South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The Las Vegas Sun had an article about a nursing home that was cited and fined $5,100 by the state for repeated health and safety violations and ordered not to accept new residents.  These violations are incredible.  The bureau said an “immediate jeopardy situation” was declared due to missing resident medications, failure to have criminal background checks, an ongoing cockroach infestation, a lack of a functioning auditory alarm system, poor care on a resident with a colostomy, tuberculosis testing and medication administration.

Eight of the deficiencies were repeats from previous inspections. The state Bureau of Health Care Quality and Compliance said there have been repeated violations dating back to February of 2007 at Best Care Facility which was fined $600 last year.  Surveys in 2007, 2008, 2009 and in February this year showed multiple violations. The bureau said the home was inspected Feb. 2 this year and received the grade of D when 30 violations were found.

“It has been determined that residents are not safe at this facility due to chronic, repeated non-compliance and that the facility is engaging in practices detrimental to the health and safety of the residents,” the bureau said.

A person named “Danny” at the nursing home answered the telephone. He said he would return a call later but he declined to give his last name.

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Ashley M Jones wrote on the Pharmacy Technician Certification blog the following article on the 12 most common medical errors and how to prevent them.  Many of these errors occur in nursing homes every day.

According to the National Academy of Sciences, medical errors injure millions of people each year and cost billions of dollars annually in increased health costs. And this does not take into account lost wages or productivity costs. If that isn’t frightening enough, the Institute for Healthcare Improvement estimates that more than 238,000 hospital deaths among Medicare patients between 2004 and 2006 were due to medical errors that could have been prevented.

With healthcare reform front and center in political discussions, but little coming from it, patients are left to rely on their overworked physicians and other caregivers for reliable services. To best avoid becoming part of the statistics, become part of the solutions by knowing the 12 most common medical errors and how to prevent them.

1. Medication Errors : The most common of medical errors, luckily it can be one of the most preventable. Errors include assigning a medication due to improper information such as allergies, other medications taken, previous diagnosis, and others. A medication error can also include lack of up to date warning or miscommunication due to poor handwriting. There is also confusion among drugs with similar names or dosage, and this effects all drugs including prescription, over the counter, vaccines, etc. The best way to avoid this medical error is to know what you’re taking, how much, and what you can’t take. If unable to remember, bring all of your medications to the doctor or hospital with you.

2. Bad Communication :  Have you been going to the same doctor for years? That doesn’t mean that he or she knows or will remember everything about you. The second most common medical error results from poor doctor/patient communication. With loads of tests and labs, doctors will not always remember every test you have, so it is up to you. The Agency for Healthcare Research and Quality lists the ten questions every patient should ask their doctor, along with many other useful tips. You can even go there to build your own personalized question list.

3. Infection : They may seem clean, but hospitals are one of the most likely places to receive an infection. Given the high incidence of people with infections, workers who can become contaminated, and the fact that many patients enter the hospital with weakened immune systems, infection can be a serious problem. If staying at a hospital, be sure to avoid a doctor’s tie, ask him or her if they have washed their hands since visiting the last patient, and be sure to wash your own often. This article reports on the incidence of high IV infection rates. If you receive one, be sure to monitor for signs of infection and ask for a new one if suspicious.

4. Falls : Because on so many new drugs, patients cannot predict how they will react to them, causing a fall, which is another leading common medical error. In fact, ten percent of falls for the elderly occur in hospitals. Patients who have other mobility issues like a broken leg, walker, or cane, can also find the clean hospital floors more slippery than those at home. If you think you need assistance standing and walking, contact the nursing staff. Be sure and allow 10-20 minutes for a response, as they may be busy assisting others stand and walk.

