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

The Northwest Herald had an article about a lawsuit involving the neglect of a resident that led to a fall that caused her death.  The wrongful death lawsuit against a Chicago nursing home, Sacred Heart Home, states that the nursing home failed to prevent the fall that led to the resident’s death.

Kathleen Koch, died after suffering from a broken back, head injuries and paralysis after she fell in a stairwell at the nursing home. The fall happened Dec. 21, and she died eight months later at 61 years old.

The case alleges that staff should have better supervised Koch because they knew she had been diagnosed with bipolar disorder and schizophrenia and was at high risk for wandering and falls.  However, her room was not near a nurse’s station, and Koch was able to go into the stairwell unsupervised.

She was the type of resident that needs to be closely monitored and supervised which clearly was not done.  I am sure the nursing home will blame the resident and claim it was all her fault.

 

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Kristi Nelson at Knownews.com had an article about the nursing home employee who was caught taking nude pictures and videos of residents and sharing them with others.  This is a violation of the residents' privacy and dignitiy.   The unauthorized cell-phone photos and videos resulted in a state penalty for Pigeon Forge Care and Rehabilitation Center, a ban on staff members using cell phones in resident areas, and, according to state surveyors, multiple violations of at least a dozen residents' privacy and dignity.

The photos and videos were found when a cell phone was left at a local restaurant.   A restaurant worker turned on the phone in an attempt to identify its owner, recognized one of the photos of a resident and gave the phone to a family member employed at the nursing home.   That person gave the phone to the director of nursing, who turned it over to the facility's administrator after seeing the photos and videos.  Administrator Jon Bowers gave the phone to the Tennessee Bureau of Investigation and immediately fired the certified nursing assistant to whom the phone belonged. A second certified nursing assistant who appeared in some photos was later fired, and two others believed to be involved had earlier left the facility's employ.

The Tennessee Department of Health conducted an investigation at the nursing home.   In its report, the state determined Pigeon Forge Care and Rehabilitation Center failed to protect the residents from having unauthorized photos and videos taken - compromising their dignity, privacy and safety from abuse - and suspended admissions to the nursing home for a week.

Twelve residents appeared in 47 pictures and 27 videos, taken between July 2007 and March 2009, found on the phone. They included:

-- A photo of a male resident sitting on a shower chair, nude, with a string of beads around his neck.

-- A photo of a female resident sitting on a bed wearing only a brief and a hat, with one breast fully exposed.

-- Photos of a female resident wearing, at various times, a bib, a feathered mask, strawberry-shaped sunglasses and a wicker basket on her head.

-- A photo of a male resident lying nude on the floor.

-- Photos of a resident being fed, "wearing a bib and food running down (his) chin and neck."

-- Videos of residents being fed or attempting to feed themselves.

-- A video of a resident eating a cookie without dentures.

-- A video of a resident lying in bed with one hand down his pants.

-- A video of a resident in a wheelchair, using a broom in a motion similar to rowing a boat.

-- A video of a moaning resident in a bed being shaken by two certified nursing assistants, in an apparent attempt to get him to make a certain noise.

-- A video of the certified nursing assistant repeatedly telling a resident "I love you" and coaxing the resident to say it back.

The report states that the worker showed the photos to fellow employees.  Meanwhile, the resident council president told state investigators that residents had first complained about staff cell phone use in October 2007.

 

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State regulators have fined a West Palm Beach nursing home $16,000 after a patient was found injured on the floor with maggots crawling out of his leg cast.

The state issued the fine in March against Azalea Court.  The nursing home somehow denies responsibility and has appealed the penalty.  They will probably either argue that the maggots were benficial or that the family put them there so they can sue!

An August 2008 report states that the 120-bed facility failed to provide the necessary care and services to a resident with the cast on his lower leg, which led to an infestation of maggots. The report says the patient's leg was supposed to be treated every three days, but the documentation proved that the nursing home only cared for the wound about once a week.

If this isn't evidence of neglect and understaffing, I'm not sure what it!

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 What kind of sicko nutjob can even imagine doing this kind of disgusting thing.  A Chesapeake nursing home, Chesapeake Health and Rehabilitation Center,  is being sued by the guardians of a comatose woman who was sexually assaulted by a male nurse while a patient there.  It is unclear which for profit chain owns this facility.

The lawsuit filed in Norfolk Circuit Court claims the nursing home should have known Mark S. Albright's conduct would violate the woman's privacy and dignity.   It is unclear if other complaints about this nurse was known or if th facility did any kind of background check or supervision of this nurse.

Center administrator Gregory Yanta declined to comment on the lawsuit.

Albright formerly worked as a licensed practical nurse at the nursing home. Police say another employee observed Albright with his mouth on the woman's breast. Albright pleaded guilty in November to aggravated sexual battery. Last week, he was sentenced last week to only six months in prison, with another nine years and six months suspended.
 

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The Seattle Times had a small blurb about Joseph Njonge, a former nursing assistant at the Garden Terrace Alzheimer's Center of Excellence in Federal Way, who is on trial for the March 2008 slaying of a woman who was leaving the facility after visiting her husband.

Njonge was arrested three weeks after Jane Britt was found strangled to death in the parking lot. Britt often visited the property twice daily to see her 77-year-old husband, Frank, who lived there.  Britt was last seen leaving the building on the night of March 18. On March 19, her Mercedes-Benz was discovered in the nursing facility's parking lot, and her body was found in the trunk, according to documents.  Investigators linked Njonge to the slaying through DNA found underneath Britt's fingernails. Britt's pocket was found turned inside out and her husband's Costco card was found in Njonge's wallet, according to charging papers.

If convicted, Njonge faces more than 20 years in prison.

Can you believe that these are th type of people that the nursing home industry hires to protect and care for our parents and grandparents?

 

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The Madison Record had an article about a lawsuit against a nursing home that allowed a disabled elderly woman to fall and fracture both her hips. Hazel Timmons, guardian of River Reed, filed a suit against Stearns Nursing and Rehabilitation Center on May 21 in Madison County Circuit Court.  Reed lived in the Granite City nursing home from May 25, 2007, through July 7.

When Reed was admitted to the nursing home, employees were aware she suffered from Alzheimer's and dementia and was usually disoriented and confused.  Nevertheless, employees allowed Reed to wander unattended in the hallway during the middle of the night on May 29, 2007. During her unsupervised walk, Reed predictably fell and fractured her left hip.  Yet again, on June 6, Reed was left unattended in a wheelchair and without a personal alarm. And, again, she injured herself when she fell out of the wheelchair.

Reed fractured her right hip after she was left unattended in her wheelchair with her tab alarm in the off position on June 15, 2007. During this incident, Reed attempted to walk unassisted when she was known to be non-weight bearing and at high risk for falling.

 

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The Buffalo News had a story about 3 nursing home employees who were only disciplined when the employees did not check on a resident or failed to report him missing for over 11 hours.  The Health Department found that the employees, over an 11-hour period, each noticed that Trent Lockridge was not in his room but did not report it.  The resident either fell, was pushed, or jumped from his second-floor room in Dosberg Manor on the night of Feb. 17, but his body was not found until the next morning.

The Health Department required that the facility discipline the employees involved, put in place new policies for ensuring the whereabouts of all residents and train its employees in the new system.

Health Department investigators visited Dosberg Manor after Lockridge’s death, interviewing staff members and reviewing facility records. Their report found that the first employee had responded to a Feb. 17 call from Lockridge’s roommate requesting help in closing the window. The employee noted that the window was wide open, Lockridge’s glasses were on the nightstand, and his walker was near the window. She neither investigated the fact that he was not in the room nor told anyone about it.  In fact, when first questioned by department investigators, she lied and told them that she had seen Lockridge in his room at 9:40 p.m. She later confessed to a co-worker that this was not the case, the report states.

The second employee, who went into the room at 11 p. m. as part of a daily census of residents, assumed that Lockridge had been hospitalized but did not follow up on this or attempt to confirm it.

The third employee, who was assigned to Lockridge’s floor, stopped by the room at midnight as part of her rounds and also noticed that Lockridge was not in his bed, according to the report. Further, Lockridge’s medical records reflected that staff had helped him take a dose of medicine at 6:30 a. m. Feb. 18, when he was still missing. He was not reported missing until 6:45 a. m., when a nurse said she couldn’t find him. His body had been outside for at least 11 hours in freezing temperatures.

The report concludes that the employees should have notified a supervisor when they saw that Lockridge was missing and that the window was open. It does not name them.  Neither the Weinberg Campus nor the Health Department would say what disciplinary action was taken. Weinberg has agreed to put in place a new system for keeping track of Dosberg Manor residents and to train employees in the new procedures.

 

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Tony Bartelme of The Post and Courier had a great article about Alzheimer's, violence, and a cover up in nursing homes using the story of Dwayne Walls. It is a tragic story and clearly preventable.  Below is a short summary of the article.  Dwayne Walls was a resident of Veterans' Victory House, a large nursing home near Walterboro, who suffered Alzheimer's.  One day, they moved Walls to another room and put a dangerously psychotic patient in his old one. His wife warned nurses that Walls would try to return to his old room. "They said they were going to really watch him. But at midnight, I got a call that he had gone to his room and gotten beaten to a pulp," she said.

One night Walls went into another patient's room and climbed in an empty bed. Moments later, another patient walked in. He was 88 years old and also had dementia.  A nursing aide saw the man hitting Walls with his cane. Walls was on the floor, bleeding and unconscious.  An ambulance took Walls to the emergency room and phoned Walls' wife, Judy Hand. That night and over the next four days, they told her that Walls had merely fallen; they didn't mention the beating. Walls spent the next week in bed, and Hand was at his side when he died.   The nursing home's doctor later would write in Walls' file that his patient had contracted fatal pneumonia after becoming "immobile," but that the beating didn't account for this immobility.

The facility had a history of problems. Veterans' Victory House was completed in 2006 at a cost of $28 million in state and federal money. It has five pavilions, and each is named after a South Carolina veteran. It houses 220 residents, making it one of the larger nursing homes in the state. A sign outside says, "Home of the Greatest Generations."   In December 2006, investigators with the U.S. Department of Justice visited the facility: Staff gave patients wrong foods and medications and too often used physical restraints to control behavior problems. They found that the facility was poorly equipped to handle combative Alzheimer's patients.

"There appears to be no formal behavior program for residents diagnosed with Alzheimer's disease, placing residents at heightened risk for the use of physical or chemical restraints to control behavior, and placing them at heightened risk of physical assault by other residents who may become frustrated at their repetitive speech or wandering," investigators concluded.

The state Department of Mental Health owns the facility but has a contract with a private company called Advantage Veterans Services of Walterboro to run it. The company is affiliated with HMR Advantage Health Systems, which is based in Easley and operates 26 nursing homes in South Carolina and elsewhere in the Southeast.

Nearly 80,000 people in South Carolina have Alzheimer's, enough to fill the University of South Carolina's Williams-Brice Stadium, and that memory loss isn't the disease's only troubling effect: More than two-thirds will exhibit some form of agitation or combative behavior.  Aggressive behavior is a normal part of the brain's breakdown, nursing homes don't hire enough people to meet the needs of these patients. Many blacklist Alzheimer's and dementia patients with histories of aggression, leaving already stressed families and loved ones with few options.

There is no cure for Alzheimer's, but doctors are zeroing in on its causes. One leading theory involves proteins. Healthy people have stringlike proteins in their brain cells that normally curl like unfurled ribbons. These ribbons help nourish the cells. But in Alzheimer's patients, these ribbons get tangled, destroying the cells in the process, along with a person's memories and functions that control behavior.

 As happens with about 70 percent of Alzheimer's patients, Walls grew more agitated as the disease marched through his brain, though he was by no means the only person in the wing suffering these effects.  In 2008, staff at the Veterans' Victory House documented in his medical records how another resident pushed him to the floor one month, and how a month later Walls hit another resident in the head with his fist. In June 2008, a resident hit another, who fell into Walls and knocked him to the floor. In July, a staff member found Walls in another resident's bed, his fists balled.   By August, a month before Walls' death, staff noted that he was "aggressive to others and himself," particularly when he was scared. But then the storm clouds cleared. Staff noted on the day Walls was beaten that he had no behavior problems and was moving around well.

Walls had fallen and needed to go to the hospital for X-rays, a nurse said. She didn't mention the beating, or that a deputy had been called to investigate.  Hand drove to Walterboro the next Monday morning for a visit. "I walked into the room and gasped. He was black and blue all over, swollen and on oxygen. I ran out of the room and got a nurse. They came and I asked what had happened." Dwayne had fallen, they told her. Throughout the day, the home's employees stopped by to visit Walls to see how he was doing.  Later that afternoon, four days after the attack, she approached a staffer. "I said, 'He couldn't have possibly gotten that from a fall.' She looked at me and said, 'No one told you? He was beaten.' "  Colleton County Coroner Richard Harvey told her over the phone that the beating contributed to Walls' death, but she was surprised when the death certificate listed the cause as natural and didn't mention the altercation. In an interview, Harvey said he did an autopsy but the results showed that Walls died of pneumonia, not from any other injuries.

The doctor wrote the summary in November, two months after Walls' death, and after an ombudsman hired by the lieutenant governor's Office on Aging visited the home. The agency had received a complaint about "residents that beat other residents," low staffing levels and "residents sitting in soiled diapers."  After the visit, the ombudsman noted the altercation involving Walls but said the agency doesn't investigate resident-to-resident abuse.

The ombudsman nonetheless concluded, "There is a shortage of staff," after looking at the facility's staffing logs. The reports showed the Alzheimer's unit had just one licensed nurse on duty for 52 patients on morning shifts before and after Walls' attack. On one night shift, the wing had no licensed nurse at all. The ombudsman asked the nursing home to follow state regulations, which requires at least two licensed nurses during the morning shift and one on the night shift.

More recently, an investigator with the state Department of Health and Environmental Control made an unannounced visit to the home and found it hadn't properly reported the incident involving Walls and the 88-year-old man who beat him. State law requires nursing homes to report "serious incidents" involving residents who assault others.

 

 

 

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The Herald Tribune has another tragic story about a nursing home employee assaulting an elderly woman in a nursing home.  How can the other staff not know what is going on?  What kind of background check do they actually do? Do they ask for references? Do they check references?

A former nursing assistant at Punta Gorda Elderly Care Center was arrested today and charged with felony elder abuse.   The woman, Letitia Calderwood kicked a 76-year-old woman in the back and slapped her in the face, according to a press release from the Punta Gorda Police Department.

On May 19, Calderwood and two other employees were helping the elderly woman get up from a fall in the bathroom, police reported. Struggling to help the woman, Calderwood kicked her in the lower back while she was still down and then slapped her in the face when she was lifted to her feet, according to the report.

Calderwood and the two other facility employees had difficulty helping the resident to her feet and Calderwood subsequently kicked in her lower back while using a profanity. Once the resident was helped to her feet, Calderwood struck her in the face with an open hand.

Both employees were interviewed by detectives and provided statements describing the incident and the alleged battery and abuse.  Calderwood was interviewed by detectives and admitted to kicking and striking the resident as originally reported. She stated that her actions were done out of frustration although she knew the patient was disabled and had limited ability to stand on her own.

Calderwood is being held without bond at Charlotte County Jail. She faces one charge of battery on the elderly and one charge of abuse of the elderly, both third-degree felonies.

 

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The family of a 69-year-old woman has filed a lawsuit against a Chicago nursing home for failing to protect her from being sexually assaulted by a 21-year-old mentally ill resident.  Maplewood Care's administrator tried to cover up a rape by calling it consensual sex.  It is an example of how mixing frail senior citizens and younger mentally ill residents in nursing homes can lead to violence if facilities do not monitor potentially dangerous residents.

"The only possible reason that you would be in this situation is a profit motive," attorney for the family said. "You want more residents in your facility, but you're unwilling to pay for the necessary elements to protect all the residents."

Christopher Shelton had been diagnosed with bipolar disorder with aggression when he was admitted to the nursing home in November.  Shelton, a convicted felon and a former resident of the Elgin facility, was readmitted to the nursing home without a proper review of his criminal history. Had the facility checked, it would have discovered Shelton had an outstanding arrest warrant on felony battery charges. The state report showed he had told the nursing home staff in December that he was sexually frustrated, but the facility failed to monitor him.

Shelton was missing at bed check, but no search was made or alarm sounded to alert residents and staff that a young, aggressive, sexually frustrated, convicted felon was prowling the halls of the nursing home. Later, a night shift nurse heard an elderly woman moaning and crying.  The nurse found Shelton in her bathroom, where he was calling 911 to report that someone was attacking the woman.  Paramedics and an emergency room doctor later examined the woman and noted signs of sexual trauma.  Doyle who was the Administrator at the facility downplayed the encounter as consensual sex in a report to the state and encouraged employees to lie about it to cover it up.

The state and federal governments only fined the nursing home $44,400 for violations related to the incident.

 

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A recent report came out on the hourly wages, injuries suffered, and poverty of CNAs. CNAs are certified nurse assistants.  They are typically unlicensed health care providers with little education and training.  They provide 80-90% percent of the care and treatment given to residents in a nursing home, if not more.  It is rare an actual RN examines or assesses residents. 

This report summarizes conditions for CNA's.   More than 50% received at least one work-related injury last year, and roughly 16% don't have health insurance, mostly because of cost. More than 33% of CNA's are receiving some form of public assistance, such as food stamps or rental subsidies. Their median wage is $10.04 an hour.  They provide 8 out of every 10 hours of resident care.   Forty-two percent of uninsured CNAs cite not participating in their employer-sponsored insurance plan because they could not afford the plan. Years of experience do not translate into higher wages; CNAs with 10 or more years of experience averaged just $2/hr more than aides who started working in the field less than 1 year ago.

The nursing home industry exploits these workers and then they wonder why their turnover rate is so high and retention is so low?  Corporations who own these nursing home chains need to understand that they should train, pay, and provide health care to these front line workers.  Provide incentives to become LPNs and RNs.  Offer better benefits or paid vacation time.

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The Middleton Journal had an article about two different employees of a nursing home, acting separately, stole narcotics from residents for years, and altered the residents' charts to make it look like residents actually received the need pain medication.  How could they not have been caught earlier?  didn't the residents complain that they were still in pain? 

Deborah Renee Richardson and Denise “Bells” Holtkamp are both accused of stealing Oxycodone from the Lebanon Country Manor nursing facility in Ohio.  Both nurses separately altered patient records so they could steal the addictive painkiller for their own use.

Both women were indicted by a Warren County Grand Jury on two counts of illegal processing of drug documents, a fourth-degree felony; two counts of theft of drugs, a fourth-degree felony; and two counts of aggravated possession of drugs, a fifth-degree felony.

 

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Lexington Herald-Leader had an article about nursing homes that caused at least 6 deaths due to their ignorance and negligence.  Incredible. State investigators have cited 4 nursing homes for failing to perform lifesaving measures on residents who had requested that they be resuscitated.

The errors alleged by the state provide ammunition for those who are pushing for a new law or regulation that would mean all nursing homes would use a purple wristband to identify residents who had signed a do not resuscitate — or DNR — order.

Kentucky has no uniform regulations regarding how to inform staff members of DNR orders at the bedside at nursing homes or hospitals.   Three different groups of nursing home and hospital officials are meeting in the next several weeks to determine whether Kentucky should join other states that have adopted a color-coded system.

Five of the six facilities sanctioned received Type A citations, the most serious the state can give. In all six cases, the individuals died.

â–  Kenton Healthcare in Lexington was cited in September 2007 after the staff allegedly did not initiate lifesaving measures on a resident despite a doctor's orders that everything possible be done to save the patient.

â–  Hillcrest Health Care Center in Owensboro was cited in December 2008 after cardiovascular pulmonary resuscitation was not performed on a resident who wanted to be resuscitated.

