Theres an article out of Lafayette, Louisiana about short staffing which points out that short staffing can lead to abuse and neglect in more ways than one.  Typically, we think that short staffing leads to poor care because of the high patient to staff ratio, or because of employee stress, but this article points out something I hadn’t thought of.  When facilities are short staffed, they often turn to agency staffing out of necessity.  However, although nursing home facilities are required to run background checks on all of their employees, staffing agencies don’t always do this, and the nursing home is "caught in the middle"  They have to have sufficient staff, and they can’t wait, so they use agency staff – they don’t always know if background checks have been performed. 

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Here is a link to an article about a Nashville CNA arrested for raping a 70-year-old resident of a nursing home.  Police arrested 44-year-old Harvey Eugene Taylor for allegedly raping a woman in her room at Madison Healthcare and Rehabilitation Center.

Police said the woman suffered from dementia. He was charged with aggravated rape.
In May, the 70-year-old woman told staff members that Taylor sexually assaulted her.

She was taken to the hospital. Tennessee Bureau of Investigation analyzed DNA recovered from her and it matched a sample from Taylor, who denies having any sexual contact with the patient.

Taylor has been a licensed nurse’s aid since 2000.

The Wall St. Journal has a great article on the use of medications to sedate residents because of short staffing at many nursing homes.  Below is an excerpt from that article.

Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals — including antibiotics, AIDS drugs or medicine to treat high-blood pressure.

One reason: Nursing homes across the U.S. are giving these drugs to elderly patients to quiet symptoms of Alzheimer’s disease and other forms of dementia.

Nearly 30% of the total nursing-home population is receiving antipsychotic drugs, according to the Centers for Medicare & Medicaid Services, known as CMS. In a practice known as "off label" use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not. CMS says nearly 21% of nursing-home patients who don’t have a psychosis diagnosis are on antipsychotic drugs.

That is what happened to a woman listed in New York state health department inspection records as Resident #18. The 84-year-old Alzheimer’s patient, who lives at the Orchard Manor nursing home in Medina, N.Y., likes to wander and roll her wheelchair around her unit, according to a report filed earlier this year, and sometimes she nervously taps her foot.

To address her behavior, which was considered disruptive, Resident #18 was given a powerful antipsychotic drug called Seroquel, a drug approved for schizophrenia and bipolar disorder. Resident #18 is not psychotic and Seroquel — like other atypical antipsychotics — carries a "black box" warning that elderly dementia patients using it face a higher risk of death.

"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they’re out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York’s nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Federal and some state regulators are pushing back, questioning the use of antipsychotic drugs and citing nursing homes for using them in ways that violate federal rules. New York has increased its focus on antipsychotics in nursing homes, training inspectors to spot signs of medication abuse. Last month, the Arkansas attorney general filed suit against Johnson & Johnson and two of its units, claiming, among other things, that they "engaged in a false and misleading campaign" to promote its antipsychotic drug Risperdal to geriatric patients.

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Here is a very interesting story from a resident’s point of view.  Billy Bogardus, a retired engineer, said he received poor care while he was a patient in Haven Health Center of South Windsor earlier this year. "You had to beg and plead to get them to pay attention," he said.  Bogardus of West Hartford went into a Haven Healthcare nursing home to recuperate from a hospital stay, but ended up fighting for his life.

For four days in April, Bogardus and his close friend, Leona Brenner, tried to convince the staff of the Haven Health Center in South Windsor that he was dying. Bogardus, who had sought nursing-home care after complications from heart surgery, was coughing, struggling to breathe and couldn’t walk the six steps from his bed to the bathroom, he and Brenner said.

Only after Brenner threatened to call 911 herself did the nursing staff finally summon an ambulance, the couple recounted. By the time the 69-year-old retired civil engineer arrived at St. Francis Hospital and Medical Center in Hartford, hospital records show, he was dehydrated and his kidneys were failing.

"If it wasn’t for [Leona], I’d be dead half a dozen times," said Bogardus, who landed in the hospital several other times during his seven months in the nursing home — once when a blood test found his level of the medication Cumadin was five times higher than normal. "You had to beg and plead to get them to pay attention. I think I would’ve been better off out on the street."

Bogardus’ complaints were not new. Last year, a state inspection report detailed numerous complaints from residents about the "difficulty they have experienced in obtaining staff assistance."
The South Windsor home is one of 13 Haven Healthcare homes with staffing levels that fall below both state and national averages, according to the most recent federal data. Nationwide, nursing homes provide an average of 3.6 hours of care per resident per day — 1.3 hours by licensed or registered nurses, and 2.3 hours by certified nursing assistants. A study commissioned by the federal government recommends that each resident receive 4.1 hours of care a day.

