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

NY Times has a blog called The New Old Age.  Recently, they had an entry by Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions” regarding nursing homes.  The entry begins with a story about Sharon Kenney’s mother, Eunice.  Eunice was waiting, and waiting, for an aide to answer her call bell and help her to the bathroom.  Her daughter stayed on the phone with her for 45 increasingly desperate minutes. Finally Ms. Kenney hung up, called the desk nurse and asked that someone be sent to assist her mother. The ensuing conversation, as she recalls it:

Nurse: “We’re really busy and we have a lot of residents here. You’ll have to wait your turn.”

Ms. Kenney (after long pause): “That’s not the answer I was expecting. The answer I was expecting was, ‘I’m so sorry, we’ll send someone right down there.’”

Nurse: “I only have one person on that wing. She needs to wait.”

Ms. Kenney: “Maybe you could go down and help her. Do I have to drive over there and help her myself?”

Ms. Kenney takes meticulous notes of the neglect. Her motto for dealing with the staff: “Be as polite as possible. But relentless.”

Virtually all nursing homes are chronically short-staffed, with too few aides and nurses scurrying to help too many residents, who are more impaired and suffer higher rates of dementia than their peers a couple of decades ago. 

The article goes on to discuss Cynthia Dyer-Bennet. She grew frustrated when the aides caring for her mother in a dementia facility outside San Francisco seemed to routinely neglect brushing her teeth. “I could tell because her toothbrush was always bone-dry,” Ms. Dyer-Bennet said. The staff denied any problem. “They’d say, ‘We did brush her teeth.’ I’d say, ‘No, look, here’s her toothbrush — it’s dry at 9:30 in the morning.’ They’d lie to me.” She understood that with three aides caring for 27 residents, the staff was doing its best. She knew, firsthand, that with an Alzheimer’s patient, brushing teeth can take 20 minutes. But she persisted, citing what she saw as broken promises about diet and activities, as well as oral hygiene. “It reached the point where the caregivers didn’t want to see me because I was waving a toothbrush, and the administrators didn’t want to see me because they didn’t want to hear complaints,” Ms. Dyer-Bennet said. She eventually moved her mother elsewhere.

Family members who perceive conflict with staff have significantly higher levels of depression, according to a 2007 study conducted in 20 upstate New York nursing homes. And interviews with nearly 700 nursing home nurses and nursing assistants revealed that conflict with family members increases staff burnout and lowers job satisfaction, which contributes to the sky-high staff turnover rates that already plague many nursing homes.

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L.A. Times had an article about the obvious importance of staffing in providing quality care in nursing homes.  The cornerstone to quality care in a nursing home is staffing.  Those with larger staffs tend to have less turnover, more stability and are more likely to meet the needs of all the residents.

"There is some very persuasive data showing staff simply can't perform all of the responsibilities they have unless there is an adequate ratio of staff to residents," says Janet Wells, policy director for the National Citizen's Coalition for Nursing Home Reform, a reform-activist-advocacy organization.  Homes should be staffed to provide at least 3 1/2 to four hours of care per resident in a 24-hour period, says Larry Minnix, chief executive of the American Assn. of Homes and Services for the Aging, a nonprofit organization that represents not-for-profit elder-care facilities. Some may need to offer four to five hours daily depending on the conditions of the residents.

To assess staffing levels, Pat McGinnis, executive director of California Advocates for Nursing Home Reform, recommends visiting at a time when a facility is most likely to have maximum staff on duty (like at lunch, the biggest meal of the day).  Telltale signs of understaffing include diners with food trays who are not eating because they are not receiving necessary assistance, residents sitting idly in common areas or their rooms with nothing to hold their attention, call buttons going unanswered, and development of pressure ulvers.

Visiting during mealtime is also a good way to gauge food quality. Weight loss can be dangerous to the elderly, so food should look and smell appetizing.  Some of the more progressive homes have buffet lines rather than the "school lunchroom program," in which residents shuffle through with trays, Minnix says. "Food is the most looked-forward-to institution for many people, especially those confined to a home," he says. "You should ask about snacks and what kind of weight loss-weight gain program they have."

