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

A new article, 'Torts Provide Best Relief for Nursing Home Residents,' is now available free from Clifford Law Offices web site at http://www.cliffordlaw.com. The Chicago law office is posting legal articles on their website in an effort to educate the public about legal matters.

Torts Provide Best Relief for Nursing Home Residents

Clifford's Notes, Chicago Lawyer, 08/01/2005
By Robert A. Clifford

A man in his 70s with a psychotic disorder, known as someone who smokes in prohibited areas, sneaks out of his room in a Niles nursing home when two of the three nurses on duty are on a break.

He leaves the dementia unit and wanders into an unused wing of the hospital, where he lights a cigarette that causes most of the room to be engulfed in flames. He is burned over 25 percent of his body, and both of his legs have to be amputated.

Another nursing home in suburban Niles fails to adequately supervise a 71-year-old woman who falls down the stairs in her wheelchair.

In Chicago, a nursing-home care worker is charged with involuntary manslaughter earlier this year after she allegedly attacked a 62-year-old resident, dragging him out of bed and causing him to fall and break his hip. He dies of a heart attack a week later, and the Cook County Medical Examiner’s Office rules it a result of the stress of the assault.

Reports of nursing-home abuse appear to be on the rise for a number of reasons: the growing aging population, a greater cognizance of neglect and abuse of the elderly and the increasing specialized care for the aged. Projections of 2000 census data indicate that the elderly population will rise to 71 million Americans by 2030, more than twice the number counted in the 2000 census. By 2050, the elderly population is expected to reach nearly 87 million, comprising about 20 percent of the U.S. population.

Who is going to take care of all of the aged people, given the number of small families, divorced couples and working people? Much of the care will be left to the 18,000 nursing homes operating in this country.

Nursing homes did not really begin to develop until after World War II, when the federal government began licensing and regulating them. With the passage of Medicare and medicaid legislation in 1965 that authorized federal reimbursements for these homes, the number of beds soared, and nursing homes became big business, from private sole-proprietorship facilities to corporate chain operations.

Such facilities deal with residents’ needs ranging from rehabilitation to custodial care. Although a host of federal regulations are in place and administered under the U.S. Department of Health and Human Services, state governments are responsible for enforcing compliance with federal and state regulations. Generally, the state’s public health department conducts inspections.

When abuse and neglect occur, it is possible to bring a breach of contract action when residents and their families sign an agreement specifying a certain quality of care. But it is generally under state tort law that nursing home residents and their families appear to find the greatest satisfaction and relief.

In Illinois, the Nursing Home Care Act, 210 ILCS 45/1-101 (2005), deals with such facilities. When it was originally passed in 1979, it was hailed as the most comprehensive legislation in the nation dealing with long-term care. The act explains the conditions necessary to provide adequate long-term care and penalties for failing to meet them, with the most drastic remedy being license revocation and closing the facility.

Although such laws are necessary to protect the elderly, they do little for those who personally suffer harm. It is generally left to negligence standards to compensate those who suffer at the hands of nursing home workers. The courts, though, have made a distinction between professional negligence and ordinary negligence, both of which can occur in a nursing home facility.

For example in Myers v. Heritage Enterprises Inc., 354 Ill.App.3d 241, 820 N.E.2d 604 (4th Dist.2004), a 78-year-old resident of a downstate nursing home fractured both legs when she fell while being transported in a special lift. She died two weeks later, apparently of unrelated causes.

The executor of her estate filed a lawsuit alleging negligent transfer and supervision of the patient under the NHCA, as well as a common law negligence. The trial court instructed the jury, though, that only expert testimony could be used to determine if negligence occurred. "You must not attempt to determine this question from any personal knowledge you have," was part of the court’s instruction under I.P.I. 105.01.

On appeal, however, the court reversed and remanded, holding that the plaintiff was prejudiced by such an instruction. The court found that operation of the lift did not require expert testimony necessitating a professional negligence instruction. Jurors should have been allowed to use their own experience to decide if the nurses’ aides negligently dropped the woman.

In Harris v. Manor Healthcare Corporation, 111 Ill.2d 350, 489 N.E.2d 1374 (1986), the Illinois Supreme Court held that the term "adequate care" was synonymous with "ordinary care" or "reasonable care," thus denoting the use of an ordinary care standard of negligence in proceedings against nursing home attendants.

Illinois defines institutional abuse as, "Any physical or mental injury or sexual assault inflicted on a resident other than by accidental means in a facility," Ill. Admin. Code, Title 77, 300, 330 (1983). Malnutrition, bedsores, improper restraints, scalding in bath water or thermal blanket burns, even food poisoning are some of the institutional abuse that has been witnessed by the residents and their loved ones.

Robert Browning, the 19th century poet, once wrote, "Grow old along with me!/The best is yet to be./The last of life, for which the first was made:/Our times are in His hand."

Life in Illinois’ nursing homes may not live up to Browning’s ideal. It is left to the legal community to at least ensure that a decent quality of life for the elderly is sustained, particularly for those who often cannot take care of themselves.

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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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The Birmingham Mail had an interesting article about a nursing home administrator defending the care provided to residents despite the fact that 27 of her resdients died in one year!  The former manager of a Birmingham nursing home has hit back at allegations she didn’t look after residents properly.

Kathleen Smith, who ran the Maypole Nursing Home, in Kings Heath, until it was shut down by inspectors told a Nursing and Midwifery Council hearing yesterday that she adequately managed residents’ incontinence.

Defending herself, Smith, described it as not "unusual" to see residents seated with incontinence pads showing above their trousers.  But, she said: "It’s different to say you’re leaving them walk around with a pad out – that’s undignified."

