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

The Star-Tribune had an interesting and scary article on a nurse who stopped giving CPR to a resident.  A registered nurse wrongly ordered a halt to CPR on a resident at Woodbury Health Care Center.  The resident was dead before emergency responders could take over. On arriving at the home they questioned why CPR was stopped.

The nurse, who was not identified in the report, had a history of disciplinary actions. "She is dead," the nurse told a fellow staff member soon after he began applying chest compressions on the resident according to a state Health Department report. The staffer kept up resuscitation efforts until the nurse repeated her command to stop by yelling at the staffer.

Clearly, this is a serious violation of a resident's rights.  Residents have a right to any and all treatment that will prolong their life.

The nurse's personnel file, included in the report, shows that she had been cited for needing to improve her job knowledge, professionalism and relationships with subordinates, residents and families. A doctor filed a formal complaint against her in 2007 for "improper conduct" and in 2009 she was disciplined for failing to follow wound-management protocol.

Until late last year, Woodbury Health Care Center was on the federal government's list of about 200 nursing homes that get closer scrutiny, including semiannual inspections, because of a history of regulatory problems. Inspectors found 23 rule infractions in the home's annual inspection in April 2008; that was down to the state average of nine a year later.
 

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The Las Vegas Sun had an article about a nursing home that was cited and fined $5,100 by the state for repeated health and safety violations and ordered not to accept new residents.  These violations are incredible.  The bureau said an “immediate jeopardy situation” was declared due to missing resident medications, failure to have criminal background checks, an ongoing cockroach infestation, a lack of a functioning auditory alarm system, poor care on a resident with a colostomy, tuberculosis testing and medication administration.

Eight of the deficiencies were repeats from previous inspections. The state Bureau of Health Care Quality and Compliance said there have been repeated violations dating back to February of 2007 at Best Care Facility which was fined $600 last year.  Surveys in 2007, 2008, 2009 and in February this year showed multiple violations. The bureau said the home was inspected Feb. 2 this year and received the grade of D when 30 violations were found.

“It has been determined that residents are not safe at this facility due to chronic, repeated non-compliance and that the facility is engaging in practices detrimental to the health and safety of the residents,” the bureau said.

A person named “Danny” at the nursing home answered the telephone. He said he would return a call later but he declined to give his last name.

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San Jose Mercury News had an article about a Stockton nursing home facing California's stiffest penalty after state investigators found the facility did not adequately protect a 92-year-old resident from a fatal fall.   The 120-bed Valley Gardens Health Care and Rehabilitation Center received a "AA" citation and a $90,000 fine for the 2007 death of retired Stockton businessman Robert Doscher.

A California Department of Public Health report found staff at Valley Gardens failed to check on Doscher as often as his chart recommended.  The state said Doscher's death certificate listed his cause of death as accidental from falling down on his head in the bathroom.

 Recordnet.com had additional information in an article.  Valley Gardens failed to ensure that the 92-year-old Doscher was adequately supervised and, as a result, he fell and later died, according to Dr. Mark Horton, director of the California Department of Public Health.  By its own assessment, Valley Gardens knew that Doscher was a serious risk to himself but it failed to act properly in protecting him from falling, according to the state's recently concluded investigation.

Doscher was admitted to Valley Gardens on May 18, 2007, from an acute-care hospital. He required the use of a walker when he was admitted, and it was initially planned that he could be discharged to a board-and-care facility when his condition stabilized. He was assessed by Valley Gardens nursing staff as a "high risk for falls" and his chart indicated that he should be checked every one to two hours. Also, he was to be told not to get up without assistance; a motion-monitor alarm was to be used to alert staff to any unsafe activity; and he should have been placed in front of a nursing station for closer observation.

Three days after he was admitted, he was found on the floor, where he hit his head, apparently after falling while trying to get back into bed by himself, according to the state's report. As of June 4, the report notes that "there was no documented evidence the resident was checked on every two hours" and he still was not located in front of a nursing station, as required by his assessment.

On June 12, two days before he died, he was again discovered on the floor, apparently after a fall. The report notes that "resident A rapidly developed a change in condition manifested by agitation and then a decrease in his level of consciousness." The next day, he was taken to an acute-care hospital in a comatose state, and within 24 hours he was dead.

Doscher's death certificate, according to the state, listed his cause of death as "accidental from falling down on his head in the bathroom," resulting in an acute subdural hematoma from blunt force trauma.