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The Times Union had an article about a nursing home failing to respond to call bells leading to residents soiling themselves and losing their dignity, or trying to get up unassisted and increasing the chances of falling.  Residents at Glendale Home were forced to wait to use the bathroom, sometimes so long that they relieved themselves in their beds or on the floor, because of a shortage of workers. The nursing home received a $20,800 federal fine.

In September 2008, six residents of the Glendale Home recounted for Health Department interviewers how they felt humiliated when no one answered their call bells for help getting to the toilet.

"We definitely had that deficiency in that period of time," said Schenectady County spokesman Joseph McQueen. He said the facility in Scotia redeployed staff to handle the workload after a study that helped determine when call-bell use was highest.  Additionally, he said, staff attended "dignity" training and the nursing home surveyed residents to ensure the bathroom problem had been addressed. No additional workers were hired.

Certified nurse aides and other employees admitted that on certain days the facility was short-staffed, sometimes to the point that residents were also not turned in their beds increasing the risk of pressure ulcers, and not bathed frequently enough.  Inspectors learned about problems encountered by one resident who had lived at the nursing home for only a month and needed the assistance of two staff members and a mechanical lift to get out of bed.

"She stated that sometimes staff would become angry with her for calling out when they were so busy and tell her she would have to wait," the inspector reported after speaking with the resident and her daughter. "She also stated that when she was waiting for help she would be in pain from the urgency of needing to void. The resident said that on several occasions she had wet herself while waiting for the staff and that she was mortified and embarrassed that she wet her bed."

The state inspectors said they observed another resident who was unclothed from the waist down as he tried to use a bed pan. The resident later said he was yelling out for someone to close the door to his room, the report said.

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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 Salt Lake Tribune had an article about response times to call lights.  This is a major problem in many nursing homes leading to falls or loss of dignitiy.  Typically, a resident who needs assistance to go to the bathroom hits the call light.  No response.  The resident then has two choices: 1.  Attempt to get up without assistance and risk falling, or 2. Relieve themselves and sit in their own urine and feces.

Call lights are little red buttons next to every bed and bathroom in every nursing home. When pushed, an alarm should sound at the nurse's desk and a light flashes over the bedroom door.
These call lights are how the frail and elderly summon for urgent help. But all too often, caretakers are slow to respond, if they respond at all. This is a common complaint from most if not all of our clients.

A Salt Lake Tribune examination shows that state inspectors have cited nearly one-third of Utah's nursing homes for a call light violation in the past two years. 

At the Hurricane Rehabilitation Center, the call lights didn't work in 10 rooms.

At the Bear River Valley Care Center, a man confined to a wheelchair waited 25 minutes for help getting into bed. "Sometimes it takes half a day," he told regulators. 

At the Willow Wood Care Center, a woman pushed her call light to get pain medication. She received her pills three hours later.

A slow response to a call light not only can impact a person's medical care, but also steal their dignity. In a number of cases, people waited so long for help that they ended up soiling themselves.

Utah inspectors receive more complaints about call lights than anything else, said Greg Bateman, who heads the state certification team.  Often, call light problems are a symptom of inadequate staffing.

Because caretakers usually respond faster when they know inspectors are watching, Bateman said he often relies on resident complaints to identify a problem. There is no hard and fast guideline for responding to a call light, but state regulators want to see someone at least assess the person's needs within the first five minutes.

Advocates for the Disability Law Center keep track of this problem. 
Eileen Maloney, who is a member of the center's abuse and neglect team, said she visits some homes where call lights are constantly ringing and staff members ignore them.
The industry is teaming with state inspectors to create a new incentive program next year that will encourage nursing homes to replace their old call light system with the latest technology. 
The system would allow homes to document response times, providing proof that either resident complaints are valid or not.

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