Nursing home fails to protect resident from violent assault

San Antonio's KENS5 had an article about the investigation into a local nursing home failed to keep a violent man from assaulting a female resident.  Her family not only wants justice against Daniel Villareal, the man who choked and beat Maier, but also the Brookdale Living Center to be held accountable for leaving their back door unlocked.  The Texas Department of Aging and Disability has finished it's investigation and revealed the facility neglected to "to have a key to lock the door" and that "no headcount was taken after the alarm sounded."

They didn't even bother to check to see if the resident was okay,  We give them our grandparents and our parents to protect.  I don't think it's a hell of a lot to ask to do one thing. Lock a door.  Her past four months have included being assaulted and three major operations.  That's the thanks she gets for trusting these people.

The regional vice president for the Clare Bridge Brookdale Senior Living Center John Nienstedt, reported that no employees were fired following the incident and that they will remain open after they provided a plan of correction to the state.

 

Illinois Task Force Proposals

The Chicago Tribune had an article about the weak and disappointing proposals to improve safety and the quality of care in nursing homes.  A panel appointed by Gov. Pat Quinn proposed  an array of sweeping reforms designed to end the chronic violence and abuse that plague some nursing homes, while fostering better treatment for people with serious mental illness living in those facilities. The proposals range from tightened criminal background checks of new nursing home residents to stronger sanctions and enforcement of facilities with chronic safety breaches.

Quinn's Nursing Home Safety Task Force also recommended that state police begin searching nursing homes for residents with outstanding warrants, and urged the state to increase minimum staffing requirements of the facilities to bring them up to standards spelled out in federal government studies on nursing home care.  "Urge"?  Why don't they propose specific hours per patient day?

 

27 "preliminary recommendations" will be refined before a final report is delivered to the governor. Quinn's task force was formed in response to a series of Tribune reports on assaults, rapes and murders in the state's nursing homes. Illinois as most states, extensively mixes geriatric and mentally ill nursing home residents, and understaffed facilities have failed to treat and monitor their most violent patients, government records show.

Mark Heyrman, a University of Chicago Law School professor and chair of public policy for Mental Health America of Illinois, was more cautious, saying the recommendations "do not go far enough. ... We are concerned that, once the media attention dies down, the state will be under renewed pressure not to enforce either the old laws and rules or the new ones proposed by the task force."

The task force recommended that the state Department of Public Health hire additional nursing home inspectors and retrain its current inspectors to focus on safety and care issues involving the mentally ill. Although mentally ill people, if given proper treatment, are no more likely than others to be dangerous or to commit crimes, many facilities provided grossly substandard care, the Tribune found. Many of the psychiatric patients are clustered in a relatively small subset of nursing facilities whose impoverished residents have few other options, and the paper's analysis showed the homes with the most felons had the lowest nursing staff-to-patient ratios.

Among the reforms that might be put into place fairly rapidly are a tightening of criminal background checks and screenings of people entering nursing homes. The Tribune's review of confidential case files showed the state's criminal background checks on new residents were riddled with errors and omissions that grossly understated their criminal records and danger to others. Some of these poorly screened offenders went on to commit assaults and other serious crimes inside the homes where they lived.

The task force recommended more detailed assessments to gauge people's potential for engaging in violent behavior, and said the criminal checks should be started before people are admitted to facilities. Also, the task force urged the state to sanction homes that do not promptly complete the screening reports.

The Health Department should get greater authority to revoke the licenses of nursing homes that repeatedly violate state safety regulations, the task force said. And government agencies should mete out more severe sanctions on nursing home administrators and top employees who engage in misconduct.

The Tribune reported that frail and elderly residents often were pumped with powerful anti-psychotic drugs without their consent and without a proper diagnosis. One of the nation's most prolific prescribers of psychiatric drugs provided assembly-line care for thousands of mentally ill patients housed in Chicago-area nursing homes -- while a large pharmaceutical company paid him to promote the drugs despite doubts about his credibility.

 

Ranking nursing homes

U.S. News & World Report issues the best and worst nursing homes every year based on federal and state inspections, surveys, and required data on staffing.  Here is the most recent article.  The rankings are only as good as the investigators which in most cases is poor.  On a given day, 1.5 million people are living in the nation's 16,000-plus nursing homes, and in a typical year more than 3.2 million Americans will spend at least some time in one. 