â–  In April 2007, staff members at Christian Health Center in Bowling Green did not immediately resuscitate a resident, despite a doctor's orders that lifesaving measures should be used.

Staff members told state investigators that the facility did not have a system that allowed immediate access to the code status of a resident.

â–  Woodland Oaks Nursing Home in Ashland is appealing a citation it received in January. Officials there deny failing to perform CPR on a dying patient who had requested lifesaving measures.

â–  On the other end of the spectrum, Green Meadows Health Care in Mount Washington received a citation in March 2008 for trying to revive a resident who had signed a DNR order. Green Meadows officials did not return a telephone call seeking comment.

â–  In March, Jefferson Manor in Louisville was cited after 95-year-old Eva Karem was resuscitated in February 2008 despite a DNR order. (It received a citation that was not as serious as a Type A.)

The Karem case prompted a series of meetings of lawmakers, nursing home officials and others who are looking at the use of wristbands.

"It is very important to accurately identify patients' preferences regarding resuscitation, while also protecting their privacy, which is a factor we will be taking into careful consideration when making our decision," she said.

Defendant nursing homes in litigation often attempt to confuse the jury regarding DNR orders.  Nursing homes always claim that a DNR allows them to ignore and neglect residents because "the family signed the order and must have wanted him/her dead".  Ridiculous.

 

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UticaOD.com had an article about a nursing home being investigated for abuse of a resident.   A former home employee claims the investigation is based on an audio recording she made of another employee repeatedly swearing at a patient.  Tracie Bowers, the former employee, said she recorded an incident at the end of March involving a patient with Alzheimer’s or dementia.  She said she also believes her reporting of the incident led to her dismissal two weeks later.

Bowers said she had worked as a certified nursing assistant at St. Joseph for about seven months when the incident occurred, and that the woman heard on her cell phone recording was an assistant as well. In the 30-second recording, which Bowers shared with the O-D, a woman can be clearly heard swearing and calling the patient in question derogatory names.

An unidentifiable sound that Bowers says is the other woman hitting the patient’s hand is followed by a harsh command: “Be nice.”   The male patient was not doing anything to provoke the other employee, but rather began repeating “be nice” over and over toward the end of the incident, Bowers said.

Bowers said she and the other assistant worked together for two shifts on the evening of the incident, and that she observed questionable behavior almost immediately.  “She was kind of rude to all of the residents, really,” she said. “She wasn’t really, really bad; it was just a weird attitude.”

Bowers took her concerns to a supervising nurse who excused the woman’s behavior by saying she was probably tired, she said.  Not satisfied with that answer, Bowers broke company policy by bringing her cell phone with her on the second shift and captured the recording.

When the supervising nurse continued to brush off her concerns, she took the matter to a charge nurse at the facility, and from there the report was taken seriously, she said.   Bowers said she met with facility administrators, who in turn notified the state health department, and copies of the phone recording were made.

Although St. Joseph administrators praised her for reporting the incident, Bowers said she began having conflicts with other nurses and nursing assistants at the facility shortly afterward, some of whom felt she should have been disciplined for having her personal phone at work that day.

“One day everything is, ‘Oh, you did a great job,’ and the next day they’re all throwing a fit because I didn’t get in trouble for having my phone,” she said. “It was just a whole stupid game of trying to get me kicked out of there, and then finally they (her supervisors) said they would probably have to terminate me.”

The facility scored in the bottom 20 percent statewide for 7 out of 19 categories on its most recent state evaluation, and a Feb. 2008 inspection noted a pattern of administrative problems that could pose “immediate jeopardy” to patients’ wellbeing. That inspection led to $12,000 in fines for various violations, a health department report states.

This CNA should be praised, promoted, and given a raise not fired for what she did.  This is a terrible tragedy becuase now this CNA will be blacklisted and will find it difficult to gain employment, and it will stop others from reporting abuse and neglect for fear of their jobs.

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This is the third day in a row that I am writing about the insane profits by nursing home chains.  I am all for them making a profit if good quality care is also delivered but I don't understand how they can complain about needing tort reform to make a profit.  It just isn't true.  Below are some highlights from the first quarter for Five Star Quality, Inc.:

-- Total revenues for the first quarter of 2009 increased 14.0% to $295.2 million from $258.9 million for the same period last year.

-- Net income for the first quarter of 2009 was $25.4 million compared to net income of $1.6 million for the same period last year.

-- Net income per share from continuing operations for the first quarter of 2009 was $0.78 and $0.67, basic and diluted, respectively, compared to net income per share from continuing operations of $0.14, basic and diluted, for the same period last year.

-- Net income from continuing operations for the first quarter of 2008 included a $3.3 million unrealized loss, or $0.10 and $0.08 per basic and diluted share, respectively, on our holdings of auction rate securities.

-- Senior living occupancy for the first quarter of 2009 was 86.5% compared with 89.6% for the same period last year.

-- Senior living average daily rate for the first quarter of 2009 increased by 3.1% to $146.69 from $142.30 in the same period last year.

-- The percentage of senior living revenue derived from private and other sources for the first quarter of 2009 increased to 69.1% from 66.1% for the same period last year.

-- For those senior living communities that we have operated continuously since January 1, 2008 (comparable communities), occupancy for the first quarter of 2009 was 87.5% compared with 89.7% for the same period last year.

-- The average daily rate at comparable communities for the first quarter of 2009 increased by 4.9%, to $149.46, from $142.43 in the same period last year.

About Five Star Quality Care, Inc.:

Five Star Quality Care, Inc. is a senior living and healthcare services company. Five Star owns or leases and operates 210 senior living communities with 22,260 living units located in 30 states. These communities include independent living, assisted living and skilled nursing communities. Five Star also operates five institutional pharmacies and two rehabilitation hospitals. Five Star is headquartered in Newton, Massachusetts.

 

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The Courier-journal had an interesting article showing how profitable Kindred nursing home chain has been this year and how they rely on "managing" labor costs to insure profitability.  This euphemism means they are understaffed.  

Kindred Healthcare's profits rose 55 percent in the first quarter of the year as the company offset a slight drop in patients by managing costs more closely, especially labor.   Net income was $22.8 million, or 58 cents per share, compared with $14.7 million, or 37 cents per share, a year earlier.

Income from continuing operations  was 57 cents per share, compared with 42 cents per share in the first three months of 2008.   The continuing-operations figure exceeded Wall Street analysts' average expectation by 13 cents per share and also topped Kindred's own previous forecast of 40 to 50 cents per share.

The Louisville long-term care company said it expects its full-year earnings to be $1.35 to $1.45 per share, the same amount it forecast in February.  That means the company can absorb a proposed Medicare cut in nursing-home reimbursements without a drop in earnings. 

Overall revenue for the January-March period was $1.08 billion, up about 3 percent.    Kindred shares rose 9 percent yesterday, adding $1.27 to close at $14.91. The latest earnings were released last night after the market closed.

See full report here.

 

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N.Y. Newsday had an article about a nursing home employee abusing an 80-year-old female patient by tying her legs together during an eight-hour shift, without supervision or authorization.   CNA Candice Pelzer was assigned to care for the patient on the midnight to 8 a.m. shift in November 2008.  Pelzer bound the woman "without advising anyone of [the] restraint.   Pelzer, who was working at the Berkshire Nursing and Rehabilitation Center, surrendered to Medicaid fraud unit, and was charged with endangering the welfare of a physically disabled or incompetent person and violating the public health law. 

"The conduct alleged in today's arrest is despicable - a disheartening violation of the trust Long Islanders put in health care professionals to care for their loved ones,"  Attorney General Cuomo said in a statement.

 

The worst and most intriguing part of the article is the fact that several unnamed witnesses saw the elderly patient with her legs tied together but did nothing to assist her or intervene on her behalf.    Pelzer initially admitted tying a sheet around the woman but later said she only used it to wrap her legs.
 

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CBS2Chicago had a tragic story of a nursing home resident found on train tracks near the facility.  There is no excuse for this kind of neglect and lack of supervision.  The nursing home has been sued for negligence after a resident with dementia was discovered lying on train tracks and suffering from cold exposure eight hours after wandering off during a group field trip. McCauley suffered from various psychological and physical conditions, severe dementia and Alzheimer's disease and required full-time supervision by staff.

Wayne Marz, the guardian of Margaret McCauley, filed the suit in Cook County Circuit Court against Sunrise Senior Living Services, the Brighton Gardens Assisted Living of Orland Park and the home's Activity Director Debra Ann Adler, following the Dec. 2, 2007 incident that left the woman with significant injuries.

McCauley wandered away unnoticed and was found approximately eight hours later just one mile away, lying on train tracks with visible injuries she had suffered from falling down and from being exposed to cold temperatures for an extended amount of time.

The suit alleges Adler and the nursing home failed to properly monitor McCauley; failed to assess her risk of wandering off; failed to provide an adequate number of staff for residents and failed to ensure her safety.  The center also failed to take proper steps to ensure McCauley's safe return after discovering she was missing.

 

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I have seen several article recently that show the poor choices many nursing home corporations have made in staffing their facilities.  Where is the supervision?  Where is the accountability?

A CNA stealing jewelry from residents.  Click here.

The head of a local nursing home was arrested this week after police said they found 26 grams in her possession of cocaine.  She was with her 4 year old son.  Click here.

The former controller of two western Pennsylvania nursing homes has pleaded guilty to stealing nearly $628,000 from the businesses and not paying federal income taxes on the money.  Click here.

These are the people that they hire to run the nursing home and to take care of our elderly citizens.  This is a disgrace.  Inadequate staff is one thing, incompetent thieving drug-addled staff is another.

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Brenham Banner-press had an article about the recent death of a nursing home resident who was not being properly supervised.  This is clear cut negligence and neglect but the article uses vague words to express a fatalistic attitude about the ability of staff to prevent accidents like this one.

An 86-year old man, reportedly suffering from dementia, rolled down a short flight of stairs in his wheelchair at Kruse Village retirement home here, suffering fatal injuries.  A resident died after the facility failed to protect him and allowed to fall down the stairs

The man was somehow able to leave the oversight of the nursing home attendants and go through at least one security door, eventually getting to the area where he suffered his injuries.  Somehow?  The facility failed to protect and supervise a demented resident and allowed him access to the stairs!

Because the man died from other than natural causes, his death is being investigated by police, who are saying unofficially that the death was almost surely an accident.  Accident?  So now negligent supervision and short staffing is an "accident".

Police say there is a very narrow timeline between the last time the wheelchair-bound man was seen by attendants and his time of death — 20 minutes or less.  How did they determine that?  From the nurses who failed this man and might get fired if they tell the truth?

They also say the alarm system Kruse Village uses to let them know if a patient has left a certain area was working and did perform as it was supposed to.  How did it work like it was supposed to if the man was able to go through without being noticed?

 

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The Des Moines Register had an article on a new fee on most nursing homes in Iowa.  The idea is for the state to create a provider fee on nursing homes, then use the extra money to boost nurse’s aides’ wages and for other expenses for caring for low-income elderly Iowans.  The bill would impose a 3 percent fee on non-Medicare revenues of licensed nursing facilities. The plan would tap about $33 million for the state. The state would then increase Medicaid payments to nursing homes and draw in nearly $41 million extra each year in federal money.  Of the 421 nursing homes that would pay the tax, about 415 would get back more in government money than they paid out, according to a nursing home group called the Iowa Health Care Association.

The Iowa Senate passed the idea 45-5 with bipartisan support. Thirteen Republican senators and all 32 Democratic senators voted yes.

I wish the federal government would do this for all nursing homes.  We, as a country, need to make sure that the people providing care to our elderly and most  vulnerable citizens are getting paid a fair and living wage.
 

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Chicoer.com reported the filing of a lawsuit against Windsor Chico Creek Care and Rehabilitation Center for negligence and the wrongful death of a Geraldine Pavcik.  Pavcik was admitted to the facility on June 17 for short term rehab after a minor back injury.

Because Pavcik was at risk of falling, her doctor had ordered bed-rail restraints, a lowered bed, an alarm system, and that she be closely attended to.   All are standard preventative measures available in most nursing homes but they depend on proper supervision and a quick response time to call bells and alarms which, of course, depends on adequate staffing.  Most residents fall because the nursing home chose to be understaffed and that leads to falls.

These measure were not in place on "multiple occasions" while Pavcik was in the nursing home.  On July 3, Pavcik was left unattended and without bed rails and a bed alarm.  At 7 a.m. that day, she fell out of bed, severly fracturing her left hip.  Although her hip was X-rayed at the facility at 2:45 p.m., she wasn't transferred to an acute-care hospital until after 9 p.m.

Pavcik had surgery for her fractured hip, but the operation affected her mental condition, and she was no longer able to eat or drink effectively.   As a result, she contracted "aspiration pneumonia," a type of pneumonia that can develop in people who inhale liquid or bits of food. The woman died of respiratory failure as a result of pneumonia.

Among the accusations against the nursing home are that its administrators failed to hire enough staff to keep Pavcik safe, that her doctor's orders were not followed, that she wasn't transferred to an acute-care hospital when she needed to be, and that her doctor was not notified as her condition declined before she died.

 

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The Tennessean reported on Murfreesboro-based National Healthcare Corp's CEO defending the ridiculous legislation to impose limitations on the amount of damages a victim of neglect, abuse, or negligence can be compensated for their injuries and pain and suffering.

Critics have labeled the bill the "Kill Old People Cheap Act."

"If we could lower our liability expense, we could put more into staffing," NHC President Steve Flatt said.  However, in all the states with caps on damages, the staffing remained the same!  These nursing homes have insurance and staffing is not affected by potential liability.  If they staffed properly to begin with then there would be less victims of neglect and negligence.  Flatt said his company saw a 20 percent loss in profits, going from $45 million in 2007 to $36 million in 2008. Opponents of the bill contend the nursing home industry spent between $700,000 to $850,000 to lobby for last year's version of the legislation.

 Daniel Clayton, a Nashville attorney and president of the Tennessee Association for Justice, says while the legislation falls short.   "There's not one word in their legislation that requires the nursing homes to improve the quality of care," he said. "We're (ranked) 47th in the country in quality of care of nursing homes by the federal government." "Quality of care comes first," said Clayton. "The legislation that they are proposing is to make good care optional. Good care should not be optional. It should be mandatory.

Opponents see the legislation as a way to enhance profits by the industry.

"This bill is all about the nursing-home industry trying to avoid full responsibility when it neglects or abuses a vulnerable resident. Caps don't improve care. If care improves, lawsuits go down."

NAACP Tennessee President Gloria Sweet-Love says the legislation comes at a time when state and federal reports have uncovered severe staffing and quality of care deficiencies. The CMS report uncovered that 49 percent of Tennessee Nursing Homes scored the poorest possible rating for staffing levels.

A report from the Government Accountability Office uncovered that Tennessee was one of nine states nationwide where health inspectors missed more that 25 percent of serious health and safety violations.  And a report recently released by AARP reconfirmed the poor state of Tennessee Nursing homes and found that tort restrictions have little impact on improving the quality of care in nursing homes.

The legislation would place arbitrary caps on non-economic and punitive damages in addition to making every negligent act that occurs in a nursing home protected under the Medical Malpractice Act.   "The nursing home industry's effort to conceal its true intentions is despicable and should be rejected by anyone who has ever had a loved one in a nursing home," Sweet-Love said.

"We need laws to protect our nursing home residents, not ones designed to protect the profits of greedy nursing home operators."

"If the nursing home industry would spend its money on more nursing staff, rather than on high-priced insiders, the quality of care in nursing homes would improve," Sweet-Love, the NAACP official, states in the news release. "The industry chooses to spend their resources on backroom conversations aimed at passing a law that immunizes the industry from negligent and abusive acts against helpless residents."

 

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The L.A. Times reported another story about a nursing home fined for allowing a resident to choke to death.  This is the third story about choking deaths in nursing homes in the last couple of weeks.  The nursing home was fined $80,000 after a 54-year-old schizophrenic patient choked on a meatball and died.

Raintree Convalescent Hospital had known the patient had problems swallowing.  The spaghetti meatball served to him needed to be chopped or sliced before being given to him.  Both the cook and the nursing assistant who served the meal failed to grind up the meatballs, as required. The cook failed to follow the directions for the patient's meal by not mashing up the meatball. He also said the nursing assistant failed to look at the meal card on the patient's tray -- which would have been a second chance to catch the error -- before serving the lunch. 
 

"I just did not think to chop up his meat that day," the nursing assistant told state investigators.   The facility was probably understaffed which did not allow her time to do her job properly.

The man stumbled out of his room, pale and unable to speak. After a nurse unsuccessfully attempted the Heimlich maneuver, paramedics were able to suction the meatball out of the man's airway, but he was pronounced dead at a hospital emergency room.

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Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI) reintroduced the Nursing Home Transparency and Improvement Act, a bill that would give consumers more information about individual nursing homes and their track record of care, give the government better tools for enforcing high quality standards, and encourage homes to improve on their own.

"Improving the quality of care in nursing homes is a constant challenge. More transparency, better enforcement and improved staff training are needed, and this legislation works to make changes in those areas and improve the quality of life of nursing home residents and to empower the family members and loved ones of those residents," Grassley said.

"Twenty-two years have passed since Congress last addressed the safety and quality of America's nursing homes in a comprehensive way," said Kohl. "As we prepare to debate reforms across our health care system, there has never been a better time to implement critical improvements to our nation's system of nursing homes. And as the GAO report demonstrates, many of these improvements are past due."

In addition to the bill introduced today, Grassley and Kohl released a U.S. Government Accountability Office (GAO) report entitled "Medicare and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Oversight of Health Care Facilities." This report suggests that the survey and certification system is significantly underfunded relative to the scope of its oversight responsibilities, which have greatly expanded in recent years. The report found that survey frequencies have greatly lengthened due to resource constraints, resulting in some facilities receiving inspections only once every ten years. The Nursing Home Transparency and Improvement Act seeks to bolster the federal government's survey and certification system.

Grassley is ranking member and former chairman of the Committee on Finance, with jurisdiction over the federal health care programs that cover nursing home care, and former chairman of the Special Committee on Aging. Kohl is chairman of the Special Committee on Aging, a standing committee that conducts oversight of issues related to the health, safety, and financial well-being of older Americans. The Grassley-Kohl bill is the product of their work together on nursing home quality, which has helped to generate some positive results in recent years, including the government's new five-star nursing home rating system and the release of the Special Focus Facility program participant list, consisting of the 135 worst nursing homes in the country.

 

Continue Reading...

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The Franklin News-Post had a story about a nursing home employee--the assistant director of nursing-- getting only three years for the distribution of prescription drugs she took from residents at her facility.  Linda Sloan Quick was also sentenced to three years probation, following her prison sentence, and she was ordered to be on good behavior for 25 years.  There was no mention if she would lose her license to practice nursing or if she was reported to the Board of Nursing.

Court records show that the drugs taken from the nursing home by Quick had either expired or had been prescribed for patients who had died or had been transferred to another health facility.  The sheriff's department received anonymous information that a nursing home employee was selling prescription drugs, and investigators got Quick's name from a confidential informant.

Quick was sentenced to 10 years for distribution of Fentanyl, but seven years of the sentence were suspended.  Quick was also sentenced to three years on each of the three counts of distribution of Hydrocodone. All nine years were suspended.

 

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 Fox8.com out of Cleveland had a recent story about a nursing home resident who was left unattended and allowed to leave the facility unsupervised.  The resident ended up walking on the road and getting hit by a car.  She died from injuries sustained in the  "hit and run" accident.  What is amazing about this story is how the article concentrates blame on the driver of the vehicle instead of the nursing home which was responsible for keeping this resident safe and out of harm's way.  The nursing home should have been watching her and not allow her to leave the premises unsupervised.