5. Surgical Errors : Because surgery is scary enough when everything goes right, it is vital to prevent errors before, during, and after. These can include wrong site, wrong procedure, and even wrong patient surgeries. Although there are new procedures in place to reduce these common medical errors, you can still do your part. Speak to your surgeon about the procedure you are having, why you are having it, and what the surgeon will be doing during the surgery. Also know the rules in place to avoid surgical errors: 1. The surgeon must sign the incision site with the patient awake. 2. Use only a signature and not a confusing “X.” 3. The entire surgery team must stop and perform a checklist before beginning the procedure.

6. Pharmacy Errors : You don’t have to be in a hospital to be a victim of a common medical errors. With dozens of patients each day, pharmacies can also make errors on your medication. In fact, according to this article from CNN, 30 million Americans are the victim of outpatient medication errors each year. Although some are minor and can be caught easily by most patients, others are not. To best prevent medical errors of this sort, know what your doctor prescribed and how much when going to the pharmacy. Also, be sure to be honest with the pharmacist about other medications and drugs you are taking to ensure that there is no harmful interaction.

7. Lab Errors : Another facility with many patients and tests in one spot, common medical errors can occur here as well. These can also be truly devastating by leading to wrong diagnosis and wrong treatment, while the initial disease continues. Types of common errors can include MRI or CT taken incorrectly, samples taken incorrectly, or results misinterpreted. If you feel your lab results are misleading, you are within your rights to ask for another lab test to confirm.

8. Treatment Errors : If you feel your diagnosis was reached correctly, a common medical error can still happen during treatment. Because many doctors have been practicing for decades, it is not unusual for them to be using outdated procedures. Be sure to ask why you are having the treatment, how long the doctor has been doing them, and if there are any alternatives. This website is full of guidelines for treating many common illnesses.

9. Follow Up Care : When discharged from the hospital or clinic, be sure and know what your follow up care is and what to expect from it. If you are given a specific amount of medication and told to take it all, take it all. Just because you feel better halfway through, doesn’t mean you are better. Ask the facility who to contact if you have follow up questions on your at home care. This link also has more on what to do.

10. Birth Injuries : It may be the most joyous time in your life, but birthing a child can also lead to medical errors. The most common can result in serious injuries such as cerebral palsy and paralysis. Women who are most at risk include those with large babies, prematurity, prolonged labor, and more. To best avoid these injuries, do research on the place you would like to have your baby in. Check several hospitals in and outside of your area. See the incidence of birth injury and, if possible, read reviews by other mothers who gave birth there.

11. Bring Family : This is vital to avoiding common medical errors. If you are too ill to answer or too tired to protest, an informed family member is your best bet to sidestepping a common medical error. They can answer questions about medications, do reviews of your current and future care, and lift spirits. Make sure they also read these 12 most common medical errors and how to prevent them. Click on this link to get more rules for family members visiting at a hospital.

12. Don’t Wait Until It’s Too Late : With healthcare costs on the rise, many patients believe they can save money by putting off the doctor’s visit. However, this can actually have the opposite effect as the worse a disease gets, the harder and more expensive it is to treat. This decision can also be deadly with the wrong disease going undiagnosed or treated. If you have no insurance, find a Take Care Clinic. Visits start at $65, which is far cheaper than many primary care visits out of pocket. They are also doing free blood glucose testing for the month of February.

If you have any questions regarding the above 12 most common medical errors and how to prevent them, ask your physician. The best way to not become lost in a system like so many million before you is to be your own best advocate. Know your rights both as a patient and an insurance holder. If you don’t have insurance, there are still many resources for you, along with many useful tips for those who do have it.
 

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ChicoER.com had an article about consumer advocate watchgroups concerned about  Assembly Bill 1629, which changed how nursing homes are paid and provided them with higher payments. The workgroup held a number of meetings. Its efforts were overseen by the state Department of Health Care Services, which was supposed to issue a report to the California Legislature last March.  The workgroup included members representing nursing home owners, the SEIU, the watchdog group California Advocates for Nursing Home Reform (CANHR), senior citizens groups and others.

