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

KansasCity.com had an article reporting the guilty plea of one of two women accused of physically and sexually humiliating nursing home residents for months in Albert Lea, Minn., to three of the charges against her in a case that has heightened attention to how aides are chosen and supervised.  Brianna Broitzman was an aide at Good Samaritan, the nursing home that was the focus of state investigations and widespread publicity about the case in early 2008.  Her guilty plea covers gross-misdemeanor disorderly conduct involving three victims.

The charges against Broitzman said she admitted to police that she poked one resident in the breast. The teens who were implicated accused Broitzman of numerous other actions, including spitting in a resident's mouth, jabbing the breasts of several residents and putting "her bare butt" on a resident's face.

According to the complaint against Larson, she admitted to police that she inserted her finger into the rectum of a resident. She said she was trying to trigger a bowel movement but acknowledged that this was not part of her training. The complaint said she also acknowledged getting into bed with a resident and making a humping motion, patting the buttocks of one resident and trying to get another angry and then laughing at her.

The allegations became public in August 2008, when state Health Department inspectors concluded that aides, to make their work "fun," had abused 15 residents suffering from Alzheimer's and other forms of dementia. The state said some of the residents were combative, easily agitated or blind.

Six aides, high school friends at the time, were charged - Broitzman and Ashton Larson as adults and the four others as juveniles who were found responsible for not reporting the abuse as required by state law. The women were accused of abusing seven residents who suffered from dementia.

Sexual abuse cases in nursing homes during the 1980s and '90s led to laws requiring reports of suspected abuse and criminal background checks of those who work with vulnerable adults.

Broitzman will be sentenced in Freeborn County District Court on Oct. 22.  A presentence investigation recommends that Broitzman spend up to a year in jail, pay a $3,000 fine or spend two years on probation.

The case against Larson, 20, another former aide at the Good Samaritan nursing home, is proceeding toward trial. Broitzman and Larson were charged with fifth-degree assault, abuse of a vulnerable adult by a caregiver, abuse of a vulnerable adult with sexual contact, disorderly conduct and failing to report suspected maltreatment. All are gross misdemeanors.

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Dale Russakoff wrote an interesting article online at The New York Times blog called The New Old Age.  He discusses how he chose a nursing home for his mother including talking to CNAs who provide the vast majority of care in nursing homes.  "After all, these were the women — and they were all women — who would spend the most time with my mother, who would notice small changes that raised big questions, who would make her feel cared for. Or not."  Most nursing homes would not allow him to talk to the CNAs.

High turnover rate is a major problem.  More than 70 percent of nurses’ aides, or certified nursing assistants, change jobs in a given year.  The reasons for the high turnover rate among nurses’ aides are the same as they were then: low wages ($10.48 an hour on average), poor benefits, high injury rates and lack of respect on the job.  Researchers have found that high turnover in a facility corresponds with poor quality of care — more bedsores and more use of restraints, catheters and mood-altering drugs. That is, more reliance on medicine and technology, less on relationships.

“Cycling in aides who don’t know you is very disorienting and upsetting, and the resident is the one who suffers on the quality end,” said Peggy Powell, a senior staffer at PHI, formerly known as the Paraprofessional Healthcare Institute, a nonprofit group focused on improving the front-line work force in long-term care.

In nursing homes with high turnover rates, certified nursing assistants tend to leave within three months, often because of inadequate training and support to juggle multiple frail, ailing residents at a time, according to Robyn Stone, senior vice president for research at the American Association of Homes and Services for the Aging. Once aides leave, everyone else must pick up their caseloads, and the stress of the job rises.He decided on the facility where they allowed him to talk to the CNAs.  "These women used the word “we” when talking about the nursing home, making clear that they felt a sense of ownership. And it seemed significant that the marketing director asked their permission before allowing me to impose on their break time. Moreover, he trusted them enough to leave me alone with them in the break room."

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McKnight's had an article about the lack of CNA training in most nursing homes. Between 1997 and 2007, the number of nursing homes providing training and certification programs for certified nursing assistants (CNAs) fell by more than a third, according to a recent report.

Researchers at Brown University's Center for Gerontology and Health Care Research learned that 24.4% of nursing homes offered CNS training and certification programs in 2007, compared with 37.6% in 1997. More than half of all CNAs (51.2%) reviewed in the study received their training at community college and paid the entire cost. As many as 80% of CNAs trained in nursing homes paid nothing for their training, according to the report.  Researchers collected administrative data for more than 15,000 nursing homes across the United States and reviewed information from the National Nursing Assistant Survey for their study.

Forcing potential CNAs to seek training outside a nursing home at their own expense will likely provide a disincentive for anyone considering the profession, according to report authors. CNA recruitment is one of the biggest staffing issues facing nursing homes since CNAs typically provide a significant majority of nursing home care. The report was published in a recent edition of The Gerontologist.

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The Evansville Courier & Press had an article written by Hanns Pieper is professor of sociology and gerontology at the University of Evansville regarding staffing.  He refers to Medicare.gov which contains nationwide nursing home comparison data.

