"Understaffed, underpaid, and overworked"

8 News Now had a great article on the problem of short staffing in the nation's for profit nursing homes.   Patient advocates and staffing experts say the low minimum numbers required by ambiguous state laws are causing neglect in local facilities. A recent report rates Nevada nursing homes as some of the worst in the country. State inspectors cited every single Nevada facility for deficiencies, including actual harm to residents.  One of the issues appears to be a lack of workers inside nursing homes. Nevada, and most other states, do not have clear regulations on how many residents are too many to oversee. 

A caregiver at one facility, who asks to go by the name Rachel because she doesn't want to face repercussions for speaking out, talks about the problem.

"Understaffed, underpaid, and overworked," she said.

She covers the overnight shift and is sometimes required to handle as many as 10 residents at once.

"You can't be constantly working, worried about this one falling, when you've got all these other people to take care of," she said.

"Half the time, these companies ought to realize, you get what you pay for, like in anything."

The article quotes advocate and former ombudsman Brian Lee who says staffing issues could be leading to neglect.

"The staff stretched too thin, couldn't supervise, couldn't watch the resident," said Brian Lee with Families for Better Care.

 

Substandard Care is the New Normal

In a recent report in Wisconsin, 40 nursing homes have been listed as having a ‘substandard quality of care.’  See article at WAOW.  This tag comes with additional federal scrutiny on the homes, many of which have a history of violations and citations. Some were even on the list in 2011, marking them as consistently below the line when it comes to quality of care. The substandard homes are being watched more closely by the state and federal authorities, prompting a more immediate response to violations and citations than in the past.

Additionally the homes aren’t allowed to train new CNAs for a period of two years after the listing. The list may be a good thing, resulting in extreme watchfulness and immediate action, but if it is such a strong list to be placed on, how come homes have been on the list more than once?   If authorities responded immediately to violations and citations, and the list was a strong deterrent to providing poor quality of care, then something is getting lost in translation, because homes are staying on the list – not improving, not closing, but maintaining a state of care that is substandard.

Is that where you want your loved one to be?

Video Confirms Neglect

Autumn Healthcare of Zanesville, OH is being shut down by the Ohio Department of Health and Ohio Attorney General, Mike DeWine. The 100 bed facility is being closed because of patient neglect. ODH received several complaints from family members about the facility, and entered into an investigation with the families’ permission. They installed several hidden cameras in the rooms of multiple patients, which revealed that staff were neglecting to provide medical, nutritional, and personal care to at least one patient.

Some staff were falsifying documents so it would appear that correct treatment had been given. After these videos, ODH conducted an inspection, and cited the home for violations of infection control, treatment and care, food and nutrition, and resident rights.

This particular facility has been on the Centers for Medicare and Medicaid Services’ watch list, Special Focus Facilities, for the past 53 months, identifying the home as one with a history of issues. All of the home’s residents are being transferred to other facilities. The move is being coordinated by the Ohio Department of Aging and all patients will be moved after the remaining days of the home’s operation are up.

See article at NBC4i.

Preventable Choking Deaths

The Hartford Courant reported that another choking death of a nursing home resident. One of the most unnecessary and preventable dangers in nursing homes are food related injuries and deaths as a result of neglect.  Patients who are cognitively impaired and require special diets have become victims of neglect. These patients, in their impaired state, are given food they cannot consume.

An incident at Paradigm Health Care Center in Norwalk, represents at least the fifth choking related death in Connecticut nursing homes in the past ten months.  Researching developmentally disabled deaths in group homes and nursing homes, The Courant, a Hartford newspaper, found 76 cases of deaths from 2004-2010.  In all of these cases, abuse, neglect, or healthcare error was a contributing factor.  Of these deaths, 14 were on special diets and choked to death after eating food they should never have ingested. 

Incidents like these, where patients die as a result of choking from food they should never have eaten are too common within nursing homes. Upon further investigation, there were a number of instances of improper food consumption within Paradigm. The facility was fined just over $1000 and had to submit a plan of correction to the Connecticut Department of Public Health.

How much do you believe a life is worth? Because the Connecticut Department of Public Health has consistently said that a life is only worth a thousand dollars.

