South Carolina Nursing Home Blog

South Carolina Nursing Home Blog

Nursing Home Information & Litigation

Indictment for Neglect Recorded on Video

Posted in Abuse and Neglect, Advocacy, Staffing

NY1 reported the indictment of 2 caregivers at the Peninsula Nursing and Rehabilitation Center in Far Rockaway, NY for allegedly neglecting a severely disabled patient as he lay bleeding on the floor.  Attorney General Eric Schneiderman says a 51-year-old patient fell and suffered a head wound.

The surveillance video shows the nurses doing nothing to help the disabled man as he crawled on the floor bleeding for about ten minutes.  A Certified Nurse Aide eventually dragged the patient back to his room.  Prosecutors say about 25 minutes later, the man crawled out of his room with blood still running down his head.  They claim the nurses continued to ignore him and he was never treated until paramedics arrived 20 minutes later.

Both nurses, 34-year-old Funmilola Taiwo and 39-year-old Esohe Agbonkpolor, were indicted. They face a felony charge of endangering the welfare of an incompetent or physically disabled person.  Taiwo was also charged with falsifying business records. The Certified Nurse Aide who dragged the patient already pled guilty to neglect.

Thompson Arbitration Decision

Posted in Arbitration

and  at Wealth Management wrote an article on the recent South Carolina case Thompson v. Pruitt Corp. (S.C. App., 2016).  ” While the enforceability of arbitration agreements in general isn’t a particularly novel topic, there’s often an added twist in this context when admissions paperwork is signed by the patient’s spouse, child, other relative or personal representative bringing the patient to the facility.  In these scenarios, there’s little uniformity regarding whether courts will enforce an arbitration agreement.”

The authors explain the facts behind the Thompson case.  In January 2011, a brother and sister had their mother, who suffered from dementia, admitted to a Pruitt Corp. nursing home facility.  Under South Carolina’s Adult Health Care Consent Act (the Act), her children were authorized to make decisions concerning her health care because she was unable to consent.  Upon arriving at the nursing home, the son was presented with an Admission Agreement, an Arbitration Agreement and several other documents to sign on his mother’s behalf.  The Arbitration Agreement was separate from the Admission Agreement and wasn’t a precondition for admission to the nursing home.  Additionally, the Arbitration Agreement contained a provision allowing the patient to disclaim the agreement within 30 days.

Within five hours of admission, their mother fell out of a bed because of a broken side rail.  The mother died as a result of the fall, and her daughter filed a wrongful death and survival action against the nursing home.  The nursing home moved to compel arbitration, but the trial court denied the motion.  The trial court found that there was no valid agreement to arbitrate because the son didn’t have authority to execute the arbitration agreement on his mother’s behalf.  The Court of Appeals of South Carolina affirmed that decision on appeal, for several reasons.

First, the court held that that son didn’t have statutory authority to execute the Arbitration Agreement for his mother.  Because the Arbitration Agreement was a separate document that didn’t deal with health care decisions, the court reasoned that the Act didn’t apply to establish the necessary principal-agent relationship.  Importantly, because the Arbitration Agreement wasn’t a precondition to admission, the court didn’t consider it related in any way to decisions concerning the mother’s health care.  This follows the South Carolina Supreme Court’s decisions in Dean and Coleman Decision.

Second, the court considered whether common law principles of agency could bind the mother’s estate to the Arbitration Agreement.  The court held that the fact that the mother had dementia prior to being admitted to the nursing home meant that she could neither consciously nor impliedly agree to allow her son to enter into the agreement as her agent.

Finally, the court noted in dicta that, even if the mother did have capacity to consent to her son handling her affairs, a standard power of attorney (POA) for property or health care doesn’t convey authority to the agent to bind the principal to an arbitration agreement, thereby waiving the principal’s right to access the courts and to a jury trial. 

