nearby building.

The coroner’s office, which is investigating the incident at the Residence Lux Gouverneur, confirmed to CTV Montreal that the woman was Duceppe’s mother, Helene Rowley Hotte.  Montreal police said a fire alarm was set off in a building in the seniors’ home complex at 4:15 a.m., but a notice followed indicating residents in Rowley Hotte’s building did not need to evacuate.

Rowley Hotte, who had hearing problems, likely hadn’t understood that she didn’t need to evacuate and exited the building. Once she made her way out of the building, she was unable to get back inside because the door was locked, police said. Staff at the facility told CTV Montreal the doors automatically unlock when an alarm sounds, but re-lock once it’s disarmed.

Nearly seven hours later the fire alarm, police received a call about a woman lying in the snow. They said she likely died from hypothermia.  At the time, it was about -20 C outside due to a severe winter storm, according to Environment Canada.

 

Willie Johnson suffers end-stage dementia and now lives in the Laurellwood Nursing Center in St. Petersburg, Florida.  His daughter, Tonya, has been his advocate for years but is troubled by the customs and practices at the nursing home.

“I’m so hurt, I’m so disappointed in that place,” Tonya said.  “In my dad’s room, they have a white sheet to the window as a cover, as a blind or as a curtain. It’s a white sheet,” Tonya stated.  On December 31, Tonya decided she’d seen enough when she spotted a large bed sore on her father’s backside. According to Tonya, her father didn’t have that bed sore when he arrived.

“I said, ‘Roll my dad over a little bit’ and that’s when I discovered (it.) I sort of stepped back, I said, ‘What is this?'” Tonya recalled. “And she said, ‘Oh, well, it’s a sore.’ And I’m like wow. I said, ‘Where’d this come from?'”  “I said, ‘Well how come nobody contacted me?’ She said, ‘Nobody ever called you?’ I said no,” Tonya said.

In addition, she was concerned about an ulcerated heel.

“I asked them to lift my daddy’s foot up. They lifted up in the air and I noticed my daddy’s foot under the bottom, like he’s got a hole and it’s spreading and it’s spreading,” she said.

In September, Laurellwood was issued 12 citations for health violations and 10 more for fire safety problems, according to Medicare’s website.

Tonya complained to the Department of Children and Families, Elder Abuse and Florida’s Agency for Health Care Administration about her father’s treatment.  DCF confirmed it received a complaint from Tonya and stated it is investigating.

The Chronicle Herald reported the tragic abuse suffered by Thelma Irene Lake at Haliburton Place.  Lake was forcibly placed and tied into a geriatric chair with a restraint. The Health Department investigated and confirmed the abuse.  Even though it’s been nearly two years since 91-year-old Thelma Irene Lake died, her daughter Marlene Hill tears up remembering what she calls the abuse her mother suffered.

“Her only crime was she wanted to use the bathroom,” says Marlene Hill.  Her mother had dementia and spent the last seven months of her life in the nursing home. She was still walking but unable to talk or ring the call bell in her room.

One November night in 2016, Thelma Lake tried to get out of bed several times to get to the bathroom. She shared the room with a 43-year-old woman named Terri Dean. Dean told Marlene Hill that she rang her mother’s bell looking for assistance because she was concerned Thelma might fall. The investigation found some documentation that said she was “at risk for falls.”

According to Dean, a nurse and a male continuing care assistant arrived but they did not take Thelma to the toilet. Instead, they forcefully removed her diaper and tied her roughly into a geriatric chair using a “posey” restraint — essentially, a rectangular piece of fabric placed around the waist with strings that are tied to the back of the chair. Dean told the investigator she heard one worker say, “We are not allowed to use this,” and another confirming, “No, we aren’t,” while continuing to tie her roommate.  Thelma was crying and continued to cry after being dragged out of the room in the chair shortly before 1 a.m. Notes from staff indicate the woman spent four hours and 15 minutes in the chair next to the nursing station.

