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

Caymanmama.com had an article about problems found at Mustang Manor Assisted Living Center including 27 nutrition and sanitation-related issues..  The Oklahoma State Department of Health (OSDH) found problems with on-site cleanliness, nourishment, and the overall welfare of the elderly residents. Reports show the Mustang Manor has been cited for numerous unspecified violations of safety and health in the last two years. These issues amounted to an excess of $35,000 in OSDH-issued penalties. 

Beyond claims of safety and health hazards at the nursing home, officials from the Mustang Police Department have received complaints of criminal activity at the establishment. According to Mustang Police Capt. Willard James, “We received a call that a resident had actually written checks to an employee of the business and had them cashed to have the money returned to her, and she had not received those funds.”

Often the two major areas where a nursing home can cut operating costs to improve profits is staffing and nutrition.  Many nursing homes cut staffing especially of RNs and LPNs to make more money for their corporate owners. 

Nutrition and sanitation are very important to prevent pressure ulcers and infections.

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Arizona Daily Star reported that Posada Del Sol nursing home has agreed to pay a fine of $4,000 to the Arizona Department of Health Services for failing to protect six of its residents from abuse.

The 156-bed facility represents that they are experts who specialize in caring for people with complex behavioral-health issues.  State inspectors said the nursing home failed to protect six residents from "mental and/or verbal abuse" regarding food preferences, and from an abusive environment toward bariatric/obese patients.

In one case, a physician had authorized a patient to eat meals in bed due to pain from bladder spasms, the staff ignored the orders and, except for one can of supplement, refused to give the resident any food.   A nurse even taunted the resident with a food tray in an attempt to coerce the resident to the dining room.

In another case, a resident with excruciating back pain asked to eat meals in bed but was denied and given a can of supplement instead, the report says.

Posada Del Sol recently made "leadership changes" and retrained its patient-care and food-service workers.

The U.S. Centers for Medicare and Medicaid's nursing-home rating system gives Posada Del Sol a rating of one star - its lowest designation, meaning "much below average."
 

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Reuters had an article discussing the overuse of feeding tubes with demented residents. Whether or not a person with advanced dementia winds up with a feeding tube  have more to do with economic concerns than his or her wishes, suggests a new study out in JAMA (Journal of the American Medical Association).  Dr. Joan M. Teno of Brown University in Providence, Rhode Island, and her colleagues found that hundreds of patients who had specified, in writing, that they did not want a feeding tube received one anyhow.

Feeding tubes don't extend survival for people with advanced dementia who can no longer swallow, and provide no other apparent benefits to these patients, according to two reviews of the medical literature, Teno and her team note in their report.

Tube feeding can also cause harm, the researcher added in an interview; demented patients who are bothered by the tube and try to remove it may be physically restrained or placed on heavily sedating drugs.

Up to a third of nursing home patients with advanced dementia have a feeding tube, Teno and her colleagues note in their article. In two-thirds of these cases, the tube was inserted while a patient was in the hospital.

To investigate what factors might influence whether or not a hospital would use feeding tubes in people with advanced dementia, Teno's team looked at 2000-2007 records for nearly 2,800 hospitals, all of which had admitted at least 30 patients who were 66 or older, had advanced dementia, and were living in nursing homes. Their analysis included Medicare claims for 163,000 patients and nearly 281,000 hospital admissions.

Twelve percent of the hospitals didn't insert a feeding tube in a single patient with advanced dementia throughout the eight-year study period, the researchers found. But at one quarter of the hospitals, patients had a 1 in 10 chance of feeding tube insertion; hospitals with the highest rate of feeding tube use inserted them nearly 40 percent of the time.

For-profit hospitals were more likely to use feeding tubes, as were larger hospitals and those with the highest level of intensive care unit use for patients in their last six months of life.

Recognition is growing that dementia is a terminal illness that affects the body as well as the mind, Teno told Reuters Health. And when a patient with dementia begins having trouble eating, she said, this indicates the final stage of the illness has arrived. For these patients, she added, careful hand feeding can offer a safer and more comfortable alternative to feeding tube insertion, "but it takes staff time and effort."

According to Buchman, the amount of caregiver time and effort to work with patients and try to feed them by mouth and to do it safely is "substantial."

Emory University Hospital's 2006-2007 rate of feeding tube insertions for patients with advanced dementia was 24 per 100; Buchman said he did not want to comment on those figures, given that he has only been working at the hospital since July 2009.

The hospital had one of the highest rates of feeding tube use in patients with advanced dementia, according to Teno's study, with 37.5 insertions for every 100 admissions of such patients in 2006-2007.