Smith also dismissed claims she allowed a resident with chest problems to be inappropriately restrained in a bucket chair.  "It’s rubbish," she said, "I totally, totally disagree with that. The chair didn’t tilt back, it was a semi-recumbent chair."

Smith also refuted accusations she had allowed a resident’s nails to grow curled and yellow. "It’s absolutely ludicrous," she added.

The misconduct probe into Smith, who said she currently worked as a community psychiatric nurse, is also looking into allegations against her former Maypole nurse colleagues Carol Estelle Bushell and Mary Kathleen Casey.

Bushell, 48, of West Heath, and Casey, 70, of Harborne, have already admitted allowing drugs to be given to the wrong patients.

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San Mateo Daily Journal had an article about a settlement three years after a mentally disabled woman was scalded nearly to death in a Redwood City nursing home.  The resolution came May 13, one day after the county was set to square off in court with Res-Care and employees, including Oretha Ocansey who was criminally convicted for her role in the severe burning of Theresa Rodriguez in May 2004.

The county, which is Rodriguez’s legal guardian, sought both punitive and actual damages for Rodriguez who was left so badly injured her hospital care costs $3,000 a day.  The lawsuit was filed after Ocansey was sentenced for placing the woman in the boiling hot stream of water but the defendants argued the entire company was not responsible for the actions of the single employee.

On May 4, 2004, Rodriguez was seated in the shower at Res-Care, located on McGarvey Avenue, when 145-degree water poured onto her lap. Rodriguez, who is unable to speak or walk, suffered third-degree burns over 60 percent of her body. Nurse’s aide Oretha Ocansey placed a diaper on Rodriguez and did not alert a supervisor for two hours. An hour after the supervisor learned of the situation, Rodriguez was airlifted to a Santa Clara County hospital and spent more than two hours on life support.

During the investigation in Ocansey’s role, prosecutors learned that Res-Care forbid workers from calling 911 until they first contacted a supervisor. Prosecutors still considered Ocansey culpable, however, for waiting two hours before even contacting her boss.  In August 2004, Ocansey pleaded no contest to felony elder abuse in return for an immediate sentence of the 34 days she had already served plus probation and a ban from working at health-care facilities. The plea bargain spared her trial and up to four years in prison if convicted by a jury.

The county went after the nursing home and its corporate owners the following January, claiming the facility knew of the water temperature problem for six days before Ocansey placed her in the shower.

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Knoxville News had an article about a nursing home resident who lost a leg due to the nursing home's neglect.    Neglect of a resident at Hillcrest-West nursing home led to the amputation of her leg last month, according to state reports quoting a doctor who consulted on the case.

The state has censured Hillcrest nursing homes for providing substandard care three times in the past two years.   Obviously the corporate managers ignored the problems and did nothing to correct them.

Now, as in the past, Hillcrest is in danger of losing federal funding if problems aren't corrected. Hillcrest-West has until May 25 to submit a detailed plan of correction, said Lee Millman, a spokeswoman for the Centers for Medicare and Medicaid Services.   During a survey conducted April 28 through May 2, the state found violations of "resident protection, administration, records and reporting, and nursing services standards."

Details in the recent state report on Hillcrest-West state that the amputee's pressure wound was at the most severe level when first noted by staff Feb. 7. The leg was amputated above the knee April 22. Doctors said the bone likely was infected and the wound was "exquisitely (intensely) painful" when manipulated.

A podiatrist said the pressure wound was the "result of neglect ... the worst wound I have seen in 12 years," and the surgeon who removed the leg concurred, the report states.   The same patient didn't get the amount of tube-fed nutrition and saline ordered by her doctor, with feedings skipped repeatedly, the report notes. Also, the family was not informed of the pressure wound and was shocked when they learned of the pending amputation, the state report said.

State inspections from 2006 and 2007 report Hillcrest-West patients found on the floor after apparently falling from beds or wheelchairs, failure to properly use restraints or alarms, patients who were unclean, and inadequate staffing.

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Here is a link to the recent GAO Report that shows a lack of investigation into nursing home neglect and abuse.  The NY Times ran a great article on this report.  Below are some excerpts from that article.

Nursing home inspectors routinely overlook or minimize problems that pose a serious, immediate threat to patients, Congressional investigators say in a new report.   In the report, the investigators from the Government Accountability Office, say they have found widespread “understatement of deficiencies,” including malnutrition, severe bedsores, overuse of prescription medications and abuse of nursing home residents.

The accountability office found that state employees had missed at least one serious deficiency in 15 percent of the inspections checked by federal officials. In nine states, inspectors missed serious problems in more than 25 percent of the surveys analyzed from 2002 to 2007.

The nine states most likely to miss serious deficiencies were Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming, the report said.

“Poor quality of care — worsening pressure sores or untreated weight loss — in a small but unacceptably high number of nursing homes continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said.   Nursing homes must meet federal standards as a condition of participating in Medicaid and Medicare.

Lewis Morris, chief counsel to the inspector general of the Department of Health and Human Services, said he had often been frustrated in trying to identify the owners of nursing homes that provided substandard care.  “We have found nursing home residents who were grossly dehydrated or malnourished,” Mr. Morris said. “We’ve found patients with maggot infestations in wounds and dead flesh. We’ve found residents with broken bones that went unmended.”

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Rome News Tribune has a story about a male resident found dead in the nursing home's utility closet.  Typically, these closets are locked and only certain staff members have access.  No one knows how the resident got into the closet or how he died.  

