South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Outlawing “Hidden” Cameras

Posted in Advocacy

The Star-Tribune reported on a bill (“Granny Cam Bill”) proposed by Minnesota lawmakers seeking to protect nursing home residents from maltreatment by giving them the right to monitor their care with electronic recording devices without fear of retaliation.   The proposal would make Minnesota the sixth state to explicitly permit residents of long-term care facilities to install surveillance equipment in their private rooms.

“No one should be treated differently because they choose to have a camera in their room,” said Sen. Alice Johnson, DFL-Blaine, the bill’s main sponsor, who said she drafted it partly in response to recent cases of abuse and neglect caught on camera.

There have been dozens of well-publicized cases in which hidden-camera footage was used to corroborate reports of abuse and neglect at Twin Cities-area nursing homes, some of which have led to criminal charges. Allegations of abuse in senior homes are notoriously difficult to prove, and hidden cameras are considered one of the few ways that families can corroborate claims by elderly relatives.

Currently, Minnesota law is largely silent on the use of hidden cameras, and this lack of regulation is partly why the technology has proliferated, say advocates. In effect, the bill would end the use of “hidden” cameras in Minnesota nursing homes.

The legislation would require a nursing home resident to consent to the use of a camera before it can be installed and to notify the facility of their intent to use electronic monitoring. In addition, signs must be clearly posted notifying visitors of the devices, among other rules.

CNA Wage Crisis

Posted in Advocacy, Staffing

McKnight’s reported that a new report confirmed what many in the nursing home industry know:  low pay leads to poor quality of care. Low pay and poor benefits for nursing assistants is resulting in a “crisis” of low quality care in nursing homes, according to a report released Tuesday by the Paraprofessional Healthcare Institute (PHI). “As a result of poor-quality nursing assistant jobs, vacancies are growing and turnover is high, undermining the continuity and quality of care for nursing home residents.” the report’s authors wrote.

Nursing assistant jobs are often characterized by poor benefits, high injury rates, erratic scheduling, high turnover, few opportunities for advancement and low pay, the report asserts. Nearly half of nursing assistants live in households below 200% of the federal poverty level, with one in three assistants relying on public benefits.

To remedy the issue, PHI argues that providers need to “raise the floor” for nursing assistants and support staff by paying competitive wages, providing health insurance and creating consistent shifts with full-time hours. The profession’s high turnover rates may also be stemmed with better employee training, support and opportunities for professional growth, the report’s authors added.

The issue could also benefit from legislative action, PHI noted, including minimum wage increases, greater transparency and requirements that a certain percentage of reimbursements be directed to wages for frontline workers.

“To attract and retain nursing assistants, policymakers and employers alike need to envision how these jobs become a family-sustaining career comparable with those in other industries,” the report states.

Fight for $15

Posted in Advocacy, Staffing, Trial themes

Workday Minnestoa had a great article explaining the need for a fair and living wage for all workers including CNAs in nursing homes.  On the same day that more than 100 Twin Cities fast-food workers went on strike, area nursing home workers took up the “Fight for $15” as well, rallying outside a Roseville care center for a contract that includes fair wages.  Employees of Golden Living Center welcomed nursing-home residents, striking fast-food workers and other supporters to an informational picket line outside GSL’s Lakeridge site in Roseville.

About 350 members of SEIU Healthcare Minnesota(link is external) are in contract negotiations with the company, which operates nursing homes across the state. Tim Sorenson, a 25-year employee and member of the union’s negotiating team, said workers want GSL to put a recent influx of state funding for nursing homes where lawmakers intended the money to go – into workers’ paychecks.

It’s getting harder to find people who want to do this work for the pay we get,” Sorenson said. “Yet our work is very important. We take care of the most vulnerable people among us, our seniors.”

In Minnesota, certified nursing assistants’ median hourly wage is $12.22, and one-third rely on public assistance. It’s a major reason turnover rates for nursing assistants exceeded 50 percent in 2012 and are expected to climb – an alarming trend in an industry expected to see an uptick in demand as baby boomers retire.

“Too many people I work with want to go to other jobs where there’s better pay instead of staying in this job to take care of our seniors,” Sorenson said.

