South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

No More Wire Hangers…

Posted in Abuse and Neglect

The New York Post reported that NY Attorney General’s office is investigating a suspicious event which occurred in a Queens area nursing home. Robert Brogan was a patient suffering from dementia when he was injured on two separate occasions, resulting in jagged wounds to his head and arms. The wounds appeared to be defensive. On both occasions, the nursing staff did not have any explanation for how the wounds appeared.

After the second incident the home was told that they would be inspected the following Monday. Before inspectors arrived the staff was allegedly made to replace all wire hangers with plastic ones. An insider said they were trying to “cover their tracks.” The attorney general’s office has met with the family of Mr. Brogan and the investigation is ongoing.

 

 

Lawsuit about Short-staffing

Posted in Advocacy, Staffing, Trial themes

ABC News reported that Preferred Care Partners Management Group L.P., one of the nation’s largest for profit nursing home chains, has been sued by New Mexico over inadequate resident care, alleging that thin staffing made it numerically impossible to provide good care. The nursing homes profited by skimping on staff “at the expense of the physical well-being of vulnerable nursing home residents.” The lawsuit  targets seven nursing homes run by Preferred Care Partners Management Group L.P. of Plano, Texas, a privately held company with operations in at least 10 states: Nevada, Arizona, Colorado, Florida, Iowa, Kansas, Oklahoma, Louisiana, Mississippi and Texas.

The nursing chain operator is structured as a manager overseeing a series of private partnerships. Its chairman, Thomas Scott, who was named defendant in the lawsuit, is the only listed individual investor in publicly available Medicare data. His company is considered to be the 10th largest nursing home chain in the country.  Since 2008, the company’s facilities have collected $229 million in revenue from taxpayers for the more than 1 million days residents cumulatively stayed there. To get that money, the nursing homes had to promise to comply with federal and state regulations requiring adequate care.

By calculating the total minutes required to properly care for residents and comparing them to the actual number of hours worked, the state found deficiencies in the total hours worked by nursing assistants of as much as 50 percent. Those numbers are especially useful because the nursing homes regularly boosted the number of nursing assistants who work during state inspections.  New Mexico’s case includes evidence such as confidential witnesses from the nursing homes’ own staffs alleging that managers recognized that nursing assistants were too overwhelmed to change diapers or help residents shower in a timely fashion. Sometimes there weren’t enough people working to help incapacitated residents eat and drink leaving residents “deprived of food and water.”

Cited as Confidential Witness #2, the daughter of one patient at a Santa Fe facility, Casa Real, said she repeatedly found her father unattended, dirty and complaining he was hungry. With the facility’s staff saying they didn’t have enough time, the woman took over the daily bathing and feeding that the nursing home was being paid by the government to do.

Preferred Care runs four of the seven New Mexico facilities with the worst grades for quality on Nursing Home Compare, a federal website that evaluates nursing homes. One of those facilities, Sagecrest Nursing and Rehabilitation, had more than six times the average number of health and safety violations for nursing homes nationwide. Another, Espanola Valley Nursing and Rehab, reported to Medicare that its certified nurse assistants had just 25 minutes a day to spend on each resident, according to federal data. The average nationwide is just under two and a half hours.

Lawsuits Alleging Overmedication

Posted in Advocacy, Medications, Trial themes

NPR reported on the federal lawsuit against two Watsonville, Calif., nursing homes which offers a new approach to dealing with the persistent problem of such facilities overmedicating their residents.  The lawsuit details multiple cases when the government says these drugs were inappropriately administered to patients.

For instance when an 86-year-old man identified in the lawsuit as Patient 1 was admitted to Country Villa Watsonville West, he could speak clearly and walked in under his own power. Within days the facility began giving him Haldol and Risperdal, drugs used to treat schizophrenia and bipolar disorder, and he became bedridden, stopped eating and developed bedsores and infections.  Antipsychotics like Risperdal and Haldol come with so-called black box warnings that say they could hasten death in elderly patients or people with dementia. Nevertheless, about a fifth of nursing home patients nationwide are prescribed antipsychotic drugs.

The U.S. attorney for Northern California claims that the two nursing homes provided “grossly inadequate, materially substandard and/or worthless services.” Meanwhile, they received about $20 million from Medicare and Medicaid for those services. So now the government wants its money back, and then some.

Deborah Pacyna, public affairs director for the California Association of Health Facilities, says that in the past couple years the federal government, in partnership with organizations like hers, has succeeded in reducing the use of antipsychotic drugs in nursing homes.  ”But a lot of the regulators, a lot of our critics seem to be ignoring the fact that antipsychoticsare being widely prescribed to patients who have dementia who are living at home, who are in the hospital or who are in assisted living settings,” Pacyna says. “Skilled nursing (homes) represents a fraction of those that have been impacted by this practice, yet we remain the focus.”