Citing declining health, her family recently convinced her to check into the nursing home.   She was very unhappy there and wanted to return home.  This is a clear sign of a risk for wandering.  Her family says she was supposed to be staying in a "locked-down area" when she somehow was allowed to escape.

"There was a security door in her room that she was able to disable at 87 years old. They appear to be very short staffed at night. We were told there was a loud alarm going off but no one went looking to see what was going on," says Meldrum.

According to the Avon Police Department, several 911 calls came in Friday evening alerting them of a car versus pedestrian crash in front of the Good Samaritan Skilled Nursing & Rehabilitation Center on Detroit Road. When officers arrived to the scene, they found Warren lying on the side of the road.  Police say the suspect vehicle did not stop after the accident and drove away from the scene.

Is there any investigation as to why and how she was able to leave the nursing home without being noticed?  how long was she missing?  Why didn't anyone hear the alarm or respond to it? Was the nursing home short-staffed?

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Keloland.com had an article about the sexual abuse allegations at an elderly home in Hot Springs, S.D.  Many family members are appropriately concerned. The DCI is finally looking into reports dating back to January at the Castle Manor Nursing home.  Hospital officials say they know of more victims. Board President of Castle Manor Rich Nelson knows of at least three victims and has received several other complaints. The suspect is a male nursing assistant.  Family members of the alleged victims claim Fall River Health Services tried to cover up the abuse.

When sisters Sharon Deboer and Gwendolyn Ketterer needed a long-term care facility for their mother two-and-a-half years ago, they had no doubts about the care at Castle Manor. That changed when the 84-year-old dementia patient started acting out of character late last year when a male nursing assistant began taking care of her.

"I just felt that there was something with him that I just couldn't put my finger on. I couldn't put my finger on it but I suspected that type of thing. It was just a feeling," Deboer said.  On January 17, Deboer's suspicions were confirmed.  "One of the staff called me and told me she had to talk to me, that she had something to tell me. She told me right when we met that this CNA, this male CNA, had been molesting my mom," Deboer said.

That was the only type of notification the sisters received from Castle Manor, despite an abuse report filed with the Department of Health three days earlier. The suspect stayed on as an employee for weeks before Manor officials say he was finally let go. That was part of Fall River Health Service's efforts to cover up the abuse.

How many others suffered abuse silently while Manor staff looked the other way.

 

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The AARP published a study of Tennessee nursing homes. They concluded that as staffing levels increased, the number of lawsuits against the facility dropped dramatically.  This seems obvious but nursing homes still only staff to the minimum levels anyway.   The report also concludes that tort restrictions on damages or caps does not increase the quality of care.  In other words, the savings that the nursing homes get with tort reform are not passed on to the residents but rather go into the pockets  of the corporate owners as profit.   Here is the link to the report.

We have also uploaded it here www.scnursinghomelaw.com/uploads/file/qualitynursinghomereporttn2009.pdf

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The Eldercare Work Force Alliance is a group of 25 national organizations joined together to address the immediate and future work force crisis in eldercare. It was formed in response to the Institute of Medicine's 2008 report, "Retooling for an Aging America: Building the Healthcare Work Force."

Eldercare employs millions of individuals in the United States, and is projected to be the fastest-growing employment sector within the health care industry. Strengthening these caregiving occupations not only is vital to our social infrastructure and improving the quality of care, but also has the potential to drive long-term economic growth, particularly within low-income communities.

Alliance members believe that we can and must create a health care workforce that meets the needs of older adults and their families. As recommended by the IOM, our proposed solutions include:

Require a minimum of 120 hours of training for certified nursing aides and home health aides, including explicit geriatric care and gerontological content; and create minimum training standards/competencies for non-clinical direct-care workers.

Increase compensation for direct-care workers through means such as: a) establishing minimum standards for wages and benefits paid under public programs, and b) targeting reimbursements to ensure that public funds directly improve compensation for direct-care workers.

Increase compensation for clinical professionals and educators with geriatric and gerontological expertise—they will be needed to care for our frailest elders and their families, and to help educate the rest of the workforce.

Increase funding for federal and state programs that support development of geriatrics faculty and clinician training—such as Title VII and Title VIII.

Implement federal and state programs that provide incentives—such as loan forgiveness—to those entering careers caring for older adults.
 

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SunTimes had a great article about the compensation given to employees of nursing homes.  Columnist Mary Mitchell does a great job explaining why the lack of good pay for nurses taking care of the sick and elderly proves that we as a country do not take care of the most vulnerable among us.   She starts the article with a simple fact:  On average, a certified nursing assistant in Illinois makes less than a dog walker.  She saw an ad offering $8.50 an hour to work as a certified nursing assistant at a suburban location.

Nationally, the annual median salary for the job, according to the Bureau of Labor Statistics, is $10.67 an hour, and certified nursing assistants (CNAs) who work in community care facilities for the elderly are the lowest paid.   After about 20 years or more on the job, these workers earn about $12 to $15 an hour, according to the Nursing Assistant Central Web page.

But with only one year of experience, a dog walker in this state can earn $11 an hour.  In New York, the amount jumps to $20.35.

We don't really care about what happens to our elderly.  But as a society, we don't care. We think we do, but we don't. What else explains why we put the most vulnerable members of society-- our children and our elderly -- in the hands of the lowest-paid workers.  Do you ever think about what that says about the value we put on these human lives?

That won't happen until we are willing to pay those who care for our children, the disabled and our elderly more than those who take care of our dogs.

 

 

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The Cincinnati Enquirer had an article about the death of a woman who was found outside of he rnursing home.   The woman died three days after she was found outside a Hyde Park nursing home on a day when the low temperature was 23 degrees.  Records do not say what time she fell or how long she was outside before she was found.   It was dry that day, with a low of 23 and a high of 40 degrees, according to the National Weather Service.

Pasquale was brought inside, taken to University hospital where she was treated for an eye injury and then moved to Hospice. She suffered from advanced dementia and stayed in a locked unit.

It is unknown how she escaped from the locked unit and left the facility.  Pasquale was found by an employee of the nursing home who was being dropped off for work.   An alarm was set off when Pasquale walked out of the facility into a courtyard.    From there, she had to open a gated area.  She was found sitting on the ground outside the nursing home.

Pasquale was moved to hospice because she grew very ill and “clearly didn’t have long to live.”

Cincinnati police said they were not called to the nursing home.

Such incidents, in which nursing home residents are found outside in the cold, are not common but not unheard of.

On Feb. 5, Dorotha Mae Gifford, 87, died outside Heartland of Woodridge nursing home in Fairfield. She was found face-down in the snow. She died of hypothermia, her death ruled an accident, the Butler County Coroner’s Office said Friday.

In January 2007, Shirley Galvin, 78, was found dead in the snow outside Sunrise Assisted Living in Finneytown. Her death resulted from heart disease, the Hamilton County Coroner’s Office said.

 

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WiredPRNews.com had an article about a nursing home owner in Albuquerque, New Mexico, who was found guilty of felony abuse and neglect in connection to charges stemming from an incident on Christmas day in 2005.

Richard Gerhardt, a 76-year-old resident at the nursing home, who was recovering from a broken hip, was placed on a bed pan and left there for 24 hours. According to reports, the bedpan became imbedded in his skin, causing an open wound that became infected and resulted in his death 5 days later.

The nursing home faces a possible $5000 fine and/or exclusion from federally funded health care programs. The case is rare, and may be the first of its type to lead to a conviction. Elizabeth Staley, director of the New Mexico attorney general Elder Abuse and Medicaid Fraud Division is quoted in the report as stating, “Nursing home and care facilities are paid to provide round the clock care to those who cannot care for themselves… Protecting this population is of paramount importance to the New Mexico attorney general and similar violations will be prosecuted vigorously.”

Sentencing for the case is set for March 13.

 

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There have been many articles about the recent deaths at a California nursing home from overmedication or intentional overdose.  Here, here, here, here, and here are some articles where I got some information.  It is an incredible story that is symbolic of the hiring practices and training of staff in the nursing home industry, and the use of medications as a chemical restraint.  The use of chemical restraint in elder-care facilities is not a new problem. However, it’s unethical, and if given without consent of the individual or a healthcare proxy, illegal.

Kern Valley Hospital houses a skilled nursing facility where several employees are accused of killing three patients by force-feeding them psychotropic drugs to keep them calm.
In one allegation, nursing home resident Opal Towery was injected with anti-psychotic drugs after an argument with the nursing director and spent the next week in a zombielike state.  In another, Louise Zimmerman was pinned down by four staffers and injected with the same drugs. She never regained full consciousness.

Those were among the disturbing stories in a criminal complaint filed by the California Attorney General’s office that led to the arrests Wednesday of three current and former employees of the Kern Valley Healthcare District’s skilled nursing facility. The complaint alleges a nursing director, pharmacist and physician drugged at least 22 elderly residents with mood-altering medications to quiet and control them, leading to the deaths of three. The alleged druggings occurred between August 2006 and January 2007.

“When I was handed the newspaper by a co-worker, I felt like somebody had slammed me in the stomach,” said Betty Dennison. Her mother-in-law, Beulah Dennison, died Jan. 21, 2007, less than three months after she was placed at the Kern Valley Healthcare District’s skilled nursing facility. Several days before Beulah’s death, a nurse told Dennison her mother-in-law had been drugged to keep her quiet and complacent.

Patti McGarvey’s 74-year-old mother, Norma Lee Cudahy, entered the facility in March 2006 to recover from knee surgery and died in November from a stroke. McGarvey doesn’t know what drugs her mother received but after hearing the alleged druggings targeted patients who complained or acted out, she got worried.

“These are powerful medications that were given, in some cases against people’s will, primarily for management, not health reasons,” Attorney General Edmund G. Brown Jr. said. “It's unconscionable behavior and it’s certainly not what people expect when they entrust their parents or grandparents to a skilled nursing home.”

Gwen Hughes was the director of nursing.  Debbi Gayle Hayes was the facility’s pharmacist.  Dr. Hoshang M. Pormir was medical director of the skilled nursing facility.

 

The 27-page complaint describes interviews with facility nurses and medical experts who say Hughes ordered certain patients to receive high and unnecessary doses of anti-psychotic drugs.

Pharmacist Hayes followed her orders, telling investigators she thought Hughes was knowledgeable in the treatment of psychiatric conditions. Pormir, the physician, signed off on the orders after the drugs were administered.

Hughes’ orders often came after residents "acted out" or complained, and were often administered without patient consent.   At least two residents were forcibly injected; a third had psychotropic drugs sprinkled on her food.  The investigation found none of the residents received a medical exam or diagnosis prior to receiving the powerful doses.

The attorney general’s investigation identified three residents believed to have died as a result of being drugged and neglected:

• Fannie May Brinkley died Dec. 23, 2006, after receiving Depakote, a drug to treat mood disorders. After not eating for six days, she was rushed to the emergency room, where she died.

• Eddie Dolenc was given unnecessary anti-psychotic medication that caused him to become extremely sedated, and unable to eat or drink. He died one month after being admitted to the facility, likely from dehydration or pneumonia.

• Joseph Shepter went to the emergency room on Jan. 14, 2007, for dehydration and died five hours later. He had been given three anti-psychotic drugs.

In addition to the three deaths, the drugged residents suffered serious side effects ranging from severe lethargy that inhibited eating and drinking for long periods to weight loss, drooling and incoherence.

People interviewed by investigators pinned most of the blame on nursing director Hughes, who was fired in 1999 from a Fresno nursing home after the state cited the facility for over-medicating patients.   Nurses at the Kern Valley facility said the drugging of patients began when Hughes was hired.  She held “interdisciplinary team meetings” in which she and the staff discussed residents' behavior and Hughes told the pharmacist what drugs to prescribe.

Tish Orr, a registered nurse at the Kern Valley facility for 25 years, said the druggings were orchestrated by nursing director Hughes.

Orr recalled Hughes ordering a potent anti-psychotic drug be given to an Alzheimer’s patient.

“I would have him up at the nurses’ station while I was working, and he’d been drinking coffee and eating graham crackers and was happy as could be,” she said. “But he’d say the same thing 140 times in a row and it drove her nuts, and that’s why she had him medicated.”

“From that day on, he didn't eat or drink. He was so weak he couldn't be in his wheelchair anymore.”

The man eventually died.

When the nurses objected or raised concerns, Hughes threatened to fire them and have their nursing license revoked.  Several nurses left the facility during Hughes’ tenure. One nurse told investigators she was so distraught by the situation that she was on the verge of “a nervous breakdown.”

Gwen Hughes was fired from two nursing facilities for over-drugging patients yet landed a job at Mercy Hospital in Bakersfield and to this day has a clean nursing record. How did Hughes — facing criminal charges in the deaths of three local nursing home patients — keep getting hired?

Interviews with health care regulators and a former employer showed that nursing homes blame privacy laws despite the firings, the result of twice being implicated in state investigations for over-drugging elderly patients.

It’s public now. Threats kept the truth about what happened at Kern Valley from coming out sooner, said Tish Orr, a registered nurse there for 25 years. When nurses objected to patients receiving heavy doses, Orr said, Hughes threatened to fire them or have their licenses revoked.

“We were so cowed and threatened with losing our jobs and our licenses that after a while we just shut our mouths and did what we had to do,” Orr said.

Nurses who worked under Hughes at the Sunnyside Convalescent Home in Fresno in the late 1990s described a similar situation, Fellen said.

“She would go up to (a nurse) and basically force them to write an order (for medications),” he said. “She threatened to fire them. She could be very intimidating.”

Hughes was fired as nursing director there in 1999 after a state investigation revealed her role in overmedicating patients. She was hired in Kern Valley in 2006. After being terminated from that job, she briefly worked at Mercy Hospitals.

Incredibly, there are no blemishes on Hughes’ nursing record. The Board of Registered Nursing said it will now act to suspend Hughes’ license. A little to late for the dozens of victims of her "care".

Three of the four drugs allegedly over-prescribed to patients at a Lake Isabella nursing home can pose such deadly side effects to the elderly that they bear the U.S. Food and Drug Administration’s “black box” warning label. Zyprexa, Resperidol and Seroquel were developed to treat severe psychotic disorders, such as schizophrenia, but are increasingly given to nursing home residents, often to treat behavioral issues, said Dr. Kathryn Locatell, a geriatric physician who specializes in forensic investigation of elder abuse.  Common side effects in the elderly are constipation, risk of falling and difficulty swallowing, which can lead to dehydration, weight loss and other life-threatening problems. In most cases, the risks or prescribing the drugs to elderly patients far outweigh the benefits, Locatell said.

Because the drugs can cause sudden death in elderly patients, said Locatell, they bear the FDA’s strongest designation for medications that may have life-threatening side effects.

The use of anti-psychotic drugs in the elderly can pose serious risks. Geriatric physician Kathryn Locatell and longterm care ombudsman Nona Tolentino said people with a loved one in a nursing home, skilled nursing facility or other residential care setting should asked for detailed information about medications.

Here are some questions to ask:

• What medication is my loved one on?

• What are you trying to treat with this drug? What are the specific behaviors that need treatment?

• How will this drug improve my loved one’s condition?

• How often and how long will it be administered?

• What are the side effects?

• Has a doctor examined my loved one to determine if this is appropriate?

• How will side effects be monitored?

• Why are drugs even being considered?

• What other approaches could be used? What has been tried?

“If you can't get good answers, then ask for a meeting with the director of nursing or the pharmacist,” Tolentino said. Or, seek an outside pharmacist’s opinion. Facilities should also have a “care plan” for each resident or patient. Ask for a meeting to review it with facility staff.

Locatell said national statistics show about 50 percent of nursing home residents are on some form of psychotropic medication. Most are on anti-depressants, which she considers OK since there’s high incidence of depression among nursing home residents. But about 30 percent of residents are now on anti-psychotics, a class of psychotropics designed to treat serious mental illness. The use of those drugs in a nursing home should “raise a flag” for loved ones, she said.

“As far as I’m concerned, it’s replaced the use of physical restraints,” said Nona Tolentino, former director of the county’s adult protective services program who now oversees the long-term care ombudsman program at Greater Bakersfield Legal Assistance. “That’s what I see and that’s what we hear. There are behavioral problems in a nursing home and staff readily presents that to a doctor and the doctors agree to prescribe the drug or increase the dosage.”

 

 

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McKnight's had an article about how the stimulus package will dramatically increase funding for nursing homes.  Hopefully, the increase in reimbursements will help improve the quality of care at nursing homes.

The completion of the bill is expected to be a huge boost for the nursing home industry.  Included in the package is $87 billion extra in Medicaid funding.   Medicaid is the No. 1 payer of long-term care in the United States. The measure also includes delay of certain Medicaid policy provisions that providers did not favor.

That is a lot of money.  I hope the nursing homes use the money to improve staffing levels, and provide more training to staff.

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A worker at a Sudbury nursing home has been charged with sexually molesting a patient while another patient slept in the same room. Prosecutors said that 46-year-old Kofi Agana sexually assaulted the 62-year-old woman who had recently suffered a stroke at Sudbury Pines Extended Care.  Agana was held on only $500 bail after pleading not guilty.

Agana has worked as an aide at Sudbury Pines since August.  Agana went into the room of a 62-year-old woman who had a stroke which greatly limited her ability to speak. Agana closed the bedroom door nearly all the way which is a violation, and began rubbing the woman’s breast.  He then grabbed her arms and held them down when he touched her genitals area, the prosecutor said.   The assault was discovered when another aide noticed the victim acting strangely toward Agana. "She was acting agitated - she was trying to get away from him."

"She’s very responsive to questions asked to her," said investigators. "She pointed to various areas of her body and she indicated it involved the defendant."

Prosecutors asked Judge Robert Greco to set bail at $10,000, noting the seriousness of the crime. He also said there was another allegation where a patient being transferred from a bed to a wheelchair said Agana fondled her. He was not charged for that, the prosecutor said.

 

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WKBW.com had an article about a nursing home employee caught in a drug bust.   This kind of incident seems to be happening more and more around the country's nursing homes.

Melanie Curry is a Licensed Practical Nurse who worked at the Fiddler's Green Manor nursing home.  The Wyoming county drug task force was monitoring Curry.  When Curry moved from Wyoming county to Springville the drug task force alerted the Erie County Sheriff's Office. "As a result of information they had provided to us we had her under surveillance," says Erie County Sheriff Timothy Howard.

Police say Curry was stealing hydrocodone pills from the nursing home residents.  The investigation came to a head when nursing home officials say an undercover officer made contact with Curry and made arrangements to meet for a drug buy right outside Fiddler's Green Manor. "(Officers) actually witnessed the drug sale of about 11 pills in front of the nursing home," says Howard.

Curry is now facing a felony sale of narcotics charge as well as misdemeanors of petit larceny and drug possession.   Fiddler's Green Manor says this is an isolated incident, and patient care is their first priority.

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MSNBC had an article about a resident who was unsupervised and was able to leave the facility unattended.  Authorities are investigating the death of the female resident.   Reports indicate that Dorotha Gifford apparently walked out of the Heartland of Woodridge home without any of the staff noticing.  Several hours passed before Gifford was discovered missing.  Employees searched the grounds and found her dead outside at about 2:30 p.m. Gifford was pronounced dead shortly after she was found.

Temperatures hovered only a few degrees from zero for  the day she was missing. The cause of death is mostly like exposure to the cold. 

The home is owned by HCR ManorCare.  They released a statement to the media refusing to accept responsibility.

The article does not mention if she was a known wanderer or if there were locks or alarms on the door.  It also doesn't mention how long she was missing or if the facility was properly staffed that day.  I hope there is an investigation and we find out some of the answers to these questions.