But in Connecticut, nursing homes have had little incentive to boost staffing. The state’s minimum-staffing law, which has not been updated in more than 25 years, requires only 1.9 hours of nursing care a day per resident — less than half of what the Centers for Medicare & Medicaid Services’ study recommends.

Although the state’s public health code also requires that each facility has sufficient staff to ensure residents receive appropriate care, state public health officials have been reluctant to use that provision to penalize homes for understaffing, or to make demands on homes to add staff when deficiencies are found, records indicate.

Federal data show that Connecticut in 2006 cited only 2 percent of nursing homes, under federal rules, for failing to provide sufficient nursing staff — a lower rate than 27 other states. In 2005, its rate of citing homes for staffing deficiencies was among the lowest in the country — zero.

Haven Healthcare — which has the lowest staffing average of the state’s three largest chains, according to the most recent data — is one of many nursing home operators in Connecticut that stand to benefit from those policies. But it also provides some compelling examples of the consequences.

Many of Haven’s 15 homes in Connecticut have been cited in the last three years for bed sores and dehydration — two key indicators of understaffing, according to federal health officials and nursing home experts. In February, the chain’s Waterford home was hit with the largest penalty imposed by the state in three years — a $100,000 fine and two years’ probation — for neglecting a sore on a resident’s heel for so long that his leg had to be amputated, in addition to other violations.

But in most cases where Haven has been cited for bedsores or dehydration, state officials have not mandated any increase in staffing. Even in the Waterford case and two other Haven cases that triggered "consent orders" by the health department — the highest level of enforcement — the department did not require increases in staffing ratios.

In a number of cases where serious patient-care deficiencies have been found in Haven homes, follow-up state monitoring often consists of the assertion: "Staffing was reviewed and found to be in compliance with the minimum staffing levels of the public health code" — a certification that nursing home advocates say is meaningless.

Jennifer Keyes-Smith, an advocate for the elderly who formerly worked for the state as a regional nursing home ombudsman, complained in a letter last winter to the attorney general’s office that she had tried repeatedly several years ago to get the ombudsman’s office and the state Department of Public Health to address chronic understaffing at Haven’s New Haven home — without success.

"I continued to visit the facility and observed resident call bells going unanswered, residents not being fed, residents not being toileted, and staff treating residents disrespectfully," she wrote last November. "With basic human needs not being met, I continually urged the program’s prompt intervention and DPH’s expedient response. I was then told to stop working on the case."

Haven Healthcare CEO Raymond said he could not recall the state ever punishing the chain for understaffing or mandating higher staffing ratios.

Last week, state Attorney General Richard Blumenthal disclosed that state and federal officials were investigating whether Haven Eldercare, the chain’s parent company, improperly diverted government funds away from patient care. Termini said the company’s financial issues never impacted the level of care.

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Staffing became an issue in the recent Kentucky Governor’s race.  Democrat Steve Beshear said that Kentucky needs to consider requiring minimum staffing levels at nursing homes, but Gov. Ernie Fletcher said the corporate owners should be allowed to determine how many nurses they hire.

Last night, Beshear said Fletcher’s administration has failed to protect seniors, citing a news story that indicated the number of citations for nursing homes has declined since the Republican became governor in 2003.

"We don’t have enough inspectors to go and enforce" laws that apply to nursing homes, said Beshear, a Democrat.

"I think it’s time to look at minimum staffing numbers," he said. "We’ve got to make sure the profit motive doesn’t interfere with the care motive."

Fletcher said the state doesn’t need to set minimum numbers of nurses for nursing homes saying that the state can ensure adequate care in other ways.

"We’ve closed nursing homes that needed to be closed," he said.

See article here.

Nursing home operators value loyalty and good nursing leaders, the latest results from the nation’s most in-depth nursing-home survey indicate. The national median salary for directors of nursing (DONs) at nursing homes jumped 5.2% this year, up to $72,515. Similarly, assistant DONs enjoyed a 4.9% rise, up to $60,022.   Both increases are much higher than the standard increase in other similiar positions.

Administrators, meanwhile, saw their national median salary increase by a less robust 3%, to $82,400. Assistant administrators’ median pay climbed to $59,357. However, compared to other type of white collar workers, this increase is substantial.

The figures come from the newly released 2007-2008 AAHSA Nursing Home Salary & Benefits Report. More than 2,500 facilities took part in the 30th annual survey, which is published by Oakland, NJ-based Hospital & Healthcare Compensation Service and supported by both major nursing home associations.