The man had been missing from a Georgia nursing home for two weeks but was found dead Wednesday in a utility closet at the facility.  The body of Walter T. Heath was found in a closet near the dining area of the Tara at Thunderbolt Nursing and Rehabilitation Center.

Heath had been missing since 5 p.m. April 16. He admitted himself into the Thunderbolt facility in February.  After he disappeared, the facility's staff and Heath's family members grew concerned about him.   Heath's wheechair was left near the dining area the day he disappeared, not far from the utility closet where his body was found Wednesday morning.

Hopefully, the autopsy and investigation will reveal what truly happened.

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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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WIStv.com had a story by Jack Kuenzie about a resident being neglected in a Prosperity, S.C. nursing home.  The owner of the Southside Residential Care Facility, Roy Lee Bowers, 64, has been arrested and charged with felony neglect of a vulnerable adult, resulting in the death of a patient.   His health care administration license was also suspended Friday by the state.

Investigators started looking into the facility when they found 59-year-old William Sealy malnourished and only weighing 94 pounds.  Sealy had injuries to his legs, bed bugs, a toenail rotted off and a toe beginning to rot off, and his socks had been left on for so long that his skin was pulled off when his sock was removed. They said he also had a scalp disease, appeared as if he hadn't been bathed in over a week, and was severely malnourished. He weighed 94 pounds and officials said he should have weighed at least 160 pounds.

Sealy died on Saturday, April 12th. Autopsy results show he died of pneumonia and severe infection.   Until he died, Sealy's family had no idea he was even there. A spokeswoman says the family had been told by his guardian to avoid contact with Sealy for fear of damaging his fragile mental condition.

To those who monitor the state's system for protecting sealy and others like him, it's another indication of just how weak that system can be.

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WBLT in Jackson, Ms. has an article about a resident who was so neglected in her diabetic monitoring that she will now lose her leg.  Below are excerpts from the article.

A nursing home's responsibility is to care for those in need.  On Friday, March 28, Willie Mae Coleman was admitted to University Medical Center in Jackson for gangrene. Her left leg will be amputated.   The family blames the Pine Crest Guest Home for neglecting to give her mother the care she needed.

"It could have been avoided if her leg had been properly elevated and proper procedure would have been done," she says. "It wouldn't have come to her having surgery."

"I think vascular disease is always preventative on several levels," said Coleman's doctor, Huey McDaniels.

Sandra says although her mother was admitted to UMC on Friday, nobody from the nursing home that brought her here notified them. In fact, her family didn't know she was there until Sunday. Sandra says her siblings went to visit Coleman at Pine Crest Guest Home on Sunday, but Coleman wasn't there. That's how they found out she was in the hospital. 

Sandra Coleman says there's no excuse for allowing her mother to get to a point where amputation is the only option.

"If it's happening to us, it could be happening to others there, too," said Sandra.

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Santa Cruz Sentinel has an article about the tragedy that is all too common for many nursing home residents.  Nursing homes fail to train on what DNR status means, and far too often simple care is not provided that would save a resident's life.  Below are excerpts from the article.

The Tragedy: On Sept. 11, 2007, a 71-year-old woman with cancer was transferred to Pacific Care Manor, a nursing home in Capitola. Just prior to her admission, the woman's doctor noted that her patient was lucid and responsive and "could have years to live." Most importantly, the patient had also expressed a desire to live.

Shortly after her admission, the woman began refusing food, water and any treatment. Within two days, she was screaming and combative. On day three, the nursing staff suggested that lab work be ordered to determine the cause of the resident's distress. The facility's director of nursing overruled the suggestion because "once we know what is going on then we will have to treat her." Instead, the nursing director asked the facility doctor to prescribe pain medication and a "do not resuscitate" order. The doctor complied and, despite the woman's documented opiate intolerance, he prescribed a Fentanyl patch, Haldol, morphine. He also wrote an order for "no CPR, no hospitalization." His patient cried out "you are all going to kill me" after the forcible administration of the prescribed medications. On Sept. 16, just five days after her admission, the resident died. 

All residents of nursing homes have the right to grant or withhold consent to any proposed treatment.  Residents have the right to refuse or consent to treatment and to receive all information relevant to making their treatment decisions. Providing such information is part of any responsible nursing home's assessment and care planning process. Federal regulations also reaffirm residents' rights to informed consent and to refuse treatment.

Regardless of a resident's mental capacity, no facility may administer treatment unless the resident has agreed or has been specifically adjudicated incompetent by a state court judge. Even after a court has determined that a resident is incompetent, it must make additional findings before terminating a resident's right to refuse treatment. Without a court order, the provision of any treatment over a resident's express refusal is a violation of several residents rights and is criminal battery.

Similarly, doctors cannot order "Do Not Resuscitate" orders without the written authorization of their patients. For DNR orders, designated health care agents may sign for the patient. However, doctors may not unilaterally impose DNR orders without a resident or resident representative signature.

Nursing homes throughout California are accustomed to interposing their notions of a resident's best interests over the expressed wishes of their residents. The Department of Public Health and resident advocates have been generally weak in preventing this illegal conduct. Hopefully, the tragedy in Capitola will serve as a warning to both facilities and advocates about the deadly consequences of disregarding residents' critical rights to direct their own treatment.

Anthony Chicotel is an attorney for the California Advocates for Nursing Home Reform in San Francisco.

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In many of our neglect and abuse cases, the victim is unable to testify regarding the bad care because of dementia or death.  I read an article today about a man who is competent and speaking up for his rights and the rights of others at the facility where he lives.  Mr. Crawley is a competent 48 year old man who resides at Sunrise Rehabilitation & Care in Marion, N.C.   "I am not being treated like, I feel, as a human being," said Crawley. 