As a result of this latest incident, James McGaughey, head of the Office of Protection and Advocacy for Persons with Disabilities, which investigated all 76 deaths, will be coordinating a food-handling training session statewide for the nursing home industry. This training session is the latest in a series of emergency training in the last decade, complementary to nurses and nurse aide’s training which is required in the licensing process.

The sad thing in these cases is that the problem is common, and the consequences are paltry. People suffer, become ill, and even die from improper food consumption. The punishment for nursing homes is a thousand dollar fine. The company owns several nursing homes, one of which was fined for an incident of patient injury. In this case, a cognitively impaired resident fell in the bathroom while being assisted by a nurse’s aide. The resident’s care plan indicated that he was to have safety measures in place when being moved, but none of these measures were in place when he fell. The facility was fined just over $1000.

In a similar instance of safety hazards, a patient with dementia died in November at the Bridgeport Medical Healthcare Center. The patient was found dead, entangled in a plastic privacy curtain. The patient had become entangled in the curtain before and had a habit of playing with the curtain. However, the patient still had access to it. The nursing home was fined just over $1000 and ordered to submit a plan of correction.
 

Warning Signs of Neglect and Abuse

MSN Healthy Living had an article on the 9 warning signs of bad care.  Below is a summary.

1. Marked emotional or physical changes. Look first to your loved one. You should be concerned if she is less able to function as usual, has stopped taking part in activities, or has become withdrawn and uncommunicative. If Mom is experiencing emotional abuse—such as being ignored or talked down to—she may be agitated and withdrawn, fearful, or experience loss of weight or appetite and sudden changes in mood or sleep pattern. Physical abuse or neglect may be a concern if Dad has unexplained bruises, pressure ulcers, or skin tears, particularly in areas that are not regularly visible, like the upper back, hips, and thighs.

2. Unanswered or deflected questions. "I don't know, but I will find out" is an acceptable response—but not regularly, and you shouldn't get the feeling there's something to hide. "If staff are evasive with your questions, unable to answer your questions, or refuse to discuss your loved one's care with you, this is a big red flag that care may be suboptimal," says Amy Jo Haavisto Kind, an assistant professor in geriatrics at the University of Wisconsin School of Medicine and Public Health.

Some questions, such as, "My mom is losing weight, what is the plan?" should always have a ready answer. "If all a person gets is blank stares or a dismissal—'Old people just do this, don't worry about it'—then that is concerning," says Uy.

What's the ultimate wrong answer? "I get more concerned when someone says, 'This is how we do things here,' and has no desire to help," says Jatin Dave, a physician at the Brigham and Women's Hospital's Center for Older Adult Health.

3. Frantic, discordant, or inadequate staff. A busy, thin-stretched staff may be unavoidable at times, experts say. But does it always feel chaotic when you visit? Are staff working well together, or do they seem to have bad attitudes? At meals, do they talk only among themselves or do they mingle with residents? Does important information get lost between shift changes?

Don't overlook the leadership. Is the director nowhere to be found and unknown to residents? "I have never seen a place with strong, involved leadership that had bad care," says Barbara Bowers, associate dean for research at the University of Wisconsin-Madison's School of Nursing, who researches long-term care delivery.

4. High staff turnover. "Some regular staff turnover is an unfortunate reality at most nursing homes," says Kind. "However, if you notice that your loved one's nursing home constantly is training new staff to the point that no one on the staff knows your loved one—well, it is time to look for a new nursing home." Consistent staff-resident pairing is important in the quality of care Mom gets.

5. "I don't want so-and-so to care for me." Your loved one should never feel distressed or uncomfortable around any staff member, experts say. Even if Dad suffers from cognitive problems, "take these statements seriously and investigate them thoroughly with the nursing home leadership," says Kind. "They may be signs of mistreatment or neglect."

And even if Dad doesn't say anything, observe him when staff enters the room. Does he seem happy? Or is he anxious, fearful, or uncomfortable?

6. Constantly ringing phones and unanswered call lights. It should raise an alarm if the nursing staff doesn't have the time to pick up the phone, says Elisa Gil-Pires, section chief of geriatric medicine and palliative care at Saint Francis Hospital and Medical Center in Hartford, Conn.