Sorenson and other GSL workers were among SEIU members in more than 40 cities nationwide who stood up for fair wages and quality care at nursing homes. The timing of the nationwide day of action – on the same day fast-food workers in a record 320 cities went on strike – is more proof that the “Fight for $15” is catching on among low-wage workers in all sectors of the economy.

“No matter if you’re in health care or maintenance or whatever, we all need to be there for each other,” Sorenson said. “That helps you get what you’re after in the long run.”

 

CNAs Deserve a Living Wage

Posted in Abuse and Neglect, Staffing, Trial themes

The Patriot Ledger reported on the need to increase staffing and pay to caregivers at nursing homes.  Better care for residents of nursing homes will require better pay and working conditions for the key workers: the nurse aides. The single factor most critical to high quality of care and quality of life for nursing home residents is the staff who provide residents with care, the Center for Medicare Advocacy states. The group says that most direct care in nursing facilities is provided by nurse aides, primarily women of color, who are poorly paid and often poorly treated.

And in a sobering new report, Raise the Floor: Quality Nursing Home Care Depends on Quality Jobs,[1] the Paraprofessional Healthcare Institute (PHI)[2] describes the growing care crisis in nursing facilities. Fewer people are available and willing to take direct care positions while a rapidly aging population needs care. Nurse aides earn “near-poverty wages.” Nationwide, the median wage is $11.51 per hour, an annual salary of $19,000. The Center for Medicare Advocacy has a discussion of the report.

You can also read another thoughtful report on this issue in Massachusetts from the Massachusetts Senior Care, which represents more than 500 facilities and organizations. Quality Jobs for Quality Care was issued by Mass Senior Care in November 2015. It also makes the case for “a path to a living wage for nursing home workers.”

It states that “certified nurse aides (CNAs) have seen a mere 4% cumulative increase in actual wages over the last seven years and a 6% decline in real wages for this 2008-2015 period.

 

A National Outrage

Posted in Abuse and Neglect, Advocacy, Staffing, Trial themes

The Journal reported a story that shows how important staffing is at long term care facilities.  Residents in a nursing home suffered physical and emotional abuse at the hands of their caregivers and were refused showers and left short of food, according to claims in released documents. In a complaint to the Health Information and Quality Authority (Hiqa), a resident in a nursing home said that they had suffered “emotional and physical bullying”.  In total, 161 complaints are listed in the documents.

The complainant said that residents at the home were refused water due to the risk of them getting wet; that they were left short of food because the staff ate it; and that the staff were negligent and inattentive.

They cover a broad range of issues people have with elderly services, ranging from complaints to do with understaffing and cleanliness, to more serious allegations of abuse, lack of care and violence.

 

In one case, a person argues that someone related to them isn’t properly cared for by staff at a nursing home.

The person states that they have found their relative sitting in wet underwear on several occasions and that “no dignity or respect is shown” to them.

The person alleges that staff “no longer encourages SU to get out of bed” and that the person is “left sitting in wet underwear”.

In another instance, a complainant noticed a bad smell in their relative’s bedroom at a nursing home and discovered soiled bed linen was left in a bag beside the resident’s bed.

Another complaint has to do with a resident “starving to death” while multiple complaints relate to elderly residents becoming dehydrated due to a lack of water.

One heavily redacted complaint alleges sexual assault by members of staff at a nursing home. Who is assaulted or what took place is not clear.

Another person said that the lack of care from staff at a nursing home had increased the health problems of an elderly perosn who later died. The person said that they had been told by nursing home staff that previously the residents was “falling deliberately”.

While some of these complaints point to alleged cases of extreme abuse – the most common concerns lodged are to do with nursing homes being understaffed.  Complainants say that staff are overstretched and in some cases under-trained.

Risk of falls increase due to to lack of sufficient staff to supervise communal rooms,” reads another.

 

Sean Moynihan, CEO of ALONE said:

It is very distressing to read reports of some of our most vulnerable citizens being neglected and even abused in our nursing homes. These are places that older people should feel safe and secure in the later years of their lives. It is especially worrying to hear of these reports now, considering the recent convictions for abuse of vulnerable people in care homesWe must reflect on what this says about us as a society that this is allowed to continue and there is not a national outrage.”

