One of the major issues with America’s health care system is how we treat people with addictions.  Anyone who has been affected by the ongoing opioid crisis can attest to the lack of resources for those addicted to the deadly scourge.  Many are stuck in nursing homes.  This is not an ideal situation for numerous reasons.  Rehabilitation hospitals work with patients to achieve therapy goals. But for long-term care, if a patient isn’t able to live independently in the community, the patient typically goes to a nursing home.

Athena Health Care Systems, a privately owned long-term care company based in Connecticut, has become one of the health care providers to offer programs to care for patients who have a history of addiction on top of the physical care diagnosis for which they are referred.  However, nursing homes are licensed by the state Department of Public Health and are surveyed by DPH to certify that they comply with federal Medicare and Medicaid regulations. They are not regulated as detoxification or addiction recovery centers. Athena-owned facilities are the only ones that have developed partnerships with drug treatment centers and in-house programs to train staff and support patients who also have substance use disorders.

“It’s an excruciating problem,” Peter Zawrotniak, program manager in addiction counseling services at UMass Memorial Medical Center, said about placing patients with substance use disorders in appropriate aftercare, particularly if they need methadone treatment.

Zawrotniak said none of the long-term care facilities in the area is equipped to address the full range of services needed for treatment and recovery. Suboxone, as long as it is prescribed by a physician with a waiver to do so, can be dispensed by nursing home staff and is easier to manage, Zawrotniak said.

Methadone, another form of medication-assisted treatment for opioid addiction, can only be administered to patients at a licensed methadone clinic. Patients must be registered with the clinic, a bureaucratic process that can be time consuming to coordinate. One patient waited in a hospital bed for two weeks. The nursing home must then transport the patient to the methadone clinic every day for their dose.

The state DPH’s Bureau of Health Care Safety and Quality issued a letter in 2016 about admission of residents on medication-assisted treatment for opioid use disorder. According to the letter, patients who have completed detoxification and are receiving medication-assisted treatment, and are otherwise eligible for admission to the long-term care facility, are expected to be admitted and have their treatment continued as prescribed by the patient’s physician or opioid treatment program.

There is no federal guidance on what reasonable accommodations need to be made for patients with substance use disorders. And extra services such as addiction counselors and enhanced security measures are not reimbursed by Medicare or Medicaid.

 

Medication errors are a serious problem in the nursing home industry. Federal law requires skilled nursing facilities to keep errors within a 5% margin. This margin is broadly defined, but includes errors such as not mixing medication as directed, giving medications at the wrong time, or not dosing the last small portion of a medication. Consumer advocates and experts estimate that at least 7 million Americans experience a medication error each year. These mistakes are preventable and costly – estimated at over $21 billion.  Errors within this 5% window don’t impact licensing and they’re the types of medications many people make at home when administering their own medications.

Nursing homes which are often understaffed, medication errors are rampant. Errors are likely underreported and that the medical coding system makes it easy to cover up error-related deaths. Under a different system, the CDC argues that medication errors might be the third most common cause of death among nursing home patients.

If you’re responsible for the health and safety of an older adult,you need to understand medication administration, particularly within nursing home settings.  By building good habits around medication preparation and administration, nursing facilities can improve patient outcomes and help minimize error rates at their facilities.

Given the potential problems stemming from improper medication administration, nursing homes need to invest in better prevention practices. That starts with increasing staffing level, a strategy that could also help prevent nursing home abuse. These facilities are chronically understaffed because of low pay and poor management and have a high rate of turnover. That means staff also aren’t familiar with patients’ care regimens and are more likely to make mistakes.

In addition to increasing staffing levels, nursing homes can decrease error rates by adopting a strong medication reconciliation program.  Reconciliation processes are especially important in nursing homes, as many patients are unable to verify their medications.

Finally, as part of reducing error rates, nursing homes should minimize high-risk behaviors, such as not properly disposing of discontinued medications or medications from discharged patients, improperly transporting medications, or administering medications without fully reviewing the label directions.

Nursing home residents are the most vulnerable members of our community and they deserve safe, careful, and appropriate treatment.

I recently read an incredible heartbreaking story about the suffering and preventable death of Gloria Dunn.  Dunn chose to live at the Bel Aire Assisted Living Facility in Utah County, Utah.  However her health began to suddenly deteriorate while a resident. Previously, she had only had trouble with her kidneys, her family says.

When Gloria Dunn arrived at the emergency room, doctors asked her son if she had cancer. It turned out the cancer-free 75-year-old had been getting large doses of methotrexate, a dangerous chemotherapy drug.

“The problems she was having were all related to that medication,” Joshua Dunn said.

Her family has filed a wrongful death lawsuit against a local pharmacy and her assisted living facility, alleging they gave her the wrong medication that led to her painful death in July 2018.  According to a lawsuit filed, Gloria Dunn had been prescribed metolazone, a common diuretic, but Select Pharmacy in Midvale, Utah, allegedly sent back the wrong drug. The staff at the assisted living facility then repeatedly administered that drug to the 75-year-old.

It took more than a week for doctors to check her medications and realize the mistake, the lawsuit states.

Gloria Dunn’s family says the woman would have wanted answers for what happened to her. Now, more than a year after the 75-year-old’s untimely death, her family is determined to get them.

“She wanted to understand why. She didn’t understand either, and when we knew, it was really powerful to be able to say to her, ‘This is what happened. It wasn’t your fault, and we’re so sorry,’” Griffin said. “The suffering that she endured through a mistake should never happen to anyone else, and that’s what we care about.”