Restraining a resident is a safety measure of last resort in consultation with the resident (if competent), or with the family. The report found no care plan or consent on file for the senior. Restraints are also to be used for the shortest time possible. In this case, they included the posey and a table tray similar to a child’s high chair.

Hill says she was told by a nurse her mother sometimes received an antipsychotic drug called Haldol to settle her. Dizziness can be a side effect and Haldol is not usually recommended for geriatric patients.

Staff admitted they took these actions to protect “the safety” of the resident.

The investigator ordered Haliburton Place to provide education on the use of restraints to the staff involved in the Thelma Lake incident and to “any other staff who require it.” The nursing home was told to train staff on the definition of abuse, signs of abuse, and how to report it.

Meanwhile, on Friday March 3, 2017, she and her sister called the attention of the registered nurse and licensed practical nurse to their mother’s leg, which was red and swollen from the knee down. Hill, who had previously worked as certified nurse assistant, wondered if it was related to cellulitis or shingles. Both were ruled out.

On Sunday afternoon, nursing notes show a licensed practical nurse reported Lake was short of breath. The nursing assessment mentions the red area on the leg had decreased, while swelling remained. By the morning of Monday, March 6, notes indicate Lake was still experiencing shortness of breath and was “clearly not herself.” Two phone calls to the attending physician who worked in the same building went unanswered.  Thelma Lake passed away at noon.

Nurses on the Monday shift told the investigator they never received information from nurses on the Friday shift concerning Thelma’s leg, and if they had, they would have summoned the doctor much sooner. It was determined Lake died as the result of a blood clot.

“My mother was a human being,” says Marlene Hill. “Blood clots are treatable. Just because she was 91 years old doesn’t mean she shouldn’t have got the medical attention the problem deserved. I don’t think anyone would have called the doctor to check on Mom if my sister hadn’t happened to drop in that morning.”

 

 

Myscience reported on the good news in a recent medical report.  New research shows that a comprehensive, coordinated care program for people with dementia and their caregivers significantly decreased the likelihood that the individuals would enter a nursing home. The study also shows that the program saved Medicare money and was cost-neutral after accounting for program costs.  The study was published Dec. 21 in JAMA Internal Medicine.

The research, conducted at the UCLA Alzheimer’s and Dementia Care Program, was designed to evaluate the costs of administering the program, as well as the health care services used by program participants, including hospitalizations, emergency room visits, hospital readmissions and long-term nursing home placement.

The findings of this study show that a health care system-based comprehensive dementia care program can keep persons with dementia in their homes and in the community without any additional cost to Medicare,” said the study’s senior author, Dr. David Reuben, Archstone Professor of Medicine and chief of the UCLA Division of Geriatrics at the David Geffen School of Medicine at UCLA.

The research focused on the UCLA Alzheimer’s and Dementia Care Program. In the program, people with dementia and their caregivers meet with a nurse practitioner specializing in dementia care for a 90-minute in-person assessment and then receive a personalized dementia care plan that addresses the medical, mental health and social needs of both people. The nurse practitioners work collaboratively with the patient’s primary care provider and specialist physicians to implement the care plan, including adjustments as needs change over time. A total of 1,083 Medicare beneficiaries with dementia were enrolled in the program and were followed for three years. The study compared them to a similar group of patients living in the same ZIP codes who did not participate in the program.

The most striking finding was that patients enrolled in the program reduced their risk of entering a nursing home by about 40 percent,” said lead author Dr. Lee Jennings, assistant professor at the University of Oklahoma College of Medicine. Jennings began the project while on faculty at the Geffen School and finished it after arriving at Oklahoma.

Participants in the program saved Medicare $601 per patient, per quarter, for a total of $2,404 a year. However, after program costs were factored in, the program was cost-neutral and might result in savings in other settings, such as at other health care systems.

Jennings added that individuals with dementia typically have not received good-quality care. “Part of the reason,” she said, “is that the care takes a significant amount of time, which primary care physicians don’t have in abundance. In addition, pharmacologic treatments for dementia are limited, which makes community resources all the more important for both patients and caregivers. However, community programs tend to be underutilized.”