Requiring more nurses to be on duty in nursing homes is key to improving care.  Nursing homes are required to provide at least 3.2 hours of nurse staffing per patient per day. Some want the minimum raised to 3.5 hours.

Each member of the workgroup produced a list of recommendations for improving care at nursing homes. SEIU and CANHR both recommended raising the minimum nurse staffing level from 3.2 to 3.5 hours.

The union wrote that plans should be made, also, for how to reach the staffing level of 4.1 hours that some experts have recommended.

CANHR recommended that nursing home rate increases should depend on homes' meeting the 3.2-hour minimum.   "We don't think they should be granting any rate increases to homes that don't meet 3.2," said Mike Connors, a CANHR advocate who served on the workgroup.

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Arizona Daily Star reported that Posada Del Sol nursing home has agreed to pay a fine of $4,000 to the Arizona Department of Health Services for failing to protect six of its residents from abuse.

The 156-bed facility represents that they are experts who specialize in caring for people with complex behavioral-health issues.  State inspectors said the nursing home failed to protect six residents from "mental and/or verbal abuse" regarding food preferences, and from an abusive environment toward bariatric/obese patients.

In one case, a physician had authorized a patient to eat meals in bed due to pain from bladder spasms, the staff ignored the orders and, except for one can of supplement, refused to give the resident any food.   A nurse even taunted the resident with a food tray in an attempt to coerce the resident to the dining room.

In another case, a resident with excruciating back pain asked to eat meals in bed but was denied and given a can of supplement instead, the report says.

Posada Del Sol recently made "leadership changes" and retrained its patient-care and food-service workers.

The U.S. Centers for Medicare and Medicaid's nursing-home rating system gives Posada Del Sol a rating of one star - its lowest designation, meaning "much below average."
 

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Mary Fridley at Gero-Resources wrote the following for The Capital. 

DEAR MARY: I just lost my dear husband of 65 years to Alzheimer's disease. Mary, you would hardly believe the many times I thought about you during his stay in the hospital and nursing home. I am so glad we had the experiences of the wealth of knowledge you shared through the many workshops and seminars we attended together.

During this difficult period there were many times I thought how much the staff would benefit from your depth and detail of knowledge of dementia care. I was horrified by how they handled him; like he was a piece of meat. One time two aides were moving him up in the bed and slammed his head into the headboard. No one talked to him like he had any sense at all. Even the doctor dismissed him as if he should just die.

He was capable of following directions if they took the time to tell him what to do. Instead, they just did things without warning, which frightened him. I think they could learn a lot by being in bed for a day and having someone tend to all their needs. They would discover how humiliating and degrading an experience it is.

My husband was a person and the love of my life, and I would do anything to have him with me today - even in his Alzheimer's state. He was a gentle, loving soul who would never hurt anyone. I am heartbroken over this experience.

DEAR READER: Please accept my sincere condolences on the loss of your husband. And I am sorry your final days together were so dreadful. No matter how often I hear this story (and I've heard it many times), it never fails to outrage me. The staff broke the most basic rule of care: to see the person, not just the disease.

It should be required that people take a sensitivity course before they work with the elderly. They should be put through the rigors of daily care, such as you suggested, experiencing first hand what it's like to be on the receiving end. I hope your letter sparks discussion among staff to do better.

I know you are grieving, but I encourage you to write a letter to the administrators of the offending facilities. They need to know about your experience. Peace be with you.

___________

I like that.  See the person, not just the disease.  Nursing home employees especially unqualified CNAs do not get enough training on how to take care of demented residents.  It is a shame and a disgrace.

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The New York Times had an interesting article about the growing industry of long term care hospitals.  The greedy owners manipulate the Medicare and Medicaid regulations on reimbursement to make even more money and profit.