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WTOC in Savannah, Georgia had an article another nursing home care taker charged with stealing from an elderly couple at Savannah Specialty Care Center.   Yvonne Winslow took the couple's debit card and used it at several businesses.  Winslow worked at the Savannah Specialty Care Center where Oglesby's grandparents Ron and Charlotte Miller live.  Winslow is in the Chatham county jail and is facing six felony charges including elderly abuse.
 

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We have many people call us asking for advice on how to choose a nursing home. Many of the people seeking advice want to rely on Medicare's star ratings.  We are not convinced that these star ratings give an accurate assessment of a nursing home's ability to provide good care.  The ratings are primarily based on surveys and investigations done by the Department of Health and Environmental Control (DHEC).  Well, the problem with that is DHEC tells the facilities when they are going to investigate or conduct a survey giving the facilities time to get their best nurses in the facility, to staff more than typical, and make sure all the documentation is revisited and changed if lacking.  

When abuse or neglect is reported, the state's investigations procedurally favor the facilities. Violations must be actually found in the facilities' own documentation, which are very self-serving. We cannot rely on the state for enforcement of regulations that are designed to protect residents and ensure proper care.

The key to quality of care is competent, compassionate, and well-trained staff.  They are less likely to get burnt-out and more likely to stay in the job thus lowering turnover rates which are detrimental to residents especially those with dementia.  The reality often is that staff who complain about resident neglect don't remain employed.  Fortunately there are laws to protect workers from retaliatory firing, but many employees still fear losing their jobs by speaking up.  Regulations exist to protect residents from neglect, but residents and employees fear retaliation. Many times families aren't aware neglect is occurring. Facilities lie and cover up to protect themselves from liability.

There are no "good" facilities here.  Unfortunately the best that one can hope for is "average" — with most "below average."  It is tragic that our area does not have "above average" facilities available. We should be outraged. Our tax payer money is going to these facilities. instead of providing quality care and adequate staffing, the facilities send the money to "management" companies that are owned by the same people who own the nursing home and don't actually provide any services.

Our community needs to make it less profitable for nursing homes to neglect our elderly. A society is ultimately judged by how it treats its most vulnerable members. At this time civil actions are the only effective solution. The state won't do it.
 

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MPNnow.com had an article about an employee of a nursing home accused of abusing an elderly resident.  I have seen more and more articles about employees abusing residents.  I am wondering if the abuse occurs often or have the incidents gotten more media attention lately?

Nellie Weller is accused of tying a 76-year-old resident’s nightgown around his neck and legs, leaving him unable to move or even use his urinal at the Edna Tina Wilson Living Center on Island Cottage Road. The nursing home is part of the Unity Health System, which includes Unity Hospital in Greece.

Weller, who was a certified nurse assistant, was charged with endangering the welfare of an incompetent or physically disabled person and willful violation of the health laws.  

The Attorney General’s Office announced a second arrest in an unrelated case. Monique Jones, 32, of Rand Street in Rochester, is accused of kicking an 88-year-old resident in his ribs while she was employed as a certified nurse aide at the Kirkhaven Nursing Home on Alexander Street in Rochester.

 

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Tulsa World had an article discussing another nursing home employee accused of sexually assaulting a nursing home resident.  Something needs to be done about the hiring practices of these nursing homes.  There are hundreds of incidents like this every year.  It is disgusting and the nursing home industry ignores and covers up the problem.  I think videotaping should be the norm in nursing homes despite the alleged privacy issues that may arise.

The article states that a nursing home worker was charged with caretaker abuse amid accusations that he sexually assaulted a resident he was bathing. Edward Lee Marshall faces a felony charge of sexual abuse by a caretaker after allegedly fondling a physically and mentally disabled man at the Southtown Nursing Home. He was arrested after an honest nurse reported the allegation, police said. Marshall worked as a restorative aide and provided various types of "therapy" to residents.  Marshall was giving a blind patient a bath when the abuse is alleged to have occurred, police said.

 

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McKnight's had an article discussing salaries and wages of employees of assisted living facilities.
Directors of nursing at assisted living facilities saw a pay increase in the last year. Their national average salaries rose to $60,000 in 2008 from $59,627 in 2007, according to the eleventh annual 2008-2009 Assisted Living Salary & Benefits Report.

RNs and CNAs in assisted living fared better, receiving a 3.34% and 3.17% pay raise, respectively. Meanwhile, the turnover rate among assisted living RNs fell from 42.33% last year to 35.5% this year, though the turnover rate for CNAs held steady at just more than 42%. This number is very high and explains the lack of consistency in care at most assisted living facilities.

The annual salary and benefits report, which was published by Hospital & Healthcare Compensation Service (HCS) in cooperation with the American Association of Homes and Services for the Aging, tracks compensation for 16 management and 24 non-management positions in all types of Assisted Living facilities across the country. 

If salaries and wages were increased (as profits have increased), turn over rates would go down.  If facilities were truly interested in quality of care, they would use their resources to adequately pay the people proving the care instead of funneling money to the corporate owners of the facilities.

 

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The CantonRep.com had an article about an unsupervised visitor to a ManorCare nursing home who was accused of fondling a physically disabled female patient at Cincinnati facility. Alvin Meyer was charged with gross sexual imposition by force. The allegation was made by the patient at the Heartland of Mount Airy facility in Springfield Township, which has about 105 patients.   Nursing home spokeswoman Julie Beckert said the alleged fondling happened in the patient’s room and that the patient was able to immediately tell staff what happened.

ManorCare Health Services of Toledo owns the facility. ManorCare has policies and procedures in place that should have protected the resident, including training and in-service of staff.

Meyer’s address is listed on the same street as the home, about a mile-and-a-half away.

 

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Carl Hessler Jr wrote an article in Delaware County Daily Times about the woman accused of assaulting a resident skipping another court date.   For the second time in a month, Henrietta Sprual was a no-show in court, where she was supposed to be sentenced for using a belt to repeatedly beat an elderly Alzheimer's patient while she worked at an Upper Merion assisted-living facility.

Defense lawyer Robert Datner couldn't explain Sprual's absence to President Judge Richard J. Hodgson, who was prepared to sentence Sprual.

"It appears to me that Miss Sprual is running 90 miles an hour down a dead-end street, and at the end of the day, she's going to hit the brick wall and she's going to have to face Judge Hodgson," said Assistant District Attorney Bradford Richman.

Hodgson issued a bench warrant for Sprual's arrest, the second warrant in less than a month. Hodgson initially issued an arrest warrant for Sprual Jan. 7 after she neglected to show up for a sentencing hearing.

The judge had rescheduled the hearing for Thursday.

Richman said Sprual's nonappearance for sentencing "is incomprehensible" and another example of her lack of remorse for her crime of striking an 87-year-old man who was in the advanced stages of Alzheimer's disease with a belt some six to eight times while she worked as a patient-care worker at Arden Court in December 2007.

Relatives of the victim were in court hoping to observe the conclusion of the case. They had to leave the courthouse without their justice.

"They were very distraught. It really inflames the wounds suffered by this family," said Richman, describing the reactions of the victim's relatives. "They want to put this behind them and they want this part of (the victim's) life to be put to rest so they can celebrate the good aspects of his life."

 

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STLtoday.com had a tragic story about the rape and abuse of a resident at the hands of a nursing home employee.  Why aren't these people checked and supervised?  How can this happen to the most vulnerable citizens?  How many others were raped and abused by this villian?  Was a criminal background check done?

The accused employee was a former janitor at a nursing home in Normandy. He has been accused of raping an elderly resident. Santonio McCoy of St. Louis is charged with forcible rape. He is accused of attacking a woman at the home.

McCoy turned himself into Normandy police on Wednesday last week. He is being held in lieu of a $200,000 cash bond. McCoy had worked at the nursing home for about a year, Madigan said. The attack was interrupted when three workers at the home walked by.
 

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This entry is a follow-up to the entry about a resident in Concord, N.C. who was allowed to wander away from the nursing home and fll off a loading dock.  A state investigation shows that a nursing home in Concord made several mistakes, which played a role in the death of a patient.  The 21-page report says that the staff and director of Five Oaks Manor knew that 87-year-old Annie Bell Scarboro was at risk for wandering because she had wandered off before.

State inspectors from the Department of Health and Human Services went into Five Oaks Manor in December after the Alzheimer's patient died. The report shows Scarboro got through three sets of doors unsupervised.

First, she went through the dining room doors. A worker says those doors hadn't locked properly for at least eight months. Then, Scarboro went through the kitchen doors and out a back door leading to the loading dock. The back door, according to the report, had no alarm.

Scarboro fell 4 feet off the loading dock .The "merry walker" chair she used to get around landed on top of her. A nurse who found Scarboro told inspectors, "I went out there and saw her blood was running everywhere."

A nursing assistant at Five Oaks told investigators, "Everyone knew that she wandered around. We all knew that she did that. She got out that kitchen door before."  The report shows that on May 22, 2008, Scarboro had exited the building through the same kitchen door.   The solution then was to check on her every 15 minutes.

The state investigation found the nursing home failed to meet several federal standards of care, meaning Five Oaks could be forced to pay a big fine and could lose their funding altogether.

NewsChannel 36 tried to get comment from the director, but he hung up on us.

To view the full 21-page report, click here.   The report does not mention the staffing levels at the time of the incident.
 

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Alliance for Retired Americans had an interesting report in June 2002 titled Nursing Home Care: When Will We Get It Right .  It has some great information and meaningful recommendations on how to improve care provided in america's nursing homes.  Specifically, the report addresses staffing levels and how staffing affects the quality of care provided.  This report should help lawyers, judges, and juries understand the importance of staffing adequately in the nursing home setting with vulnerable residents. 

We have also uploaded the testimony of Toby Edelman who is a Senior Policy Attorney with the Center for Medicare Advocacy, a private, non-profit organization that provides education, analytical research, advocacy, and legal assistance to help older people and people with disabilities obtain necessary health care.   Since 1977, Toby Edelman has represented and worked on behalf of nursing home residents.  He also explains the correlation between adequate staffing and quality of care.

See also U.S. Department of Health and Human Services' May 2003 Report titled: Staffing Ratios in this annotated review of the literature here.  The purpose of this project is to inform federal and state policymakers about what can be learned about the implementation and enforcement of state minimum nursing staff ratios for nursing homes, and related issues, such as labor shortages and resident casemix. The experiences of states that have already grappled with the complexities of setting, monitoring, and enforcing minimum staffing ratios could be instructive. The project will describe the states’ minimum ratios and their goals, the issues states confront as they implement the ratios, and the perceived impacts of these ratios on the quality and cost of nursing home care.

The study took a two-pronged approach to determining what is currently known about state minimum nursing staff ratios and their implementation. The first was an annotated review of the published and unpublished literature on state standards. The purpose of the literature review was to identify states with minimum nursing staff ratios and to learn howthis type of standard is being implemented. This paper provides the annotated review ofthe literature.

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Fort Worth Star Telegram had an article about a nursing home facility that allowed a resident to wander away from the facility unsupervised.  The resident is a 67-year-old woman with an aggressive form of Alzheimer’s disease who walked away from a Fort Worth nursing home.

The woman was last seen about 5 a.m. at the Tanglewood Oaks nursing home.  Police described the woman, Linda Kay Eichelberger, as white, 5-feet 3-inches tall, weighing about 135 pounds, with blond hair. Police think she may have tried to walk to her home near TCU.

Anyone with information about Eichelberger can contact Fort Worth police at 817-335-4222.

I am not sure how this happens when the facility knows that the woman suffers from dementia. Why weren't they keeping an eye on her?  How long was she missing before they even noticed?  Did they have a wanderguard on her? Were the doors locked to the facility?  Did they have enough staff to watch her?

 

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McKnight's had a great article on Senator Kohl's new bill, "Retooling the Health Care Workforce for an Aging America Act of 2008."   The bill has garnered strong praise from the nation's top nursing home advocates.

"The ability to recruit, retain and support high quality talent is essential for providing high-quality care and services," said Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, in a statement. This act will offer more opportunity to invest in the long-term care workforce and effectively meet the needs of an aging society, he added.

The nursing home industry claims that 110,000 full-time healthcare positions in the country are vacant.

Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care, added.

"We are pleased Senator Kohl has introduced this sweeping piece of legislation which deals directly with the fact that demand for long-term care workers far outstrips the available supply of the key workers our profession requires to sustain the provision of quality care today and the years ahead," he said in an announcement.
 

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The Chicago Tribune recently had an article talking about the shortage of qualified and compassionate nurses in Indiana.  The article states that Indiana’s nursing homes are facing critical shortages of registered nurses and nurses aides.  An industry survey found nursing homes in this state had the nation’s highest vacancy rate for registered nurses last year, and the rate for vacant aide positions was the eighth highest in the nation.

Advocates for seniors agreed with the urgent need for more nurses and aides. An AHCA survey released last month found 26.0 percent, or more than a quarter, of registered nurse positions in nursing homes were vacant last year on June 30. The survey found that 13.7 percent of certified nurses’ aides slots – about one in seven – also were empty on that day. The national vacancy rate for nurses was 16.3 percent and for nurses aides, 9.5 percent.  This hurts the quality of care since many nursing homes will hire anybody and not fire anyone even if caught abusing or neglecting residents.

What we’re seeing over and over again is there’s a direct link between quality and staffing.   With unqualified or incompetent staff, many nurses get burnt out or over worked which leads to high turnover rates. The AHCA report estimated the two-thirds of RNs in nursing homes left their jobs last year and that 93 percent of aides did.

Michelle Niemier, executive director of the advocacy group United Senior Action of Indiana, agreed nursing homes needed more RNs and aides, but said those staffs also had to have the training, supervision and consistent hours to adequately serve residents and their families.

“The number one concern of family members is the number of well qualified, well trained, well supervised staff in nursing homes,” Niemier said.

 

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The Minneapolis Star Tribune had an article recently about the 8 teenagers involved in the abuse and taunting of nursing home residents.  The young women attended high school together and worked at the Good Samaritan nursing home in Albert Lea, Minn. They also laughed together early this year as they spat in residents' mouths, poked and groped their breasts and genitals and at times taunted them until they screamed.

The allegations became public when state Health Department inspectors concluded that four aides, to make their "work fun," had abused 15 frail residents. The State claims that prosecuting the aides could prove difficult because the evidence is largely based on their own statements and those made by another aide who blew the whistle to the home's administrators while she was being fired for swearing in front of a resident. That aide was among those charged as a juvenile.

According to the complaint: "MRW stated that they openly discussed things among themselves. She stated the girls were confident they would not get caught because 'residents did not have their minds.'"

Another aide, identified as RMM, said the group gathered at breaks at work or school to "talk and laugh about the incidents," the complaint said.

The Health Department's findings were turned over to the Minnesota Nursing Assistant Registry, which bars aides who have maltreated nursing home residents from continuing in that line of work. Last year the department substantiated 68 cases of maltreatment in Minnesota nursing homes.  Three of the aides have challenged the Health Department's findings and their subsequent disqualification to work with vulnerable adults.

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The Milwaukee-Wisconsin Journal Sentinel had an interesting article about Bruce Bowman.  He was a resident at a nursing home facility who was given Risperdal, an anti-psychotic medication.  Normally it is used to control agitation and aggression but many nursing homes use it and other medications as a chemical restraint to "quiet" the residents.

Mr. Bowman had adverse reactions to the Risperdal.  These reactions were well known to his health care providers but the nursing home never warned the family of any possible side effects.  Mr. Bowman's throat swelled up. His body went rigid. He got pneumonia from lack of mobility. The once strong former logger withered away. Two weeks before he died June 19, Bowman weighed only 112 pounds.

Six months before he died, Bowman was given Risperdal by the nursing home. his children insist they were never told by the nursing home staff that Risperdal has a black-box warning that reads: "Increased mortality in elderly patients with dementia-related psychosis." They didn't know that in clinical trials for Risperdal, most patient deaths occurred from cardiovascular or infectious complications, such as pneumonia. The drug's listed side effects also include vomiting, weight loss and muscle stiffness, among many others.

"I'd never give any kind of consent for any of that," said Martin Bowman, Bruce's son, who was the legal guardian of his father's care and needed to approve any changes in medication.

The black-box warning for Risperdal was issued by the Food and Drug Administration in 2005. The drug is only approved for use in people with schizophrenia, bipolar disorder and some irritability associated with autism. Martin Bowman never saw that warning because the nursing home was using 7-year-old medication consent forms, Public Investigator found.

The old forms didn't have the paragraphs of warnings about Risperdal because the warnings hadn't been issued in 2001, when the forms apparently were printed.  The nursing home should have downloaded an updated form from the state Department of Health Services Web site.

Anti-psychotic drugs often are prescribed to elderly patients with dementia to control their agitation and outbursts.  Many researches believe that anti-psychotic drugs are overprescribed to subdue nursing-home patients. The consequences can be deadly.

Many nursing homes use medications as a restraint so they can save money on staff.  The less vocal a resident is or the more they are asleep, the less the staff has to do for them.  Nurses are happy because of less work, and the corporation who owns and operates the facility gets more profit.

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The Charleston Gazette out of West Virginia had an article about the tragic and clearly preventable death of a nursing home resident who wandered away from the facility unsupervised and was struck by a train on nearby tracks.  Why didn't the facility notice he was missing?  Why weren't they able to prevent him from wandering away from the facility? What was their staffing level on that day?  Did they have a wanderguard on him?

In a lawsuit filed in Kanawha Circuit Court, George W. King Sr.'s children, Sharon Milam and George W. King Jr., allege that Heartland of Charleston, a subsidiary of Health Care and Retirement Corp. of America, LLC, failed to properly monitor the 73-year-old former owner of Pineview Cemetery in Orgas.  "George King Sr. could not care for himself or be allowed to walk outside the facility and the staff of the facility at Heartland of Charleston was aware of this fact," the suit reads.

Workers at the facility failed to follow the company's established protocols for missing residents and failed to adequately supervise King.  "The staff of Heartland of Charleston failed to keep him secure in the facility, failed to immediately discover that he had left the facility, searched for him in the wrong area (because they confused him with a different person who had left the facility on a prior date), failed to use the exterior security cameras to identify the direction in which he left the facility and failed to utilize all available resources to locate him quickly [such as a search dog team]," the suit states.

 

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The Morning Call had a story about another nursing home employee stealing narcotics from the residents.  State police in Pennsylvania have arrested a Bethlehem woman named Heather L. wolters for stealing drugs from a nursing home where she worked. She was employed as a nurse at the Lehigh Center nursing home in Lower Macungie Township when police say she stole 10 vials of injectible Hydromorphone from a computerized medication dispensing system.

A derivative of morphine, Hydromorphone is used as an alternative to morphine in cases of analgesia, and as a cough suppressant. Wolters was charged with numerous counts of possession of a controlled substance, theft by unlawful taking or disposition, theft by deception and receiving stolen property.

 

How could this happen?  Doesn't the nursing home conduct a narcotics count after every shift?  If so, one or more of the residents are not getting their medication.  If not, they are negligent in dispensing medications.

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The PostStar.com had an article about a registered nurse working at a nursing home despite being convicted and sent to prison for selling prescription drugs he stole from the hospital where he had worked.  How could he keep his license?  Why would a nursing home hire him for a job where he could steal drugs again?

Bradley Winslow is on parole until August 2009, and said Tuesday he did not lose his nursing license, and was not disciplined by the state, for the January 2007 conviction for third-degree criminal sale of a controlled substance.

He said he "fully disclosed" the conviction when applying for a job at the nursing home, and that the nursing home was aware of his conviction when they looked into his background.

Winslow was a nurse at Saratoga Hospital when he was arrested in July 2005 on charges he sold stolen morphine to an informant for the state Department of Health. He had taken the morphine while working at the hospital. The informant was a doctor who later died of a heroin overdose.

