Residents at a nursing home in Idaho are alleging the facility is neglecting its residents and has failed to provide hot water for nine days.

A new water pump was ordered Thursday when hot water went out at the home.  Hot water was  available in the home’s kitchen and laundry room. The hot water was temporarily restored Thursday, failed again Friday and was not repaired until Sunday because the replacement pump was damaged in transit.  Relatives of some patients deny hot water was available.

"My mom hasn’t had a bath since she’s been here," said Butch Malone, whose mother arrived at the care center Dec. 10.

The families also say the center’s staff is unresponsive when patients call for help. For example, Randy Speaks’ 40-year-old daughter said it has taken staff as long as an hour to respond when his daughter is in need.

During the facility’s last inspection in September, state inspectors said the home was deficient in failing to properly treat or prevent bed sores, according to reports posted on the national Medicare Web site.

The inspection also found the home "failed to prepare food that is nutritional, appetizing, tasty, attractive, well-cooked and at the right temperature."

See full article here.

Here is another article about a nursing home’s failure to prevent a resident from falling and then failing to intervene or inform the family. 

The family was never told that their 60-year-old mother had broken both legs in a fall and died of complications.  Eventually,  the family discovered the horrific details. Their mother, Linda Ober, had been dropped by staff at the nursing home where she lived and left to moan for help in her bed for five days.

Employees tried to cover up the injury by giving her pain medication and telling her that her memory of being dropped as they moved her out of her wheelchair was simply a bad dream.  The family is haunted by the thought that her mother spent her final hours wondering why her daughter didn’t come to see her. According to the suit, the resident  told hospital staff that they didn’t need to call her daughter, because nursing-home employees said they would. Cunningham, who lives a mile from the nursing home, said she was not told.

"I wasn’t there to hold her hand," said Cunningham, breaking into tears. "All I needed was a phone call."

Thomas D’Amore, the attorney representing Cunningham and her siblings, said Ober’s death was the result of having too few staff and not adequately training them to care for the center’s residents. According to the U.S. Department of Health and Human Services, a review of the Gateway nursing home about the time of Ober’s death found that the number of nurse-hours per resident was below the state average by 33 percent.

She was critically injured Oct. 29, 2006, when two employees dropped her after improperly wrapping a sling around her torso to move her from her wheelchair to her bed, according to the suit.   X-rays show Ober’s badly broken legs. In one X-ray, her femur is jutting away from its normal position by 45 degrees. According to a summary of a state investigation that D’Amore provided, staff who treated Ober at Mount Hood Medical Center said Ober’s pain was "off the scale" and that "you could feel the bones in her legs moving in your hands, and they were crunching."

Here’s an interesting little article about the former director of operations for Beverly LIving Centers in one of the midwestern states.  "Ken Williston," as he’s called in the article, says he was the representative of the national office, and assisted nursing home administrators in meeting the company’s clinical and financial goals.  Seems he realized that Beverly was attempting to eliminate family choice of hospice care in favor of SeraCare, which is owned by Beverly.  Mr. Williston reported this finding to his immediate supervisor and to the company compliance officer, and was unemployed within 30 days.

Williston, himself a nursing home administrator, states "Its all about family choice, patient choice.  That’s what its all about.  By law, the family has the right to choose their hospice care and home care.  I raised that point with management, and that’s why I’m sitting here right now."

Beverly is one of the chains that was recently (2005) acquired by a private equity firm (Fillmore Capital).  Williston says that they know nothing about nursing homes, and they’ve cut the overhead by ten to fifteen percent to increase their income.

Also sounds like Beverly was increasing their income by encouraging families to "choose" additional health care from their own companies – more money in, less money out.

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.

Attorney for Amel Trezza asked the jury to compensate for his wrongful death at a nursing home  which occurred on May 31, 2001. The total verdict in the case regarding nursing home negligence amounted to $2,522,232.08. The total monetary figure makes the case the largest nursing home negligence case in Connecticut history.

Amel Trezza died on May 13, 2001 after he was administered the wrong food at the Country Manor Healthcare Center in Prospect.  During 2001, there was a widespread strike amongst nursing home employees stemming from a demand for improved wages and conditions of employment.

A replacement worker made the mistake of serving Mr. Trezza, who was blind, food that was supposed to be for a patient on a regular diet. Mr. Trezza was administered a soft diet, which meant that all of his food was put through a food processor, thus making it easier to swallow.

After serving Mr. Trezza the wrong meal and failing to look at the name card, the replacement nurse moved on to other patients in an adjoining room. Meanwhile, Mr. Trezza began to choke after unknowingly beginning to eat the wrong meal. 

