In a recent report in Wisconsin, 40 nursing homes have been listed as having a ‘substandard quality of care.’  See article at WAOW.  This tag comes with additional federal scrutiny on the homes, many of which have a history of violations and citations. Some were even on the list in 2011, marking them as consistently below the line when it comes to quality of care. The substandard homes are being watched more closely by the state and federal authorities, prompting a more immediate response to violations and citations than in the past.

Additionally the homes aren’t allowed to train new CNAs for a period of two years after the listing. The list may be a good thing, resulting in extreme watchfulness and immediate action, but if it is such a strong list to be placed on, how come homes have been on the list more than once?   If authorities responded immediately to violations and citations, and the list was a strong deterrent to providing poor quality of care, then something is getting lost in translation, because homes are staying on the list – not improving, not closing, but maintaining a state of care that is substandard.

Is that where you want your loved one to be?

Seacoastonline.com reported that the Department of Health and Human Services recently investigated a nursing home in Sanford, Maine after receiving reports that maggots were found on an elderly resident.  Incredibly, the investigation of the Newton Center for Rehabilitation and Nursing found “no problems”.    How is that possible?

Additionally, the DHHS spokesperson defended the facility after the incident claiming that since the resident had been checked twelve hours before, the larvae were caught “early” and the vulnerable resident was fine.  Maybe you should ask the resident or his family if the resident was fine after laying in bed watching helplessly as maggots ate away at his tissue.

Galesburg News reports on a new piece of legislation to be passed before the House in Illinois that would eliminate the ability to fine Nursing homes after serious injury or death.

The House Bill 5849 passed before the House unanimously and was the brainchild of Republican David Leitch.  This Bill leaves nursing home residents more vulnerable and at risk without any means of protection and creates more bureaucracy in the system of Nursing home review. Despite its unanimous passage, law makers still say: “ It is not a perfect bill. We will continue to work with the sponsors. We certainly still have some concerns, too.” 

Advocates for nursing home reform say this is a threat to advancements made on Nursing home reforms. Opponents of the bill sight its unanimous passage to lack of involvement from Public Health, who should have voiced concerns over the rights of nursing home residents.

In the state of Illinois, the passage of this bill will allow Nursing homes more room to get out of fines and citations through an appeals process. This bill will also lengthen the time of review on cases which resulted in serious injury or death, cases that need immediate action. The state of Illinois is aiding legislation which will allow Nursing homes more power and more abilities to avoid citations and fines through a system of bureaucracy.

 

KSTP reported that the staff at Mission Nursing Home had to receive basic training on wound care after a male resident was found to have maggots in open sores on his right foot. "In the facility’s documentation, an aide reported a blister on the resident’s right foot to the nurse at the beginning of September, but the nurse did not follow up with proper treatment. Nearly a week later, another aide discovered two open wounds on the man’s foot and saw maggots in both wounds, as well as in his sock and shoe, said the report. The investigation noted the man did not have feeling in his lower extremities due to diabetic neuropathy."

The resident was hospitalized with cellulitis of the foot and discharged back to the facility after the nearly nine days of treatment. In response to the incident, the facility provided re-education regarding wound and skin care policies and procedures. State health officials say no citations were issued due to the re-training effort.

No citations or fines were given.  That is ridiculous.
 

The Daily Pilot reported that the Newport Nursing and Rehabilitation center is fighting a $100,000 fine that the California Department of Public Health has issued after a woman died on September 6, 2011 because of a preventable fall after she was left alone and unsupervised in the bathroom. Several nurses noted that the woman needed constant supervision.

The Department of Public Health found that the nursing home failed to properly supervise the woman causing the fall.  The nurse who was responsible for supervising the resident in the bathroom left her alone to go take a break.  Why wouldn’t she wait to take her break?  Where was the charge nurse?

Another employee of the nursing home found the woman face down on the floor.  Medics were able to briefly revive her but she remained brain dead and had a fractured spine.

 

Journalist Robert Garrett wrote a great article for the Dallas News about the failure of Texas to penalize nursing homes that neglect and abuse residents.  Current and former inspectors say that they’re being discouraged from reporting bad care and unsafe conditions. Experts fear that elderly and frail residents are at risk of abuse and neglect as some operators routinely cut corners and understaff facilities. 