And if Mom says she's waiting a long time after pushing the call button, "find out for yourself," says Erin Hilligan, a licensed nursing home administrator at Ebenezer Ridges, a long-term care facility in Burnsville, Minn. "Put the light on. Note if the delay is during a specific time of day—shift change or a meal time, maybe. Then bring up your concern to a staff person and note how it is handled." Of particular concern, adds Sewell, is if Mom says something like, " 'I waited as long as I could for someone to help me to the bathroom and then I just could not wait any longer, and so I got up on my own.' "

7. Dehydration and malnourishment. "One of the most frequent and insidious signs of neglectful nursing home care is dehydration," says Kind. "If a nursing home does not have the adequate number of high-quality staff, residents in that home may not receive all of the food or fluids they need to remain hydrated and nutritionally sound. Meals may even be completely missed." Act immediately if you suspect this is occurring, Kind says.

8. Status quo reigns. Ask staff what improvements the nursing home has recently put in place, especially since your loved one moved in. In particular, ask about anything they told you would be updated by now. "It is easy to identify nursing homes that are trying to improve and ones that are trying not to get shut down," says Uy.

9. A bad feeling. Ultimately, your gut knows. "Most of these warning signs will be the family member's concern that something is not right, or a feeling of uneasiness when they visit," says Gil-Pires.
 

Spartanburg Neglect Arrest

Authorities are investigating the death of a 104-year-old woman they say had been neglected by her son. Demetra Leventis was found at her Spartanburg home lying in her own feces and had fist-sized bed sores filled with maggots.  Leventis was hospitalized for an infection, and later died.  Her 63-year-old son, George Leventis, was arrested and charged with neglect. 

This type of neglect is common in nursing homes but no one ever gets arrested for neglect.  Sad.

Neglect at St. Thomas More Facility

My Fox 5 reported that St. Thomas More, a Maryland nursing home, is accused of deadly neglect of James Franklin because of poor nursing care. St. Thomas More in Hyattsville has an extensive history of health and safety violations. State inspections show the facility was cited for 60 deficiencies in 2010, another 36 last year and this year it was cited with 27 deficiencies, nearly triple the state average. The repeated violations prompted the state to list St. Thomas More as a special focus facility, a nationwide Medicare list of nursing homes with a history of persistent poor quality care. "One state health official told Fox5 patients at St. Thomas more are at higher risk than at other nursing because of the ongoing deficiencies."

"A former patient at St. Thomas More claims he almost died. James Franklin remains weak and bed ridden, six months after his stay at the 230-bed facility for what should have been the road to recovery."

"In May, Franklin was discharged from the hospital and sent to St. Thomas More for rehabilitation. Medical records show he had a sacral ulcer, commonly called a pressure ulcer or bedsore. At that stage it was small and healing. A month later, he was rushed back to the hospital, the bedsore now nearly as long as a football covering his back and buttocks, with an infection deep into the tissue and muscles."

"The wound had massive gangrene and a foul smelling discharge putting him into septic shock, when the body's organs begin to shut down."

"The nursing home settled a medical malpractice lawsuit last year for an undisclosed amount, in the 2005 death of a patient from infected bed sores. The same kind of infection that nearly killed James Franklin."

In Maryland and most other States including South Carolina, the legal hurdles to file a medical malpractice lawsuit and financial caps on jury awards make it difficult to hold bad nursing homes accountable. 

Cover up of Fall leads to Arrest

The Journal News/LoHud.com reported that the family of an elderly woman discovered both the circumstances and the culprits behind her mysterious death. They did not discover that she had died from more than mere natural circumstances until the day of the funeral when they opened the casket and were shocked to see how battered her body was. 

The woman, Sinia Malone, 86 years old and a former resident of the Tarrytown Hall Care Center in Sleepy Hollow, NY, died as a result of injuries sustained when she was dropped by one of the nursing home aides on February 15.  The aide, Maureen Flowers, was arrested, as well as another aide named Donna Pagan, who is accused of helping coverup the incident.  Flowers was accused of attempting to move Malone from her bed to a wheelchair without any assistance or without using a mechanical lift, both of which were mandatory.  Malone fell during the transfer, “fracturing her spine and right leg and suffering a broken nose.”   Flowers did not call for help right away; instead, she approached Donna Pagan, asking to lie and say that she assisted in the transfer. After she agreed, Flowers sought medical attention for Malone. 