 

Another NPR Article on Over-medication

Posted in Advocacy, Medications

NPR continued its reporting on the problem of over-medication in nursing homes throughout the country.  One of the worst fears we have for our parents or for ourselves is that we will end up in a nursing home, drugged into a stupor. Almost 300,000 nursing home residents are currently receiving antipsychotic drugs, usually to suppress the anxiety or aggression that can go with Alzheimer’s disease and other dementia.  Antipsychotics, however, are approved mainly to treat serious mental illnesses like schizophrenia and bipolar disorder. When it comes to dementia patients, the drugs have a black box warning, saying that they can increase the risk for heart failure, infections and death.

Federal law prohibits the use of antipsychotics and other psychoactive drugs for the convenience of staff. It’s called a “chemical restraint.” There has to be a documented medical need for the drugs.  Professor Bradley Williams, who teaches pharmacy and gerontology at the University of Southern California, says antipsychotics should only be used as a last resort, and just for a month or so, before gradually being eliminated.  Antipsychotic drugs change behaviors, Williams says. “They blunt behaviors. They can cause sedation. It increases their risk for falls.” And in the vast majority of cases, the drugs aren’t necessary. “If you want to get to the very basic bottom line,” he says, “why should someone pay for something that’s not needed?”

In 2011, a government study found that 88 percent of Medicare claims for antipsychotics prescribed in nursing homes were for treating symptoms of dementia, even though the drugs aren’t approved for that. So the next year, the federal government started a campaign to get nursing homes to reduce their use of antipsychotics by 15 percent.  That 15 percent reduction was supposed to take less than a year. It took almost two. And it still left almost 300,000 nursing home residents on risky antipsychotic drugs. But Beatrice DeLeon is no longer one of them.

 

Prohibition of Chemical Restraints Not Enforced

Posted in Advocacy, Medications, Regulatory enforcement

NPR followed up with an article explaining how nursing homes do not get penalized for over-medication that causes sedation, lethargy, and related health problems.  Antipsychotic drugs for older people with Alzheimer’s or other forms of dementia, can be deadly. The Food and Drug Administration has given these drugs a black box warning, saying they can increase the risk of heart failure, infections and death. Yet almost 300,000 nursing home residents still get them.  So in 2012, the federal government started a campaign to get nursing homes to reduce their use of these drugs. An NPR analysis of government data shows that the government rarely penalizes nursing homes when they don’t get with the program.

The approach being taught is sometimes called individualized care. The idea is that if nursing home employees know enough about a resident, they can figure out the reason behind challenging behavior and deal with it without resorting to antipsychotic drugs.  For example, what should you do if you’re caring for a resident who won’t go to sleep and wanders the halls all night?  Well, if you know he used to be a night watchman, you can just continue to treat him like one. The world won’t come to an end if you deviate from the schedule and let him sleep during the day.

An NPR analysis of federal government data found that even though Texas nursing homes have the highest rate of antipsychotic drug use in the nation, they are less likely to be censured for it than nursing homes in most other states.  NPR’s analysis of CMS data found that harsh penalties are almost never used when nursing home residents get unnecessary drugs of any kind. Inspectors grade these deficiencies according to the severity of the offense. And only 2 percent of the infractions were ranked at a level that might trigger a fine or worse.

 

NJ Legislation to Allow Video Cameras

Posted in Abuse and Neglect, Advocacy

NJ Spotlight reported on proposed legislation that would protect the vulnerable adults living in New Jersey nursing homes. Legislators want to safeguard nursing-home residents by giving them and their families the right to install video cameras and audio recorders in their rooms to help prevent instances of abuse and theft by staff members.  Advocates say measure would safeguard residents but nursing-home owners contend it would undermine trust and violate privacy.

The bill says the recording devices could be in either a visible or hidden location. The resident or authorized representative would inform the nursing home of the type of device being used and that the resident consented to the recording. The nursing home would be released from any civil liability for privacy violations related to the recording. The recording couldn’t start until the nursing home confirmed that it’s been notified. In addition, if the resident has any roommates, they would have to consent to the recording. The roommate could also allow video recording but prohibit audio recording, or require that the video camera be pointed away from them.

“This is about the choice of the resident and their families in their homes, because the nursing home is their home,” said AARP New Jersey Associate State Director Evelyn Liebman, adding that the hundreds of millions in taxpayer-funded Medicaid money that support nursing homes also warrant added transparency.  She said the tool would be particularly useful for family members who live far away and are unable to visit frequently.

Several states — including Maryland, New Mexico, Oklahoma, Texas and Washington – allow recording in nursing home rooms.

 

Corruption in SC?