Winslow said he was not disciplined by the state, a comment that was corroborated by the Web site of the state Office of Professions, which lists disciplinary actions against licensed professionals in New York, including nurses. His name is not included among those subjected to disciplinary cases.

Jane Briggs, a spokeswoman for the state Education Department, which oversees the Office of Professions, said the agency could not discuss Winslow’s disciplinary history because it was "pending." She could not explain why the matter would still be "pending" 23 months after he was sent to prison, though.

 

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UticaOD.com had another story about nursing home employees stealing from residents.  This time, the Bonnie and Clyde stole an 89 year old's diamond engagement ring and pawned it.

The arrest came about as a result of Attorney General Andrew Cuomo'a investigation into nursing homes.  He is doing a great job shedding light on the misdeeds that occur frequently in nursing homes.

Certified nurse aide Amanda Thaler and her boyfriend, dietary technician Sheldon Stoddard, both work for Bethany Gardens Skilled Living Facility.   Court records show that Thaler took two rings from the vulnerable woman, a gold and diamond engagement ring and another family ring. When the woman asked for them back later, Thaler ignored her and pawned the engagement ring, which the victim’s husband had given her in 1940.

“These employees are accused of stealing a personal heirloom with priceless sentimental value from a vulnerable nursing home resident for whom they were supposed to be caring,” Cuomo said in a statement. “Allegations like this demonstrate how nursing home patients can be taken advantage of by those entrusted with their care. Whether it is physical abuse or stealing money or personal possessions, my office is taking significant steps to protect New York’s seniors from those who would do them harm.”

Andrew Cuomo is doing a great public service by investigating these types of incidents. I can only hope that other Attorney Generals start their own investigations soon.

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I got the below email today.  Not sure what to make of it.  It is an advertisement for recruiting nurses in Spartanburg, S.C. 

Nursing, Nursing Assistant/CNA - $52,330 - $74,760

These Are Recession Proof Positions

Top 10 Reasons for Ray Mullman to Be A Nurse in Spartanburg - This opportunity is for both men and women. Request training information before November 28, 2008

130,000 open positions right now. Demand will be even more in the future. In fact, the Health Resources and Services Administration (HRSA) has projected a shortfall of 800,000 nurses by 2020. Think of the job opportunities there will be.

According to Bureau of Labor Statistics, the average nurse earns $63,630 - before overtime and other benefits, which could push your pay to over $100,000.

You can work in hospitals, schools, government agencies, home care facilities, private nurse in patient homes and other locations.

Flexible schedules. Nursing shifts can come in increments of 4, 8, 10 or even 12 hours, on weekends and weekdays.

You'll make a difference in people's lives. Caring for people and helping others lead healthy lives is satisfying and important.

You'll interact with different people everyday, including patients, doctors, medical staff and administrators.

Nursing is exciting. You never know what's going to happen, and have to stay on your toes, solve problems and make good decisions. Every day is different.

Opportunities for advancement. Get promotions and take on bigger roles over time.

Nurses can change specialties. If you're interested in pediatrics or trauma, you can move into those areas when the opportunities arise.

Nurses can work anywhere. Nurses are in demand nationwide and with your portable skills, you can work where you want within the United States.

Get Ray Mullman's online training package and begin work sooner than you think.

 

 

 

 

 

 

 

 

 

 

 

 

 

Instant Grant Search

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Ryan Harris of the Daily Post-Athenian wrote a story about a nursing home employee from an Etowah nursing home who was arrested and charged with abusing a 74-year-old blind woman. 
Joyce Stanley is charged with willful and physical abuse after hitting the elderly woman with a clipboard and an incontinence pad, as well as pulling her hair and slapping her.

Stanley is being held at the McMinn County Justice Center in lieu of $20,000 bond and is due in court today. Moses said the elderly victim and four other workers at the nursing home reported the abuse.  Stanley is a certified nursing assistant at Etowah Health Care Center. 

No further investigation at Etowah Health Care Center was done to see if other residents have gotten physically or verbally abused. Stanley has been a certified nursing aid since November 2002, according to the Tennessee Department of Health's Web site.

How did the nursing home not know about her propensity for violence?  Was she overworked?  Burnt out?    What is the explanation?  did they interview other residents?  Who was her supervisor?

 

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Whatever happened to the American work ethic?  Whatever happened to common decency?  Recently one of the nurses at a nursing home was arrested for leaving several elderly residents alone and without proper care and supervision.   One of the residents got injured after the nurse left and put another resident in charge! 60-year-old Epifania V. Fitzgerald returned 2 1/2 hours later.  The authorities were there waiting on her.

One of the facility's residents, a woman, had slipped and fallen in the bathroom. Another resident had called 911.   Fitzgerald was supposed to have been watching out for 21 elderly patients.

Authorities would not identify the facility.   Why do they protect these homes?  This is outrageous. if this was a day care center, the "authorities" would have shut down the place.
 

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Central Florida News 13 had a disturbing article about thieves pretending to be nursing home employees preying on the sick and elderly.  Why didn't the staff realize that these people did not work there?  Is the turnover rate so high that the nurses don't know all the employees?

Police in Central Florida said the women take credit cards, cash and checks and go on shopping sprees.  Surveillance video shows two women trying to cash a falsified check.  Video also shows three women who used a stolen credit card inside the Altamonte Springs Mall and may have also used it in Sanford.

The women dress in hospital scrubs, go into nursing homes acting like workers and steal credit cards, checks and cash.  Once inside the patient's room, police said, the woman wearing the scrubs asked the patient if that patient was physically able to walk to the bathroom by themselves. Police said that is when the patient demonstrated that they could and that was when the crime was committed.

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The Roanoke News recently had an article about the numerous deficiences and violations found by infrequent inspections of nursing homes. 

At Avante at Roanoke, an unannounced health and fire inspection turned up 34 deficiencies in 2007 -- more than four times the national average for for-profit nursing homes. During visits to the facility, inspectors found patients not being bathed because of staff shortages, problems with cleanliness and at least two instances where residents faced immediate harm.

A new national study finds that such problems are not uncommon. Inspectors cited 94 percent of nursing homes last year for federal health and safety standards, the Department of Health and Human Services reported this week.  Nationwide, about 17 percent of nursing homes had deficiencies that caused "actual harm" or put patients in "immediate jeopardy," the report noted, and for-profit homes were more likely to have citations than government-sponsored and nonprofit nursing homes.

Take bed sores, for instance. Last year, Virginia was ranked among the 10 worst states in the nation for high-risk pressure ulcers, she said, noting 2,260 instances.

Virginia's Medicaid reimbursement rate is so low that facilities lose an average of $7 per day per Medicaid resident, he said. "And yet we have to meet the same 150 federal standards as nursing homes in other states, some of which get close to double the reimbursement."

Avante at Roanoke, a 130-bed facility, had the most violations, with 28 health-inspection infractions and six fire and safety deficiencies. Average daily certified nursing assistant time per patient at Avante was one hour, 40 minutes -- less than the region's top performer by 70 minutes.  Clearly this proves that inadequate staffing impairs the quality of care provided.

The 180-bed Virginia Veterans Care Center had 26 health and three fire and safety violations. "The year before we had three or four total," said Bill Van Thiel, administrator of the Salem facility. "It's important to remember that any survey is pretty much a one-time snapshot, and there's a huge range in severity." The existence of bed sores is a much more telling gauge of facility excellence, he added. "Normally we run about three acquired bed sores for 180 patients; that's way under the national average [of 12.7 percent]. Today, I have none."

 

 

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Associated Press reported that a nursing home was fined $360,000 related to the suspicious deaths of 6 patients at a northern Illinois nursing home.  Investigators have evidence that leads them to believe that the nurses employed by the nursing home was giving unnecessary drugs to the residents so they would not have to care for them.  This kind of behavior is considered a chemical restraint.  Because of patient load and lack of adequate staffing, the nurses give sedatives and other medications to quiet the residents so less care is required.  If the residents are asleep, the staff doesn't have to respond to call bells, change briefs, or feed the residents. 

Penny Whitlock was indicted last spring on criminal charges including neglect and obstruction of justice.   Authorities began investigating the facility in Woodstock after six patients suspiciously died in 2006. Another employee, nurse Marty Himebaugh, also has been charged in the case.

 

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McKnights Long Term Care had a great article on a study that proves the importance and necessity of one-on-one supervision, exercise, and encouragement when feeding residents in a nursing home.  Because of prevalent understaffing in the nursing home industry, most nursing homes do not or cannnot provide enough staff to make sure that the residents are eating enough nutritious foods.

Supervision and encouragement during meals has been proven to reduce the occurrence of unintentional weight loss among long-stay nursing home residents according to the Journal of the American Geriatrics Society.  Vanderbilt University researchers assessed the unintentional weight loss of 76 nursing home residents.

Half of the group received additional attention during mealtime while the other half served as a control group.  Researchers noticed that 52% of residents maintained their weight when they were part of the extra attention group. That compares with 28% of residents in the control group.  Researchers suggest that groups of three or four residents per staff member during mealtimes are more practical and just as effective as one-on-one care.

The new study found that the combination of light exercise and specific nutritional supplements could help keep seniors fit for a longer period of time.   Researchers at Manchester Metropolitan University in England divided 60 seniors into two groups. One group performed moderate exercise once a week and the other performed high resistance exercise twice a week. Within those two groups, some received carbohydrate and protein supplements before and after exercise; some did not.   While all groups showed improved muscle mass and overall strength at the end of the 12-week trial, the most striking results came from the light exercise group that received supplements, according to the study.

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Dan Miller of the Patriot-News wrote an interesting article about Harry Accor who runs a temporary staffing agency that provides nurses, practical nurses and certified nursing assistants to fill employment gaps in nursing homes. Accor's agency, Care Corps LLC, provides temporary staffing to 16 nursing homes from Lancaster and York to Philadelphia.

Care Corps has 89 employees. As part of his expansion in this region, Accor expects to hire 55 to 70 licensed practical nurses, 15 registered nurses and more nursing assistants.  He previously worked as a nurse through various agencies, but the experience was frustrating and the work sporadic.   Agencies sent him to homes he hadn't been to before, where he didn't know the staff or patients.

Accor said the nurses and nursing assistants his agency places in nursing homes are Care Corps employees and not independent contractors. Care Corps offers benefits and tuition assistance.  These measures make his work force more stable providing stability at nursing homes where staffing shortages are always a problem.

The use of temporary staffing agencies by nursing homes is a sensitive subject.  Accor would not identify any nursing homes to which his agency, Care Corps, provides staffing. He said those homes don't want people to get the impression that they are experiencing staffing problems. 

Almost all nursing homes have difficulty keeping adequate staff, especially because of high turnover among nursing aides who might not make much more than minimum wage, said Nicholas Castle, an associate professor at the Graduate School of Public Health at the University of Pittsburgh.  Castle's own research has found a link between lower quality and nursing homes that rely heavily on temporary staffing.  High use of temporary staffing can be an indicator of more significant issues at a home, running the whole way through top management, Castle said.

Nursing homes also typically pay a higher wage to nurses and aides from agencies, in return for agency staff being quickly available at the home's convenience, Castle said. This can lead to a vicious cycle, by making it more difficult for nursing homes to increase wages and benefits and reduce the staff turnover that leads to use of the staffing agencies.

 

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ABC News, the Denver Channel, had an article about a nursing home employee beating a sick and vulnerable resident of a nursing home.  This story disgusts me.  I hope they throw the book at this guy.  I hope he will never be able to work in the health care industry again. This kind of assault happens far too frequently and typically gets covered up by the nursing home or regulatory agencies.

The article mentions thar Kalen Randolph was arrested for nearly beating to death an elderly patient in his care. He physically assaulted a 74-year-old stroke victim at Ashley Manor.   "He struck him repeatedly. Turns out, he had serious bodily injury, according to one doctor. (Randolph) also then fled the scene leaving eight of these elderly patients at the home without supervision," said Aurora Police spokesman Detective Bob Friel.

Because of a 911 hangup call, police responded quickly to the attack at 3:40 a.m., but Randolph was not in the area.   "We know that he ended up meeting with a girlfriend and having sex in her car. And that's what he was doing at the time when these elderly patients were left in the home," said Friel.

Randolph, a certified nurse's assistant, is charged with eight counts of neglect and one count of second-degree assault.  Ashley Manor is a small facility for Alzheimer's and brain injury patients. It has only nine patients.

Where was his supervisor?  Was he the only person working on third shift?  The nursing home should be held accountable for the actions of their employees.

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KAALtv.com had a disturbing article on residents being abused in a Minnesota nursing home.  The conduct of these "professionals" is outrageous and disgusting.  They should be arrested and thrown in jail and never work in the health car eindustry again.  I would be surprised if anything happens to them.  They will probably get rehired easily knowing how the nursing home industry works.

The article mentions that an investigation by the Minnesota Department of Health found that at least 15 nursing home residents were abused mentally and physically.  The abuse actually could have been prevented months earlier.

According to the Minnesota Department of Health 15 residents at the Good Samaritan Society nursing home were verbally and or physically abused by several nursing assistants, some of them are not even 18 years old.  The abuse was discovered back in December of 2007, but could have been earlier than that.

The 5 perpetrators were responsible for caring for the residents.  The Freeborn County Attorney's office says dealing with vulnerable adults makes it difficult to prosecute when they don't have statements from the victims.   It sounds like the prosecutor is making excuses for his own incompetence.  Why doesn't he ask the nurses to take polygraph tests?

The Freeborn County Attorney says the five women face gross misdemeanor charges, which means only one year in jail, a $3-thousand dollar fine or both as a maximum plenty. There is no mention in the article if the nurses licenses have been revoked or if they work at another nursing home now.

 

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Spartanburg Herald had an article about the emergence of nurses in nursing homes stealing narcotics from residents who need them.  It is shocking that this could happen so often without anyone at the nursing home being aware.  Do they take these drugs while providing care?  That would explain all the neglect and negligence that seems to exist in some of the homes mentioned such as Magnolia Manor and Magnolia Place--both are owned and operated by the national for profit chain of THI and Fundamental Long Term Care Companies which previously ran IHS into bankruptcy.  Maybe the nursing homes should initiate random drug tests of their employees to protect the residents.

More than 650 nurses--one out of every 100 licensed nurses in Spartanburg, Cherokee and Union counties has been disciplined by the state Board of Nursing for a drug-related offense. Half of them stole prescription painkillers from hospitals, doctor's offices and nursing homes. This doesn't even count the CNAs who ar enot licensed health care providers.

The nurses have faced disciplinary action for offenses including stealing drugs, forging prescriptions, testing positive on drug screens or coming to work impaired at employers including Spartanburg Regional Medical Center and Mary Black Memorial Hospital. Many returned to work after an evaluation and completing, when deemed necessary, mandatory treatment with the S.C. Recovering Professionals Program, or RPP.  These numbers do not reflect the nurses who did not get caught or the ones where the emnployer looked the other way.

Frank Sheheen, RPP director, said most medical professionals referred to the program didn't steal medications just once, and many program participants were referred there before disciplinary action was taken. There are "absolutely" more medical professionals in the state "in need of treatment who aren't getting it," he said. "If they get caught stealing once, how many times have they been stealing?" he asked. "That's just the one time they got caught."

Drug abuse has increased over the past decade, and the percentage of medical professionals who are addicted to drugs is about 2 percent higher than in the general population, Sheheen said.

Many nurses committed violations that placed proper patient care in jeopardy. In more than one case, nurses came to work impaired from alcohol or medications such as Demerol. One nurse, who was employed as a staff nurse at Magnolia Manor, was suspected of removing Duragesic patches from nursing home patients and reporting to work impaired.

Another nurse admitted to stealing prescription narcotics from Allen Bennett Memorial Hospital in Greer on four occasions. He also admitted that  when he was employed at Magnolia Place nursing home, he stole OxyContin by opening pill packages and replacing the white OxyContin tablets with other white-colored pills, according to board records.

Board records show one nurse admitted to taking multiple drugs from Allen Bennett, including Demerol, Dilaudid and Lortab. The next year, she was fired from Spartanburg Regional Healthcare System, where she had gained employment, for taking a patient's medication and administering it to herself while on duty. She submitted to a drug screen and tested positive for morphine.

Thom Berry, spokesman for the S.C. Department of Health and Environmental Control, has seen all types of drug cases involving medical professionals across the state. Some cases clearly endanger the patient's quality of treatment if they're not receiving the appropriate amount of painkillers, he said.

 

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The Fort Worth Star Telegram had an article about a tragic situation where an abused resident died before the grand jury was able to indict his tormentor. 

Elaine Doores, a retired biology professor diagnosed two years earlier with Alzheimer’s, struggled to find the right words to describe the abuse she survived.   "He has hurt me a lot. Every time he bathes me. He puts things in me.  . . . He had sex with me more than once. It’s all the time in the bath."

The 68-year-old woman’s statement led to the arrest of Donald Gene Shelby, a certified nursing assistant at the James L. West Alzheimer’s Center where Doores had been living.

Her daughter says the district attorney’s office stalled in handling the case.  "They sat on it while the victim got worse," Pitt said. "That’s the disservice they did to my mom and my family."

She believes that prosecutors dealing with victims who have dementia or Alzheimer’s should try to present the case to a grand jury without delay.

Elaine Doores was placed in a nursing home Jan. 23, 2007, two years after being diagnosed with Alzheimer’s.  Pitt said Doores had difficulty speaking and performing motor skills but recognized relatives.

Pitt said that on Feb. 18, Shelby told her that her mother was upset the day before because the pajamas that she wanted to wear were dirty. Pitt said she was puzzled because her mother had never seemed to care what she wore.  Later, during the same visit, Pitt said that when she suggested getting "Donald" to help Doores go to the bathroom, her mother became agitated. When questioned, Doores told her daughter that Shelby was "bad" and had done something "wrong."

Pitt said she sought the help of a floor nurse, who asked Doores whether Shelby had touched her. Doores answered, "Yes." When the nurse asked where, Doores replied, "Everywhere," Pitt said.

Pitt went home and told her husband, Deven Pitt, a Fort Worth police detective. At his suggestion, the two contacted Detective S.L. Schloeman, the on-duty investigator with the sex crimes unit, and filed a police report.

Afterward, Doores provided a statement to Schloeman, a copy of which Pitt gave to the Star-Telegram. Doores described Shelby as "scary" and said she was afraid of him. She said he made threats and told her not to tell anyone what he had done.

Schloeman, now a sergeant in patrol, said that to determine Doores’ mental state, she had asked Doores questions, including some about her daughter’s birth date, the current year and where she lived. Doores answered every question correctly, Schloeman said.

"She displayed symptoms of having just a minor case of Alzheimer’s," Schloeman said. "She was able to give me a clear, concise description of what had happened to her. She was able to identify the suspect in a photo spread and identify him by first name."

On March 2, 2007, Schloeman obtained an arrest warrant for Shelby on suspicion of aggravated sexual assault. The next day, Shelby surrendered at the Tarrant County Jail and was released after posting $50,000 bail.

Tarrant County court records show that Shelby was indicted in March 1987 on a charge of indecency/fondling. The state dismissed that case in January 1988 after the accuser, a male minor, committed suicide. 

How could he get a job at a nursing home when he had been arrested for abusing a vulnerable person?  Did the nursing home do a criminal background check?

 

 

 

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David Krough wrote, for Portland's kgw.com, an article stating that a nurse assistant at a nursing home was arrested for stealing narcotics from residents in other nursing homes.  Nursing assistants provide about 85-90 percent of all the care to residents.