Finally, whether the arbitration agreement is a precondition to admission is also a critical factor.  Where an arbitration agreement is purely voluntary, courts typically hold that the agent doesn’t have authority to bind the patient.  In practice, this factor may leave nursing facilities desiring to arbitrate all disputes stuck between a rock and a hard place, in that these agreements may be seen as unconscionable if entered into solely because they’ve been made a prerequisite to the patient receiving critical health care services.

Quality Measures added to NH Compare

Posted in Advocacy, Medicare

Leading Age website had an article from LeadingAge’s MDS expert consultant, Judy Wilhide-Brant, RN, providing guidance on the 3 new MDS-based quality measures to be added to CMS Nursing Home Compare beginning April, 2016. These measures are calculated using two ADLs in G0110 that have not been used before.  She offers a guide to coding and highlights relevant insights to assist with answering the necessary questions within the section.

 

 

 

Resident to Resident Conflict

Posted in Abuse and Neglect, Staffing, Trial themes

Reuters reported on a new study that found at least one in five nursing home residents may endure verbal or physical abuse from their roommates or other residents, a study found in Annals of Internal Medicine, online June 13, 2016.  Researchers examined data on 2,011 nursing home residents and found 407 of them had been involved in at least once occurrence of abuse involving another resident during the four-week study period. To assess the prevalence of abuse involving residents, researchers examined data from interviews with staff and residents of five urban and five suburban nursing homes in New York, as well as information from medical charts and accident or incident reports.

Verbal taunts were the most common, accounting for about 45 percent of these cases, followed by physical assaults, which made up 26 percent of incidents.  While verbal and physical abuse was the most commonly reported type of abuse residents suffered from other residents, about 20 percent of incidents involved invasion of privacy, researchers report.

In about 4 percent of cases, one resident directed menacing gestures or facial expressions at another resident. Slightly less than 3 percent of cases involved some form of sexual abuse.  The most common types of verbal aggression were screaming at another resident and using inappropriate words. With physical aggression, the most common cases involved hitting or pushing another resident.

Most nursing homes do not have adequate staff and training to deal with older adults with cognitive and psychiatric issues like dementia, depression, and delirium.   Incidents were more common in units with fewer certified nursing assistants — the staff who are responsible for residents’ daily care.  The study also found that incidents were more common in nursing homes’ dementia units. On the other hand, one-quarter of residents with no dementia symptoms were involved in at least one incident.

Families should look for nursing homes with rooms or units set aside for dementia patients or residents prone to aggressive behaviors,” said Dr. Janice Du Mont, a public health researcher at the University of Toronto who wasn’t involved in the study.

“During a tour, see if there is adequate open space or if the facility feels overcrowded,” Du Mont added by email. “Assess how many residents are in each room, if there are separated recreational areas, and how many staff you see on duty.”

See another article about this topic from Health Day.

 

Prevention of UTIs

Posted in Advocacy, Dementia Care, Infection Control, Trial themes

Health Day had an interesting article about a recent study about urinary tract infections (UTIs).   A team from New York City’s Columbia University School of Nursing surveyed 955 nursing homes in 2014. The researchers also analyzed data from the Centers for Medicare and Medicaid Services.

They found that in any given month, for over 88,000 nursing home residents in the study, an average of 5.4 percent of them — more than 4,700 people — had suffered a UTI.  This research finds the infections are common in nursing homes, often due to a lack of proper prevention and use of catheters. In fact, in the Columbia study, nursing home residents with catheters were four times more likely to get a UTI than those without catheters.  UTIs in nursing home residents can often have serious effects, including delirium, debilitating falls and even fatal blood infections.

“It is obvious, based on this random survey of nursing homes, that there is a lack of education and inconsistent practices that can raise the risk for infection,” Donna Armellino, a nurse and vice president of infection prevention at Northwell Health, in Lake Success, N.Y said.  UTIs often occur “when bacteria enters the urinary tract through the urethra and move up the tract to infect the bladder or kidneys,” she explained. “This infection is often related to an inserted device referred to as an indwelling urinary catheter.”