Crawley became a paraplegic as a result of a car wreck in 1982. His 81-year-old father, Joe Crawley Sr., can no longer take care of him and he started living at Sunrise Rehab on Oct. 15. For the first two weeks there, the staff didn't give him a bath or shower.  "I don't know what is going on here," he said. "It seems like they make a lot of errors in simple things."

Crawley said his elderly roommate will talk incoherently and constantly yell about having to urinate, and, rather than listening to him, the staff will shut the door. With the heater running, that makes the room get hot for both Crawley and his roommate. He said he has called the nurse's station to have the door opened but is ignored.

His sister said the staff once left a feces-soiled blue pad on his wheelchair for more than two hours. His father, who visits him twice a week, found it and thought his son had had an accident. He bagged up the soiled pad and took it to the nurse's desk.  "That's an unsanitary condition and that's neglect," said Pilgrim.

Crawley said he's confined in his bed 21 hours a day.   This will increase the likelihood of developing pressure ulcers. 

Crawley added he's paying $879 a month to stay at Sunrise Rehab, which leaves him with just $30 out of his monthly disability check. He wishes he could go someplace else.

"I don't know if they think I am incoherent or lost my faculties or don't know what is going on," he said. "But I do know what is going on. I need more than anything to be transferred to a place that deals with wound care."

"They are neglecting the people," said Buckner. "That is why there is a waiting list at Autumn Care."

The official Web site for Medicare contains information about nursing homes across the nation. The site states that Sunrise Rehab had 11 health deficiencies, which are above the state and national averages. One of the deficiencies included failure to "write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property."  Another deficiency found on May 10 by inspectors was failure to "give professional services that meet a professional standard of quality."

In addition, inspectors found on Aug. 30 that Sunrise Rehab failed to "make sure that residents are safe from serious medication errors" and it also failed to "make sure that the nursing home area is free of dangers that cause accidents."

See full article here.

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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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Texas Attorney General Greg Abbott has filed a lawsuit against a Fort Worth assisted living center, claiming its manager threatened residents with a hammer, withheld food and locked some of them out of the building at night.  See full article here.

Abbott says the alleged abuse took place at the Oasis Village assisted living facility, located in Fort Worth's Polytechnic neighborhood. A district judge issued a temporary injunction against the owner of the facility, God's Intercessory Prayer Warriors Ministries, Inc., and its manager, Bertha McCoy.

According to state inspectors from the Department of Aging and Disability Services, at least five residents at the facility have complained that McCoy abused them. Some residents said she took the mattresses from their beds and forced them to sleep on metal bed frames, as punishment for soiling their sheets. They also said she locked them out of the building overnight. State inspectors also found evidence that McCoy hit several residents and threatened some with a hammer.

Inspectors reportedly found a hammer in McCoy's office during a recent visit.

The state has filed suit against Oasis Village with the facility facing a punishment of up to $10,000 per penalty.   All of the residents at the facility have been relocated.

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Des Moines Register has a great article on Senator Grassley's comments and complaints about how states investigate nursing home abuse and neglect.  He is calling for a federal investigation into the way states respond to complaints of poor nursing home care.

"I have an obligation to protect Iowans, and all Americans, from substandard nursing care," the Republican senator from Iowa said in a letter Thursday.  Grassley criticized Iowa's nursing home inspectors for failing to thoroughly investigate a complaint involving Waterloo's Ravenwood Nursing and Rehabilitation Center.

In August 2006, Maizie Bickley was an 89-year-old resident at Ravenwood. Nurse aide Connie Rust called Bickley's daughter, Sandra Bickley, one night to report concerns that Maizie Bickley was very ill and wasn't being properly evaluated or treated by the nurses.  Within hours of Maizie Bickley's arrival at the hospital, she was diagnosed with a bowel obstruction, an infection and dehydration.

The facility fired Rust, the aide that told the family the truth citing a company policy that prohibits conduct "that results in serious negative public relations." I guess being caught providing substandard care is considered bad for "public relations" but it is worse for the neglected resident!

Sandra Bickley was furious, particularly when the Iowa Department of Inspections and Appeals looked into Ravenwood's care for her mother and found no problems. She complained to Iowa Citizens' Aide Ombudsman William Angrick and to Grassley. 

Dean Lerner, who heads the state inspections department, asked the federal Centers for Medicaid and Medicare Services to do its own review of his agency's work on the case.  That federal review concluded that state inspectors didn't conduct a thorough investigation of the Bickley case and didn't interview nurses, ambulance workers or the hospital's emergency room staff.

Grassley is asking the GAO to examine the nation's state-run nursing home inspection agencies and the manner in which they respond to complaints. He is also asking the Centers for Medicaid and Medicare Services to give him four years' worth of investigative reports dealing with state inspections. He wants to know whether the Bickley case is an indicator of a widespread problem.

Although certified nurse aides have relatively little training compared with registered nurses, it's the aides who provide most of the hands-on care in nursing homes. But they typically are prohibited from sharing concerns about quality of care with residents' family members.

"But the problems with nursing homes are widespread," she said. "We're basically just warehousing our senior citizens in this country. Too many homes are owned by corporations, and for them the bottom line is profit."

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Jay Cameron whose mother died in a California nursing home filed a lawsuit against the facility saying it caused his mother’s death by reducing staff to save money. 