The article is informative but does not provide key information such as prior arrests, employment history, knowledge of the mangement of the nursing homes regarding the missing narcotics or her conduct.  How could she get hired?  Was she a user or a pusher?  What safeguards do they hav ein place to make sure this doesn't happen?  Below is a summary of the article.

Surveillance cameras caught a woman on camera, posing as a resident's granddaughter, then as an employee. Administrators there said the woman snuck in and spent at least three evenings with one of their residents.

Theresa Smith was a nursing assistant who worked at nursing homes in the Portland Metro area.  Police listed Smith as a person of interest after a report of theft of Fentanyl patches at the Laurelhurst Village Nursing Home on SW Stark Street.  She was accused of stealing Fentanyl pain patches from nursing home residents while the residents were wearing the patches. Detectives said she stole from several patients at area nursing homes.

Detectives arrested Smith Wednesday while she was working at the Care Center East Nursing Home on NE Wielder Street.  Smith was charged with burglary, criminal mistreatment, possession of a controlled substance and theft. Police said she may face more charges.
 

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Times Record-Herald had an article about a resident who wandered away from an adult home and froze to death.  These kinds of incidents are preventable if the home has well-trained and competent number of staff members supervising the residents.  A death from wandering is a sure sign that understaffing, inadequate training, and a lack of supervision exists in that nursing home.

The article mentions that Karen Preston walked away from the Roscoe Manor Adult Home. She stumbled into the woods about a mile away. She fell repeatedly. She walked in circles. She curled up under a pine tree. And that's where police found her frozen body two days later - her socks next to her body, no shoes on her feet. A medical examiner ruled that she died of hypothermia.

Karen Preston was 54 years old and suffered from severe schizophrenia. She had lived in Roscoe Manor because she needed help with daily activities and supervion that an adult home is supposed to provide.

Preston's tragic death underscores the deplorable conditions at many nursing homes.  The Times Record-Herald reviewed inspections at 22 licensed adult homes in Ulster, Sullivan and Orange counties from 2001-07 and turned up 846 violations deemed to directly affect the safety or well-being of residents - with two-thirds of those citations recorded at the seven adult homes operated in Sullivan County.

A year after Preston disappeared, another Roscoe Manor resident, Ella Maye, walked away from the home.  Maye, 78, had dementia and heart disease. State police believe she suffered a fatal heart arrhythmia while walking on Rockland Road early on Feb. 23. They believe she was trying to crawl back to Roscoe Manor when she collapsed on a neighbor's front lawn and died.

The adult home was supposed to do hourly bed checks, but Roscoe Manor owner Charles Benson said at the time that an employee had failed to do so.  No one noticed Ella Maye was missing.

Adult home inspection reports and history documented by state agencies make it clear: Residents of some Hudson Valley adult homes are at a significant risk of illness, injury or even death due to carelessness or negligence on the part of the homes' operators and staff.

Despite reforms over the past few years, state oversight has been ineffective in regulating these homes, which house a vulnerable population of the elderly, infirm and mentally ill. And anyone can end up in an adult home. All it takes is a medical crisis that renders someone unable to live on their own.

State documents paint a disturbing picture of homes where residents are left to sit in soiled clothing, are subjected to physically or verbally abusive staffers and repeated instances of mismanaged medications.

 

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Newsday ran a story from the Hartford Courant about how states relying on nursing home chains raise concerns about quality of care provided to the residents.

The article states that large, for-profit chains nursing home chains dominate Connecticut's market, according to an analysis of federal data released Sunday by the Hartford Courant. Such facilities have lower staffing levels and higher rates of serious patient-care violations than small chains and independently owned homes, according to the newspaper's review.

"Ownership is certainly a factor in quality of care," Toby Edelman, senior policy attorney with the nonprofit Center for Medicare Advocacy, told the Courant.

 

He said many of the larger chains have complex organizational structures with multiple layers of management. "They send a lot of money to their corporate offices," he said. "There can be a lot of distance between the owners and the facilities themselves. They're not on the ground."

The Courant looked at two years of inspection and ownership data from the federal Centers for Medicare and Medicaid Services for the more than 240 licensed nursing homes in Connecticut.  Adjusted for size, homes owned by large chains provided, on average, 16 percent fewer registered and licensed nurses than small-chain and independent nursing facilities, according to the data.

The state's large-chain homes had a 30 percent higher rate of causing patients harm or putting them in immediate jeopardy, the Courant determined. For the five large chains in Connecticut, which control about one third of the state's nursing home beds, such serious deficiencies occurred at a 42 percent higher rate than at homes not controlled by large chains.

Information from: The Hartford Courant, http://www.courant.com
 

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An Oregon newspaper ran a scary story about a woman caught on camera posing as nursing home employee.  It is incredible that none of the staff members realized that this woman did not belong.  How bad is the turnover rate at this nursing home for them not to recognize that this woman doesn't work there. Who are supervising the employees?  If this was a day care center full of cute babies, this would be a national story. 

A resident's family member was the one who discovered the intruder.   Surveillance cameras at Beaverton's Maryville Nursing Home caught a woman on camera posing as an employee. Now the nursing home wants to find her, to figure out why she snuck in, and why she spent at least three evenings with one of their residents.

That resident told her son, Jim Cole, about the incidents. "I thought, I'll come and hang out and see what happens," Jim said. He spent the evening with his mother, when he said the woman walked in. "Said, 'hi grandma,'" Jim said. "And my mom kinda looked back. [I said], 'who the heck are you?'"

Jim said the woman was wearing scrubs, and tried to explain that she was there to give the resident a massage. But when Jim asked for identification, he said the woman bolted. "I said, 'where's your nametag?' She looked down and said, 'I don't have a nametag.' She just darted out of the room so fast, by the time I got... down the hall, she was nowhere to be seen. I took off down the hall and came out here and she was nowhere. Nowhere around."

No one has idea what the woman was doing there or what she did to other residents for three nights

 

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The Milwuakee Journal had an excellent 2 part series on nursing homes recently.  They can be found here and here.

The Journal describes how dozens of nursing homes in Wisconsin have been cited for improper care after the deaths of 56 residents since 2005 - a period marked by a dramatic surge in serious violations around the state.  Neglect was noted after hundreds of elderly or disabled nursing home residents were found with bruises, broken bones or pressure ulcers - some so deep they tunneled to the bone.   In hundreds of cases, reports document how inadequate training, lack of supervision and understaffing contributed to a rising number of injuries.

The Journal Sentinel built a database from thousands of pages of nursing home regulatory records over the past 3 1/2 years. Among the findings:

• Health care violations that put patients in jeopardy or resulted in harm spiked 34% the past three years.

• Dozens of homes are cited repeatedly for serious violations.  Many of the homes cited multiple times are owned by out-of-state corporations.

• Deaths and injuries are occurring at a time of significant worker turnover. In one case, a problem home reported nursing staff turnover rates as high as 257% last year while it led the state in serious citations.

• Families are often kept in the dark about citations issued after the deaths of their loved ones. Four families learned from the Journal Sentinel that serious citations had been issued months and even years after their loved ones were buried. 

Uunprecedented growth and profits in the industry is expected to continue. Last year, the federal government spent about $75 billion on nursing home care through the Medicare and Medicaid program.

The ownership and operation of Wisconsin nursing homes has changed dramatically. Locally owned mom-and-pop operations have given way to out-of-state for profit corporations that own clusters of homes. 

Health care experts cite other factors that have affected nursing home care.   The increase in pressure iulcers are a major concern and a leading indicator of neglect.   Pressure ulcers occur when nursing home residents are left in one position too long. The ulcers get worse when people are forced to lie in their own waste which is common in uunderstaffed facilities.  Without immediate attention, the ulcers can be life threatening.

High turnover rate is an major problem.  The aides do not get paid well and are typically asked to do the work of 2 or 3 aides.  Most aides don't stay at one facility for long. The Journal Sentinel found that turnover for full-time nursing assistants at Wisconsin nursing homes can be as high as 200%, with an average of 42% last year.   Many nursing assistant jobs start at less than $9 an hour.

"It's a hard job, but it's better than working at McDonald's," said Jim Wilson, administrator at Oak Park Nursing and Rehabilitation in Madison.   The turnover of full-time professional nurses who monitor residents' care is also high. Among the homes cited repeatedly for serious violations, the turnover rate for full-time registered nurses averaged 57% last year with some homes reporting turnover as high as 300%. The state's average turnover for full-time registered nurses in all nursing homes was 32%.

Staff turnover can directly affect care, said Julie Eisenhardt, a spokeswoman for the union representing nursing assistants. Inspection records back that up.

Sava Senior Care, a Georgia-based corporation, operates 185 homes nationally. Two of its four homes in the state have been cited with serious violations at least three times since 2005.
Even when large fines or other enforcement actions are imposed against nursing homes after serious injuries or deaths, families might never know about them. Neither federal nor state law requires that families be notified.

A Journal Sentinel analysis found that nursing homes in Wisconsin were cited for poor care after the deaths of 56 residents since 2005. But Nursing Home Compare doesn't offer any details about those deaths.   The Web site also doesn't mention anything about corporate ownership, meaning that consumers would be unable to determine if the nursing home was owned by an out of state corporation or even one with a history of violations and fines.  "Figuring out who is accountable for poor care can be very difficult," said Alice Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform. "Consumers often don't know who owns and operates a facility. Unless a facility tells them, there is no public way to find that out."   For consumers, knowing who owns a home is important if they want to determine whether the same problems are showing up in multiple homes owned by the parent corporation.


The number of nurses and aides on staff to help residents is a key factor in determining whether quality care is being provided, according to experts.   "The higher the staffing, the better the quality," said Charlene Harrington, a professor of sociology and nursing at the University of California in San Francisco.   Staffing numbers provided by Nursing Home Compare are merely a two-week snapshot from the most recent inspection - and in an industry that has widespread staff turnover, those numbers can't always be trusted, Hedt said.

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I stumbled across this article from the New York Times which I found interesting regarding violence against nurses being a serious issue - especially in terms of workplace violence.  It reminded me that in all the talking we do about abuse and neglect of patients, we sometimes forget that nurses and aides, and really anyone providing "front-line" care to patients in a health care setting, are at risk for abuses as well.

The article points out that workplace violence is 12% higher in for nurses and personal care aides than in the private sector, which may not sound like a lot, but certainly seems like a high risk if you work in this field.  The article goes on to say that the most dangerous setting is psychiatric facilities and nursing homes due in part to patient confusion.  However, the author also points out that part of the problem in these settings is the long wait time for services in places like nursing homes and emergency rooms.  This is made worse still by the nursing shortage.

"Nurses say the persistent nationwide nursing shortage is making matters worse, because understaffing increases the risk of violent incidents. And nurses cite the fear of assault as a reason for low morale, especially if they feel that management does not share their concern."

We have to remember that often times, our clients, our family members, our patients (whatever angle you look from) are quite often not the only victims in these situations.  Many times, too many times, the people who provide the care are victims as well - if they don't have enough support, then they effectively have an increased risk of being harmed.  Interesting, isn't it - without enough staff, we know the care of the resident's suffers, but we forget that short staffing affects the staff as well.

I, myself, when working at a nursing home, have been cornered in my office by an elderly lady who was furiously swinging at me.  I was a social worker, the resident was in my office because she had been disruptive all day and the nurse's simply couldn't watch after her anymore.  I realized right quick that part of the fear is that they might injure you (its amazing what sort of strength a demented, angry 95 pound woman can have), and part of the fear becomes that you might injure them in trying to protect yourself.

I don't know what the solution is, but I am reminded again, as I often am, about a discussion with a friend about one way to keep plenty of good staff is to pay them well - pay them to continue to care, pay them to be accountable for the care they provide.  Of course, I know that money is not the absolute solution, but Management types should certainly know that if they have good staff, they should pay them to stay - and while thy're there, they have to listen to and support them emotionally.  If Management sees their front line staff as just another warm body, then eventually morale becomes such that you have just that, another warm body.

It takes a certain, special kind of person to care for patients of all kinds, nursing home residents included.  The article reminded me that we have to remember that caregivers are sometimes victims as well, and often through no fault of their own.  And, like the residents they care for, they should have some measure of safety as well.  Thoughts?

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Interesting article from the Courant.com about a deal to sell the bankrupt Haven Healthcare nursing-home chain.  Attorney General Richard Blumenthal said that Formation Capital, which owns Genesis HealthCare, notified the state that it was pulling out of an $85 million deal to take over 14 of Haven's homes in Connecticut and 10 in other New England states, without giving a reason.

Formation announced June 12 that it had signed a purchase agreement for the homes, but the company had two weeks to reconsider before the deal was to be finalized in bankruptcy court Thursday.

Many nursing homes across the country are owned by real-estate investment firms and managed by other entities — a form of ownership called a REIT, or a real-estate investment trust. By law, a REIT cannot operate a nursing home, but must hire a licensed provider to do so.

"The former management of Haven is history. We are all committed to a new day for these nursing homes, their residents and their dedicated employees," Blumenthal said.

Blumenthal and officials of the state Department of Social Services said they and the health department will be closely monitoring operations of the Haven homes while the future of the chain remains in limbo.   Occupancy in some Haven homes has fallen off dramatically since the chain declared bankruptcy seven months ago.

Haven — one of the largest chains in the state, with more than 1,800 beds — declared bankruptcy last November in the wake of a series in The Courant detailing its financial troubles and repeated citations for patient-care deficiencies. The company defaulted on millions of dollars in bills for supplies and utilities while its CEO used corporate assets to launch a Nashville recording company and make other personal purchases.

The Department of Social Services had offered Genesis sizable Medicaid rate increases and other incentives to take over the chain, but also had required that Genesis agree to provide detailed financial reports and meet certain staffing standards once it took over operations. 

Blumenthal said Thursday that a wide-ranging investigation of Haven's financial dealings will continue, regardless of the outcome of the sale of the chain.

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NY Times had an article about the overuse of certain medications in elderly residents.  Below are excerpts of the article.

Ramona Lamascola thought she was losing her 88-year-old mother to dementia. Instead, she was losing her to overmedication.  Last fall her mother, Theresa Lamascola, of the Bronx, suffering from anxiety and confusion, was put on the antipsychotic drug Risperdal. When she had trouble walking, her daughter took her to another doctor — the younger Ms. Lamascola’s own physician — who found that she had unrecognized hypothyroidism, a disorder that can contribute to dementia.

Theresa Lamascola was moved to a nursing home to get these problems under control. But things only got worse. “My mother was screaming and out of it, drooling on herself and twitching,” said Ms. Lamascola, a pediatric nurse. The psychiatrist in the nursing home stopped the Risperdal, which can cause twitching and vocal tics, and prescribed a sedative and two other antipsychotics.

“I knew the drugs were doing this to her,” her daughter said. “I told him to stop the medications and stay away from Mom.”

Not until yet another doctor took Mrs. Lamascola off the drugs did she begin to improve.

The use of antipsychotic drugs to tamp down the agitation, combative behavior and outbursts of dementia patients has soared, especially in the elderly. Sales of newer antipsychotics like Risperdal, Seroquel and Zyprexa totaled $13.1 billion in 2007, up from $4 billion in 2000, according to IMS Health, a health care information company.

Part of this increase can be traced to prescriptions in nursing homes. Researchers estimate that about a third of all nursing home patients have been given antipsychotic drugs.  [Blogger's note: Typically these medications are used as "chemical restraints" to quiet the residents down--a sure sign of understaffing.]

The increases continue despite a drumbeat of bad publicity. A 2006 study of Alzheimer’s patients found that for most patients, antipsychotics provided no significant improvement over placebos in treating aggression and delusions.

In 2005, the Food and Drug Administration ordered that the newer drugs carry a “black box” label warning of an increased risk of death. Last week, the F.D.A. required a similar warning on the labels of older antipsychotics.   The agency has not approved marketing of these drugs for older people with dementia, but they are commonly prescribed to these patients “off label.” Several states are suing the top sellers of antipsychotics on charges of false and misleading marketing.

Ambre Morley, a spokeswoman for Janssen, the division of Johnson & Johnson that manufactures Risperdal, would not comment on the suits, but said: “As with any medication, the prescribing of a medication is up to a physician. We only promote our products for F.D.A.-approved indications.”

Nevertheless, many doctors say misuse of the drugs is widespread. “These antipsychotics can be overused and abused,” said Dr. Johnny Matson, a professor of psychology at Louisiana State University. “And there’s a lot of abuse going on in a lot of these places.”

Dr. William D. Smucker, a member of the American Medical Directors Association, a group of health professionals who work in nursing homes, agreed. Though the group encourages doctors to conduct a thorough assessment and prescribe antipsychotics only as a last resort, he said, “Many physicians are absent without leave in the nursing home and don’t take an active role in the assessment of the patient.”

Nursing homes are short staffed, and insurers do not generally pay for the attentive medical care and hands-on psychosocial therapy that advocates recommend. It is much easier to use sedatives and antipsychotics, despite their side effects. 

Common causes of the symptoms include ministrokes, reparable brain hemorrhage from a mild bump on the head, hypothyroidism, dehydration, malnourishment, depression and sleep disorders.

The Medicare Web site has basic information on individual homes at www.medicare.gov/NHcompare. The National Citizens’ Coalition for Nursing Home Reform, at www.nccnhr.org, offers a consumer guide to choosing a nursing home.

Theresa Lamascola still has dementia, but she went from confinement in a wheelchair — unable to sit still and screaming out in fear — to being able to walk with help, sit peacefully, have some memory and ability to communicate, understand subtleties of conversations and even make jokes.

Or, as her daughter put it, “I got my mother back.”

This article has been revised to reflect the following correction:

Correction: June 25, 2008
An article on Tuesday about the use of antipsychotic drugs in dementia patients misspelled the names of two drugs in a different class, sometimes used to treat the symptoms of Alzheimer’s and Parkinson’s diseases. They are Exelon and Namenda, not Exalon and Menamda.

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CBS affiliate KDKA in Pittsburgh had an article about another sexual assault at a nursing home facility.  Do they even bother to do background checks or supervise their employees?

A nursing home employee is facing charges after he allegedly sexually assauted a patient who uses a motorized wheelchair.  Allegheny County Police have charged Marc Lane, 37, of Kittaning, with involuntary deviate sexual intercourse, two counts of indecent assault, indecent exposure and criminal attempt.

The 65-year-old male victim who suffers from Parkinsons Disease said in a police report that Lane came into his room at the Consulate Health Care facility on Saxonburg Boulevard in Indiana Township between April 11 and April 25 and drew the curtain for privacy.

Lane allegedly told the patient he would treat a skin condition, but that in fact led to a sex act. The victim is refered to as "John Doe" in the affidavit.

"Lane then asked Doe if he had ever been with a man," according to the affidavit. The resident told police he resisted the advances but that led to another sex act until a nurse walked into the room.

After a mini mental status exam, the victim scored 28 out of 30. Police determined the victim is of sound mind.

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Alabama NewsChannell 19 had a horrendous story of neglect on their website.  NewsChannel 19's Carson Clark reported that a Marshall County Nursing Home is in trouble with state and federal officials after a patient died there. A doctor says the Golden Living Center in Boaz allowed a young woman to scream for help for more than six hours, before finding her dead.

The patient, 20-year-old Felicia Ann Engle of Boaz, suffered from kidney disease. She had to be placed in Golden Living because her father was no longer capable of taking care of her needs.

According to state records obtained by NewsChannel 19, Engle began to yell for help around 3:00 p.m. on April 3, 2008. The records quote nurses at the facility, with one saying Felicia was, "...begging us to call her doctor that something was really wrong this time. She was hurting so bad it was unbearable."

The nurse tells investigators she went to another nurse to tell her of Engle's request. The nurse reportedly replied, "Yes, we know, we've heard all about it four times at least."

NewsChannel 19 contacted Dr. Tom Geary with the Alabama Department of Public Health in Montgomery. He says the way in which Engle was treated violates the law.