Conflicting Versions of incident

Posted in Nursing home cases in the news

MLive reported that according to Walter Jarnot’s death certificate, he died Sept. 4, 2015 of asphyxia due to aspiration of food, but the circumstances surrounding his death remain suspiciously unclear.  According to an autopsy, the World War II veteran living at Glacier Hills Adult Care Facility was eating dinner when he began to choke on his egg drop soup.  The autopsy confirms Jarnot was pronounced dead at 7:25 p.m. after choking on egg drop soup at dinner in Glacier Hills Adult Care Facility in Ann Arbor. It states Jarnot began having difficulty breathing while eating, and staff members attempted the Heimlich maneuver but Jarnot became unresponsive.

The autopsy states the funeral home received the death certificate Sept. 9—five days after the incident—and the cause of death was listed as “asphyxiation due to aspiration on food bolus due to probable dementia.”

Under Michigan law, the facility should have notified the county’s medical examiner within two days if there was suspicion that the death was sudden or accidental.

Jarnot’s family members, the Ann Arbor Police Department and the Michigan Department of Licensing and Regulatory Affairs are all trying to figure out exactly what happened next.

Walter’s son, Charles Jarnot, was informed by Glacier Hills that Walter’s death was a result of “natural causes.” He said the nursing home was negligent in documenting his father’s death and a nurse at the home may have incorrectly responded to the 89-year-old’s choking.

An inspection by the state of Michigan’s Department Licensing and Regulatory Affairs (LARA) found there was no documentation of the incident at Glacier Hills, and staff gave conflicting accounts of what happened during interviews and subsequent investigations.

 

 

According to a LARA investigation, an unnamed Glacier Hills administrator said she was not made aware of the incident until Sept. 11 and started an investigation. The investigation report contains a similar narrative to the autopsy up until the point after the Heimlich maneuver was administered. Then it diverges.

“(Nurse “E”) realized that [Jarnot] was not choking, as he was breathing and had coughed in normal fashion,” the investigation report reads.

“The staff initially moved the resident from the dining room into the hallway and attempted to take [his] vital signs. They had difficulty obtaining a blood pressure. The staff then assisted the resident into his bed… Verbal and Tactile stimulation continued with limited response from [Jarnot]. Within moments, the staff stated he took a couple of big breaths and then stopped breathing.”

The nurse stated during the investigation that the whole event lasted about 10 minutes and that she would classify it as an “unusual event or incident.” She added that she did not document the occurrence because it slipped her mind.

 

Walter Jarnot’s son, Charles Jarnot, said the family was preparing to bury their father in Buffalo, New York when they received a call from an employee of the funeral home asking if they were aware of the cause of death.

According to Charles Jarnot, the man told the family that their father’s death was an accidental death, and it should have been followed by an autopsy performed by the medical examiner. At that point, Jarnot’s autopsy had not yet occurred because the death had not been reported by Glacier Hills to the examiner’s office.

The call prompted the Jarnot family and the funeral director to confer, and the funeral director to notify the medical examiner.

Washtenaw County medical examiner Dr. Jeffrey Jentzen said under normal circumstances of death at a long-term care facility, the facility notifies his office within a 48 hour period, with some leeway for weekends and holidays.

“We perform autopsies on cases in which the cause of death is uncertain or when there is additional information that needs to be documented,” Jentzen said. “If a patient died in a long term care facility when there’s a suspicion that the death may have been accidental or caused by an external cause, they are reported to the medical examiner and they make the decision if it’s going to be autopsied or if it won’t be necessary.”

 

 

Reform Mandatory Arbitration

Posted in Arbitration

The New York Times reported on the attempt to reform arbitration, a private justice system for resolving disputes that is often slanted against consumers, to make it fair to all participants.  The special session is part of diverse efforts across the country to prevent companies from inserting arbitration clauses in contracts.

Representative Hank Johnson of Georgia, a ranking member of the House Judiciary Committee, implored Congress to strictly curtail the use of mandatory arbitration, in which judges and juries are replaced by arbitrators who consider the companies their clients.  In his remarks, Mr. Johnson cited an investigation by The New York Times, saying that it “pulled back the curtain and cataloged the immense harms of forced arbitration.”

In its investigation, based on thousands of court records and interviews with hundreds of lawyers, judges and arbitrators in 35 states, The Times found that, by using arbitration clauses, corporations can circumvent the courts and quash challenges to elder abuse, discrimination, rape, predatory lending and even wrongful death.

