What is going on in Wisconsin?  Nursing homes that receive Medicare and Medicaid are required by federal law to report all instances of alleged mistreatment, neglect or abuse, including injuries of unknown origin, to the state health department’s Division of Quality Assurance within 24 hours.  A recent investigation by the Wisconsin Center for Investigative Journalism found facilities do not get punished when they fail to comply with the legal requirement and report incidents.  Most of the time they don’t even investigate the incidents themselves.

Families of residents complain that facilities’ failure to report serious injuries or deaths related to abuse or neglect is not uncommon, and the state health department only learns about incidents after a family member files a complaint.  In some cases, nursing homes file internal reports after a resident injury or death, but do not report the incident to the state, in hopes to cover up the incident.

The number of complaints the state received about Wisconsin nursing homes and assisted living facilities rose from 1,684 in 2000 to 2,562 last year — an increase of more than 50 percent.  At the same time, the Wisconsin health department has cut its staff of full-time nursing home surveyors from 100 in 2002 to 64 in 2012 despite an aging baby-boomer population. A state report found that Wisconsin will have 1.3 million residents over 65 by 2030, compared to about 777,000 residents in 2010.

Meanwhile new laws to help nursing homes avoid accountability prevent juries from hearing about state investigation reports of nursing homes even in criminal cases which means that more neglect or abuse will go undetected and unpunished. Critics say the law removes a useful tool for ferreting out abuse and neglect, noting that attorneys cannot use state inspection reports to affirm allegations or impeach witnesses.

Representative Jon Richards, a Democrat from Milwaukee, says the new law is making it harder for families to win their cases in court. “The bill was passed, nominally, to produce job creation, but I don’t see how letting abusers off the hook creates a single job. That is a real problem.”



Articles at HaywardWI.com, GreenBayPressGazette, and Wisconsin in Watch.


The L.A. Times reported that the California attorney general Kamala Harris found widespread health and safety problems in nursing homes throughout the state. Inspectors discovered cases of bed sores not being treated properly, patients being given the wrong medication or being over-medicated with psychotropic drugs and residents left in feces and urine for hours. Nursing homes were out of compliance with nurse-patient ratios and fraudulently billing for services, according to the reports.  The investigators are part of a program known as Operation Guardians, which was created in 2000.

At one nursing home, the report read, “Systemic problems in the nursing department included the listing of inaccurate diagnoses, poor end-of-life care, avoidable dehydration and inadequate fall prevention.”

At another, the report noted, “Residents are being avoidably harmed due to deficient nursing care in a number of aspects, including pressure ulcer prevention and treatment.”

The reports, although public documents, are not posted on the website and were released by California Advocates for Nursing Home Reform, an advocacy organization. Executive Director Pat McGinnis said in a statement that although the inspections are valuable and expose “inexcusable elder abuse and neglect,” their results were unknown to nursing home residents and their families. The organization did a California Public Records Act request to get access to the inspection reports and then released them to the media.

Don’t the residents and the general public have a right to know?  See another article at Senior Housing News.

The website MedicalXpress had an article discussing the new study called, "Nurses’ Perceptions of Error Reporting and Disclosure in Nursing Homes," published in the January 2012 issue of the Journal of Nursing Care Quality.   The majority of registered nurses who responded said error disclosures are difficult to process in nursing homes.   In NHs, nurses more routinely interact with patients with complex needs, which in turn increases the chance of errors occurring. Nursing errors refer to a nurse’s action that adversely affected, or could have adversely affected, a patient’s safety, quality of care, or both. Examples of nursing errors include lack of prevention (eg, breach of infection control precautions), inappropriate judgment or attentiveness, misinterpreting a physician’s order, or documentation errors.

NYUCN Assistant Professor of Nursing, Laura M. Wagner, PhD, RN, GNP-BC said  "Our research highlights the need for nursing homes to improve communication processes and policies, ultimately rendering a culture of safety in nursing homes."  The authors found that multiple barriers exist that might inhibit disclosure; almost one-third of the respondents were less likely to disclose if they believed they might be sued or reprimanded.

"Although there is increasing attention to disclosing harmful events, there is a significant gap between what is expected and what actually occurs in current practice. The process of disclosing is an ethical and legal obligation that provides essential information to patients and families."

The cover up is always worse than the initial mistake made by the caregiver.

Ted Rayburn is on the Editorial Board for The Tennessean who recently wrote an eloquent editorial in response to lax regulations and less accountability for nursing home operators.  See editorial below:


Open, festering sores.

Lying in urine and feces.

Such has been the plight of a higher number of residents of nursing homes in Tennessee than in almost every other state, as facilities operate with inadequate and underpaid staff, even as the number of elderly people needing nursing homes is increasing.