Cameron alleges the home committed elder abuse, fraud, wrongful death, negligence and violated patient rights. He is asking for an undetermined amount of money and reimbursement for attorneys’ fees. 

Cameron’s mother, Margaret Williams, was a resident at Mission View before being transferred to French Hospital Medical Center where she died.  Williams fell three times at the facility, suffered a hip fracture and developed pneumoniacausing her death.

Compass Health and administrators at Mission View are trying to increase profits by reducing staff and employing people who were not properly trained or qualified, leading to Williams’ death.

Attorneys for Cameron, Greg Coates and Michael Thamer, argue that the nursing facility took short cuts in care that resulted in unsanitary and hazardous living conditions and left residents unsuper vised. They also said there was an increase in accidents and injuries suffered by residents and nursing staff and other signs of inadequate care.

State records for 2006-07 show the state Department of Public Health issued three citations against the home in 2006 for patient care and fined the facility $2,800, spokeswoman Lea Brooks said.   In April 2007, during a recertification survey, state investigators found deficiencies at the home, Brooks said.

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Here is an article about a nursing home in Arizona losing its Medicare and Medicaid funding because of patient neglect.   This action is the only one the multi-chain corporation understand.  Government oversight must be increased and serious consequences of neglect must be felt by the corporations.

Some Evergreen Foothills Health and Rehabilitation Center residents would have to be relocated to a facility capable of providing good care. The state is working to move those patients.

Arizona Department of Health Services records paint a disturbing picture. Problems cited include: failing to investigate injuries to rule out abuse; failing to provide regular catheter cleansing for one patient; and failing to notice when one patient had three broken ribs.

Evergreen's corporate defense attorney stressed that, although Medicare and Medicaid funding will officially be cut next month, the state is allowing the center to remain open for now.  I am sure that is a relief to the neglected residents who remain.

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The family of a Pennsylvania man who died shortly after falling and fracturing his hip at an Oakmont nursing home has filed a lawsuit asking for reasonable compensation from the facility for neglect and causing his death.

The family of Charles Grice filed suit Thursday against Presbyterian SeniorCare over negligent operation of its nursing home, The Willows.  Mr. Grice injured his hip when he fell unassisted out of his wheelchair. He died after surgery to fix his fractured hip. 

The staff of The Willows failed to take necessary precautions with Mr. Grice's care even though he was assessed as being at high risk for falls. He had entered the nursing home for rehabilitation, and was to return to home.

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A Rockport, Arkansas nursing home chose to evict an elderly resident who was chronically ill. The home dropped her off at a motel in Aransas Pass and never notified the family. 

The home claims it wasn't getting paid for her to stay there.  Ladewig suffers from chronic bronchitis and a muscle disease. Ladewig said she was brought to this motel room after getting evicted. Her family were never told about the move.

When nursing home personnel dropped her off, the family said they left her with food for the weekend and these two portable oxygen tanks that would last about eight hours.

"I would have run out of oxygen and died," said Ladewig. "That's what would have happened to me if she wouldn't have come out looking for me. That's what would have happened."

"There is no phone in this facility, even if in the middle of night she went in respiratory failure or a situation where she couldn't get up, she has no way to contact anybody, whatsoever," Biggs said.

The family said the nursing home was paid through early December.

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The Naplenews had a frightening article about a recent lawsuit that chronicles severe neglect of a resident. 
Sophie Arvigo moved into Lakeside Pavilion Nursing Home in Naples.  After several years there, her care and treatment took a dramatic turn for the worse.

There was neglect that led to painful and humiliating medical problems, and traumatic injuries that resulted from physical mishandling by staff.   The family contends nursing home staff dropped Arvigo from a Hoyer lift, a sling-like device to move immobile individuals, and wasn’t taken for X-rays until two days later despite outcries of pain.  She suffered an impacted hip fracture that was not recognized by the staff despite numerous signs and symptoms of a broken bone.

She was injured a second time while being wheeled in her wheelchair and a third time while being moved again in a Hoyer lift.   The complaint said the nursing home staff and administrators were negligent by failing to protect Arvigo against injuries and for failure to properly hire, retain and supervise nurses who were qualified and capable of treating her as expected in the nursing profession.

The nursing staff failed to address Arvigo’s numerous bouts of dehydration and severe weight loss, numerous urinary tract infections, respiratory infections, bed sores and odorous drainage from her left ear, among other medical conditions.

The complaint also says the nursing home failed to notify a doctor about the significant changes in Arvigo’s condition and failed to follow doctor’s orders for her treatment, including monitoring her changes.

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There is a great article at Tennessean.com about dozens of deficient Tennessee nursing homes that have been closed or fined as a result of neglect including drug dealers visiting The Cornelia House nursing home to sell crack to employees and residents; at Mitchell Manor, patients went without necessary pain medication for a week because the facility was out; and at McKendree Village, staffing shortages caused multiple problems, such as one patient lying in his own feces for 3½ hours, despite pushing the call light five times.

"Things aren't right here," one Cornelia House resident told a state inspector. "Residents are buying drugs almost every night. … Staff are aware but don't do anything. The patients are left wet and not taken care of." 

The 159-bed Cornelia House and the 42-bed Mitchell Manor have closed since losing tax payer funding. The 300-bed McKendree is still open to private-pay residents, but 200 of its residents dependent on federal funding must find a new place to live by Dec. 29.   However, plenty of nursing homes in Tennessee have been identified as having serious violations without losing funding. 

While lots of facilities have been cited with these serious violations, the facilities that lost their funding were unable to fix the problems within the reasonable time given or were unable to stay in compliance.