 

 

People with Alzheimer’s and other forms of dementia often suffer from dehydration issues for a variety of reasons. One of those reasons is that dementia patients may simply forget to drink water; loss their thirst; forget where to find water; or caregivers forget to encourage residents to drink fluids throughout the day. Still others may even forget how to drink water or how to swallow. Dementia patients who suffer from dysphagia—a swallowing difficulty—often have a hard time swallowing thin liquids and require thickening agents to help them get the hydration they need.

When a patient reaches the last stages of dementia and is no longer getting the water they need due to one of the reasons listed above, they rely on the help of caretakers to provide water-laden foods and thickened or flavored beverages to combat dehydration.

Lewis Hornby got creative with hydration techniques that can keep people with memory loss problems from experiencing the discomfort and pain of excessive thirst, developing other dehydration-related health issues, and even dying of dehydration.  When Hornby noticed that his grandmother, who suffers from dementia, was not getting enough to drink and decided to invent something that would make it easier for her to get the fluids she needed. So he used sensory deprivation tools and VR tools to get a better understanding of the issue, spoke with a dementia psychologist, spent a week living in a dementia care home, consulted with doctors about how to create a hydrating product, and returned to the care home several times to test the prototypes of his project. All in an effort to do something to help.

“For people with dementia the symptoms of dehydration are often mistakenly attributed to their underlying condition, meaning it can easily go unnoticed until it becomes life-threatening,” Hornby writes on the James Dyson Award website. “About a year ago my grandma was unexpectedly rushed to hospital, she was found to be severely dehydrated. Thankfully, after 24 hours on IV fluids she was back to her normal happy self, and is still enjoying a good quality of life to this day.”

What Hornby came up with were Jelly Drops—brightly colored bite-sized balls of liquid that are easier to swallow than water but just as hydrating. The drops are made of 90 percent water with gelling agents and electrolytes to aid in hydration.

Photo: Twitter/john thackara

The drops don’t require any utensils, are firm and easy to grasp, and don’t leave any residue on the hands. The packaging doesn’t look like a medical device of any sort, so it’s not threatening; instead, it looks like an inviting box of candies.

Hornby says he’s found that people with dementia immediately recognize the colorful Jelly Drops as a treat and are eager to eat them, even if they would normally turn down other types of food or drinks.

“When first offered, grandma ate 7 Jelly Drops in 10 minutes,” says Hornby, “the equivalent to a cup full of water, something that would usually take hours and require much more assistance.”

Photo: Vimeo/Lewis Hornby

Jelly Drops have won the Helen Hamlyn Design Award, Snowdon Award for Disability, and the Dyson School of Design Engineering DESIRE Award for Social Impact. They are being trialed in other care homes in the UK, and Hornby hopes to do more research and begin production of his drops soon. Hopefully this ingenious invention will help thousands of current and future dementia patients get the hydration they need to stay comfortable, healthy, and alive—and enjoy it at the same time!

Some 150 million people worldwide are expected to be affected by dementia by 2050. And while there are many ways people can change their behavior to lower their risk of heart disease and cancer–such as eating a healthy diet, exercising and avoiding or stopping smoking–there are few similar steps that have been scientifically proved to reduce the risk of degenerative brain disorders like Alzheimer’s. Genes play a prominent role in determining who will develop the disease, and age is also a major factor–neither of which are under human control.  That’s why Alzheimer’s experts have focused their attention on developing drug treatments for the disease.

Wake Forest Baptist Medical Center sought people with hypertension to volunteer for a study called SPRINT MIND which was designed to test whether aggressively lowering blood pressure would have an effect on people’s risk of cognitive decline, including symptoms of dementia related to Alzheimer’s disease.  So far the trial’s results are the first solid confirmation that lowering blood pressure reduces the risk of both mild cognitive impairment (MCI), a degree of brain decline that’s considered the gateway to dementia.   The study provides the strongest evidence yet that there may be something in people’s control that lowers their risk of cognitive decline. The results of the trial, which was funded by various agencies in the National Institutes of Health, were presented at the annual meeting of the Alzheimer’s Association in Chicago in July and immediately buoyed the hopes of Alzheimer’s experts.