Posted in Advocacy, Tort Reform, Trial themes

FITS News reported on new developments in an ongoing federal-state investigation of corruption at the S.C. State House.  Specifically, powerful S.C. ways and means chairman Brian White – who in addition to other things is reportedly being investigated for some sort of “residency” issue.  In reviewing past residences listed by White (he quit providing taxpayers with residency information in 2012), one of the properties we uncovered was owned not by him but by Brad Moorhouse - director of an Anderson County, S.C. nursing home that’s operated by the National HealthCare Corporation (NHC).

 James Randall Lee, a registered lobbyist and executive with the S.C. HealthCare Association, was one of the central figures in the Operation Lost Trust scandal – a federal sting that snared seventeen lawmakers in bribery-related corruption charges a quarter century ago.  Lee’s lobby – the nursing home industry – is responsible for appointing a member to the South Carolina Health Planning Committee, which is the entity responsible for administering the state’s health plan.  This planning committee is the entity responsible for administering the state’s Certificate of Need (CON) program – which decides where and how health care services are administered in this state.  Moorhouse …  is on that committee.

White’s yet-to-be-investigated 2011 campaign finance scandal (and his recent campaign payments to his wife’s charity) need to be addressed in relation to the ongoing corruption probe.

 

Center for Public Integrity

Posted in Advocacy, Staffing, Tort Reform, Trial themes

The Center for Public Integrity released a three-part investigative series on nursing home care.

Part One: Analysis shows widespread discrepancies in staffing levels reported by nursing homes

In part one, Jeff Kelly Lowenstein discovers discrepancies in staffing levels reported by nursing homes, finding that over 80% of facilities report higher levels of registered nurse care to the CMS Nursing Home Compare website for consumers than are reflected in their reports to Medicare.

 Part Two: Poorly rated nursing homes got HUD-guaranteed mortgages anyway Part two exposes poorly run nursing homes across the country that have received low-cost, HUD-guaranteed mortgages after having received the lowest possible quality rating from the federal government on the Nursing Home Compare site. Part Three: Nursing homes serving minorities offering less care than those housing whites The third and final installment of the series exposes the racial disparities in registered nurse care levels in facilities across the country. Lowenstein found that although residents of all racial groups had lower registered nurse staffing levels, the discrepancy was particularly pronounced in nursing homes where the majority of residents were either black or Latino. In addition to the three-part series, Lowenstein also wrote another article, Running a five-star nursing home, finding that facilities that received 5-star ratings on the Nursing Home Compare website had more registered nurses on staff and less staff turnovers than facilities with lower star ratings.

Seniors on Sedatives: Is YOUR Grandmother Being Drugged?

Posted in Advocacy, Medications

 Gemma Vale, a fantastic freelance writer, was kind enough to contribute the following article.

 Around the world, there are 36 million people who have Alzheimer ’s disease or a related form of dementia. Dementia is an umbrella term for a group of diseases that cause mental decline and confusion.  It is caused by damage to the nerve cells in the brain. Often, clumps of protein are found in the brains of people with dementia. In some cases, the nerve damage results from trauma or blocked blood vessels in the brain. Blocked vessels cannot deliver oxygen rich blood to the brain effectively and the lack of oxygen causes brain damage.  This type is called vascular dementia.

Initially, your loved one may experience problems with their memory. They might also have difficulties with decision making and abstract thought, display disorientation about what time it is or where they are and behave inappropriately in certain situations. Depression is common in older adults with dementia. As the illness progresses, they could have gait and balance difficulties and loss of communication skills and self-care skills. In the latter stages, they could require round the clock care.

This is why many families are faced with the challenging decision of how best to care for their loved one. If a full time carer isn’t available in the family, a care home may be the only option.

Force Drugging of the Vulnerable Elderly

Unfortunately the term ‘care’ home may only be the title and nothing to do with the practice. The rights and welfare of the elderly may be overlooked in an institutional setting. There are more than 25,000 residents in the USA are being drugged with anti-psychotic drugs to control symptoms of dementia and to make them more docile and compliant towards staff. Most of these prescriptions for ‘off-label’ reasons are not approved by the FDA and are ordered by doctors who haven’t seen any combative behavior in the resident. Instead of providing supportive care and companionship to the elderly, nursing home staff may rely on medications to keep their charges quiet.

Sometimes, drugs are prescribed without the consent of the elderly person or their relatives. Finn Christensen was 85 years old when he was admitted to hospital with confusion. Just a day after his admission he was physically restrained and force medicated with two anti-psychotic drugs. He wasn’t informed before this was done, wasn’t asked for his consent and neither were his family members. Mr Christensen endured a 16 day nightmare as he was drugged repeatedly by three different physicians. When his family complained, the Medical Board refused to investigate, saying the drugs were only low dose and ignoring issues of informed consent and drug safety.