Joined by lawmakers from across the country, Mr. Johnson urged the passage of a bill he introduced that would prevent civil rights cases, like employment discrimination disputes, and other critical lawsuits from being pushed into arbitration. The impact of arbitration clauses, he noted, is especially devastating for women trying to fight gender discrimination in the workplace.

Buried in the fine print of everything from consumer contracts and employee handbooks to nursing home agreements, forced arbitration clauses insulate corporations from accountability by eliminating access to the courts for untold consumers and workers,” Mr. Johnson said.

Today, it is virtually impossible to rent a car, get a job, borrow money for college or enroll an elderly parent in a nursing home without signing away the right to go to court. The clauses, buried in the fine print of tens of millions of contracts, bar Americans from banding together in a class-action lawsuit, the only realistic way that an individual with limited resources can fight a wealthy corporation.

Corporations, casting the lawsuits as “frivolous litigation”, have said that class actions are not needed because arbitration allows individuals to resolve their grievances, one by one, without the headaches of court. But The Times found that once blocked from going to court, most people simply dropped their claims. The Times found, for example, that from 2010 through 2014, only 505 consumers went to arbitration over a dispute involving $2,500 or less.

Last year, attorneys general from 16 states and the District of Columbia urged the federal government to deny Medicaid and Medicare money to nursing homes that use the clauses. Other efforts to scale back arbitration are underway. In a preliminary step, the Department of Education is discussing whether to deny federal funds to schools that include arbitration clauses in their enrollment contracts.

Representative Maxine Waters, Democrat of California, introduced a bill last year that would cut off student aid funding for schools that use arbitration clauses.

It is time for Congress to reconsider the value of predispute mandatory arbitration agreements,” Representative John Conyers Jr., Democrat of Michigan, said in a statement arguing that Congress should also back the Arbitration Fairness Act, a bill that would give consumers a choice, once a dispute arises, to go to court or arbitration.

Legislation that protects consumers and employees is a common-sense solution for all Americans,” he said.

Wages, Stress, and Turnover

Posted in Advocacy, Staffing

Latina reported that Texas caregivers can make more money at a fast food joint than providing care and services to nursing home residents.

Advocates for Texas healthcare professionals who work in nursing homes or provide in-home care to the disabled visited the state capital to warn legislators about an impending staffing shortage due to low wages that are leading some to leave the field for better salaries at fast food restaurants like McDonald’s. 

They testified before state lawmakers in a House Appropriations subcommittee because Texas has the third-lowest Medicaid reimbursement rate in the country. Scott Kibbe, with the Texas Health Care Association, told the committee that low reimbursement rates make it difficult for nursing homes to offer competitive wages for staff that are the lifeblood of long-term care facilities.

“You know, you can start off at McDonald’s at $13-$14 an hour in some cases, you could certainly find easier jobs for more money and that’s a real problem when you’re trying to keep good people in your facilities,” Kibbe told the committee.

He also said that registered nurses in Texas nursing homes have a 94 percent annual turnover rate. With the aging baby boomer generation reaching 70, the number of healthcare workers to elderly patients in Texas is predicted to drop by half, he said.

Latina spoke with a registered nurse, who chose to be anonymous, in the Rio Grande Valley, and she said that nursing home jobs are tough to fill because licensed vocational nurses (LVNs), who get paid less than registered nurses, do the bulk of the work, and the job is tough. The two LVNs who work at her clinic come from the nursing home industry and one of them still works at one, meaning she has two jobs.

 

 

Job Stress Causes Neglect and Abuse

Posted in Abuse and Neglect, Advocacy, Staffing, Trial themes

NPR had an interesting article on how job stress and burnout affects the quality of care provided by caregivers.  Nursing has long been considered one of the most stressful professions, according to a review of research by the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention in 2012. A major reason is cuts in staffing; some California nurses struck last month for a week over low staffing and wages.  A 2007 study in the American Journal of Respiratory and Critical Care Medicine found that 24 percent of ICU nurses and 14 percent of general nurses tested positive for symptoms of post-traumatic stress disorder.