"These facilities were afforded the same number of days as others across the country to develop and implement a plan to correct the violations, maintaining an appropriate standard of care for residents," said Christy Allen, assistant commissioner of the Tennessee Department of Health, Bureau of Health Licensure and Regulation.

The Cornelia House has had a history of problems.  For the last four  years, the nursing home was repeatedly cited with immediate jeopardy violations. Inspection reports show that residents had wallets and clothes stolen; patients were observed smoking crack; residents were told to go to the bathroom in their pants; and their health-care needs weren't attended to, among other problems.

Officials with McKendree Village declined to be interviewed for this story. However, they assert that  the issues identified by the state have not resulted in any "actual harm".

They say that many of the state's findings are related to documentation. For example, the inspectors found that the facility failed to investigate the cause of injuries for 11 of 42 residents to ensure that abuse or negligence had not occurred. However, they argue that doesn't mean that abuse or negligence did occur.  Well, if they didn't investigate, how do we know?

The Health Department's Allen said immediate jeopardy is determined through a multi-tiered process of checks and balances that includes state and federal officials. 

According to the state inspection reports, many residents weren't happy with the care they received. The documents show the facility was short-staffed and that contract employees in particular didn't receive proper training and sometimes neglected patients.  Another said staffers respond like snails to call lights, but "break their necks" when state inspectors are on the prowl.

"We need TLC, not being stomped on," one resident said.

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Residents at a nursing home in Idaho are alleging the facility is neglecting its residents and has failed to provide hot water for nine days.

A new water pump was ordered Thursday when hot water went out at the home.  Hot water was  available in the home's kitchen and laundry room. The hot water was temporarily restored Thursday, failed again Friday and was not repaired until Sunday because the replacement pump was damaged in transit.  Relatives of some patients deny hot water was available.

"My mom hasn't had a bath since she's been here," said Butch Malone, whose mother arrived at the care center Dec. 10.

The families also say the center's staff is unresponsive when patients call for help. For example, Randy Speaks' 40-year-old daughter said it has taken staff as long as an hour to respond when his daughter is in need.

During the facility's last inspection in September, state inspectors said the home was deficient in failing to properly treat or prevent bed sores, according to reports posted on the national Medicare Web site.

The inspection also found the home "failed to prepare food that is nutritional, appetizing, tasty, attractive, well-cooked and at the right temperature."

See full article here.

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Here is an article about a self described "nursing home survivor" who relays his experience in a nursing home.  Below are excerpts of his article.

I was an industrial electrician by trade, trained to evaluate current flows and make connections between positives and negatives. Get shocked once and you'll never grab a live wire again. I'm also a Tennessee nursing home survivor, and the same goes for the 5½ years I spent living in a "home." The experience was beyond shocking. I will never repeat it.

Jan. 15, 1984, was the day of the accident that changed my life forever, leaving me with quadriplegia. I began a journey no one would want to take — but many probably will. I was 35, young enough to at least put up the kind of fight that many nursing home residents are too elderly or sick to wage. I survived several life-threatening mistakes by poorly trained staff, years of conflict with unequipped and unsympathetic "caregivers" and countless unanswered calls for help.

I made it my mission to get out of that home, and now work to help others do the same. I wish I could say that conditions have greatly improved since 1984. But 20 nursing homes across the state have had their admissions suspended this year, a 100 percent increase from 2006; and 91 percent of the state's homes had complaints filed against them in 2006.

Yes, nursing homes are inspected every year by the state. But what inspectors never see are the nurses and administrators scrambling after getting notice of an upcoming visit. During one of these frenzies, I told a friend, "Better watch out, you might get run over by somebody doing something they haven't done all year!"

Before these inspections, staff members are like juveniles trying to clean up after a party before their parents get home. Bedsores are dressed, soiled linens are washed, meds are — quite generously — given, the stale scent of sickness is replaced with that of disinfectant.

Lobby keeps funds flowing

Despite their miserable track records, nursing homes receive 99 percent of the $1 billion in tax dollars that Tennessee dedicates to long-term care. Eighty percent of these homes are private, for-profit entities. It's no wonder the nursing home lobby gives hundreds of thousands in campaign contributions each year to our state legislators; they're trying to protect what they claim is "their" money.

Only 1 percent of tax dollars goes to home- and community-based care, even though this type of care is usually far better. This completely lopsided allocation of tax dollars makes Tennessee 50th in the U.S. — dead last — in funding for long-term, home-based and community care.

We can change this. Most of us will ultimately need to arrange long-term care for a loved one or will need it ourselves. We must demand legislators redistribute our tax dollars in favor of significantly more funding for home- and community-based care.

We must also demand that, as long as the current system is in place, the state increase the number and quality of nursing home inspections.

And finally, we must bring to a grinding halt the practice of notifying homes of upcoming inspections. The state represents the citizens who have to live in these places. On their behalf, its inspectors should be welcomed at any time.

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The Associate Press had this story today.   Fifty-six nursing homes are among the worst in their states and are being called out in an effort to goad them into providing proper patient care.

Lawmakers and advocacy groups complain that too many facilities get cited for serious deficiencies but don't make adequate improvement, or do so only temporarily.

The homes in question are among more than 120 designated as a "special focus facility." CMS began using the designation to identify homes that need more oversight.   The homes on the list got not only the special focus designation, but also registered a lack of improvement in a subsequent survey. 

There are about 16,400 nursing homes nationwide. About 1.5 million elderly people live in nursing homes. Taxpayers spend about $72.5 billion a year to pay the cost of nursing home care.

The AARP also applauded the administration's action.