The state has stopped imposing the most severe penalties, such as revoking a home’s license and government contracts, or seeking a court-appointed overseer.  Four employees who performed inspections for the state in recent months told The News that their superiors often resist letting them cite homes for possible life-threatening abuse and neglect.  Without that implicit threat, corporate owners will treat minimal fines as a cost of doing business instead of correcting the problem.

The Dallas News investigated and found:

State regulators whose job is to keep shoddy operators from owning or running homes have done cursory, and at times inaccurate, background checks that in at least one case failed to keep out a federally banned health-care provider.

State budget cuts have reduced staff by about one-fourth since 2001, even as the number of nursing homes in Texas is virtually unchanged, at about 1,200.

Legislative changes, especially limits on lawsuit damages passed in 2003, have virtually eliminated trial lawyers as de facto watchdogs of nursing homes. Other changes limited the state’s ability to fine nursing homes and have created an industry-friendly cadre of “quality monitors.”

After inspectors discovered practices endangering the lives of elderly and disabled residents, the state regulatory agency hasn’t gone after the homes’ licenses.

AARP said the state’s relatively infrequent use of harsh sanctions “raises serious concerns about the agency’s commitment to quality.”  AARP , a leading advocacy group for seniors, recently gave Texas poor marks for quality care. Using data from the federal government, it ranked Texas 34th among states in avoiding bedsores for high-risk nursing home residents and 42nd in preventing hospital readmissions.

In 2001 (the nursing home industry spent as much as $575,000 during the 2001 session),
Republican lawmakers removed about 45 of the 557 inspector positions and converted them to “quality monitors” who try to help operators solve persistent problems, such as bedsores. Today, the inspector force has dwindled to about 400.  And the quality of care has suffered.  Budget documents show that state nursing-home enforcement has remained on tight rations.  For the last several years, inspection teams have had fewer people and spent less time at a home during annual visits than in previous years.

 

Read More →

The NY Times had an informative article on the state of care in New York’s adult homes.  The Times undertook its own analysis of death records and found disturbing patterns: some residents who were not supposed to be left alone with food choked in bathrooms and kitchens. Others who needed help on stairs tumbled alone to their deaths. Still others ran away again and again until they were found dead.

In New York, it is unusually common for developmentally disabled people in state care to die for reasons other than natural causes.  "One in six of all deaths in state and privately run homes, or more than 1,200 in the past decade, have been attributed to either unnatural or unknown causes, according to data obtained by The New York Times."   State officials in New York cannot even agree on how many people are dying. The Office for People With Developmental Disabilities says 933 people in state care died in 2009. The Commission on Quality of Care says 757 did. Neither agency could explain the discrepancy.

New York has made no effort to track or investigate the deaths to look for patterns or trends, resulting in the same kinds of errors and preventable deaths, over and over.  The state does not even collect statistics on causes of death, leaving many designated as “unknown,” even after a medical examiner has made a ruling.

The records shows neglect may be contributing to those unexplained deaths. The average age of those who died of unknown causes was 40, while the average age of residents dying of natural causes was 54.

New York, like most states, relies heavily on the operators of the homes to investigate and determine how a person in their care died and, in a vast majority of cases, accepts that determination without investigation or corroboration.  Courtney Burke, the commissioner of the Office for People With Developmental Disabilities, which operates and oversees thousands of group homes, acknowledged that her agency suffered from a lack of transparency and what she called “a culture of nonreporting.”

The problems in the New York system appear especially troubling given that the state spends $10 billion a year caring for the developmentally disabled — more than California, Texas, Florida and Illinois combined — while providing services to fewer than half as many people as those states do.

 

Several media outlets have reported the investigations that found maggots in the throat and pubic area of two elderly women in Michigan nursing homes. The Department of Licensing and Regulatory Affairs, and the Michigan Protection and Advocacy Service, Inc., said the two women suffered severe neglect and abuse. The two nursing home were cited for several serious violations.

The first case involves a woman who had been complaining of “itching and burning around her catheter.” She could not attend to her own personal hygiene without help. Bed baths were not routinely provided. Both a CNA and the charge nurse said the woman did not get a shower because the nursing home did not have enough staff. Maggots were found to be infesting in and around the catheter area. The woman was sent to the hospital where they discovered she suffered septic shock secondary to an untreated urinary tract infection, skin wounds and kidney stones. Later tests and examinations revealed she had a broken hip and extensive skin changes due to poor hygiene and not being turned in bed.

