Mary Ellen Low, a medical professional who works in the nursing home industry, has written a book titled Dear God Letters From the Nursing Home. She wrote the book to try and change the negative stigma surrounding the nursing home industry. Low says that nursing homes are a place to meet friends and die with dignity. With this book, Low hopes to break down barriers and do away with the traditional stigmas associated with nursing homes. While there are sad stories, involving death, there are also funny stories. See the full article here.
HBO is premiering a new series tonight called "Getting On" about an extended/long term care unit at a hospital. It's described as a "dark comedy." Here is a link to an article and trailer
LifeHealthPro reported that Kindred Healthcare will buy Senior Home Care, a home health provider that does business in Florida and Louisiana, for $95 million. Senior Home Care has 47 locations and has $143 million in annual revenue. Kindred is making the Senior Home Care deal because it wants to expand its ability to control care delivered in different types of settings.
Kindred Healthcare Inc. runs nursing and rehabilitation centers, long-term acute care hospitals, hospice locations, home health services, and inpatient rehabilitation units. The company's RehabCare unit provides services for other companies' facilities. Kindred said it expects to keep the Senior Home Care management team in place.
Kathleen Leech was diagnosed with a seizure disorder. Her doctors figured out how to stabilize her seizures with a mix of anticonvulsants including the maximum allowed dose of Keppra. Once in the nursing home however, her condition worsened, eventually resulting in her death within a month of her placement there.
After her tragic death, a "charting error" was discovered. The error showed she was only being given half the prescribed dosage of Keppra, one of the drugs which controlled her condition. It appears that while the morning shift nurse was doling out medications properly, no one in charge of Ms. Leech's care realized that her evening dose was not being given. Her daughter says that she feels "betrayed and saddened as to how she was treated." See article at Independent here.
The New England Journal of Medicine had an interesting article discussing how the health industry should disclose medical errors. Most of the time, the health care providers cover up the error. "Although a consensus has been reached regarding the ethical duty to communicate openly with patients who have been harmed by medical errors, physicians struggle to fulfill this responsibility."
"Existing guidelines emphasize the overall importance of disclosing errors, but (with the exception of the case study of the American College of Physicians Ethics and Human Rights Committee) they offer little guidance on disclosing others' mistakes; this lack of guidance heightens clinicians' uncertainty about what to do. Consequently, patients may be told little about these events, and opportunities to build trust, ensure that learning occurs after errors, and avoid litigation may be lost."
"Although anxieties about damaging collegial relationships loom large in situations of potential error involving other clinicians, a patient's right to honest information shared with compassion about what happened to him or her is paramount. Simply put, when disclosure is ethically required, the fact that it is difficult must not stand in the way. Patients and families should not bear the burden of digging for information about problems in their care."
New research shows that at least 210,000 people die every year from medical errors.
N.Y. Times had an interesting article on a new study that shows some obese individuals are "healthy". "They are a mystery to researchers: people who are significantly overweight and yet show none of the usual metabolic red flags. Despite their obesity, they have normal cholesterol levels, healthy blood pressure levels and no apparent signs of impending diabetes."
Researchers call them the metabolically healthy obese. A study in the journal Diabetologia has found that people who are obese but metabolically unhealthy have impaired mitochondria, the cellular powerhouses that harvest energy from food, as well as a reduced ability to generate new fat cells. Unlike fat tissue in healthy obese people, which generates new cells to help store fat as it accumulates, the fat cells of the unhealthy obese swell, straining the cellular machinery and ultimately dying off.
This is accompanied by inflammation, and it may lead to ectopic fat accumulation. In the healthy obese, however, the fat tends to remain in the subcutaneous padding just beneath the skin, where it appears to be fairly innocuous.
Nursing Home Pro published a controversial article on how to increase profits by getting rid of Medicaid residents. "You and I have to ensure we stay in compliance while providing a safe environment for our residents and keep their best interests in mind; but this is also a business and it’s our job to ensure we push the facility to it’s highest financial potential. It’s unacceptable to just accept a financial loss month after month."
"Sometimes we all run into a problem with getting stuck with a resident. Either they were supposed to be short-term and just stayed tying up your rehab bed, or the family has disappeared without getting the paperwork needed to apply for Medicaid and now you’re losing money, or maybe the resident has a personality that just doesn’t fit well in your building. At any rate, something has to be done. Their condition makes it impossible to just send them home unless you’re willing to face potential compliance issues for an unsafe discharge."
The article's solution is to find a one star facility that is despearte for any type of resident. "Think about what nursing homes actually NEED residents… any type of residents. Which facility would be glad to just get a head in a bed? The ones with numerous open beds, of course! Think about it. When you are low on census, don’t you take a second look at referrals you normally turn down?"
"We only want the facilities with 1 Star. These are the desperate facilities. That’s what we’re looking for. They typically have had tough surveys resulting in the low 5-star rating. You can check the survey activity on the same site. When you see facilities that have had IJ level deficiencies.
"Depending on how recent their surveys have been, they may still be suffering the after-effects of the remedies imposed against them which can kill the census quickly (if they’re not admitting). Plus, if they had negative media exposure relating to their surveys, it may take quite a while to bring census back up. Make a referral to these facilities asap!"