 

The U.S. News rankings rely on Nursing Home Compare, a program run by the federal Centers for Medicare and Medicaid Services. CMS analyzes information on all homes enrolled in Medicare or Medicaid.  The homes also receive ratings of one to five stars in each of three areas: health inspections, nurse staffing, and measures of care.

At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code. But you can't assume that all five-star homes, or those with three or four stars, are of the same quality. There are so many homes in each rating—1,855 in the five-star and 3,661 in the four-star categories alone—that the range of performance is bound to be very wide. Nor can search terms be combined if, say, you want only five-star homes within 50 miles of a specific city.

America's Best Nursing Homes addresses these and other issues. Homes are presented in tiers within each star category, based on their total stars in all three of the major areas. The topmost tier, for example, consists only of five-star homes that got 15 stars. The next tier down is five-star homes with 14 total stars, and so on.

Here are more details about the measures that go into the CMS ratings.

Health inspections. Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months. They also investigate health-related complaints from residents, their families, and other members of the public. "Health" is broadly defined, as is evident in the 180-some items on the checklist. Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents' rights and quality of life, and proper skin care. A home's rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame. State inspectors also check for compliance with fire safety rules, although their findings do not factor into the CMS ratings.

Nurse staffing. Even the best nursing care is not enough if there are too few nurses to spend much time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day. 

Quality measures. Nursing homes have to furnish the latest three quarters of clinical data showing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair. The Best Nursing Homes rankings and Nursing Home Compare display data for each home on all 19. The ratings, however, are based on 10 that are considered the most valid and reliable, such as the two above and measures related to pain, bedsores, and mobility.

 

Resident wanders away from facility

NewJersey.com ran an editorial about the resident who was allowed to wander away from Preakness Healthcare Center in Wayne.  A resident with dementia wandered out of the nursing home and was found more than two hours later, roaming in the snow and ice and subfreezing weather. 68-year-old Vidal Mojica, was rescued by members of the Passaic County Sheriff's Department. Mojica, who uses a walker to get around, was found behind the nursing home on Oldham Road wearing just a golf shirt, pants and shoes. Mojica was transported to St. Joseph's Wayne Hospital, where he was being treated for exposure to the cold.

One Preakness employee said Mojica would have to have climbed unsupervised down three flights of stairs with his walker to leave the building. The employee also said Mojica is the second resident to wander away from the nursing home since it opened in October.

While we understand the need to protect the confidentiality of a patient, we are disturbed by the county's stonewalling about the circumstances of his escape from the facility. This is an issue that concerns not just one Preakness resident and his family; it is an issue of deep concern to every county resident.

Numerous questions need to be answered:

How could a patient using a walker have escaped so easily? How could he have gotten so far so fast and remained unseen for more than two hours?

Is there some design flaw in the new building that makes it susceptible to such "escapes"? If so, what steps are being taken to correct them?

Finally, has this happened before, and how can we be assured it won't happen again?

Such a lack of information about what appears to be a severe breach in security in a brand-new, $90 million facility that has already taken on the scorn of taxpayers is not something the county or facility administrators can afford to just slough off.

Perhaps there is a perfectly reasonable explanation of how a 68-year-old man using a walker was able to elude authorities for more than two hours. If so, we'd love to hear it.

At-home technology protects elderly

Miami Herald had a great article about how new technology is helping elderly people.  New devices monitor how well seniors are managing activities of daily living, aid with some tasks and help avoid any move to a nursing home.  Scientists, doctors, engineers and philosophers  gathered last month at a TEDMED (Technology, Entertainment, Design Medicine) conference to unveil solutions to some health care problems.

One of the devices that has been improved over the last few years is a pendant that can call 911 if the wearer falls.  Now the device can be programmed to answer the phone, reminders to take  medicine or alert to a fire, among other things.   It's one of several new products designed to help seniors stay in their homes.  At-home technology now can monitor senior citizens' movements, vital statistics, and sleep and bathroom patterns.  Many older people like having technology provide this extra layer of security because it doesn't require them to give up privacy.

The monitoring systems, which cost $150 to $200 a month, are more often prescribed to seniors for a limited time after a hospitalization or health issue. Some also are being used in assisted-living facilities where operators like the additional protections they offer.

Technology will allow seniors to avoid ``unnecessary early institutionalization'' because it will relieve the anxiety of loved ones. The ability to closely monitor a person's lifestyle also can help family members know when the older person is unable to remain home, said Katie Boyer, director of marketing for Home for Life Solutions, in Lee Summit.