It’s a dire situation that clearly demands state and federal action to remedy the problem.

But, no.

Oversight of Tennessee’s 325 nursing homes has been dramatically reduced, making it easier for abuse and neglect of nursing home patients to flourish — if “flourish” is the right word for it.

When too little attention is paid to nursing homes and complaints about their performance, it is not just the patients and their families who suffer; it is the staffs of nursing homes, the vast majority of whom are not to blame for what is happening, and who actually care about the welfare of their patients.

The General Assembly passed tort reform earlier this year that gave greater protections to nursing-home operators from patients or their families seeking big judgments. But the problem actually goes further back, to 2009, when the previous General Assembly and the Bredesen administration eliminated regulations that required nursing-home operators to file detailed reports on patients’ adverse events. The requirement that the state investigate those same cases was dropped, also, as state investigators were said to need more time to investigate other, more serious complaints.

It’s clear that even as nursing home staffs are getting short shrift, so are state investigators.

Whether nursing-home companies refuse to hire enough staff, or cannot because nurses and other professionals are lured to higher-paying jobs in other areas of care, is not as clear. However, it is not the type of problem that should be allowed to continue without some review of licensing requirements. For example, current state law requires that licensed nursing personnel provide only 15 minutes of direct care per patient each day. That is insufficient time even to ensure that a patient who needs help eating a meal will be fed.

So the question now is: How long can the state nursing-home monitors and the operators continue to say they are doing their real job — taking care of people who can no longer take care of themselves? Just how many people must suffer malnutrition, bedsores, filth and worse before someone demands that it stop?

It is a false assertion for nursing-home operators to blame the shortages on federal changes in Medicare. Those costs are going to make it harder on nursing-home staffs, but cases of patient abuse and neglect were at a high level in Tennessee long before the current federal health-care reform act was proposed.

Nursing-home companies could take the many thousands of dollars they have contributed to political candidates over the years and use them to hire more staff. Even if it prevented only a few of these sad cases of patient suffering, it would be worth it.



The Des Moines Register continues their excellent reporting of the problems at Iowa’s nursing homes.  Five Iowa nursing homes have each been fined more than $8,000 because of allegations of resident neglect that resulted in two deaths, a leg amputation and other injuries.

The Good Samaritan Home in Indianola was fined a total of $24,500 for a series of problems involving different residents, including one who allegedly lost a leg to gangrene. The staff noticed the resident had a blister on his or her left foot on Christmas Day last year. Over the next four weeks, staff members documented the resident’s complaints of severe pain as the wound grew in size, turned black, then emitted a foul odor. On Jan. 23, the resident begged for help, telling the staff, “I want to go to the hospital. I can’t take the pain anymore.” The resident was admitted to the hospital with a diagnosis of gangrene and bone infection, which resulted in the left leg being amputated above the knee.  Good Samaritan was fined $10,000 for failing to adequately care for the resident.

The home was fined an additional $9,500 for failing to monitor a resident who sustained a bleeding head wound and a hip fracture after falling out of a mechanical lift.  After the resident fell, the staff went to dinner or were summoned to work in the dining room. When the resident’s daughter arrived, the resident was alone, on the floor with no blanket and was bleeding from the head wound.  The daughter remained by her side for the next 35 minutes until an ambulance  arrived. No workers checked on the resident or provided any services.

Good Samaritan was fined an additional $5,000 for failing to prevent a serious injury. A resident of the home had fallen out of a recliner four times over a period of several weeks. The last fall resulted in a broken clavicle.

Several other Iowa care facilities have recently been fined for problems related to resident care. Among the cases:

The Keystone Nursing Care Center was fined $15,000 when a resident died six days after a series of falls there.  The facility allowed the resident to fall in March, April and May. On July 12, the resident was found on the floor and taken to a local emergency room. Doctors diagnosed the resident with a skull fracture and brain bleed. The resident died on July 18, and the home was cited for failing to provide adequate supervision of residents.

Altoona Nursing and Rehabilitation Center was fined $8,000 after state inspectors reviewed 19 patient files and found that in 16 cases the home hadn’t taken adequate measures to prevent falls. In a four-month period, the home documented 133 falls.  In one case, a resident was found on the floor crying out in pain, then taken to the hospital and treated for a broken leg. The resident died 10 days later.

The home’s dementia unit reportedly had only one nurse aide to care for 17 residents during an eight-hour shift, although several of the residents were incontinent, needed feeding assistance or required the help of at least two workers to get to the bathroom. Some of the alarms used to alert the staff to wandering residents weren’t working properly, the state alleged.

“I have told them about the alarms being broken,” one worker reportedly told inspectors. “It gets scary back here when you’re trying to care for two to three residents at once and alarms are going off. You can’t even call for help because you are so busy.”