"If the patient requests to go to the hospital, [if] they say something is wrong, I need to go to the emergency room, they are supposed to take them to the emergency room. They are not supposed to make a judgment that the person is just trying to disrupt the normal services in the facility, close the door and leave them alone," he says.

The director of Golden Living, Kevin Cogan, refused an on-camera interview and asked NewsChannel 19 to leave the property when they visited.

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Vermont Legislative Study Tackles Direct Care Workforce: Study Reveals that Wages, Health Coverage, Training are Keys to Retention
Published by hthier on April 7, 2008 in Press Releases .

Montpelier, VT, March 25, 2008 –An impending health care crisis has not gone unnoticed in the Green Mountain State. The number of Vermonters age 65 and older is expected to double between 2005 and 2030 while the direct-care workforce continues to decline. A new study funded by the Department of Disabilities, Aging & Independent Living, The Community of Vermont Elders, and PHI has made nine recommendations to help avert this crisis. The Legislative Study of the Direct Care Workforce in Vermont reveals that wages, benefits and training are critical to retaining workers in this field.

LEGISLATIVE STUDY RESULTS
The study analyzed survey responses from 1,700 direct-care workers in Vermont regarding wages, benefits, training, and career development. Key findings include:

Only half of the respondents expect to receive a raise. The forces of inflation, without annual cost-of-living increases, actually decrease wages over time. The responses show that the higher the wage, the longer caregivers remain in the profession.
Only one-third of direct-care workers in Vermont receive health insurance coverage as an employment benefit. However, workers with employee-sponsored health coverage remain in their jobs an average of 2.5 years longer.
Only 42 percent of respondents received formal job training. Those caregivers who do receive professional training remain in their jobs significantly longer.
Direct-care workers currently see few opportunities for advancement because of a lack of standardized and portable curricula and credentials. However, national research shows that workers who receive training, recognition, and advancement opportunities tend to remain in their profession.
Other results from the study show that 64 percent of Vermont’s current direct-care workers are over the age of 40.
In anticipation of the report, workforce and consumer advocates (the Community of Vermont Elders, the Vermont Association of Professional Care Providers, the Vermont Center for Independent Living and PHI) joined forces at a recent town meeting that featured Vermont Senator Bernie Sanders, members of the community, and direct-care workers, who gathered to address the need to support caregivers.

Several direct-care workers spoke candidly about the profession, noting the low wages, poor benefits, and lack of training for what is a remarkably difficult job.

Deborah Lisi-Baker, the executive director of Vermont Center for Independent Living, spoke about the need to improve the lives of caretakers to address the current and expected future declines of the workforce.

Direct-care workers provide crucial hands-on assistance to persons who are unable to perform basic activities of daily living (ADL) that many take for granted. Examples of ADLs include getting out of bed, attending to personal hygiene, eating, and other such tasks. Some people need help communicating, remembering, or simply engaging in meaningful activities. These workers provide 80 to 90 percent of the hands-on care for Vermont’s elders, children and adults with disabilities, and persons with chronic conditions.

PHI, a nonprofit organization that supports quality long-term care by improving direct-care jobs and served on the study group’s advisory board, notes that the Vermont study echoes their findings that direct-care workers are truly invested in their work and want to make a positive difference in other people’s lives.

However, PHI also notes that the common industry practices—including low wages, few opportunities for advancement, lack of training, and inadequate benefits—make it difficult to attract new workers and retain current ones in this field. This problem will only grow in the future, unless the state focuses on improving the quality of direct-care jobs.

For more information on this study, visit www.dail.vermont.gov.

Contact:
Alexandra Olins
PHI Northern New England Regional Director
802.655.4615
aolins@PHInational.org

Alan Krawitz
Youngworth Public Relations
800.615.1230, ext. 18
newsroom@youngworthpr.com

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 Amanda Falcone has an article about Connecticut's attempt to increase staff in nursing homes.  A  plan to raise the minimum staff-to-resident ratio in nursing homes was described as historic, necessary and long overdue at a press conference Wednesday.

The plan would provide $9.5 million in fiscal year 2008-09, which begins on July 1, to increase staff-to-resident ratios from 1.9 hours to 4.2 hours of care per day at nursing home throughout the state.   The increase for nursing homes will be sustainable, adding that after the coming fiscal year, it will probably take about $30 million in subsequent years to maintain the change.   Staffing levels at nursing homes have not been addressed in 25 years.

Nursing staffing levels are a problem across the country, and Connecticut is no exception, said Toby S. Edelman, a senior policy attorney for the Washington, D.C.-based Center for Medicare Advocacy.   Adequate nursing staff is critical to providing good care, she said.

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The Moultrie Observer reported a story about another nursing home employee who sexually assaulted a resident.  How can this happen if a criminal background check was done and RNs are properly supervising the staff?

Charles David Cone, 47, of 321 12th Ave. N.W. in Cairo, was charged with sodomy and sexual battery.   An employee at the Woodlands at Cobblestone on Cobblestone Trace reported Feb. 27 that Cone allegedly touched a 92-year-old male patient inappropriately. The patient stated there were two separate incidents, one on Feb. 25 and the other the next day.

According to a warrant for Cone’s arrest, he is accused of putting the patient’s penis in his mouth on Feb. 26. Cone allegedly fondled the patient’s genitals on Feb, 25,

Executive Director Joann Sloan said Cone was terminated from his job at Woodlands immediately after the alleged incident was reported.  “Our standard of practice and our goal is to provide a safe environment for our patients,” Sloan said.

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U.S News & World Report has an article on the proposed Nursing Home Reform Bill.  Below is a summary of the article.

The byzantine world of the corporate nursing home industry may soon become a whole lot clearer. Republican Sen. Chuck Grassley and Democrat Sen. Herb Kohl seek to force nursing homes to provide more information about ownership and accountability.

The Nursing Home Transparency and Improvement Act would force nursing homes to clearly state ownership—something that has become increasingly complicated to figure out, as private investment groups have bought up nursing homes and enveloped them in labyrinthine legal structures. The opaque ownership makes it difficult for regulators to identify parties responsible for poor care and unfairly shields owners from complaints of neglect and abuse.

The bill also seeks to standardize complaint forms, improve reporting on staffing information, and replace some self-reported information with that gathered by independent audits. The primary goal is to make it easier for the public to compare nursing homes, a growing concern as baby boomers age.

The American Association of Homes and Services for the Aging, an industry group that represents not-for-profit nursing homes, applauds the bill.  The nonprofit sector is already required to produce information about finances and ownership to the IRS to qualify for its tax status.

The fight over nursing home reform will continue as the bill works its way through Congress. Proponents like the bill's chances, in part because it's authored by the respected Grassley, who is the senior Republican on the Senate Finance Committee.  Even the AAHSA wants some provisions removed, such as the bill's call for an increase in civil penalties of up to $100,000 for a deficiency resulting in death. Delays likely to come from those and other proposed changes mean, for those waiting for nursing home reform, it could be 21 years and counting.

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Seniorjournal.com has a great summary of the bill introduced by Senators Kohl and Grassley aimed at improving the quality of care in nursing homes with more and better information for consumers on the Nursing Home Compare Website published by The Centers for Medicare & Medicaid Services.   Supporting the bipartisan bill are the Service Employees International Union (SEIU) and the National Citizens’ Coalition for Nursing Home Reform (NCCNHR).

The bill:

? Enables the residents and the government to know who actually owns the nursing home

? Strengthens accountability requirements for individual facilities and nursing home chains, including annual independent audits for nursing home chains

? Improves Nursing Home Compare by including a nursing home’s ownership information, the identity of participants in the Special Focus Facility program, a standardized complaint form and links to nursing home inspection reports

? Provides more transparency of a nursing home’s expenditures by requiring more detail in cost reporting

? Provides for improved reporting of nurse staffing information so that apples-to-apples comparisons can be made across nursing homes

? Brings uniformity and structure to the nursing home complaint process by requiring a standardized complaint form and complaint resolution processes that includes complainant notification and response deadlines

? Strengthens available penalties by making them more meaningful. 

Instead of imposing civil money penalties (CMPs) up to $10,000, the Secretary would be able to impose a range of penalties of up to $100,000 for a deficiency resulting in death, $3,000-$25,000 for deficiencies at the level of actually harm or immediate jeopardy and not more than $3,000 for other deficiencies. 

The Secretary would be able to reduce CMPs for facilities that do not appeal CMPs and for self-reporting deficiencies below the immediate jeopardy level or the actual harm level if the harm is found to be a “pattern” or “widespread” or those resulting in death. 

Penalties must be collected within 90 days, following a hearing.

? Equips the Secretary with tools to address corporate-level problems in nursing home chains by giving the authority to develop a national independent monitor program specific to multistate and large intrastate nursing home chains

? Provides greater protection to residents of nursing homes that close by requiring advance notice of the closure as well as the development of a transfer and relocation plan of residents

? Requires a study on the role that financial issues play in poor-performing homes

? Requires a study on best practices for the appointment of temporary management for nursing homes as well as barriers

? Requires a study on barriers to purchasing facilities with a record of poor care

? Authorizes demonstration projects for nursing home “culture change” and for improving resident care through health information technology

? Improves staff training to include dementia management and abuse prevention training as part of pre-employment training

? Requires a study on increased training requirements either in content or hours for nurse aides and supervisory staff

Hopefully, this bill will pass Congress and get proper funding in the budget.

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Washington Post has a great article by Marie-Therese Connolly about demographics and elderly abuse.  Ms. Connolly worked at the DOJ and has years of experience with the nursing home industry.  Below are some excerpts.

As though declining health, impending mortality and other challenges weren't hard enough, too often old age is also plagued by abuse, neglect and exploitation.

Science has extended our lives dramatically: In 1900, Americans' average life expectancy was 47. By 2000, it was 77, and it's still rising.  Estimates of the prevalence of elder abuse vary wildly, but by some reports there could be up to 5 million cases a year, with 84 percent going unreported. All other factors being equal, victims of even relatively minor mistreatment are three times more likely to die prematurely than those who are not victimized.

Furthermore, our nation is in the midst of three seismic demographic shifts that will put seniors at even greater risk for mistreatment. Older people are living longer, until they're frailer and more vulnerable. They are increasingly alone in old age, given that families are smaller and more geographically and emotionally dispersed. And the pool of potential caregivers is aging and shrinking. We need 30,000 geriatricians: We have only 9,000.

Neglect may sound more benign than abuse, but it usually lasts longer, is harder to prove and prosecute, and can be just as lethal.   Thirty percent of seriously ill elders surveyed have told researchers that they would rather die than go to a nursing home.  But while neglect of one person is tragic, systemic neglect by a facility or chain housing numerous residents can be catastrophic.

Facility owners may extract millions in profits, leaving insufficient funds to care for residents. Insulated by corporate structure, casting blame on facility staff, they are rarely held accountable.  But the news about staffing, the most critical factor in the quality of long-term care, is bleak: A government study in 2002 concluded that more than half of the nation's nursing homes are understaffed at levels that harm residents. Nursing homes receive $80 billion from Medicare and Medicaid annually to care for 1.5 million residents.  Yet not a single federal employee works on elder abuse issues full-time.

Marie-Therese Connolly, a fellow at the Woodrow Wilson International Center for Scholars, is former coordinator of the Department of Justice's Elder Justice and Nursing Home Initiative.

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Foxbusines.com has a good article about the difficulty the government has in evaluating funding levels for Medicaid.  The article insists that an expansive view of nursing homes industry is needed to determine funding needs.

The Bush Administration's FY 2009 budget will include no Medicare funding update to help care for the growing number of seniors who need high acuity nursing home care.  The Alliance for Quality Nursing Home Care will work to demonstrate that Medicare funding decisions can be accurately determined only by taking a more expansive, complete view of the industry's operating environment. 

This White House has often cited the work of the Medicare Payment Advisory Commission (MedPAC).   Alan G. Rosenbloom, President of the Alliance, stated, "On behalf of nursing home patients and the hundreds of thousands of caregivers who serve them, we are disappointed that again, MedPAC's flawed funding policy guidance is being adopted, and superseding the economic realities experienced by providers in the long term care marketplace.  By failing to consider the substantial Medicaid payment shortfalls to nursing homes in formulating its recommendations, MedPAC provides the Administration, Congress and the public a flawed basis upon which to assess the funding landscape, and to ultimately determine the best policy." 

Medicare funding is important when states are cutting Mediciad to balance their budgets. 

SOURCE The Alliance for Quality Nursing Home Care

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The Courier-Journal in Kentucky has a great article about the necessity to increase staffing at nursing homes, and how the nursing home industry lobbyists are fighting against it so their profits remain large despite the poor care that is guaranteed with low levels of staff.  Please read the entire article and the Comments from other interested people.  Below is a summary of the article.

Lois Pemble said she once found her mother alone, sprawled on the floor of her nursing home room, where she'd fallen.   On other occasions, Pemble found her mother with her clothes soaked in urine, waiting for help to get to the bathroom.   She has joined with Kentuckians for Nursing Home Reform in pushing a bill that would require Kentucky to join 37 other states in setting minimum standards for the number of caregivers in nursing homes.

House Bill 109 would require nursing homes to have one nurse's aide for every nine residents during the day shift; one aide per 13 residents during the evening shift; and one aide for every 19 at night.   The bill also would increase the number of RNs required to be on duty -- currently the law requires only that one RN be on duty for only eight hours a day and that one licensed practical nurse be on duty the rest of the time.

The bill would require one nurse for every 21 residents in the day; one for every 29 on the evening shift; and one for every 42 residents overnight.

Other than requiring that a nurse be on duty, Kentucky law now says only that a "sufficient" number of staff be on hand to care for residents, but it does not define "sufficient." 

The reasonable measure already has encountered opposition from the industry, which has contributed more than $110,000 to lawmakers' campaigns, according to records from the Kentucky Registry for Election Finance.  The political action committee of the Kentucky Association for Health Care Facilities has donated $114,150 to lawmakers, and many of the recipients were on key committees or in leadership roles.

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There is an article in an Ohio newspaper that discusses an alleged rape of a male resident at a nursing home.

After visiting her fiancé Saturday night at Concord Care and Rehabilitation Center, Linda Monegan knew something was wrong.  Unable to talk or see after suffering a stroke, her 55-year-old fiance nodded his head to signify he was in pain. He had been sexually assaulted by a nurse.

Concord Care night-shift nurse John R. Riems, 49, 100 block of W. Cedarwood, was arrested Monday on felony charges of rape and gross sexual imposition. During questioning Riems recalled abusing nearly 100 patients during his more than 20-year career.  Riems, who obtained his registered nursing license in 1985 through Providence Hospital's nursing school, has worked at several nursing homes.

Concord Care director Jessica Short refused to answer any questions. Instead, she handed over a four-sentence typed statement, closed her office door and called police. The statement indicated an employee accused of "inappropriately touching" a resident was fired.

After she told police about the incident, Monegan said she was ordered by a nurse not to return to Concord Care, and now fears for her beloved's life.

Many of Reims' victims were elderly or disabled and unable to report the abuse.

The family is calling for justice to be served not only on Riems, but the entire nursing staff, who they say are responsible for patient neglect.   Besides the sexual abuse, Monegan said her fiancé suffered from burns to his legs, dehydration, bed sores and an unkempt trachea tube while staying at Concord Care since October 2007.

"What if that was your family member?" Monegan said. "What if that was your loved one?"

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The Hartford Courant has an article about proposed reforms in nursing homes by the Connecticut Ombudsman's office.  I wish the South Carolina Ombudsman's office would play a proactive role in protecting resident's care and preventing neglect.  Below is a summary of the article.

Connecticut's long-term care ombudsman is proposing reforms in oversight that would protect residents who complain about poor care from retaliation and encourage state agencies to monitor and evaluate the performance of chains, rather than just individual homes.

The program outlined a dozen reforms, including protections for residents who complain about poor care such as preventing nursing homes from issuing involuntary discharges to people who file complaints for at least a year following the complaint.

The ombudsman's office also wants the Department of Public Health to impose "significant sanctions" when patient-care deficiencies result in death, and to weigh "common ownership and management" as a factor in imposing penalties against corporate operators. 

The recommendations were prompted by revelations about the troubled record of one of the state's largest nursing-home chains, Haven Healthcare, which filed for bankruptcy in November and faces a federal fraud investigation. Some of the chain's 15 Connecticut homes had escaped severe sanctions despite repeated citations for serious patient-care deficiencies resulting in death. The chain also defaulted on millions of dollars in bills for supplies and services, while its owner used corporate assets for personal profit.

Democratic state senators proposed strengthening state oversight of nursing homes and boosting staff levels. 

The ombudsman's office wants to require more financial "transparency" from nursing-home corporations, including disclosures of detailed information about related business entities. Owners shield excessive profits by diverting money to related ventures without detailing those transactions.

Other proposals call on the state to more carefully review the public-health and financial records of any new owners or managers of nursing homes or assisted-living facilities, and for "improved communication" among state agencies charged with overseeing elderly care.

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Woman admits stealing from Hyde Park nursing home January 14, 2008  See full article here.

A former employee of a nursing home faces prison after admitting in court today she stole more than $8,000 from a resident of the home.  Melissa Johnson acknowledged she had stolen the money by using the woman’s debit card between February and August 2006. 

Johnson had been placed on probation in May of 2006 on an unrelated conviction on a felony forgery charge. She admitted today she had violated the terms of her probationary sentence by carrying out the thefts from the woman at the nursing home.

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Indiana Court awarded damages to nursing home whistleblower.  A whistleblower who claimed she was fired in retaliation for reporting an employee who was sexually abusing a patient at Heritage Manor Nursing Home in Colfax recieved $17,000.

Earlier the state fined Heritage for failing to report the suspected abuse to the state public health department.  Judge Charles Reynard awarded $10,0000 in pain and suffering to whistleblower Michele Bolster. He pointed out the widow had nine children, including six adopted with special needs, and that Bolster's firing left her with the uncertainty of having medical insurance. Judge Reynard called it, "particularly excruciating."

Heritage Enterprises issued a statement calling Bolster a disgruntled employee who has used numerous avenues to accuse the company of wrongdoing but says her allegations have been proven false.

See full article here.

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Theres an article out of Lafayette, Louisiana about short staffing which points out that short staffing can lead to abuse and neglect in more ways than one.  Typically, we think that short staffing leads to poor care because of the high patient to staff ratio, or because of employee stress, but this article points out something I hadn't thought of.  When facilities are short staffed, they often turn to agency staffing out of necessity.  However, although nursing home facilities are required to run background checks on all of their employees, staffing agencies don't always do this, and the nursing home is "caught in the middle"  They have to have sufficient staff, and they can't wait, so they use agency staff - they don't always know if background checks have been performed. 

Continue Reading...

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Here is a link to an article about a Nashville CNA arrested for raping a 70-year-old resident of a nursing home.  Police arrested 44-year-old Harvey Eugene Taylor for allegedly raping a woman in her room at Madison Healthcare and Rehabilitation Center.

Police said the woman suffered from dementia. He was charged with aggravated rape.
In May, the 70-year-old woman told staff members that Taylor sexually assaulted her.

She was taken to the hospital. Tennessee Bureau of Investigation analyzed DNA recovered from her and it matched a sample from Taylor, who denies having any sexual contact with the patient.

Taylor has been a licensed nurse's aid since 2000.

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The Wall St. Journal has a great article on the use of medications to sedate residents because of short staffing at many nursing homes.  Below is an excerpt from that article.

Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals -- including antibiotics, AIDS drugs or medicine to treat high-blood pressure.

One reason: Nursing homes across the U.S. are giving these drugs to elderly patients to quiet symptoms of Alzheimer's disease and other forms of dementia.