“UTIs in the elderly can have a significant health impact by leading to a confused delirious state or — if undiagnosed — leading to dehydration or infection in the bloodstream,” explained Dr. Paula Lester, a geriatrician at Winthrop-University Hospital, in Mineola, N.Y.

Many nursing home residents suffer from dementia, or have conditions that rob them of their ability to communicate, therefore caregivers must be properly educated and trained to prevent UTIs, and recognize the signs and symptoms such as painful urination, foul odor of urine or increased frequency of urination of a UTI.

The findings were presented this month at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC), in Charlotte, N.C.  Read more about APIC at Eureka Alert.

Nursing homes typically have four main ways of lowering UTI rates.

  1. Nursing homes that used portable bladder ultrasound scanners to confirm that a patient had voided all urine were 10 percent less likely to have high rates of UTIs not associated with catheter use.  Unfortunately, only about one in every five facilities surveyed had this policy, the researchers found.
  2. Regularly cleaning the urine collection bag attached to the resident’s leg. That step cut catheter-linked UTI rates by 20 percent.  However, only 44 percent of facilities had this policy in place.
  3. Nursing homes with “infection preventionists” on staff — who also took a national course through APIC — were also 20 percent less likely to have high rates of UTIs, the study found.  But again, only 9 percent of the nursing homes in the study had such staff.
  4.  Prevent UTIs by make sure the patient is mobile when possible, has “regular toileting” and is kept clean and dry.

According to Armellino, other things to look for if you visit an infirm loved one in a nursing home include:

  • Making sure that urinary catheters are inserted “only when clinically needed,” assessed daily and removed when no longer necessary.
  • Urine collection bags are kept below the bladder.
  • Urine flows freely in the drainage tube.
  • The device is “secured to the leg to minimize movement.”
  • Patients are washed frequently with soap and water.
  • Staff members use proper hand hygiene before and after touching the catheter device.

 

Great Arbitration Decision in Arkansas

Posted in Arbitration

Can a State employee waive a citizen’s constitutional right to a jury trial when acting as a legal guardian?   Arkansas says no.

Johnathan Mitchell, an agent of the state’s adult protective services program, gained emergency custody of Maylissia Holliman in 2010.   After becoming Holliman’s custodian, Mitchell admitted her to Courtyard Gardens Health and Rehabilitation and signed the facility’s admission paperwork and arbitration agreement.

The facility was subsequently sued by Patricia Ann Sheffield on behalf of the Estate of Holliman , who claimed the facility’s neglect, negligence, and inadequate staffing levels led to Holliman’s injuries and death. Holliman died at Courtyard in 2014.

The facility filed a joint motion to dismiss the suit and compel arbitration. That motion was dismissed by a trial court, which ruled that Mitchell didn’t have the authority to sign Holliman’s arbitration agreement.

In its Order the Arkansas Supreme Court agreed with the lower court, stating that “if an agent is merely the guardian of the person, he has no authority to bind the ward’s property.”

“The Legislature intended for custodians to play a more limited role than guardians,” wrote Judge Rhonda Wood, an associate justice of the court. “The main purpose of a custodian is to ensure that the ward is safe and cared for appropriately and that the ward’s assets are secure.”

Wood ruled that Mitchell lacked the authority needed to make decisions concerning Holliman’s estate and could not bind her to arbitration, rendering the arbitration agreement with Courtyard invalid.

CNA Arrested for Forgery

Posted in Staffing, Trial themes

McKnight’s reported the disturbing story of  Jennifer Pizzuti, a certified nursing assistant arrested for allegedly forging a certification that would allow her to work in New Jersey long-term care facilities.  Pizzuti was told in 2015 that her 2-year Nurse Aide Certification had expired. She couldn’t renew the certification until she “cleared up some outstanding issues” that disqualified her from renewal, according to the state attorney general’s office.