Fewer than 10 hospitals dedicated to long-term care existed in the early 1980s, according to Medicare officials.  More than 400 long term care hospitals have opened nationally in the last 25 years.   These hospitals have sprouted driven by Medicare rules that offer high payments for hospitals that treat patients for an average of 25 days or more.  Long-term care hospitals now treat about 200,000 patients a year, including 130,000 Medicare patients — at a projected cost of $4.8 billion to the government this year, up from $400 million in 1993. 

Among the more peculiar aspects of long-term care hospitals is that nearly half of them, and almost all of Select’s, are actually “hospitals within hospitals.” They do not have their own buildings and instead occupy a floor or two of an existing hospital. They contract most services from the host hospital, so they can be opened quickly and cheaply.

Yet under Medicare rules, because they have different owners, the two hospitals are considered separate for payment purposes. This means there can be a second reimbursement when a patient is simply transferred between floors.  Under Medicare payment rules, traditional hospitals often lose money on patients who stay for long periods. So they have a financial incentive to discharge patients to long-term hospitals, which then receive new Medicare payments for admitting the patients. Both hospitals benefit financially.  The industry’s growth is an example of how health care companies can exploit the $450 billion Medicare program.

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Auburn Pub had a great article on the increase of family caregivers, and the problem of burn out, frustration, and exhaustion that naturally arises.  The article is based on information from New York but the results and demographics apply nationwide.

2.2 million New York residents are the caretakers of a parent, spouse, grandparent or friend. Their work is worth about $25 billion, which reduces state and federal health care costs, according data from the AARP, and allows the sick to remain at home.  T he emotional cost for caregivers is immeasurable. Many caregivers have only a few hours to themselves a week, become secluded from their community because those they care for cannot leave home or be left alone, and neglect their own health from being so focused on the health of someone who will not get better.

More than half of caregivers live with the person they care for, and spend with that person anywhere from 10 hours a week to 24 hours day, according to a study by the state Office for the Aging that surveyed 1,109 caregivers between May and June 2008. The study, which aimed to identify New York's caregivers and their needs, found that the average caregiver is a white female caring for a parent or a husband.

The study, “Sustaining Informal Caregivers,” shows that a majority of caregivers, 75 percent, care for someone who has been diagnosed with Alzheimer's disease or another form of dementia. About half say the person they care for cannot be left alone. They reported an average of 10.3 hours a day spent providing care - more than a full-time job.

Guilt, isolation and physical exhaustion are only a few of the side effects of full-time care giving. The job can have serious health consequences, said Dr. David Strickland, director of the Center for Behavioral Health at Auburn Memorial Hospital.

Full-time caregivers commonly experience clinical depression, sleep deprivation and inadequate nutrition. The frustration that builds while caring for another person day in and day out can turn into anger, and anger can lead to depression or thoughts of harming the person receiving care, Strickland said. He said the guilt of feeling negatively toward someone whom they still love often leads caregivers to ignore mental health problems, such as suicidal feelings.

“Accept these things do occur and are not to be ashamed of,” Strickland said, rather than ignoring - and exacerbating - the problem.

Caregivers should contact a doctor with any serious health problems, but interaction with others, especially other caregivers, can help manage the daily stress, Strickland said.

Cayuga County's Office for the Aging networks caregivers, educates them about the diseases they deal with and helps them find ways to cope, by connecting them to aids, recommending day programs or just lending an open ear. The decision to make the move to a nursing home is among the hardest decisions caregivers make.  But it is a move Strickland advises caregivers to see as an opportunity. Nursing homes can manage the daily hygiene and medication that are among the most stressful tasks of caring for someone, making time spent together enjoyable again, he said.

“You don't have to be a caregiver,” Strickland said. “You can be a sibling, a child, a relative.”

The fear that nursing home staff will not be able to provide adequate personalized care available at home is a major reservation for people considering the move.

Coping strategies

Tips for stressed caregivers from Dr. David Strickland, director of the Center for Behavioral Health at Auburn Memorial Hospital:

Recognize you are not alone - join a support group. Resources such as the county Office for the Aging and the Alzheimer's disease Web site can direct you to groups for caregivers that meet regularly.