Besides monitoring falls and daily activities, her company sells equipment that will turn off a stove if the user forgets. A built-in motion detector turns the appliance off if the user leaves the room and does not return in a specific time frame. As for managing medicine, systems exist that will dispense it at appropriate times and remind patients to take it. If the patient fails to take the medicine, the pills can move into a locked chamber to avoid an overdose.

GE has two products aimed at seniors: Health Guide allows users to check their blood pressure, sugar levels or heart rate daily. The information is sent to a medical provider who tracks it. If problems arise, the patient can have a teleconference with a nurse or schedule an appointment with their doctor.

The company also offers QuietCare, which uses sensors that learn daily activities and behaviors, and then watches for changes. The sensors will alert help if a person falls, goes to the bathroom at night and doesn't return to bed, or fails to get out of bed in the morning. Sensors also can be placed near the medicine cabinet or refrigerator, so monitors can track whether the person is taking their medicine and eating.

John Cobb, CEO of Senior Lifestyle, started to install QuietCare in some of his company's 70 senior living facilities this summer because he thought it would make residents safer. With QuietCare, his staff can keep track of residents' whereabouts at night, he said.

 

Staffing and Fall Prevention

Another great Star-Tribune article about the inadequate staffing levels in nursing homes.   John Doll and Sharon Erickson Ropes wrote the article.  They are state senators and policymakers in Minnesota.  They focused on two important themes that ran through the entire prior series: inadequate staffing and staff training at Minnesota nursing homes.  Both relate to funding of Medicaid reimbursements and the greed of the for profit national chains.

State funding for nursing homes has been a highly charged issue at the State Capitol under the Pawlenty administration. The governor has repeatedly thwarted efforts to raise funding for nursing homes despite protests from senior advocacy organizations and the ardent efforts of legislators on both sides of the aisle. Just this past year the governor unalloted an increase in reimbursements that would have helped nursing homes keep up with the cost of providing quality care to their residents.  However, safety and quality care should never be compromised. Failing to properly fund these services for our elders leads to tragic outcomes.  Budget cuts are forcing caregivers to be responsible for more and more vulnerable adults without adequate supervision, resources or proper training.

Nursing homes depend on state and federal dollars to keep their doors open. As funding has been stripped away, these facilities have been forced to reduce staff, freeze wages, delay needed upgrades and repairs, and sometimes cut corners when it comes to providing quality care, as was shown by the Star Tribune series. Inadequate staffing leads to poor working conditions for caregivers, which in turn significantly increases the risk of serious mistakes.

Our goal is to supply nursing homes with the tools and resources they need to provide quality care to their residents, and to ensure that when accidents occur, every step is taken to prevent future mishaps and to provide seniors and their families with the answers they deserve.

 

 

Star-Tribune Series on Falls Part 3

The third part in the series based on the Star-Tribune's excellent investigation into falls in nursing homes deals with prevention.  The key to prevention is proper staffing and training.  Inadequate staffing is a common complaint from nursing home workers, industry watchers and families with loved ones in nursing homes. More than 1,000 Minnesotans suffered fall-related deaths in nursing homes from 2002 through 2008, according to a Star Tribune analysis of death certificates.

Every night, after pulling on her scrubs and heading to work for the night shift, the nursing home aide would start to feel tense. Frail people's lives would soon be in her hands. Call lights would blink. Alarms would beep. Sometimes she felt too rushed to care for everyone properly.

"If there's one alarm going off in one hall and there's another one going off in the other hall in the other direction, which one do you go to first?" she said. "One of them you're going to save from falling. The other one is going to fall."

"I think it's really related to the inadequate staffing. Totally related. And, you know, the damage is untold," said Charlene Harrington, a professor emeritus of sociology and nursing at the University of California, San Francisco. She has done numerous studies on nursing home staffing. Though state and federal staffing standards are not precisely defined, 75 percent of Minnesota nursing homes reporting data are understaffed by one federal measure.

In interviews with the Star Tribune, 16 nurses aides at some homes with more than 10 fall-related deaths from 2002 through 2008 frequently complained of insufficient staffing. They requested anonymity, fearing for their ability to get jobs in the industry. The former night shift aide, who once worked at two metro area nursing homes, said it sometimes felt like chaos, even at 2 a.m.

Nurses aides help nursing home residents do the routine things others take for granted: Get out of bed, go to the bathroom, walk, eat.  Nursing homes have struggled to find good workers in the past, although the recession has widened the pool of candidates recently.  The average hourly wage for a nurses aide in Minnesota is $12.86, according to the state Department of Employment and Economic Development.