"People in nursing homes have a right to know how well they're performing," said David Certner, director of legislative policy for AARP, an advocacy group for people 50 and older. "Their families certainly have a right to know what kind of care their relatives are receiving and if that care is substandard."

Here is the link to the list.

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A family whose mother passed away two years ago after spending just a month in a nursing home says her death should not have happened then and now they're asking for help. "She walked, talked, could eat on her own," said Arnold Trevino, remembering his mother before she checked in," he said, "when she left out of there, she left out of there an invalid, she couldn't talk," he explained. Full article here.

He says after his mother stayed at the Valley Grande Manor for just 30 days, the damage was done.   Trevino said his problems with Valley Grande Manor began when his sister, a registered nurse, told the staff her mother was suffering a heart attack. He claims the staff refused to take her to the hospital, so he called the state to get her out. "When she was taken to the hospital, doctors told us she had not been fed, given any water and that she had abusive bruising that they don't know how she relieved," said Trevino.

That's when he took pictures he says are even more proof. Natalia Trevino died just weeks later, her death certificate names malnutrition as a contributing factor.

Trevino says he's frustrated, because even though this report shows several violations including LVN staff without a valid license, and others with convictions working there, he can't get anyone to take action.

But Trevino wants someone to take action against the staff that treated his mother. "I want for them to face the same consequences that I would have faced if I would have taken my mother to the hospital in that condition," Trevino said.

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This story really upset me.  I can't imagine the excuses the nursing home will use to explain this neglect away.  Florida police began investigating why an 82-year-old man from the University Center West nursing home was so severely neglected, he ended up in the hospital.

The man was taken to the hospital suffering chest pains and difficulty breathing.  What doctors found was so alarming, they had to call DeLand police.

Doctors told police the hospice patient had bed sores, his breathing tube was infected, and they found maggots in his left eye.

JoAnn Grasso, the administrator of the nursing home, declined to comment specifically on the case.

Former University Center West employee Monique Miller said she was not surprised.

"I haven't seen maggots — but bed sores, yes," Miller said. "That doesn't surprise me at University Center West. No, it does not, because I've seen it several times."

Miller said supervisors at the home are lax and allow unhealthy conditions to continue until its too late.

"You have to be half dead for them to send you out to the hospital, because they're afraid to lose money, or their beds will be empty," Miller said. "That's scary. It's very scary. You have to watch it. You have to be very careful when you put a family member in a nursing home — all nursing homes."

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I saw this article about a woman who was a resident of a Tennessee nursing home where they found maggots in her ear. How could this happen?  Who is checking her?  It is disgusting and unacceptable.  I'm surprised the facility isn't claiming it is part of her care and treatment!

A Health Department investigation revealed that a resident at Johnson City nursing home had maggots in her ear because of a hygiene problem at the facility.

Records show the woman suffered from dementia and needed assistance with dressing, eating and bathing. But attendants at the Lakebridge Health Care Center had not washed her hair since July 23 when they found the maggots on August 4.

The state found the home deficient in providing daily hygiene to patients and is requiring a plan of action to fix the problem.  A Lakebridge administrator says that the woman did have her hair washed regularly, but that staff had failed to always record it.   The Administrator should know the Nurse's Axiom:  If it wasn't documented, it wasn't done." All nurses are trained this way and most good facilities have a written policy to that effect.

 

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Although there is a concern regarding privacy issues, many families use hidden video cameras to document neglect by nursing home employees.  These cameras are useful especially when the nursing home denies neglect or fails to supervise employees apporpriately.

I ran across an article that illustates my point perfectly.  An ex-employee of a Rochester nursing home admitted today that she neglected a patient in a case that included the use of a hidden camera.

Tammy Devos, 43, who was employed as a certified nurse’s aide at the Jennifer Matthew Nursing and Rehabilitation Center in Rochester, NY pleaded guilty to the misdemeanors of second-degree falsifying business records and willful violation of health laws. 

She was sentenced to spend 16 weekends in county jail, beginning Sept. 1. As a condition of her plea, she agreed to surrender her nurse’s aide license.

She’s one of five former employees of the nursing home to face felony charges.
She was initially charged with first-degree falsifying business records, a felony.

Nine other former employees pleaded guilty to misdemeanors and received probation. The employees were charged after an investigation by the state Attorney General’s Office that involved putting a hidden camera in a patient’s room in the spring of 2005.

According to court documents, the 70-year-old patient, who suffered from dementia, was not turned regularly, was allowed to lie in his own waste, and was not given adequate food or hydration. False entries were made in the patient’s records to show that proper care was given.

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I wish South Carolina enforced the nursing home rules and regulations and issue fines when neglect has occurred. To my knowledge, SC has never fined any "for profit" nursing home.

A nursing home was fined $100,000—the most severe penalty under state law—after investigators ruled that poor health care led to the death of a 76-year-old patient.
Pleasant Care Convalescent of Petaluma operates a 54-patient facility where a woman died March 12 from an infection, said Norma Arceo, a spokeswoman for the California Department of Public Health.

The woman developed an infection and died from complications in a hospital eight days later, Arceo said. Records showed the patient had extensive cavities and food debris throughout her mouth, causing large swelling in her neck. 

Here is the full article. 

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There is a great discussion on abuse in nursing homes that I found here.

Nursing Home Abuse is on the rise even though less people are entering nursing homes with debilitating conditions according to recent data. The true number is probably much higher but The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse. There are nearly 1.4 million Americans that are living in nursing homes right now.

Unfortunately, a nursing home is not always the place of respite and healing it should be. According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to witness, and even participating in, acts of nursing home abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse.