Ogden Manor was fined $8,000 after staffers allegedly tried to prevent a resident’s dentist from calling 911 to summon emergency medical personnel.  The resident arrived at a dentist’s office by bus and was helped inside by the driver. The dentist’s staff called Ogden Manor to report that the resident was crying, seemed to be in pain and was asking to be taken to the hospital. The Ogden Manor staff allegedly told the dentist’s staff not to call 911, adding that the resident had been like that for days and was fine. When the resident was finally admitted to a hospital, he was diagnosed with gastrointestinal bleeding, severe anemia, dehydration and a dental infection. 

The Akron Care Center was fined $10,500 for allegedly failing to provide residents with a safe environment, and $2,000 for allegedly failing to provide residents with the required nursing services. One resident was hospitalized with a head injury after a fall, and another was hospitalized with bowel problems the staff had allegedly failed to assess.


North County Times had a great article about Lynda Tammone.  Her husband had a horrible experience at a nursing home.  She is promoting better documentat ion of resident complaints so investigators can find the necessary evidence to fine a facility and improve the conditions.

An investigation by the California Department of Public Health substantiated only three of Tammone’s 27 claims against the facility. That frustrated Tammone, 65, a former paramedic, who said better record-keeping could have aided state inspectors.   Tammone, a retired emergency medical technician, said she spent most of each day at her husband’s bedside at Village Square taking notes. On July 12, 2010, she filed a 13-page letter with the California Department of Public Health alleging 27 instances where she said her husband did not receive proper care.

Tammone wants a state law that would require nursing homes and other long-term-care facilities to document complaints in a patient’s medical file. Tammone said she plans to begin making the rounds with local legislators soon.

"As it is now, a patient or family member can complain day after day about being left, as an example, in a urine-saturated diaper and sheets and the (Department of Public Health) ultimately has no evidence to indicate a shortcoming," Tammone said.  An investigator who handled her complaint told her during a telephone conversation that many of her claims could not be proved because alleged incidents were not mentioned in her husband’s medical record.

"(The company) is saying, ‘If it’s unsubstantiated, it didn’t happen,’" she said. "My position is, it happened, but I couldn’t prove it because my complaints were never documented in John’s medical record where investigators would have seen the pattern when they did their investigation."



Press of Atlantic City wrote an article discussing the dismal record of New Jersey nursing homes. Seven New Jersey nursing homes received the lowest quality ratings from the federal government last year based partly on state inspections in 2009 and 2010. Inspection reports show that residents in the worst-rated homes live in dirty conditions, endure verbal and physical abuse, and are neglected.

Hundreds of violations of rules that govern quality of care, safety and sanitation were found by inspectors during the past two years at the 60 nursing homes in Atlantic, Cape May, Cumberland and Ocean counties. The reports are used by the U.S. Department of Health and Human Services to develop consumer ratings of one to five stars for nursing homes. The majority of area facilities – 65 percent – are rated three stars or lower, federal data show, and half are in the bottom two levels.

A review of more than 1,800 pages of New Jersey Department of Health and Senior Services inspection reports from 2009 through April 2011 for 10 nursing homes showed that residents are routinely found living in dirty conditions, endure verbal and physical abuse, and are subject to neglect. Other violations include staff giving out the wrong medications, residents being strapped into wheelchairs and ignored for hours, theft, untreated infections, falls resulting from fragile residents being left unattended, and fire- and building-code violations.

State reports provide details of problems found during inspections. Some residents live in fear of reprisal if they complain about conditions.

A recurring theme was a failure to investigate or report incidents of abuse. Another recurring problem was failure to properly administer medication.  The medication error rate is not supposed to exceed 5 percent. A November inspection found an 18 percent error rate at South Jersey Extended Care. Our Lady’s Residence had a 14 percent error rate. Lincoln Specialty Care was at 9 percent, and Arcadia was at 8 percent. In one case at South Jersey Extended Care, a resident was supposed to get morphine every three hours for rectal pain, but went days without it because there was none.

A nurse and an aide allegedly told a resident who wanted help getting out of bed frequently overnight that she could not get up before 4 a.m. The inspection report states the staffers threatened to take away her wheelchair, withheld snacks and threatened to keep her in bed longer if she complained. The report states the resident shook in fear in the presence of the nurse and aide.

There are 367 nursing homes in New Jersey charging an average of $250 per patient per day, said Paul Langevin of the Health Care Association of New Jersey, a trade group of 185 homes.  Most homes are for-profit businesses run by companies that have multiple facilities. Costs of more than $90,000 per patient per year are often paid through Medicare and Medicaid, so tax dollars pay much of the bill.