"Staffing time measures are especially important because it's the staff that actually delivers the care. The data are based on the nursing home's staffing hours during the two weeks before the inspection and represent the average amount of time available per resident. All other things being equal, the more time per resident the better."

CNA data is the most important since they provide 90-95% of the direct care to residents.  CNAs have the most frequent contact with the residents, so the time they have available is key.  The time available measure is an indicator of staffing adequacy and there often is a significant difference among the different star ratings.

He looked at a list of Indiana nursing homes, and randomly selected a nursing home with a 4-star rating and one with a 1-star rating for staffing.  The 4-star nursing home provided almost an extra hour per day per resident.

There are other important indicators of staffing adequacy that are not presented in the charts such as staff turnover, and call bell response time.   Data that shows how many CNAs who were working on Jan. 1 and still were employed on Dec. 31 should be available.   A CNA's leaving often has a significant emotional impact on residents. The quality of care is affected. A high turnover rate also may be an indicator of other inadequate conditions in the nursing home.

The time it takes for a staff member to respond to call lights/bells requesting assitance made by a resident is also not presented in the data.  When facilities don't have an intercom to determine if the situation is an emergency or routine event, a long response time can lead to devastating results. Inrercom systems and electronic recording of alarms and call bells should be standard in most nursing homes.
 

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Results of First National Nursing Assistant Survey were recently published sponsored by the U.S. Department of Health and Human Services. The survey was designed to provide information needed to recruit, retain and expand the direct care workforce. Some of the characteristics the survey examined include demographics, career decisions, work experience and training, pay and benefits, work environment, home environment, injuries and vaccinations.

According to the findings almost half of all CNAs are members of a minority group; their median hourly wage was $10.04; almost two-thirds lived on an annual family income of less than $30,000; 16 percent had no health insurance and more than half were injured on the job at least once during the previous year.

The survey represents the data available about CNAs in nursing homes and provides a resource for evidence-based policy, practice, and applied research initiatives to address the CNA workforce shortage and to improve recruitment and retention efforts.   National Nursing Assistant Survey can be found here.

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Dunn Police in North Carolina are investigating a nursing home after a 78-year-old patient was sexually assaulted by a male staff member, according to reports.  A 43-year-old, male CNA at Magnolia Living Center is under investigation relating to the sexual assault of two female residents.  The first incident involves an elderly female resident at Magnolia Living Center who reported that on May 2 around 10 a.m., a CNA at the nursing home touched her inappropriately.

Nursing Home Director Shelley Tinsley reported the incident to police on May 5, three days after the assault allegedly occurred and one day after the victim initially told another CNA what had happened.  The second incident involving a 51-year-old resident was reported to police on May 12th.  The incidents are currently under investigation as aggravated assaults with sexual motives. The suspected CNA has finally been removed from his position while the investigation continues.

According to other media outlets, the victims remain at Magnolia Living Center for now.

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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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John Ette, a certified nurse assistant is charged with abusing an 88-year-old bed-ridden resident at Adirondack Medical Center's Mercy Nursing Home. He is accused of hitting, grabbing and punching the visually and dementia-impaired woman last October, leaving her with a broken collarbone and facial bruising.  Officials say John Ette hit and pushed an 88-year-old bedridden woman while working at the Adirondack Medical Center and Mercy Nursing Home in Tupper Lake. The woman had multiple bruises and a fractured clavicle in October 2008.

Shortly after midnight on Oct. 20, 2008, Ette struck the bedridden patient in the face, grabbed her arm and pushed her down into her wheelchair, according to the court complaint filed against him.  The patient suffered a broken collarbone and some facial bruising. Her condition is now stable, and she still lives at the nursing home, said David Doyle, spokesman for the state Office of the Attorney General.

Ette admitted the act to state investigators on Nov. 12, 2008.  Nursing Home staff noticed the woman's severe injuries the next morning and notified administrators and her family. Ette was fired following an internal investigation last October.  Ette was charged Wednesday by the Attorney General's Office with second-degree endangering the welfare of a vulnerable elderly person, endangering the welfare of an incompetent or physically disabled person and willful violation of health laws.

"Nursing-home care must be administered with the respect and professionalism that New York's seniors deserve," Attorney General Andrew Cuomo said in a news release. "It is appalling when our dependent and vulnerable loved ones are victimized by the very people who are entrusted with their care."

AMC goes through an extensive screening and background check process before it makes a hire.

Ette's estranged wife, Jodi Ette, told the Enterprise John Ette had displayed violent tendencies in the past. She said he had never been violent toward her but had lashed out at inanimate objects.  She said that when the incident happened, it took John Ette several days to divulge the details of the alleged abuse. "He wouldn't tell me the full story for quite some time," she said.

"We want to reassure families that we are taking the proper steps to protect the safety and well-being of our residents, patients and staff," AMC's Chief Financial Officer Patrick Facteau said.

 He had worked at Mercy since Feb. 21, 2006.

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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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