Neglect is the most common form of abuse. Residents in soiled beds and clothes, or those suffering from bedsores and frozen joints are most likely victims of neglect. Indications that a patient is over or under medicated can also signal neglect.

About 2500 cases of physical abuse or rape are reported each year.

Neglect is often caused by understaffing at nursing homes. However, this does not mean that neglect is more benign than other forms of abuse. In fact it can be deadly, as it was for an Alzheimer’s patient living at the Atrium I Nursing Home in Pennsylvania. The 88-year-old woman was allowed to wander away from the facility and died from exposure. The nursing home administrator was later charged and convicted of involuntary manslaughter in the patient’s death. 

Because this type of abuse can easily be covered up by staff, the true number is not really known. Elderly people can often be victims of falls, so sometimes, bruises, sprains or factures do not alarm a patient’s loved one. However, if these injuries cannot be fully explained, or if they are occurring frequently, further investigation is probably needed.

One of the most insidious forms of nursing home abuse is sexual abuse. According to a 1996 Medicaid Fraud Report, 10% of all physical abuse cases in nursing homes are of a sexual nature. Sexual predators will usually take advantage of disabled patients who are physically unable to tell anyone about their assaults. Often, this type of abuse is only discovered when a patient shows evidence of sexual contact, perhaps in the form of a sexually transmitted disease. In Illinois the repeated rape of a mentally disabled woman wasn’t discovered until she became pregnant. A nurses’ aid was charged and plead guilty to sexual assault in that case last month.

Because its victims are so helpless, nursing home abuse is one of the most underreported crimes in our nation Families of nursing home patients must become aware of the signs of abuse, and they must be willing to advocate for their loved one. Often, family members are the only people who can prevent a tragic outcome for a long-term care patient.

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I saw this story in a Pittsburgh paper.  I can't believe they gave probation to a nurse who lied, changed medical documents, and covered up the circumstances of neglect that caused the death of a nursing home resident. 

What kind of deterrent is this?

Kathleen Galati who was a nursing home supervisor was sentenced to only five years' probation.
She pleaded guilty in March to perjury, false swearing, criminal conspiracy, and tampering with evidence in connection with the October 2001 death of Mabel Taylor, 88, at Ronald Reagan Atrium I Nursing and Rehabilitation Center.

Allegheny County Common Pleas Judge David R. Cashman also banned Galati from working in health care during her probation.  So in five years she can go back to covering up neglect in nursing homes!

Atrium head Martha Bell helped cover up the death of Taylor, who died after wandering outside on a cold night.  Bell was convicted of involuntary manslaughter and health care fraud and sentenced to at least seven years in prison.

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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.”

The GAO report also found that those deficient facilities that do make the effort to attain compliance often slip back into poor performance, and that of the poorly performing nursing homes studied by the government in 1999, nearly half of those had made no progress in their standard of care by 2006. In his opening statement, Chairman Kohl said he would be sending a written request to the Centers for Medicare and Medicaid Services (CMS) for a bimonthly briefing on any progress made in regard to today’s GAO recommendations. Chairman Kohl also expressed interest in improving the availability of public information on the quality of individual nursing homes, so that consumers can easily access information concerning any deficiencies found or sanctions levied against a nursing home in order to make an educated decision about which facility can best serve the long-term care needs of a family member.

Additionally, Chairman Kohl announced his intention to introduce legislation that would create a streamlined, cost-effective system of background checks nationwide for those who apply for jobs in long-term care facilities, much like the pilot program that is being conducted by the state of Michigan. After establishing a comprehensive system that combined several state registries with the state criminal background check and an FBI check, Michigan prevented more than 600 people with criminal and/or abusive histories from working in the long-term care industry in the past year alone. 
Friends and Relatives of Institutionalized Aged (FRIA) has been NYS’s unique consumer resource for free information and assistance on long term care issues, with a special focus on nursing home care. FRIA has played a pivotal role in reforming the industry since its inception. In addition, FRIA provides direct services to seniors and their informal caregivers, working to improve individual problems with long term care as well as positively impact the state system generally. FRIA’s services include:

–Free telephone bilingual Helpline service that assists over 1,500 callers each year on a wide array of long term care concerns,

–Organizing, assistance and support for over 60 NYS Family Councils attendant to nursing homes, representing over 20,000 nursing home residents,

–Caregiver Advocacy Center that provides information and interventions on resident rights, family rights, and care complaints, and,

–Community education and outreach that educates seniors and their families on NYS’s long term care system, reaching over 1,000 community members in 2006 alone, not counting media appearances. http://www.fria.org/index.shtml

Over 1.6 million people are living in nursing homes in the U. S. today; in New York State where FRIA is based there are 657 nursing homes with 120,347 certified beds. Generally, people in these homes suffer from chronic disease, physical disabilities and mental disabilities and/ or dementia and depend on professional assistance for day-to-day care and continued survival. They may or may not have close family or friends nearby to oversee their care. They depend on the compassion and professionalism of the nursing home staff to make their end of life days more dignified, supportive and as pain free as possible.

Demographic projections predict a doubling by 2030 of people over 65 years of age, with expectations of increasing numbers of over 85 year olds and of those with dementia. Addressing the issues presented by the NHRA is critical not only for those older Americans alive today, but also, given the staggering aging baby boomer demographics, so we can resolve the issues before the problems take on unmanageable proportions.

The Nursing Home Reform Act has had notable successes in reducing restraints, in some cases reducing overmedication of residents, and in recognizing family and friend council organizations. Yet, it