McKnights and the Chicago Tribune had articles about the recent firing of 10 of the state’s 38 nursing home inspectors by Iowa Gov. Terry Branstad to save $125,000 in the budget.  Inspectors monitor Iowa’s 442 nursing homes for compliance and to prevent fraud and waste.  Obviously, the remaining 28 inspectors will not be able to spend as much time at each facility after these cuts.  Six months ago, Iowa cited a shortage of state inspectors in warning federal officials that the state was close to falling short of federal standards for oversight of the homes.
Branstad, during his campaign which was heavily funded by insurance and health care lobbyists, said state inspectors often fine Iowa nursing homes "unfairly".  Now he has cut more than 25% of the staff that ensure elderly Iowans are properly cared for at nursing homes.  Sounds just like understaffing at a nursing home.



California’s Browning Manor Convalescent Hospital in Delano has received an AA citation, the most severe penalty under state law, and a $100,000 fine from the state of California after an investigation concluded that inadequate care led to the death of a resident, the California Department of Public Health announced. State investigators found that the facility failed to protect the health and safety of a 58-year-old male resident who had a history of exhibiting aggressive and combative behavior.  According to the state’s investigation, inadequate supervision and monitoring of the man — in direct violation of the facility’s own policy — resulted in his death when he unbuckled the safety strap on his wheel chair and fell forward onto the floor. He had been known to unbuckle the safety strap in the past, the investigative report indicated but no other safety interventions were attempted.

In the days leading up to the incident, employees reported the resident behaved aggressively, "started to yell at staff, stripping his shirt. Tried to swing at anybody who goes near him…"

Nursing home policy states that residents experiencing behavioral outbursts and physical aggression are to receive one-on-one monitoring, according to the investigation. But the victim was not receiving one-on-one monitoring at the time of his fall.  In addition, a cervical collar was not placed on the patient previous to transport.

 In June of 2009, the Health Department said 58 year old resident fell out of his wheelchair and was taken immediately to a hospital in critical condition with a brain injury and fractured spine.  He died two days later.  Elizabeth Tyler, a representative for the nursing home, said the man left the facility in "good condition" that day.  The Kern County coroner wrote the cause of the resident’s death was a direct result of injuries he suffered.

The Health Department’s report on the incident stated the man had previous episodes of safety and behavior issues.  According to the report, the facility failed to provide one-on-one monitoring consistent with its policy.  Nursing home policy states that residents with aggression should be monitored for at least 72 hours or until the resident calms down.

Browning Manor Convalescent Hospital has appealed the decision.  Seems like they refuse to take responsibility and would rather file frivolous appeals. 

The Union Leader had an article about the quality of nursing home care in New Hampshire. More than half the nursing homes in New Hampshire are rated above average by a federal oversight agency, one-quarter of them rank below average.  When it comes to finding the right home for a loved one, advocates say using the wealth of data that’s out there, in tandem with personal visits, is the best approach.

One good place to start is medicare.gov, where you’ll find 80 licensed nursing homes in the state rated from one to five stars (five is the best). The ratings are based on health-inspection reports, staffing levels and quality measures the nursing homes are required to report to oversight agencies.  The state’s Health Facilities Administration is required by federal law to inspect every licensed nursing home sometime between nine and 15 months after the previous inspection.

New Hampshire has 16 five-star nursing homes, rated "much above average."  Most are nonprofit or church-related.  The state currently has three nursing homes rated one-star, considered "much below average," and 17 "below average" two-star facilities. (One facility that got one star is no longer a licensed nursing home.). Sixteen homes get three stars, rated "average," and 27 are "above average" with four stars.

Kathleen Otte, administrator of the state Bureau of Elderly and Adult Services, said families should use the five-star ratings as a foundation for their decision-making. But then they need to "do their homework in another area, the human element," she said. "I would suggest people go unannounced, meet the staff, meet families if possible, review the survey results that they can find at the administrator’s office, and see for themselves." "Because every family member will have certain expectations, and you want to make sure that that facility that you’re touring can meet those expectations," Otte said.

Each home is required to publicly post the results of surveys conducted by state inspectors.  hat’s where you’ll find any deficiencies such as fire-code violations, and data about how many patients had bedsores, physical restraints, pain, anxiety or depression. Families also can obtain inspection reports from the state, and on medicare.gov.

Fmilies can find help making these decisions from the trained counselors at ServiceLink resource centers. She noted New Hampshire was first in the nation to create this statewide network of Aging and Disability Resource Centers.

For health and safety reports on nursing homes, go to medicare.gov and click first on "facilities and doctors," then "compare nursing homes." There’s also a "Nursing Home Checklist" to help narrow your choices.

Free counseling about long-term care options is available at the state’s ServiceLink resource centers. Call 1-866-634-9412.