The survey also indicates that a Registered Nurse manager was instructed by clinical corporate staff to document the discovery as “debridement” (removal of dead tissue) rather than “maggots.” The documents show that a nursing assistant said maggots were still in the genital area of a 66-year-old woman three days after their initial discovery. Staff members told a state inspector they had observed flies on and near the woman about two weeks before the discovery of the maggots and one staffer even reported telling a supervisor “she’s gonna get maggots.”

The violations at Whitehall Healthcare Center of Ann Arbor included failure to supervise two residents in wheelchairs, both of whom were injured as a result; failure to provide a sanitary, comfortable and orderly interior; failure to adequately monitor the fluid intake and output for a patient who became dehydrated; and failure to maintain complete staff personnel files and complete required certification, license and background checks. Whitehall was fined $17,000 for the violations, and the state recommended other penalties to the Centers for Medicare & Medicaid Services.

The documents shed more light on conditions at the 102-bed nursing home, which has been identified through state inspections as among the worst in Michigan. Now three former CNAs have sued the nursing home and its parent company alleging they were fired for reporting patient abuse and neglect at the facility. One was fired after filing a complaint that brought the state to the facility to investigate a patient’s fall, the lawsuit states. Two others were fired after they and the employee who filed the original complaint told state investigators about the discovery of the maggots, the lawsuit claims.

The lawsuit also alleges the nursing home tried to prevent employees, including two of the nursing assistants and a nurse and a nurse manager, from participating in the investigation into the maggot discovery by suspending them while it was under way, then firing them.

The lawsuit filed Nov. 22 by Nikenda Morton, Wanda Mosley and Latasha Bryant seeks relief under the state’s Whistleblower Protection Act, asks for a jury trial and seeks unspecified compensatory damages for economic injury, including loss of employment, mental and emotional distress, humiliation, all attorney fees and court costs.

The other investigation involved a female resident at Cambridge South Nursing Home who had a trachea and “had been coughing more than usual but she was not immediately assessed because staff was ‘rushed.’” “The resident’s condition became so severe that emergency medical services were called to the facility where they found her airway obstructed by maggots,” the report said. Very active maggots, estimated to be in the first to second stage of development were found, as the woman’s throat was being suctioned to open her airway, the report said.“This is a disgrace and an outrage, not only are there outrageous abuses occurring, but the multiple layers of agencies and regulatory safeguards to protect the residents have failed miserably,” said Elmer Cerano, executive director MPAS.

See articles at The News-Herald, Ann-Arbor.com, and Ann-Arbor.com.

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:

Malnutrition.

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.

 

 

Critics and health care experts fear that Iowa Governor Terry Branstad’s relationship to the nursing home industry will cause premature deaths of vulnerable and disabled elderly.  Disability Rights Iowa, which is part of a national network of advocacy groups established by Congress in the 1970s, published a scathing, open letter to Branstad, questioning the governor’s lax supervision of Iowa’s nursing homes.

Sylvia Piper, executive director, Disability Rights Iowa, Des Moines recently wrote "Terry Branstad believes nursing home residents, many who have witnessed or experienced abuse or neglect, no longer need anyone to protect them. Rod Roberts, director of the Iowa Department of Inspections and Appeals, gets his marching orders directly from Branstad. They both agree that no inspectors are needed; the nursing homes should be left to police themselves."  Sylvia Piper told Branstad in the letter that because of his “political choices, people are suffering and dying on a regular basis in Iowa’s nursing homes.”  In March, Roberts who has no prior management experience, eliminated the positions of 10 nursing home inspectors and two abuse prosecutors, citing budget constraints. After lawmakers restored funding for the positions, the department opted to spend the money elsewhere, saying the inspectors were not needed.

"Branstad has a lucrative arrangement with the nursing home lobby. They give his campaign tens of thousands of dollars, he helps them run under the radar by removing those who would hold them accountable. Under this egregious arrangement, nursing home residents are left alone and helpless in an environment historically notorious for abuse and neglect."

The (Republican) state auditor, long-term care ombudsman, and Iowa citizen’s aid ombudsman cited him for failing to adequately regulate nursing homes. Clearly, he wants to protect his campaign contributors. There has been an increase in complaints regarding nursing homes and other types of care facilities in Iowa.

Piper said her organization has investigated specific cases in which residents have died or been injured as a result of negligent care that could have been prevented through more aggressive action by the inspections department. 

 

See articles at Des Moines Register, here and here.