The impact of staffing can be profound. At St. Anthony Health Center, a frequent visitor told state inspectors doing a routine survey that she saw residents sit unattended for long periods, get out of chairs on their own and get agitated waiting for help to the bathroom. One nurses aide said she was concerned about residents' safety. Another said it was sometimes difficult to get to beeping alarms when they're busy with other residents. The survey the home for insufficient staffing, at the same time noting multiple falls.

The biggest roadblock to more staffing, by all accounts: greed for profits.

Nursing home care is already too expensive. The homes receive from $3,000 to almost $9,000 a month per resident in Minnesota, according to the state Department of Human Services. The average monthly cost is $4,858. About $1.35 billion was spent on nursing home care in Minnesota in 2007, according to the department. Medical Assistance paid for $813 million in fiscal year 2008.

At a minimum, Minnesota requires that homes provide two hours of nursing care per resident per day. Federal regulations say a nurse must be on duty 24 hours a day. Both say homes must have "a sufficient number of qualified nursing personnel on duty" to meet residents' needs, but give no number or ratio.

The federal Centers for Medicare & Medicaid Services (CMS) regulates nursing homes nationally and contracts with states to enforce the regulations. It calculates expected staffing levels for each nursing home, taking into account the severity of their residents' needs and time needed to care for them. Using those expected staffing levels, 278 of 371 Minnesota nursing homes are understaffed.

One federal study in 2001 found a high staffing ratio helps only to a point. For long-term residents, it found, staffing above 4.08 hours of care per resident each day didn't improve quality of care.

Little Sisters of the Poor nursing home in St. Paul is one of about 90 nursing homes in the state that has higher staffing than CMS expected.  Sister Theresa Robertson, the nursing home's administrator, said she believes there is a correlation between staffing and falls.  Higher staffing means residents can be watched more closely, she said. That may help the staff figure out when residents are acting differently and understand ways to help them and prevent falls, she and other administrators said.

Nursing home resident Jim Grant, who once lived at Rose of Sharon Manor in Roseville, said it took too long to get a response when he turned on his call light. Grant, a 73-year-old stroke victim, said that once when he needed to go to the bathroom, he got up by himself and fell and cracked bones in his right leg about a year ago.

There are no uniform regulations for timeliness in answering call lights. As Grant sat in his cramped room at Rose of Sharon, his bed surrounded by family photos and knickknacks, a woman down the hall bellowed in a hoarse voice, "I have to go to the bathroom! ... I've got to go. I've got to go ... I've got to go now." "She's got to go bad," Grant said. He noted that yelling to get a staff member's attention wasn't uncommon.

State health investigators and regulators rarely issue citations for staffing levels, data shows.  But nurses aides know that, even if they're working short-staffed, they're often the ones who take the blame for falls. In about 60 cases where records showed what happened to the nurses aide, homes fired aides about half the time. In 18 cases, homes issued suspensions or warnings or retrained the aides. In 11 instances, nurses aides quit.

One former nurses aide at Crest View Lutheran Home in Columbia Heights said she got frustrated by staffing levels when she worked there in 2007. She and other former Crest View workers described a lack of teamwork. At 4:30 on a Sunday afternoon this summer, the Crest View dining room came alive as staff members in colorful scrubs helped residents to dinner using wheelchairs, walkers and belts. One hallway was nearly deserted, except for one resident who talked on the phone in her room, another resident who sat near a room window, and a third who quietly ambled down the corridor. Throughout the hallway, a beep echoed repeatedly. There were no staff members in sight. The nurse's station sat empty. Crest View, which had at least 13 fall-related deaths from 2002 through 2008, was cited for insufficient staffing early this year as part of regular nursing home surveys.

 

Great report about falls in Star-Tribune

The Star-Tribune had a series of articles based on their investigation into nursing home sin Minnesota.  Although the series concentrates on records from one state, it is persuasive as to what is going on nationally.  The first article "When Death comes without Dignity" discusses the investigation itself.

A Star Tribune report documents a troubling pattern in nursing homes based on death certificates.  They looked for patterns that might lead to a story, such as drug overdoses or medical errors. The death certificates noticed a number of deaths related to falls by patients in nursing homes.  More than 1,000 deaths related to falls in Minnesota nursing homes over the six-year period.

"As we worked on these stories these last several months, editors and reporters would literally shudder at some of the examples we had uncovered. Our minds would quickly flash forward to what would be in store for us when we grew old. Does anyone want to imagine being 90 years old, alone at night in a nursing home, struggling to get to the bathroom when no one is around to help?"