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.

 

 

Melanie J. Hunter, a caregiver and registered nurse at Dycora Transitional Health, was charged with taking narcotic drugs that were meant to go to nursing home residents.  Hunter is charged with intentionally abusing residents-causing bodily harm. She could face up to six years in prison and a $10,000 fine if convicted of the charge.

This is sad and just one example of how the opioid abuse epidemic can affect everyone.

Texas has slowly reduced the misuse of antipsychotics in nursing homes in recent years, but experts and advocacy groups say more can and should be done. Texas legislators are considering a pair of bills that would require the written consent of a patient or a family member before an antipsychotic drug is given to a nursing-home patient.

Amanda Fredriksen, associate state director at AARP Texas, explained about 12,000 nursing home residents are being given antipsychotic drugs for no legitimate reason, perhaps other than the convenience of staff in caring for patients who otherwise might be difficult. She said these medications are intended to treat schizophrenia, bipolar disease and Tourette’s syndrome, but are dangerous for those with Alzheimer’s and dementia.

“These drugs can increase the risk of falls, increase blood glucose levels, they dramatically increase the risk of stroke – all these risks are well known,” Fredriksen said. “We outlawed physical restraints many, many years ago and now we’ve moved to chemical restraints. It’s fairly barbaric. ”

Fredriksen noted there are other alternatives to antipsychotics, including music and memory therapies and safer medications.

“There are also behavior techniques that can be used to know how to anticipate some of the reactions from residents and intervene with different kinds of behavior techniques that don’t require any drugs at all,” she said.

Kristy Winburn, an employee at Five Star Senior Living assisted living facility in Hartsville, is accused of taking prescription pills from an elderly resident who was left in her care.  One employee advised officers that Winburn had taken 11 Percoset pills from an 80-year-old resident. The employee said Winburn was replacing the missing Percoset pills with vitamins and Tylenol pills and passing it off as “legitimate medication” for the 80-year-old, according to the police report.

When police interviewed Winburn about the stolen prescription pills, she admitted to taking four of the pills.

The offender admitted to taking four of the pills while on duty and was clearly intoxicated as she was almost falling asleep, her head was nodding, and was clearly under the influence,” the police report stated.

The investigation also found that Winburn forged the signature of an employee for providing Tramadol, which is a schedule IV-controlled substance

Winburn faces several charges including failing to report abuse/neglect of a vulnerable adult, petty larceny and forgery.

Tulsa World reported on a bill pending in the Oklahoma House to crack down on the administration of antipsychotic drugs to nursing home residents. Oklahoma ranks first in the nation in giving antipsychotic medication to nursing home residents, according to AARP Oklahoma, which is backing Senate Bill 142, by Sen. Stephanie Bice, R-Oklahoma City.

This legislation will provide a stop to this immoral practice of drugging our seniors,” said Sean Voskuhl, AARP Oklahoma director.  “We rank No. 1 in the country in this category with the high use of antipsychotic drugs,” Voskuhl said. “We owe it to our most frail and vulnerable citizens to provide dignity and care.”

The measure defines antipsychotic drugs as a “drug, sometimes called a major tranquilizer, used to treat symptoms of severe psychiatric disorders, including but not limited to schizophrenia and bipolar disorder.”

Bice said the legislation requires written informed consent from the patient or legal representative.

If the nursing home resident is given the antipsychotic in an emergency situation, a physician would need to do a follow-up exam to ensure the proper diagnosis, according to the measure.

The medications are being prescribed for nonpsychotic reasons, Bice said.

“We want to ensure that if there is a medical diagnosis and they need it, they get it,” she said.

But if a patient doesn’t need it, caregivers must be careful about over prescribing, she said.

Some of the medications have negative side effects, such as sedation, which can increase the risk of a fall, Bice said.

There is a high occurrence of nursing homes giving antipsychotic medication when it is not necessary.

Nico Gomez is president and CEO of Care Providers Oklahoma, which represents about 200 nursing homes. Gomez said his organization is not opposed to the measure.

“It is an issue we have been working hard to improve for a number of years,” Gomez said. “We can understand that people who care for our residents like we do are getting frustrated with the lack of progress that other states have made.”

He said his organization is working to educate its members and with physicians to make sure “we are prescribing the right medications to the right person at the right time.”

Gomez said he didn’t have an answer as to why the state ranks first in the nation on administering the drugs to nursing home residents.

I read the most despicable thing about a nurse named Michelle brown who is charged with multiple felonies after prosecutors said she stole liquid pain medication from residents who needed it to relieve pain.  A grand jury on Friday handed up an indictment charging Brown, a licensed practical nurse, with tampering with drugs, theft, drug possession and illegal processing of drug documents.  This lady needs to be buried under the jail.

This nurse replaced the morphine and the hydromorphone that she stole with water, leaving the diluted doses to be injected into patients at Crestmont North Nursing Home.  Investigators could not determine how much of the medication Brown took, or how diluted she left the medication.

Brown took the bottles as they sat on the medication cart, poured some of it into pill baggies and then put water back into the bottle to bring it back up to the level it was before, prosecutors said.

Other employees at the home reviewed the facility’s surveillance video after they noticed Brown acting suspicious in March, and saw Brown ducking into closets, empty rooms and rooms of patients assigned to other nurses, prosecutors said.

They confronted Brown, who admitted to stealing medication twice, on March 1 and March 7, then taking it home and using it herself, prosecutors said.  Drug addiction is a major problem in the health care field where access and opportunity come together.