Mr. Trezza was found unconscious after he had already lost a great deal of oxygen to his brain, leaving him with severe brain damage. He was subsequently intubated, which was not according to his wishes, and died 10 days later.

The case of wrongful death was tried in Waterbury Superior Court in the recent weeks. Because Connecticut doesn’t provide the framework for punitive damages, according to Atty. D’Amico, the case was settled on the basis of non-economical damages. The state of Connecticut enacted such a system as a detriment to lawsuits against nursing homes.

I read an article today about the death of a resident caused by the improper transfer by the nursing home staff.  Falls are always so dificult for the elderly to survive.  the injuries cause by falls can lead to immobility, pain, and demntia.  Preventing falls should be a high priority but often isn’t.  Training and staffing are lacking in this area.

A Pennsylvania Coroner concluded a nursing home resident’s death was caused by injuries she suffered after being dropped by staff from a mechanical lift.    Judith Bilger was dropped Aug. 9 and died three days later at the Laurel Crest Rehabilitation & Special Care Center.

Coroner Dennis Kwiatkowski says the 64-year-old woman died from internal injuries caused in the fall.   Among other things, she broke ribs and developed pneumonia from a lung contusion.

Proper staffing and education on proper use of mechanical lifts could have prevented the above incident and prevented this woman’s death.

In the latest issue of the magazine Trial, thereis an interesting article about how medical malpractice settlements are reasonably related to the quality of care provided according to an analysis of 11 different studies on settlements.    The article is in the December 2007 | Volume 43, Issue 12 and the author isValerie Jablow, Associate Editor.

Below is an excerpt of that article:

An analysis of the results of 11 studies of medical malpractice claims and settlements shows that “medical malpractice settlements are neither random nor irrational” and that “quality of care drives settlement outcomes,” with the likelihood of payment and the amount paid “closely related to the merit of the underlying claim of medical negligence.” (Philip G. Peters Jr., What We Know about Malpractice Settlements, 92 Iowa L. Rev. 1783 (2007).)

“People who studied the field have been aware of these findings for some time,” said Philip Peters, a University of Missouri law professor who conducted the analysis. “But the previous descriptions of them have tended to be relatively anecdotal, not attempting to tie them all together in a concrete way to show what the pattern is.”

Tort “reformers” have long alleged that medical malpractice settlements are an “irrational lottery,” where fault and settlement are unrelated, Peters noted in his report. Many critics have relied on a small analysis in the widely cited Harvard Medical Practice Study, which concluded that the merits of 51 malpractice claims examined had no relation to the likelihood of settlement. (Troyen A. Brennan et al., Relation Between Negligent Adverse Events and the Outcomes of Medical Malpractice Litigation, 335 New Eng. J. Med. 1963 (1996).)

Peters looked at that study and 10 others completed between 1988 and 2006 that examined settlements in almost 20,000 medical malpractice cases. He found that the 1996 Harvard study is an “outlier”: Taken together, the data Peters analyzed showed that “weak claims are much less likely to result in a settlement payment than strong claims,” with only 10 percent to 20 percent of weak cases resulting in payment (and then, usually only a “token” amount, such as forgiveness of unpaid medical bills).

Strong cases, Peters found, settle at a higher rate (85 percent to 90 percent) and for much larger average payments. “Borderline” cases fall somewhere in between strong and weak ones.

Peters also found that many cases settle at a “discount,” often for less than their expected value. Such discounts operate in two ways, Peters wrote, “once in the insurer’s decision whether to make any settlement offer at all and again in the size of the offer to make.” He found settlement offers to be significantly less likely in weak cases than in strong ones, and when an offer is made in a weak case, it is significantly smaller.

This “surplus discounting,” Peters noted, reflects the “superior bargaining power of malpractice defendants,” including greater risk tolerance, better access to information and experts, and more experienced lawyers.

The fact that some weak cases settle “does not mean that the process is working unfairly,” Peters wrote. “This conclusion would only be justified if the payments were not being discounted to reflect the weakness of the claims being settled.”

The report also noted that about the same percentage of strong cases—10 percent to 20 percent—get no payment at all.

However, the study also concluded that “to the extent that settlement outcomes depart from the merits, the discrepancies usually favor malpractice defendants. . . . As a result, plaintiffs have more reason to complain about the system’s imperfections than defendants do.”

“Through 11 studies, we have the benefit of people who have accessed the files and found that cases settle much the way ordinary people would handle them if they were lawyers,” he said. “The reassuring finding from these studies is that the civil justice system really is asking the right question: ‘Did the patient get competent care or not?’ The findings show the system works.”

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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