Wisconsin Senator Herb Kohl is trying to prevent abuse by insituting a national system for criminal background checks on nursing home employees.  Please contact your Senators and encourage them to support this legislation.

Sen. Kohl says the best way to protect our elders from physical abuse is to institute a national system for background checks to determine whether those seeking to work in nursing homes and other long term care institutions have a criminal history before they are hired.

He and Sen. Pete Domenici (a Republican from New Mexico) introduced last month that would provide funding for a national register.   Kohl said the national register will be a tool employers can use to ensure they are hiring responsible people. It would also prevent workers with a history of abuse from moving from state to state to find new jobs.

Statistics and first-hand accounts prove that brutality and abuse exist in long-term facilities.
Nationally, one of every 20 elderly people will be abused in their lifetime. Between one and two million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depend for care or protection, according to Kohl’s statistics.

The bill would require states to notify employers about whether an individual has a disqualifying criminal history and provides employers with immunity from anti-discrimination lawsuits filed by individuals who are terminated based on a disqualifying history. At the same time, the bill calls for an independent appeals process for those who are disqualified.

The bill would also allow each state to decide which crimes would be considered disqualifying.
States would also have the authority to penalize providers for knowingly hiring workers with histories of abuse.

See full article here.

I was sent this great editorial regarding how much staff could be hired if CEOs were compensated reasonably instead of exorbitantly like Manor Care’s CEO Paul Ormond.

SNF CEO’S WINDFALL COULD HAVE PROVIDED MORE STAFF AND SERVICES

To the Editor:

Reports that Manor Care’s CEO Paul Ormond would personally realize between $118 and $186 million when his company, the largest nursing home chain in the United States, is acquired later this year by a private equity group got us thinking about staffing in nursing homes. Knowing that the federal government has reported that more than 90% of nursing homes do not have enough staff to take care of their residents, we wondered how many nurses and nurse aides could be hired for a year at Manor Care’s nursing facilities with that same money.

Using federal wage estimates for nursing home workers, we calculated that Manor Care’s 278 nursing homes could hire an additional 5346 certified nurse aides or an additional 2198 registered nurses if $118,000,000 were spent on staff (19.2 aides or 7.9 RNs at each Manor Care nursing home). If Mr. Ormond’s $186,000,000 windfall were spent on staff, Manor Care could hire an additional 8427 certified nurse aides or an additional 3464 RNs (30.3 CNAs or 12.5 RNs at each Manor Care nursing home).

Like all nursing home chains, most of Manor Care’s revenues come from public programs, Medicare and Medicaid. How should our public health care dollars be spent? One man’s windfall or certified nurse assistants and registered nurses in nursing homes?

Sincerely,

Toby S. Edelman
Center for Medicare Advocacy
California Advocates for Nursing Home Reform
The John A. Hartford Institute for Geriatric Nursing
National Conference of Geriatric Nurse Practitioners

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Here is an article talking about another rape of a resident at a nursing home.  Where is the supervision? Where is the criminal background check? Wher eis the good ol fashioned judgment!?

Salt Lake Police arrested a worker at a nursing home today accused of raping an 85-year-old resident.  Jacob Bolith was arrested on suspicion of rape. The CNA is accused of raping a patient at St. Joseph’s Villa nursing village July 1.

Police said Bolith has worked at various nursing facilities in the Salt Lake Valley over the past decade. Bolith told police that he faced similar accusations in the past, according to a probable cause statement released by the jail.

I read an article this weekend about a resident who was physically and sexually assaulted by the groundskeeper for a nursing home facility.  The family of an Alzheimer’s resident who was sexually assaulted by former Bedminster supervisor Robert Holland has sued him and the woman’s nursing home for civil damages.

The late Helen Priester was 92 and in a wheelchair when Holland, a groundskeeper at Pine Run Community in Doylestown Township, was caught with her in her room.

“We want to collect fair compensation for the injuries and damages Helen Priester suffered, but we also want to make sure that this doesn’t happen again,” said attorney Edward Shensky.

Holland, a Bedminster supervisor for 15 years, was sentenced in March to two to four years in prison for aggravated indecent assault, institutional sexual assault and related charges. Though he pleaded guilty, Holland maintained that Priester initiated the sexual contact and consented to the acts.

The suit says Holland was discovered May 5, 2006, by a Pine Run employee who noticed Priester’s door was closed.   The employee opened the door and found Holland assaulting Priester. The worker yelled at Holland to stop and went to get security when he would not.

When they returned, the door was again shut and Holland was continuing the assault.
Holland, who used a service entrance to come into the nursing home, admitted to assaulting Priester for at least three years, the suit said.
Shensky said the nursing home should have done more to restrict access to vulnerable patients.