Unfortunately, it was too late and she died just two hours later at the Westchester Medical Center in Valhalla.  The family was worried and suspicious about the way Malone died, but did not know who was responsible until a relative read a news story reporting the arrest of the two aides.  Whereupon they pieced together the story, and their “worst fears were realized”. Malone’s niece, Lella Oates Jones, rightly stated that “‘no one deserves to die like that.’” She considered the prosecution of the two aides to be a just way of preventing the occurrence of further similar incidents.

Criminal Neglect Charges

It was reported by the News Talk 1240 WRTA radio station that three women are facing charges of shameful neglect in their operation of a nursing home in Altoona.  One of them, Sherry Jo Warner, who ran Warner’s Home for the Aged, had her license revoked near the end of last year, and two of the care aides, Diana Frye and Marjory Koch, are also facing charges of neglecting a care-dependent person.

These charges relate to the neglect of Kenneth McGuire who died several days after he was admitted to the Altoona Regional Hospital because of the many unattended sores he had suffered.  He had so many sores that had not been properly treated that a doctor frankly told a grand jury “that it was the worst case he had seen in 30 years.”   The negligent trio of Warner, Frye, and Koch just had their preliminary hearings on October 3rd.

Burnout and Infections

NBC had an interesting article about how understaffing leads to poor care including increasing the risk of preventable infections.  Heavy patient loads and chronic burnout have long been among the top complaints of nurses in the healthcare industry.  A new study proves that those problems affect not only the nurses themselves, but also the patients they are responsible to care for.

This study confirms that there is a direct link between staffing, the number of nurses providing patient care, and patient outcomes. The issue of nurse-to-patient ratios is hotly debated in the U.S., where no one appears to track nationwide staffing averages. Neither the ANA nor the American Hospital Association keep such statistics. Nursing patient loads can vary from as low as one nurse for every one or two patients in intensive care units to far higher than the 1:5 ratio mandated in surgical units in California.

This certainly isn’t the first time that UPenn nursing researchers have found that staffing levels have had direct effects on patient health. A 2002 study found that adding a single patient to a nurse’s caseload increased the risk of dying within a week by 7 percent. Boosting the load from six patients to eight increased the risk by 31 percent over a nurse caring for four patients.

And a 2010 study found that patient deaths would drop by 14 percent in New Jersey and 14 percent in Pennsylvania if those states adopted California’s hard-won mandated nurse-to-patient ratios of 1 to 5 in surgical units. That study was led by Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, who also collaborated on the current study.

 

"Adding extra patients to nurses' already heavy loads, or logging more nurses with high levels of burnout was tied to an increase in two kinds of hospital-acquired infections. For every extra patient added to a nurse’s workload, there was roughly one additional hospital-acquired infection logged per 1,000 patients, according to researchers from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing."

For each 10 percent jump in the proportion of nurses who logged high levels of burnout, there was roughly one additional catheter-associated urinary tract infection per 1,000 patients and almost extra two surgical site infections per 1,000 patients, according to a study published today in the American Journal of Infection Control.

More than a third of the nurses reported high levels of job-related burnout. That was measured by the Maslach Burnout Inventory, a recognized scale that tracks factors like emotional exhaustion, depersonalization and whether the nurses feel a sense of personal accomplishment.

The nurses cared for an average of 5.7 patients apiece, and when even one extra patient was added to that load, the result was an additional 1,351 infections within the hospital population studied. That means additional risk of serious illness or death for patients who catch those infections while in the hospital. For people with cancer or other conditions that compromise immune system function, even a low-level bladder infection or a common infection in a surgical wound can tip them into far more serious illness.

This study is important because it is among scant research to factor in the impact of burnout, she added. When nurses are chronically stressed and feel unsupported by the work environment, it can lead to lapses in infection control practices. At the same time, the study found that reducing burnout cuts infections – and saves money.

Reducing burnout by 30 percent cut urinary tract infections by more than 4,000 and surgical site infections by more than 2,200, saving between $28 million and $69 million per year in estimated costs to treat those infections.