Pizzuti then decided  to forge her certification and giving it to her employer, R.J. Healthcare Services, a medical staffing agency. She was given work placements at two nursing homes and one assisted living facility before the forgery was finally discovered last June.

Pizzuti was taken into custody this week after a grand jury indicted her on charges of making a false government document, forgery, uttering a forged writing, uttering a false government document and falsifying or tampering with record. The charges carry a range of possible prison sentences of 18 months to 10 years, and between $10,000 and $150,000 in criminal fines.

“The insurance companies that provide coverage for elderly patients in long-term care facilities expect that patients are being provided quality care by qualified professionals who meet the standards set by the state,” said Acting Attorney General Robert Lougy in a statement. “Anyone who attempts to falsify their work credentials to circumvent those standards will be dealt with harshly.”

Discrimination Case Settled

Posted in Staffing

Bloom at Belfair, a nursing home located in Bluffton, S.C., will pay $40,000 and furnish other relief to settle a race discrimination lawsuit brought by the U.S. Equal Employment Opportunity Commission (EEOC), the agency announced.

EEOC filed suit in 2015 alleging that Bloomfield Senior Living of Bluffton, LLC, operating as Bloom at Belfair, discriminated against Michelle Billups Tensley, an African-American employee, because of her race when it fired her in September 2014. Tensley was the activities director at the Bloom at Belfair facility. She was terminated after she missed a single day of work because of a family medical issue, an absence she had announced openly in advance. Bloomfield said that Tensley did not personally speak to her supervisor the day of her absence; however, EEOC said that the supervisor was either unavailable or refused to accept Tensley’s phone call. EEOC charged that Tensley’s firing followed the termination of other black managers at the same facility, and was part of a plan to eliminate African-Americans from management.

Such alleged conduct violates Title VII of the Civil Rights Act of 1964, which prohibits employment discrimination based on race. EEOC filed suit in U.S. District Court for the District of South Carolina, Beaufort Division (Civil Action No. 9:15-cv-04047-CWH-BM) after first attempting to reach a pre-litigation settlement through its conciliation process.

In addition to providing monetary relief for Tensley, the consent decree settling the lawsuit includes provisions for equal employment opportunity training by the company, reporting by the company to EEOC, and the posting of a notice about the lawsuit to the company’s employees.

“Plain and simple, employers cannot fire employees because of their race,” said Bernice Williams-Kimbrough, director of EEOC’s Atlanta District Office. “Company rules must be enforced fairly and without regard to anyone’s race.”

Lynette Barnes, acting regional attorney for the Atlanta District Office, added, “It is important for workers to know that they will be treated fairly in the workplace, without regard to race.”

EEOC is responsible for enforcing federal laws against employment discrimination. Further information is available at www.eeoc.gov.

Guest Post: Seniors and Sleep: How Much Do They Need to Stay Healthy?

Posted in senior care
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While many senior citizens sleep less than younger adults, they actually need the same amount of sleep in order to stay healthy. Continue reading to learn more about seniors and sleep.

Studies have shown that 13% of men and 36% of women who are age 65 or older require at least 30 minutes to fall asleep. This inability to fall asleep quickly (if at all) is often coupled with frequent waking throughout the night. While it is true that sleeping patterns change as we age, it is important that senior citizens get the amount of sleep they need to stay healthy.

How Much Sleep Do Senior Citizens Need?

The average person needs seven to nine hours of sleep per night to perform at their best. Though many senior citizens get less sleep than the recommended amount, they actually still need these critical hours of rest.

While the specific amount of sleep needed varies from person to person, it does not change as we age. In other words, if you required 7 hours of sleep in your mid-twenties, you will likely need a similar amount of rest for the remainder of your life. So, while many senior citizens may seem spry, despite rising before dawn, there may be a plethora of underlying issues. Continue Reading