One care home resident dialled 911 when sick from being force medicated with four anti-psychotic drugs and morphine. Reaching out to the emergency services was a desperate plea for help, but instead of helping, her doctor gave her more drugs. She later developed a permanent disability as a result of drug side-effects and her doctor was never prosecuted.

The situation is not unique to America. The forced sedation of seniors is occurring in many first world countries.

Half of all care home residents in British Columbia, Canada, are being given anti-psychotic medication – the highest rate of drugging anywhere in the world.

In the UK, more than 100,000 people living in care homes are given drugs. Of 934 homes, a quarter use medication to control behavior and one home surveyed drugged three quarters of its residents. 82% of prescriptions were completely unnecessary and in the case of some of the homes, not one person prescribed the drugs should have been taking them.

Sick from Psychotropics

Seniors are at special risk from psychotropics. Age related changes affect absorption, kidney function and the immune system, putting the elderly at increased risk from serious drug side-effects such as heavy sedation, psychomotor retardation, cognitive impairment,   tardive dyskinesia and drug induced Parkinson’s disease.  There is also an increased risk of death in elderly people with dementia who take anti-psychotics. Despite the lack of evidence for their safety in this population, doctors and nursing homes continue to force dangerous and unproven medications on the most vulnerable members of society.

Don’t put up with it

If you suspect your loved one is being force medicated, contact Poliakoff and Associates today.  We are a respected law firm with nursing home abuse attorneys who are experienced in lots of issues relating to elder abuse to give a voice to those who need it most.

Sources:

Madhusoodanan S et al, Pharmacological treatment of the psychosis of Alzheimer’s disease: what is the best approach? CNS Drugs. 2007;21(2):101-15, accessedDecember 8, 2014, http://www.ncbi.nlm.nih.gov/pubmed/17284093/

Pamela L Lindsey, Psychotropic Medication Use among Older Adults: What All Nurses Need to Know, J Gerontol Nurs. Sep 2009; 35(9): 28–38, accessed December 8, 2014, doi:  10.3928/00989134-20090731-01, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128509/

Pitkala KH et al, Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards, Int Psychogeriatr. 2004 Mar;16(1):61-74, accessed December 8, 2014, http://www.ncbi.nlm.nih.gov/pubmed/15190997/

Crisis Behind Closed Doors: Antipsychotic Drugging of Canada Seniors, Mind Freedom, accessed December 8, 2014, http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/seniors/canada-seniors-antipsychotic

 

 

Family Left in the Dark

Posted in Abuse and Neglect, Advocacy, Regulatory enforcement

An investigation conducted by the Wood 8 News Station, an NBC affiliate in the central Michigan area, illustrated a common travesty that occurs in the nursing home industry.  Sharon DeWitt, a great-grandmother, was at MagnumCare of Hastings to rehabilitate a broken hip.  Dewitt had the forethought to inform the nursing home ahead of time in writing that CPR was to be done and an ambulance was to be called in the event that she had a heart attack.  Terri DeWitt, the daughter-in-law of Sharon DeWitt told Target 8 news station that:  “She wanted anything and everything done to keep her alive” and “She was very adamant about that.  She did not want to die, and whatever it took to keep her alive, she wanted it done.”  Despite DeWitt writing down exactly what the facility should do if she had health complications, state records show that the nursing home took none of those life-saving steps when her heart failed, and as a result, she unfortunately died.

Years after DeWitt’s death, relatives believe that they were “left in the dark” by both the state and the facility itself.  Although the state issued one of its’ largest fines to MagnumCare of Hastings, the family says that they only found out about the details of the incident when the news station conducted an investigation about Sharon DeWitt’s death.  For example, in June of 2011, a nurse found that Dewitt was not breathing and did not have a pulse.  This discovery should have triggered a full, life-saving response but instead, no action was taken.  Terri Dewitt says that the nursing home facility never released those details to her or any other family members.

At one point, a nursing home worker suggested that the family should demand a state investigation.  The family requested an investigation but the state never got back to them and never mentioned the fact that it had fined the home $85,000.  A state spokesman, Jason Moon, mentioned that it was someone else, not Terri DeWitt who filed the complaint and that the facility reported the incident as well.  The original complainant’s name was not released in order to protect privacy.

Unfortunately, the DeWitt family is not alone, as the issue has manifested to another resident within the same facility.  The state recently fined the same home $5,818 in the death of Alfie Vincent for a seven hour delay for not getting him proper medical attention.  Records show that his medical guardian reported the death to the state, but not MagnumCare of Hastings.  The news station stopped at MagnumCare of Hastings to request an interview and, not surprisingly, no one responded to the calls for a discussion of the facilities recent headline making fallacies.

It is rather troubling when a resident is not assisted during times of extreme medical distress, it is even more disturbing when the same level of neglect is repeated in a consecutive manner, almost suggesting that this facility and probably others are operating independent of local, state, federal, and most importantly, moral guidelines.