Theresa Brown is a clinical nurse in Pittsburgh who has written two books about what it’s like to be a nurse. She says nurses are often stretched to the limit.  “A friend said when she started working as a nurse, when she would drive, she would vomit on the way in to work just because of the incredible level of stress,” Brown says.  “One of the senior nurses said there is no place we can go to just be alone and be in a quiet room for five or 10 minutes, except for the bathroom … you could have a patient get really really sick, you could have a patient die, and there’s no break,” she says.

 

Linda Aiken says she’s worried that hospitals think of nurses as a cost to be cut and not as a revenue stream. Cynda Rushton, a professor of nursing and bioethics at the Johns Hopkins Berman Institute of Bioethics and School of Nursing, agrees. “There is a mindset among some administrators that nurses are easily replaceable commodities — a nurse is a nurse is a nurse,” she says.

Almost 20 percent of newly registered nurses leave a hospital within the first year for the same job elsewhere, or a different job in a different organization, according to a 2014 study. Rushton says to her, that means health care organizations aren’t investing enough in their nursing staff.

Nurse burnout also is linked to moral distress, Rushton says, from situations where nurses know what they should do for their patients but can’t act on it. For example, nurses might have to give a patient at the end of life a treatment that causes suffering without any medical benefit. She just started a program called the Mindful Ethical Practice and Resilience Academy to try to help new nurses deal with moral distress.

If the nurse sees that the medicine isn’t working, she could say that she’s assessed the patient’s pain, it’s a 10 out of 10, Rushton says. She could say she’s concerned about the treatment because “in my role as a nurse, one of my primary goals is to relieve my patient’s suffering and I’m not able to do that, so I’d like to talk about how we can figure out a way to more fully address this patient’s pain and their suffering.”

The goal is to help nurses better communicate with other staff members, Rushton says, as well as take care of themselves through mindfulness, reflection and other practices.

Nurses around the world are struggling with how to fulfill their ethical obligations, Rushton says. “In one sense, it could be considered a public health crisis, because if we don’t have sufficient nurses to meet the needs of people in need of health care,” the entire health care system could crumble. “I think that it’s time that nurses are recognized as a scarce resource that needs to be invested in, supported and respected.”

CMS To Investigate Therapy Minutes

Posted in Advocacy, Medicare, Trial themes

Medicare reimburses skilled nursing facilities, or SNFs, for “rehabilitation therapy” according to the amount and level of care they provide. The amount of care is measured in minutes per resident per week. The largest payments are awarded to SNFs for residents who receive “very high” or “ultra-high” therapy, respectively equal to at least 500 and 720 minutes per week.

Consumer advocates and experts have objected that this payment method incentivizes SNFs to subject some residents to excessive rehabilitation therapy to hit a higher-paying threshold.  A Wall Street Journal report last August quoted current and former industry employees who said they faced financial pressure to maximize reimbursement rates for rehabilitation services. “The system really rewards high-intensity care,” David Grabowski, a Harvard University expert on nursing-home spending, told the Journal. “There are patients being treated who aren’t appropriate.”

 The data released by CMS recently supports their concerns. In a March 9 press release announcing the data, CMS noted that nearly two thirds of residents who received ultra-high therapy received between 720 and 730 minutes per week — just enough, but little more, to qualify the SNF for a rich payout from Medicare. A majority of residents in the very high therapy category received between 500 and 510 minutes of rehabilitation per week.  CMS also observed that at more than 200 SNFs, 100 percent of all patients receiving ultra-high therapy got 720 to 730 minutes of weekly therapy. 

At least 19 of those facilities, located in 11 states, ​administered 500 to 510 minutes of therapy to every resident billed ​to CMS as having received very high therapy and administered 720 to 730 minutes of therapy to every resident billed as having received ultra-high therapy. Collectively, according to the newly released CMS data, these 19 nursing homes billed Medicare for more than 2,000 residents whose therapy minutes fell into one or the other of those 10-minute bands. ​​​​​​​​Not a single eligible resident treated at any of these facilities in 2013 received 511 to 719 minutes of therapy per week.

To help ensure that patient need rather than payment incentives are driving provision of therapy services,” CMS stated in its release, “CMS is providing approval to the Medicare Fee-for-Service Recovery Auditor Contractors (RACs) to investigate this issue.”