So this guy wants you to send a resident to a bad facility so he can make more money.
Update (10.22.13): The article has since been taken down, which is unsurprising given the nature of the content. For those interested in seeing the full text, we did save a copy of the article. If you are interested, send us an email and we'll pass it along.
The Herald Sun reported on the cover-up of neglect that caused a nursing home resident's wrongful death. Caterina Montalto's family was told by Arcare's Hampstead nursing home that their mother had a heart attack and fell. The family noticed a graze on her forehead and a small mark on her chin. What the family did not know was that four days later the coroner's office would call his family. Tell him an investigation was underway. Caterina's body was needed for a post-mortem.
A 22-year-old employee at the nursing home, who had seen where Caterina was found, claimed there had been a terrible accident. And, worse, a cover-up. Nobody had told the family how she really died. The evidence showed that a nurse falsified a progress report. The facility bribed and threatened employees not to tell the truth about her death.
What had actually happened the day she died was caught squarely on CCTV, and played half a dozen times to the court. The scene shows a pathway through a long courtyard, short light poles lining the edge, strappy grasses and plants in the garden. Caterina walks into view. On the right of the pathway something in the garden catches her eye. She wanders off the path and round the side of a pond, looking in the plants. Caterina turns to go back on the path, but kicks one of the light-poles. She stumbles over it into a pond. Caterina didn't move again. That was it. Nobody pulls her from the water. She just lies there. Caterina lay there for 51 minutes, before first one, then two, then five staff came to her aid. It was too late.
Lea Sanchez, the first on the scene after nurses upstairs spotted the lady face-down in the water, was very upset. She was crying, she screamed, the court heard. Caterina's lips were already blue, she couldn't feel a pulse in her wrist. Two nurses got the job of drying her and laying her in her own bed.
But in the nurses' station at 4.45 pm, soon after the ordeal, Ms Sanchez said she described to her superior, Ms Condon, what she planned to write in the progress notes about Caterina's death.
"I said to Cathy Condon that I would write down that Mrs Montalto was found lying on her left side in the fountain,'' she said in evidence.
But Ms Condon dictated to her the words to write.
"Cathy sat beside me at that time. She doesn't want me to write what I was supposed to write and she threatened that we will be sacked with our employment with Arcare.''
Shortly after the dictation, Ms Sanchez said she was instructed: "This matter shouldn't be discussed on the floor, otherwise you will be sacked. Tell your staffs (sic).''
What she falsely wrote into the progress notes was this: "Found in the courtyard at 1600 hours lying on the ground…Appears to have a massive MI (myocardial infarction, or heart attack).''
ARCARE got media handling advice from a PR firm on the night Caterina died. It was forwarded to Cathy Condon detailing what to say if there were inquiries over her death. The responses were in first-person and were headed: "Suggested responses - Arcare Hampstead incident". "I can say it appears the lady suffered a heart attack. She was found near a pond in our dementia care unit's sensory garden, where she frequently liked to walk,'' the PR company advised should be said.
Ms Foster said in the inquest Ms Condon had told her that day a "disgruntled employee'' was spreading rumours about Caterina's death.
An article was provided by Bohrer Law Firm, L.L.C. to Digital Journal discussing a recent report. Below are excerpts of the article. The non-profit advocacy group Families for Better Care recently compiled a report comparing the quality of care that elderly people in nursing homes receive in each state. Factors like staffing, reported violations and hours of direct care were taken into consideration to generate a grade between A and F for each state. As reported by CBS News, Louisiana was among 11 states that received an F.
Louisiana was ranked overall as the second worst state in the nation. The report found that Louisiana had the lowest number of facilities with "above average" registered staffing. More disturbingly, according to the report, nursing home residents receive an average of just 32 minutes of daily care.
The CDC reports that abuse or negligence -- which can occur when residents don't receive sufficient attention or appropriate treatment -- may cause the following:
- Wounds, injuries and persistent pain
- Nutritional deficiencies or dehydration
- An enhanced risk of contracting an illness or worsening an existing health problem
- Psychological problems like anxiety and post traumatic stress syndrome.
Nursing home neglect can lead to lower quality of life, and it can increase the risk of premature death. The Families for Better Care report does not indicate that every nursing home in Louisiana is substandard, but it does show that people should be cautious when choosing a nursing home. If you already have a relative in a nursing home, it's important to pay attention to his or her condition as well as any complaints or concerns about the facility.
Jamaica Plain Gazette reported a nursing home in Massachusetts has been bought by new owners and is immediately undergoing a massive transformation. The group that bought the home is dedicating $1 million dollars to the renovation. The first priority of the project is to improve the state of the patient rooms at the facility. The patient rooms were previously dimly lit and dreary, but after the renovations they resemble bright hotel rooms. The improvements to the patient rooms also include the addition of flat screen TVs with cable, phones, wireless internet, and air conditioners. After the living areas are completed the renovation is also to include improvements to the nursing station, rehabilitation gym, cafeteria, and lobby. The facility states that all the current residents will be able to stay at the facility throughout the duration of the renovation project. Hopefully they will have enough money left over to hire enough staff to take care of the residents.
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