Take time for yourself - write it in your schedule. Even if you can spare only an hour, spend a little time every week doing something you enjoyed doing before you became a full-time caregiver.

Build a relief system. Keep in touch with friends and family who can lend a hand in caretaking or lend an ear to listen when you need to talk.

Look into respite care. Many facilities offer overnight stays for both you and the person you care for that allow you to take a break without being far away.

Do not ignore your mental health. Know the signs of depression - sleeplessness, guilt, hopelessness, and suicidal thoughts - and consult a doctor if you recognize them in yourself.

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Boston Herald had a great article about a family's attempt to learn the truth behind a document a resident allegedly signed while suffering from delusions and memory loss.  They hope to shed light on what she called an “outrageous and deceptive” practice.  Having demented residents sign their right to a jury trial away.  This is a tragic story that I hear all the time.  Resident clearly gets hurt by negligence of facility.  The facility, instead of taking responsibility, tortures the family by ridiculous legal machinations such as arbitration, health courts, malpractice tribunals.  This family has waited years for closure.

John J. Donahue died after suffering injuries at a Brockton nursing home in 2005.  Donahue, a paralyzed retired railroad engineer, spent the final 46 days of his life being shuffled between nursing homes and hospitals following an eye injury he suffered at Embassy House, Hoey said. On Sept. 5, 2005, Donahue’s left eye was gouged by a metal safety hook on a machine an employee was using to move him from his bed. Two people were supposed to operate the machine, called a Hoyer lift, per facility policy, according to a state investigation on the incident. The state Department of Public Health investigated Sept. 21, 2005, and found the allegation of neglect to be valid. The certified nursing assistant who operated the Hoyer machine alone was fired.

He was taken to the hospital more than 15 hours later, where his eye was removed. Donahue died weeks later of sepsis causing blood clots and organ failure. Hoey said experts will testify at trial that the eye trauma placed Donahue in a compromised state, which made him more susceptible to disease and infections.

Two years later, Owens filed a lawsuit alleging the nursing home’s negligence led to her father’s health decline, and in turn, his death.  The nursing home claimed that Donahue had signed an arbitration agreement in 2003, when he was 91, waiving his right to a trial if he was injured or killed.

Arbitration agreements are becoming more common at nursing homes and they are costly and time-consuming to contest, said Donahue’s attorney, David Hoey of North Reading.  Hoey said he fought the alleged agreement for two years, until the Court held the agreement was void based on testimony and records from staff at Embassy House Skilled Nursing and Rehabilitation Center in Brockton.

In December 2003 - the month Donahue signed the agreement - staff noted that Donahue made “confused, depressed (and) delusional statements” and showed “delusional ideation,” according to the February 2009 Plymouth Superior Court order signed by Judge Charles J. Hely. Hely ruled that Donahue was “unable to act in a reasonable manner” on the arbitration contract and that Embassy House “had reason to know of this significantly impaired condition.”

On Feb. 9, a Superior Court medical tribunal cleared the case to go forward to trial.  In Massachusetts, medical malpractice lawsuits must be heard by a tribunal before going to trial.

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Kentucky's LEX 18 reported that  a plea deal has been offered to a nurse's aide accused of abusing an elderly patient at a Madison County nursing home.  Amanda Sallee was set to go to trial on wanton neglect and abuse charges on March 15.

Sallee is one of three former nurses aides at Madison Manor Nursing Home in Richmond accused of abusing the late Armeda Thomas. The 84-year-old's granddaughter placed hidden cameras in Thomas' room, fearing Thomas was being neglected by nursing home staff. Sallee is seen on tape eating Thomas' food instead of giving her the meal.

Two other women have pled guilty to similar charges after they were caught on camera taunting and grabbing Thomas around the neck.   Thomas' family is also pursuing civil action in addition to the investigation brought on by the attorney general's office.
 

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