Nearly 30% of the total nursing-home population is receiving antipsychotic drugs, according to the Centers for Medicare & Medicaid Services, known as CMS. In a practice known as "off label" use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not. CMS says nearly 21% of nursing-home patients who don't have a psychosis diagnosis are on antipsychotic drugs.


That is what happened to a woman listed in New York state health department inspection records as Resident #18. The 84-year-old Alzheimer's patient, who lives at the Orchard Manor nursing home in Medina, N.Y., likes to wander and roll her wheelchair around her unit, according to a report filed earlier this year, and sometimes she nervously taps her foot.

To address her behavior, which was considered disruptive, Resident #18 was given a powerful antipsychotic drug called Seroquel, a drug approved for schizophrenia and bipolar disorder. Resident #18 is not psychotic and Seroquel -- like other atypical antipsychotics -- carries a "black box" warning that elderly dementia patients using it face a higher risk of death.

"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Federal and some state regulators are pushing back, questioning the use of antipsychotic drugs and citing nursing homes for using them in ways that violate federal rules. New York has increased its focus on antipsychotics in nursing homes, training inspectors to spot signs of medication abuse. Last month, the Arkansas attorney general filed suit against Johnson & Johnson and two of its units, claiming, among other things, that they "engaged in a false and misleading campaign" to promote its antipsychotic drug Risperdal to geriatric patients.

Continue Reading...

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Here is a very interesting story from a resident's point of view.  Billy Bogardus, a retired engineer, said he received poor care while he was a patient in Haven Health Center of South Windsor earlier this year. "You had to beg and plead to get them to pay attention," he said.  Bogardus of West Hartford went into a Haven Healthcare nursing home to recuperate from a hospital stay, but ended up fighting for his life.

For four days in April, Bogardus and his close friend, Leona Brenner, tried to convince the staff of the Haven Health Center in South Windsor that he was dying. Bogardus, who had sought nursing-home care after complications from heart surgery, was coughing, struggling to breathe and couldn't walk the six steps from his bed to the bathroom, he and Brenner said.

Only after Brenner threatened to call 911 herself did the nursing staff finally summon an ambulance, the couple recounted. By the time the 69-year-old retired civil engineer arrived at St. Francis Hospital and Medical Center in Hartford, hospital records show, he was dehydrated and his kidneys were failing.

"If it wasn't for [Leona], I'd be dead half a dozen times," said Bogardus, who landed in the hospital several other times during his seven months in the nursing home — once when a blood test found his level of the medication Cumadin was five times higher than normal. "You had to beg and plead to get them to pay attention. I think I would've been better off out on the street."

Bogardus' complaints were not new. Last year, a state inspection report detailed numerous complaints from residents about the "difficulty they have experienced in obtaining staff assistance."
The South Windsor home is one of 13 Haven Healthcare homes with staffing levels that fall below both state and national averages, according to the most recent federal data. Nationwide, nursing homes provide an average of 3.6 hours of care per resident per day — 1.3 hours by licensed or registered nurses, and 2.3 hours by certified nursing assistants. A study commissioned by the federal government recommends that each resident receive 4.1 hours of care a day.

But in Connecticut, nursing homes have had little incentive to boost staffing. The state's minimum-staffing law, which has not been updated in more than 25 years, requires only 1.9 hours of nursing care a day per resident — less than half of what the Centers for Medicare & Medicaid Services' study recommends.

Although the state's public health code also requires that each facility has sufficient staff to ensure residents receive appropriate care, state public health officials have been reluctant to use that provision to penalize homes for understaffing, or to make demands on homes to add staff when deficiencies are found, records indicate.

Federal data show that Connecticut in 2006 cited only 2 percent of nursing homes, under federal rules, for failing to provide sufficient nursing staff — a lower rate than 27 other states. In 2005, its rate of citing homes for staffing deficiencies was among the lowest in the country — zero.

Haven Healthcare — which has the lowest staffing average of the state's three largest chains, according to the most recent data — is one of many nursing home operators in Connecticut that stand to benefit from those policies. But it also provides some compelling examples of the consequences.

Many of Haven's 15 homes in Connecticut have been cited in the last three years for bed sores and dehydration — two key indicators of understaffing, according to federal health officials and nursing home experts. In February, the chain's Waterford home was hit with the largest penalty imposed by the state in three years — a $100,000 fine and two years' probation — for neglecting a sore on a resident's heel for so long that his leg had to be amputated, in addition to other violations.

But in most cases where Haven has been cited for bedsores or dehydration, state officials have not mandated any increase in staffing. Even in the Waterford case and two other Haven cases that triggered "consent orders" by the health department — the highest level of enforcement — the department did not require increases in staffing ratios.

In a number of cases where serious patient-care deficiencies have been found in Haven homes, follow-up state monitoring often consists of the assertion: "Staffing was reviewed and found to be in compliance with the minimum staffing levels of the public health code" — a certification that nursing home advocates say is meaningless.

Jennifer Keyes-Smith, an advocate for the elderly who formerly worked for the state as a regional nursing home ombudsman, complained in a letter last winter to the attorney general's office that she had tried repeatedly several years ago to get the ombudsman's office and the state Department of Public Health to address chronic understaffing at Haven's New Haven home — without success.

"I continued to visit the facility and observed resident call bells going unanswered, residents not being fed, residents not being toileted, and staff treating residents disrespectfully," she wrote last November. "With basic human needs not being met, I continually urged the program's prompt intervention and DPH's expedient response. I was then told to stop working on the case."

Haven Healthcare CEO Raymond said he could not recall the state ever punishing the chain for understaffing or mandating higher staffing ratios.

Last week, state Attorney General Richard Blumenthal disclosed that state and federal officials were investigating whether Haven Eldercare, the chain's parent company, improperly diverted government funds away from patient care. Termini said the company's financial issues never impacted the level of care.

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Staffing became an issue in the recent Kentucky Governor's race.  Democrat Steve Beshear said that Kentucky needs to consider requiring minimum staffing levels at nursing homes, but Gov. Ernie Fletcher said the corporate owners should be allowed to determine how many nurses they hire.

Last night, Beshear said Fletcher's administration has failed to protect seniors, citing a news story that indicated the number of citations for nursing homes has declined since the Republican became governor in 2003.

"We don't have enough inspectors to go and enforce" laws that apply to nursing homes, said Beshear, a Democrat.

"I think it's time to look at minimum staffing numbers," he said. "We've got to make sure the profit motive doesn't interfere with the care motive."

Fletcher said the state doesn't need to set minimum numbers of nurses for nursing homes saying that the state can ensure adequate care in other ways.

"We've closed nursing homes that needed to be closed," he said.

See article here.

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Nursing home operators value loyalty and good nursing leaders, the latest results from the nation's most in-depth nursing-home survey indicate. The national median salary for directors of nursing (DONs) at nursing homes jumped 5.2% this year, up to $72,515. Similarly, assistant DONs enjoyed a 4.9% rise, up to $60,022.   Both increases are much higher than the standard increase in other similiar positions.

Administrators, meanwhile, saw their national median salary increase by a less robust 3%, to $82,400. Assistant administrators' median pay climbed to $59,357. However, compared to other type of white collar workers, this increase is substantial.

The figures come from the newly released 2007-2008 AAHSA Nursing Home Salary & Benefits Report. More than 2,500 facilities took part in the 30th annual survey, which is published by Oakland, NJ-based Hospital & Healthcare Compensation Service and supported by both major nursing home associations.

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Wisconsin Senator Herb Kohl is trying to prevent abuse by insituting a national system for criminal background checks on nursing home employees.  Please contact your Senators and encourage them to support this legislation.

Sen. Kohl says the best way to protect our elders from physical abuse is to institute a national system for background checks to determine whether those seeking to work in nursing homes and other long term care institutions have a criminal history before they are hired.

He and Sen. Pete Domenici (a Republican from New Mexico) introduced last month that would provide funding for a national register.   Kohl said the national register will be a tool employers can use to ensure they are hiring responsible people. It would also prevent workers with a history of abuse from moving from state to state to find new jobs.

Statistics and first-hand accounts prove that brutality and abuse exist in long-term facilities.
Nationally, one of every 20 elderly people will be abused in their lifetime. Between one and two million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depend for care or protection, according to Kohl's statistics.

The bill would require states to notify employers about whether an individual has a disqualifying criminal history and provides employers with immunity from anti-discrimination lawsuits filed by individuals who are terminated based on a disqualifying history. At the same time, the bill calls for an independent appeals process for those who are disqualified.

The bill would also allow each state to decide which crimes would be considered disqualifying.
States would also have the authority to penalize providers for knowingly hiring workers with histories of abuse.

See full article here.

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I was sent this great editorial regarding how much staff could be hired if CEOs were compensated reasonably instead of exorbitantly like Manor Care's CEO Paul Ormond.

SNF CEO'S WINDFALL COULD HAVE PROVIDED MORE STAFF AND SERVICES

To the Editor:

Reports that Manor Care’s CEO Paul Ormond would personally realize between $118 and $186 million when his company, the largest nursing home chain in the United States, is acquired later this year by a private equity group got us thinking about staffing in nursing homes. Knowing that the federal government has reported that more than 90% of nursing homes do not have enough staff to take care of their residents, we wondered how many nurses and nurse aides could be hired for a year at Manor Care’s nursing facilities with that same money.

Using federal wage estimates for nursing home workers, we calculated that Manor Care’s 278 nursing homes could hire an additional 5346 certified nurse aides or an additional 2198 registered nurses if $118,000,000 were spent on staff (19.2 aides or 7.9 RNs at each Manor Care nursing home). If Mr. Ormond’s $186,000,000 windfall were spent on staff, Manor Care could hire an additional 8427 certified nurse aides or an additional 3464 RNs (30.3 CNAs or 12.5 RNs at each Manor Care nursing home).

Like all nursing home chains, most of Manor Care’s revenues come from public programs, Medicare and Medicaid. How should our public health care dollars be spent? One man’s windfall or certified nurse assistants and registered nurses in nursing homes?


Sincerely,

Toby S. Edelman
Center for Medicare Advocacy
California Advocates for Nursing Home Reform
The John A. Hartford Institute for Geriatric Nursing
National Conference of Geriatric Nurse Practitioners

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I read an article this weekend about a resident who was physically and sexually assaulted by the groundskeeper for a nursing home facility.  The family of an Alzheimer's resident who was sexually assaulted by former Bedminster supervisor Robert Holland has sued him and the woman's nursing home for civil damages.

The late Helen Priester was 92 and in a wheelchair when Holland, a groundskeeper at Pine Run Community in Doylestown Township, was caught with her in her room.

“We want to collect fair compensation for the injuries and damages Helen Priester suffered, but we also want to make sure that this doesn't happen again,” said attorney Edward Shensky.

Holland, a Bedminster supervisor for 15 years, was sentenced in March to two to four years in prison for aggravated indecent assault, institutional sexual assault and related charges. Though he pleaded guilty, Holland maintained that Priester initiated the sexual contact and consented to the acts.

The suit says Holland was discovered May 5, 2006, by a Pine Run employee who noticed Priester's door was closed.   The employee opened the door and found Holland assaulting Priester. The worker yelled at Holland to stop and went to get security when he would not.

When they returned, the door was again shut and Holland was continuing the assault.
Holland, who used a service entrance to come into the nursing home, admitted to assaulting Priester for at least three years, the suit said.
Shensky said the nursing home should have done more to restrict access to vulnerable patients.

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 Police are investigating claims that a 91-year-old woman was raped at a nursing home.

The director of The Life Care Center says once they learned of the allegations on June 4, they immediately called the Department of Social and Health Services, Federal Way Police and the woman's guardian.

Police say the rape happened about a month ago.

The family of the woman has removed her from the facility. The alleged rapist has been placed on leave during the investigation.

I wonder if they did a criminal background check or if they asked the suspect to undergo a polgrapg examination.

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States that set high staffing standards for elder care in nursing homes are the only ones that come close to having enough staff nurses to prevent serious safety violations, according to a new study by a professor in the UCSF School of Nursing.

The majority of the nation's elderly and disabled in nursing homes remain in situations where staffing is well below national recommendations for safe care, the study found. While no states have ideal nursing levels, those states with higher Medicaid reimbursements or higher mandated nursing levels have come closer to meeting the recommendations, according to the analysis published in the June issue of the journal "Health Services Research."

The study's initial objective was to examine the relationship between Medicaid reimbursement rates, which many states have cut under their cost-containment efforts, and nurse staffing levels in US nursing homes, according to Charlene Harrington, PhD, RN, UCSF professor of sociology and nursing and lead author of the report.

She said previous studies have shown a direct correlation between staffing levels and higher Medicaid reimbursement for nursing homes, but this is the first to show that states with higher mandated staffing standards had substantially higher staffing as well.

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 At a hearing this month concerning the state of the nursing home industry 20 years after the landmark Nursing Home Reform Act (better known as OBRA ‘87), Senate Special Committee on Aging Chairman Herb Kohl (D-WI) addressed the deficiencies of a system that has allowed some poorly performing nursing homes to escape penalties.

Testimony by the Government Accountability Office (GAO) presented at the hearing concludes that many nursing homes shown to be providing substandard care are still not being subjected to any sanctions, and are therefore not be motivated to make the lasting improvements necessary to protect the health and safety of residents.

According to the GAO, in 2006 nearly one in five nursing homes nationwide was cited for poor care or, more specifically, care that can cause actual harm to residents.

“Without question, the Nursing Home Reform Act improved nursing home care in this country. Today, many of the nation’s 16,000 nursing homes are providing adequate or excellent care. But shamefully, quite a few nursing homes are getting away with providing a lot less, putting a good number of the seniors living in long-term care facilities at risk. This is unacceptable, and raises questions about how and why our enforcement system is failing,” said Chairman Kohl. “This committee has a long history of closely scrutinizing the quality of nursing home care, and we intend to reaffirm that commitment.”

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 I saw this story and thought of all the residents who suffered pain as a result of his intentional act. This is why supervision of nursing home employees is crucial.

A 40-year-old nurse who pleaded guilty to switching out painkillers meant for nursing home patients has been sentenced to just over five years in prison.

Michael Paul Smith of Falmouth was charged with tampering consumer products and health care fraud.  Smith may face mandatory exclusion from working in any federal health care program.

Prosecutors say he removed pills containing oxycodone and morphine by separating the cardboard backing from blistercards and substituted the pills for similar-looking medication nearly two years ago.

He was employed at the Odd Fellows Nursing Home in Worcester at the time.

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I just read this article about staffing at night in hospitals.  It starts and ends with a particular incident at the Medical University of South Carolina's children's hospital.  This is a truly terrifying account of the lack of staffing in hospitals on night shift. 

Now take this same idea of less staffing to a nursing home setting.  In nursing homes, often the residents can't speak for themselves, or they can't make sense out of what's going on around them - maybe they no longer know how or when to call for help.  And maybe they don't know the difference when no one comes.  Add to that the number of residents that have no family to check on them during the day, much less at night.

As an example, we recently talked to a gentleman who was in a nursing home for a short time for rehab.  He said that night time was the worst part of it all.  He said that patients call for help half the night, and no one comes.  He said you can hear staff members talking and laughing, but they wait for hours to respond to call bells.  The fact of the matter is, there is no real supervision on night shift, and often the staff does whatever they want.  I know that this is not the case with all nursing homes, but I've heard that same story more than once, about more than one facility. 

In the article, a child died  - in large part because there was not good staffing at night.  This child died with his mother sitting beside him, unable to get help.

Put yourself in the position of a nursing home patient, who has no one sitting beside them trying to get help.  The staff is all they have.  That's why staffing is such an important issue in medical facilities - and its not just about the quantity, its also the quality.

This article is worth reading, if for no other reason than to educate yourself about the dangers of night staffing in medical facilities.  We may all be there one day, or we may be able to help someone that is.

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State and national organizations pushing for nursing home reform say life-threatening problems in facilities for the elderly usually are linked to inadequate staffing.

Nursing home residents have their needs ignored because staffers are overworked, according to top officials with the National Citizens' Coalition for Nursing Home Reform in Washington, D.C., and Kentuckians for Nursing Home Reform, which has its headquarters in Lexington.

Serious problems have also occurred at Baptist Convalescent Center in Newport, where two patients became severely dehydrated, with one dying, and at Villaspring of Erlanger Health Care Center, which is under investigation by the Kenton County Commonwealth Attorney's office. 

"Ninety-two percent of the nursing homes in the country are not staffed at a level that allows them to provide adequate care," said Alice Hedt, executive director of the national coalition, which is pushing federal legislation that would mandate specific staffing levels in nursing homes.

"Our main issue is staffing in nursing homes. It's the basis for most of the abuse and neglect that we see," said Bernie Vonderheide, who heads the advocacy group in Kentucky.

Like the federal government, Kentucky has no specific staffing requirements that establish a ratio between the number of patients and the number of staff members that must be on duty to care for those patients, Vonderheide said.

"Kentucky is one of 13 states without staffing regulations. They follow the federal regulations that only say that you must have sufficient staff to provide adequate care. We say that they interpret these widely and wildly," Vonderheide said.

Thirty-seven other states have much more specific standards on staffing, he said.

Hedt testified before the Senate Special Committee On Aging on May 2 - roughly 20 years after passage of the federal government's Nursing Home Reform Law. In her testimony, Hedt cited two studies that had been completed by the U.S. Department of Health and Human Services.

"These reports and other research show that below 4.1 hours of nursing care a day, residents will almost certainly be harmed - suffer from pressure sores, dehydration, malnutrition, fractures, infections and other conditions that cause pain, decline in functioning, avoidable hospitalization and death," Hedt told the committee.

The Baptist Convalescent Home in Newport received a citation from the state earlier in the week after a resident died two days after he was removed from the home suffering from dehydration.

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 U.S. Medicare Monday proposed a $690 million increase in payments to nursing homes. The 3.3-percent increase would go to nursing facilities that provide skilled nursing and rehabilitation care to Medicare beneficiaries, according to the Centers for Medicare & Medicaid Services.

Under the new payment schedule, called the skilled nursing facility prospective payment system, the daily rate for room, board, medical care and other expenses would be increased. Current payments are based on a 1997 market basket, but the proposal would update rates using a 2004 market basket.

Hopefully, this increase will lead to more staff who are better trained.

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I recently read an interesting article about CNAs in nursing homes.  CNAs change adult diapers, clean soiled residents and help the elderly dress, eat and shower among other duties.  Unfortunately, these employees who handle so much of the daily, essential care needed by nursing home residents are underpaid.  The article states that the average pay for new CNAs is less than $8 an hour, only a dollar or so above minimum wage.

As a result of the low pay and demanding job description, CNA turnover is as high as 170 percent at some facilities.  Dale Patterson, vice president and chief financial officer of Evergreen Healthcare Management says about CNAs, "It's hard work.  And on a relative scale (employees say) 'I can flip hamburgers for the same pay or I can take care of old people with incontinence problems.'...So of course turnover is high."  Gary Weeks, executive director of the Washington Health Care Association industry group says that many CNAs qualify for food stamps and other public benefit programs.

Low pay for CNAs also means lower quality of care for residents in nursing homes.  Facilities with high numbers of Medicaid patients report "losing" money because of low government reimbursements for such patients.  Less revenue means lower pay.  These facilities spend an average of 44 fewer minutes on direct care of patients each day, they have more patients spending most of their day in bed and a higher percentage of patients with pressure ulcers.  This adds pressure to the nurses who end up overmedicating residents or using chemical restraints.  Larry Minnix, President & CEO of the American Association of Homes and Services for the Aging backs this theory up by stating "The best proxy for quality that we have is staffing."

Starting pay for a CNA in upstate South Carolina has recently been increased about $8.50 per hour.

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