Although her study didn't investigate why hospitals opted for feeding tube insertion, Teno said it's likely that cost concerns are a factor. Most of these older patients are on Medicare and Medicaid, and the way that reimbursement works means nursing homes tend to ship them to hospitals when they get sick. Then, hospitals will try to discharge these patients back to the nursing home as quickly as possible. Inserting a feeding tube allows the hospital to discharge a patient faster, Teno added, while for nursing homes, tube feeding is less time consuming than hand feeding.

It's questionable, Teno noted, whether hospitalizing these patients in the first place is helpful. "It can be very disruptive and very stressful to take someone who is in the throes of dementia and put them in an acute care hospital," Teno said. "I'm really concerned that the financial incentives now are aligning with hospitalizing these people rather than trying to keep them in a less restrictive environment and treat them in a nursing home."

For a person with advanced dementia, the onset of eating difficulties should be "a stop sign to say listen, we need to talk about what are the patient's wishes and values for future medical care," she added. "Helping people make the best decision for their loved one is very important."

Teno and her team have compiled a list of hospitals and their rate of feeding tube insertion in patients with advanced dementia, which is available online here

SOURCE: Journal of the American Medical Associations, February 10, 2010.

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The NY Daily News had the tragic story of Verda Henry.  She entered a Westchester County nursing home in 2005 after she fell and injured her arm, thinking she would receive therapy and be home in a month.  Two years later, after repeated denied requests to go home, she in the  nursing home because of a horrific, infected bedsore.

Her daughter, Patricia Henry, said she and her children visited her normally active mother every day at Sutton Park, often for eight hours. The family complains that the facility was short-staffed.  "There would be a nurse and she would run between floors and they had no time," Henry said. "Nobody checks on her. Nobody feeds her. Every time we asked to take her home there was a reason we couldn't."

One day, Patricia Henry went to change her mother's gown and noticed the bedsore, already in an advanced stage, over her mother's tail bone.   Within days the sore was infected and she heard her mother's last words - screams - as doctors scraped at blackened skin.

"You could put your whole hand down in her back," she said. "You could see the bones and spinal cord. It was like raw meat. Mommy screamed until she couldn't scream no more."   Henry wants justice for her mother, who died a painful death because of a negligent system.

Bedsores, or pressure ulcers, are lesions caused by unrelieved pressure on the skin. They are largely preventable with adequate nutrition and by making sure a patient is regularly moved or turned every two hours, but are also often fatal once infected.

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Josephine Sciacca died on October 24, 2007 after a year and a half in a nursing home in Trinidad, Colorado.  Her family has filed a wrongful death lawsuit alleging that negligent care resulted in the fatal injuries. The lawsuit alleges that Sciacca died due to dehydration, malnutrition and complications due to a pressure ulcer, all problems stemming from neglect and mistreatment at the facility.

The nursing home was negligent in failing to heal and prevent the reopening of a pressure ulcer,  not properly feeding or hydrating Sciacca, and tampering with Sciacca’s medical records.  Sciacca’s mistreatment and death were the result of “knowing and/or intentional actions” by the Colorado nursing home officials and staff, according to the family.

Although there is a cap of $150,000 for Colorado wrongful death lawsuits against the state, the family indicates that they hope to force changes in how the state administrates medical facilities, to make them more caring facilities and less like assembly lines and storage houses for the elderly.
 

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McKnights Long Term Care had a great article on a study that proves the importance and necessity of one-on-one supervision, exercise, and encouragement when feeding residents in a nursing home.  Because of prevalent understaffing in the nursing home industry, most nursing homes do not or cannnot provide enough staff to make sure that the residents are eating enough nutritious foods.

Supervision and encouragement during meals has been proven to reduce the occurrence of unintentional weight loss among long-stay nursing home residents according to the Journal of the American Geriatrics Society.  Vanderbilt University researchers assessed the unintentional weight loss of 76 nursing home residents.

Half of the group received additional attention during mealtime while the other half served as a control group.  Researchers noticed that 52% of residents maintained their weight when they were part of the extra attention group. That compares with 28% of residents in the control group.  Researchers suggest that groups of three or four residents per staff member during mealtimes are more practical and just as effective as one-on-one care.

The new study found that the combination of light exercise and specific nutritional supplements could help keep seniors fit for a longer period of time.   Researchers at Manchester Metropolitan University in England divided 60 seniors into two groups. One group performed moderate exercise once a week and the other performed high resistance exercise twice a week. Within those two groups, some received carbohydrate and protein supplements before and after exercise; some did not.   While all groups showed improved muscle mass and overall strength at the end of the 12-week trial, the most striking results came from the light exercise group that received supplements, according to the study.