The Star-Tribune staff spent several months tracking down the families of those who had died from falls, exploring the conditions that led to an individual death, and talking to nursing homes in the hopes of explaining why so many of the elderly die in such a painful manner. One thing that became clear was how quickly the stability of a nursing home resident can change, "how one little incident can lead to the end."

The reporters also discovered some clear trouble spots: Reporters talked to nursing home aides who were at wit's end trying to keep up with the needs of their patients; to children who couldn't get a straight answer about how their parents had died, and to nursing home advocates who asked whether we just wanted them to tie up old people to make sure they don't hurt themselves. (Of
course not.)   The nursing homes' internal investigations are private, and the state does not require a complete review of every death by fall.

I will blog the next couple of days regarding this series of articles.

 



 

Invention provides self-reliance, dignity for the wheelchair-bound

Argus Leader had an interesting article written by Anna Bahney about a new invention that may help wheel chair bound residents.   Greg Johnson designed the wheel-chair to help his parents. Glenice Johnson spends her day in a wheelchair that her son developed, and Greg has turned over the wheelchair to a group of South Dakotans who work to find others who could benefit the way his mom has.

The chair, called the Dignity200, is the first wheelchair on the market that allows what the makers call "self-toileting."  The user pushes a lever that drops a center panel from the seat. The person backs the chair over the commode, readjusts clothing and urinates or allows for a bowel movement as if sitting on a toilet seat. Once clean, and after adjusting clothing, the user moves the chair away from the commode and the panel is returned to place.

"If I'm here by myself, I can take care of what I need to," Glenice said. "Mentally and emotionally, it is a tremendous plus. It makes all the difference in me being at home."

The adjustable, custom-built chair, available at Kreisers medical supply store in Sioux Falls and a growing number of similar stores, costs $2,950.   It is an expensive chair, Greg admits. But chair effectively pays for itself every three weeks, considering that a month's stay in a long-term care facility can run at least $5,000.

But the greatest benefit might be a wheelchair-bound person staying home as long as possible.

Greg said he was able to figure out how to remove the understructure from beneath the wheelchair but couldn't work out the drop-down panel.  He called up a rancher friend with a background in engineering to pick his brain.   Together, they began to work on prototypes. The hardest part, Greg said, was "making sure the seat cushion would be of a quality that allows her to stay in the seat all day. If that didn't work, it wouldn't be possible."

The Dignity200 now is approved by the Federal Drug Administration and is in testing for applications outside the home. According to the Centers for Disease Control and Prevention, health care workers who routinely lift and move patients have a higher risk of injuries than workers in most other occupations, and the number of those injuries are increasing.

In September, the chair became part of a risk prevention study overseen by the University of South Dakota medical school in partnership with the Good Samaritan Society.

"The lifting and transferring from chair to commode and so forth for residents whose conditions tend to be frail, that's a significant issue and a significant source of injury to residents and staff," said Bill Kubat, vice president for resident community and quality service at the Good Samaritan Society.

A trial of the chairs at a Good Samaritan facility helped the chair get where it is now. Stories emerged, including staff who felt the chair made their work safer and a woman who had not used the bathroom on her own for four years and cried when the chair had to be returned at the end of the trial.

But the longest test case has been Greg's mom, who has been in the chair for two years.

"For my mom, she can feel like she's on her own a little more again," Greg said. "And my dad doesn't have to be home. He's got a lot more freedom and he's doing a lot less lifting. It has changed their life."


 

Georgia dumping violent prisoners into nursing homes

Macon.com posted an article about a proposal in Georgia to house sex offenders, violent offenders, those being electronically monitored and those with medical and mental health needs in nursing homes.   The state DOC is working with the state Board of Pardons and Paroles to recruit nursing homes, assisted-living facilities and other organizations interested in housing offenders upon release from prison.  Why would they be interested in bringing these dangerous people into the homes of our parents and grandparents?  The only reason is greed and reckless indifference to the safety of their other residents.

The statewide briefings are designed to serve as an "educational forum" for potential housing service providers, according to a Georgia Department of Corrections news release.  Briefings will be held across the state through February 2010. For more information about the meetings, contact LaTrese Schofield, residential coordinator for the state DOC, at schofl00@dcor.state.ga.us or (404) 463-2947.

Please contact Ms. Schofield and tell her this is a bad idea.

 

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