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

McKnight's site had an article and Science Daily also ran an article about how nurses and relatives routinely fail to detect the severity of chronic pain among nursing home residents, especially those with cognitive impairments, according to a new study in the September issue of the Journal of Clinical Nursing.

The five-year study from The Netherlands followed 174 nursing home residents at six different facilities. A total of 171 nurses and 122 relatives also took part in the study. Researchers conducted interviews with the non-cognitively impaired residents to determine how much, if any, pain they had reported in the week prior to the interview. Relatives and healthcare staff find it hard to diagnose pain levels in nursing home residents accurately, especially if they are cognitively impaired with illnesses such as dementia or unable to speak, according to a study .

The findings have led experts from The Netherlands to call for nurses to be given more education about how to assess and treat chronic pain and encouraging greater mobility and providing soothing massages, to alleviate pain.

Previous studies have shown that some people with mild or moderate cognitive impairment are still able to use simple zero to ten scales, where zero is no pain at all and ten is the worse pain imaginable.   "When the team interviewed the residents without cognitive impairments they found that all of them reported pain in the last week, but that only 89 per cent of the caregivers and 67 per cent of the relatives were aware of that pain" says Dr Rhodee van Herk. "However, if they were aware that the patient had experienced pain, the nurses and relatives gave it a median score of six out of ten, with the same score reported by the patients."

Nurses and relatives were less unaware of pain levels when the patient was at rest. They gave their pain levels a median score of zero, compared with the patients, who gave it a median score of four out of ten. However relatives were more aware of pain issues than nurses, with their median scores ranging from zero to five, compared with nurses, who reported a median score of zero to two. 

In general, there was more agreement between residents and relatives on pain levels than between relatives and nurses.

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The Middleton Journal had an article about two different employees of a nursing home, acting separately, stole narcotics from residents for years, and altered the residents' charts to make it look like residents actually received the need pain medication.  How could they not have been caught earlier?  didn't the residents complain that they were still in pain? 

Deborah Renee Richardson and Denise “Bells” Holtkamp are both accused of stealing Oxycodone from the Lebanon Country Manor nursing facility in Ohio.  Both nurses separately altered patient records so they could steal the addictive painkiller for their own use.

Both women were indicted by a Warren County Grand Jury on two counts of illegal processing of drug documents, a fourth-degree felony; two counts of theft of drugs, a fourth-degree felony; and two counts of aggravated possession of drugs, a fifth-degree felony.

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The British newspaper The Mirror had a shocking story about an elderly woman tragically abused and neglected.  She was found bed-bound, underfed, dehydrated and covered in ulcers.  She died after she was so badly neglected in a nursing home that horrific open wounds covered most of her body.

Gwendoline Hoar had painful pressure ulcers on her back, hips and feet.   She was in dreadful pain but managers at the private home refused to give her pain relief until the final two days of her life.  Two docotrs who visited Mrs Hoar and failed to help her have refused to co-operate with the coroner.

Two years after she died - no one has been arrested over her death.  Gwen's family now want a full inquiry. Son-in-law Gavin Langley said: "What happened was avoidable and dreadful. Someone has to be held to account. It's horrifying."

Gwen lived at home until the death of second husband Stan in 2004. He had been her teen sweetheart and they wed after first husband Cyril died. Gavin said: "They had 25 blissful, happy years. It was idyllic."

When Gwen developed dementia devoted Stan cared for her at home until his death. She went into one nursing home where she was well looked-after, but her condition got worse and she had to move to River Court. Both homes were paid for from savings.

Within four months of entering River Court she was close to death. After concerns were raised about the home, BUPA sent in skin expert Ann Moore, told the inquest into Mrs Hoar's death: "I found a frail little lady in her room who appeared quite undernourished.  She was very dehydrated. I could see she hadn't been turned frequently. In fact she hadn't been turned at all, according to the documentation."   Ms Moore found more wounds than listed in the notes. Some had dressings but others were open to infection. A specialist mattress to relieve sores had not been fitted properly so was of no benefit.

It was another month - and only after a visit from inspectors - before the local health trust was called in. Two district nurses who examined Gwen were shocked by her condition, which had got even worse. One said there were too many sores to list.   Some were found to be Grade 4 - the most serious - with skin and tissue split down to the bone. But instead of sending her to hospital doctors took the advice of a BUPA nurse that Gwen should be treated in the home.

The inquest heard that when they were urged to provide 24-hour pain relief for Gwen, managers "resisted" installing the equipment until two days before she died. A post-mortem found the sores were so painful they stopped Gwen moving, which led to pneumonia.

Coroner Graham Danbury said the care provided at the home was "seriously disturbing". 

Daniel Blake of Action on Elder Abuse said it was "a disgrace" no one had been held to account.

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A New Jersey appeals court ordered a new trial in a medical malpractice case because the award for pain and suffering was too low to adequately compensate the plaintiff for the rest of her life.  The jury awarded $100,000 for pain and suffering.  The Appellate Division ordered a new trial finding the award "grossly insufficient and a miscarriage of justice," but left in place the liability verdict and $800,000 in economic damages.

Maureen Walsh saw a succession of doctors starting in 1995 for circulatory problems in her toes. By the time she met with vascular surgeon George Constantinopoulos in early 1998, she was in severe pain. He recommended an arteriogram, saying it should be done promptly but that another doctor should arrange it because he was not in her health plan.   A subsequent bypass operation showed that amputation might be necessary because painful gangrene had set in. First she lost her foot, then part of her leg and finally, in 1998, most of her leg as the gangrene advanced upward and her leg began to turn colors.

She was 50 at the time, and federal government estimates give a woman of that age a life expectancy of 32.5 years. 

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