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A jury found Life Care Centers of America guilty of negligence. The jury awarded $1.5 million in compensatory damages to the family of a former resident who died as a result of the nursing home's neglect and negligence.

Life Care Centers of America was sued by Dennis Matthews, son of the late Verdie Matthews. He proved the nursing home allowed Mrs. Matthews to develop severe dehydration and malnutrition which caused her death. 

Thomas Hornbuckle, attorney for Matthews, alleged the nursing home intentionally acted recklessly by falsifying fluid and nutrition records of Mrs. Matthews. Hornbuckle said evidence and witnesses had proved Life Care acted negligently and was at fault in the death of Mrs. Matthews.

Mrs. Matthews, 83, was a resident of the facility from the beginning of April 2006 to May 1, 2006. She was admitted to Bradley Memorial Hospital on May 1, 2006, and died on May 4, 2006. Medical records indicate at the time of admission to the nursing home Mrs. Matthews weighed 105 pounds. At the time of her death four weeks later, she weighed 92 pounds.

Attorney Steve Hornbuckle confirmed the jury found Life Care Centers guilty of negligence in contributing to the death of Mrs. Matthews.   The jury also found the nursing home acted "recklessly," according to Hornbuckle.

The jury will reconvene Monday morning to deliberate on awarding punitive damages. Both attorneys will be given a chance to argue the case.

Jury will decide punitve damages.

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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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McKnight's has an article about diabetes in the nursing home population. One out of every four residents over the age of 65 is diagnosed with diabetes, according to a new report from the Institute for the Future of Aging Services. Researchers analyzed data representing 1.32 million nursing home residents over age 65.

Among the findings: Non-white residents were twice as likely to have diabetes as white residents; diabetic residents were younger than their non-diabetic counterparts; and the prevalence of diabetes in U.S. nursing homes was higher in 2004 compared to previous years. IFAS is the applied research arm of the American Association of Homes and Services for the Aging. Those afflicted with the disease are at a greater risk for developing other conditions that can affect their quality of life and care needs, according to researchers. Diabetics are more likely to take more medication and arrive at a nursing home with pre-existing circulatory problems. Diabetics are also 56% more likely to have a pressure ulcer upon admittance. The research was published in the February 2008 issue of Diabetes Care. To view the report, please go to http://www.futureofaging.org.

This underscores the need for better nutritional assessments and interventions requiring getting blood work and lab results on a regular basis.  This also shows why preventative measures are needed to prevent skin breakdown.

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The NY Times has an informative article on the multi-disciplinary approach needed to prevent pressure ulvers in nursing home residents. 

The article defines a pressure ulcer as an area of skin breakdown that occurs when sustained pressure cuts off blood circulation — usually in patients confined to their beds nursing homes — a bedsore can result in a wound so deep (sometimes to the bone) and painful that some patients require narcotics. If a bedsore becomes infected, the complications can be fatal.

Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence.  New research requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. 

Dr. Joanne Lynn, who helped begin the project when she was a senior natural scientist with the RAND Corporation (she has since joined the Medicare centers), said the goal was to educate nursing home workers in bedsore prevention and to encourage them to come up with creative, low-tech solutions of their own. “It was a combination of education, cheerleading and something like systems engineering,” Dr. Lynn recalled.

Nutrition including additional protein, special mattresses made of high-density foam to reduce pressure in key areas, keeping feet elevated, repositioning frequently, keeping incontinent residents dry with routine changes, and proper fitting clothes are easy low tech solutions to preventing the developement or worsening of pressure ulcers. 

Clinicians document four stages of pressure ulcers, in which Stages 1 and 2 are superficial sores and Stages 3 and 4 are deep wounds that result from death of the skin and underlying tissues.

Dr. Horn, of the Institute for Clinical Outcomes Research, praised the collaborative as “the first major national effort driven by Medicare to reduce pressure ulcers.” But she said that better outcomes could be achieved if more nursing homes improved their documentation, so that all of the information on a given resident, including details on eating, urinary and bowel function, appeared on a single sheet, with key reminders to nursing assistants and other staff members about best practices.

Bedsores are “a major quality-of-life issue, and a self-esteem issue,” said Joanie Jones, a nurse at David Place in Nebraska. “No one wants to have sores on their bottom. I don’t care how old you are. You still want your skin intact.”

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