The SPRINT MIND study involved more than 9,300 elderly people who had had heart problems or were at higher risk of developing heart disease–some because they had high blood pressure. They were randomly told to lower their blood pressure to either less than 120 mm Hg or 140 mm Hg systolic. (Current guidelines, revised in 2017 after the study began, now recommend that most people keep the upper number, or systolic pressure, under 130 mm Hg.) They were tested over an average of three years on various cognitive skills, including memory and processing of new information.

After an average of three years, people who lowered their blood pressure to less than 120 mm Hg lowered their risk of developing MCI or probable dementia as measured by the tests by 15%, compared with people who lowered their blood pressure to 140 mm Hg.

There are finally some promising drugs for Alzheimer’s that are now being tested.  These could be the first to actually slow or even reverse the damage to brain nerves that cause memory loss, disorientation and other problems related to thinking skills. The latest studies on two drugs, BAN2401 and aducanumab, show they may shrink the amount of disease-causing protein plaques in the brain and could even slow the progression of cognitive decline.

 

The New York Times had an article on a new medication that works to treat Alzheimer’s dementia.  For the first time in a large clinical trial, a drug was able to both reduce the plaques in the brains of patients and slow the progression of dementia. The drug may be the first to successfully attack both the brain changes and the symptoms of Alzheimer’s.  The results were presented at the Alzheimer’s Association International Conference in Chicago.

“This trial shows you can both clear plaque and change cognition,” said Dr. Reisa Sperling, director of the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital in Boston, who was not involved in the study. “I don’t know that we’ve hit a home run yet. It’s important not to over-conclude on the data. But as a proof of concept, I feel like this is very encouraging.”

Aside from a couple of medications that can slow memory decline for a few months, there is no effective treatment for Alzheimer’s, which affects about 44 million people worldwide, including 5.5 million Americans. It is estimated that those numbers will triple by 2050.

In the data presented, the highest of the five doses of the new drug — an injection every two weeks of 10 milligrams per kilogram of a patient’s weight — both reduced amyloid levels and slowed cognitive decline when compared to patients who received placebo.

Of the 161 patients in the group taking the highest dose, 81 percent showed such significant drops in amyloid levels that they “converted from amyloid positive to amyloid negative,” Dr. Kramer said in an interview, meaning that the patients’ amyloid levels dropped from being considered high enough to correlate to dementia to a level below that dementia threshold.

And on a battery of cognitive and functional tests measuring memory and skills like planning and reasoning, the performance of the high-dose group declined at a rate that was 30 percent slower than the rate of decline in the placebo group.

McKnight’s had an article about FDA concerns over the use of Nuedexta as a chemical restraint.  Nuedexta is the only drug approved to treat uncontrolled laughing and crying due to pseudobulbar affect.  However, some nursing homes are using it for residents without pseudobulbar affect.   It’s a rare condition yet the U.S. government is cautioning private insurers to look for suspicious off-label use there because officials fear the drug is being misused to control behavior.

A CNN investigation published in October found Nuedexta’s maker had been “aggressively targeting frail and elderly nursing home residents for whom the drug may be unnecessary or even unsafe.”   CNN unearthed what seems to be a concentrated effort to keep the increasingly controversial drug in nursing home’s formularies.  The station obtained complaints sent to the Food and Drug Administration from insurers and nursing home physicians who questioned the maker’s marketing and advertising tactics.

In a follow-up article published Monday, the news organization said the Centers for Medicare & Medicaid Services issued a March memo asking Medicare Part D providers to monitor prescriptions for appropriate use.

The CMS memo told plan sponsors that Nuedexta is only approved to treat pseudobulbar affect, and that they are legally required to ensure the drug is only covered for medically-accepted prescriptions. Neudexta’s maker, Avanir Pharmaceuticals, has said that dementia patients may suffer from PBA.  No medical research supports that contention.  Since the drug launched in 2011, CNN reports Avanir has generated millions of dollars in annual sales in nursing homes.