Valley Gardens is a for-profit skilled nursing facility owned by Kindred Healthcare Inc. of Louisville, Ky. Kindred, with revenue of more than $4 billion as of June 30, operates 222 skilled-nursing facilities and more than 650 health care programs in 41 states, according to its Web site.

Its Stockton facility has a two-star "below average" rating - out of five stars - on Medicare's Nursing Home Compare Web site, which looks at health inspections, nurse staffing and quality measures and then assigns ratings based on nationwide standards.

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WCCO out of Minnesota had an article about how most violations in nursing homes are under reported.  This seems like common sense since most employees do not want to risk their jobs admitting mistakes, and there is not enough personnel to enforce the regulations or conduct proper investigations. Many complaints are ignored because the nursing home claims the resident was demented.

The system designed to help Minnesotans choose a nursing home for loved ones is under fire. Serious flaws in the system have been uncovered by a nursing home watchdog group.  You might not know about physical and sexual abuse happening inside the nursing home.

Wes Bledsoe, the founder of a nursing home watchdog group, says he can prove that the rating system on Medicare.gov does not show what is really going on in nursing homes.  For example, after all of the well known abuse at Good Samaritan Society in Albert Lea, a report from the Minnesota Department of Health says no deficiencies were noted at the nursing home.

At a different facility in the state, someone saw an employee pick up a nightgown soaked with urine and that worker "shoved it in the resident's mouth and told her to shut up." Again, the Department of Health didn't note any deficiencies.

A spokesperson from the Minnesota Department of Health said "If a facility has taken appropriate steps to correct problems, they may not be cited with deficiencies."  However, when deficiencies aren't noted, they don't show up on the Medicare site, so there's no way you could know if you've only checked that Web site.

Bledsoe said it's happening all the time. He found that 80 percent of confirmed abuse cases in Minnesota in the last four years didn't get reported to the feds.

"I think it's bureaucratic mumbo-jumbo that's deceiving the consumers and the American public about what's really going on in our long-term care facilities," said Bledsoe.

Bledsoe said another big problem is the star system on the Medicare Web site. On a lot of the nursing home Web sites, a lot of the information is not available, so he's wondering how they can give a place four or five stars when there's no information.

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The St. Paul Star-Tribune had a tragic story about abuse in local nursing homes, and new measures used to protect residents.   After state investigations at two homes last year, three former aides were charged with 10 or 11 counts of physically and sexually abusing residents with dementia.  Ashton Larson and Brianna Broitzman were accused of abusing seven residents at Good Samaritan Albert Lea.  Maria J. Bjerke was charged with abusing six residents at Luther Haven in Montevideo.  

The episode started when the doctor of a resident in Cerenity's 30-bed dementia unit reported Oct. 13 that she had trichomonas, a sexually transmitted disease.   Cerenity's investigation swung into high gear 16 days later, when a different resident with dementia said she had been attacked.

The home notified regulators and began to investigate.  The medical director and nurses from other homes started to examine every woman on the unit, and by nightfall six were sent to a hospital for sexual assault exams.  Doctors there found that three showed "lacerations and physical findings consistent with recent sexual assault."

The home reported the allegations to the state and to police, and launched a two-prong plan to investigate the case and protect residents from a potential sexual predator.

The Cerenity Bethesda nursing home stationed guards at its doors to register and escort visitors, sent eight male employees home with pay and called in national experts to examine all male and female residents in the 117-bed facility.   It also retrained staff on how to spot sexual abuse and for more than a month used a "buddy system'' to ensure that no resident was alone with an employee or visitor. The Department of Health cited Cerenity Bethesda twice during its investigation for inadequate measures. The "immediate jeopardy'' citations faulted the home for failing to adequately protect residents and failing to take immediate corrective action.

There has been growing public awareness in the past year that Minnesota nursing home residents with dementia are particularly vulnerable to physical and sexual abuse.

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The San Diego Union-Tribune had an article about a nursing home which received the most severe citation and a $90,000 fine after an investigation found that poor treatment and supervision resulted in a resident choking to death last year.   Escondido Care Center, a 180-bed facility, failed to adjust the patient's meal plan to meet his changing dietary needs. The resident suffocated when food became stuck in his windpipe and the right main bronchial stem. He was eating a lunch of beef with barbecue sauce, mashed potatoes, and steamed cabbage and carrots. During lunch, the patient coughed repeatedly until he became unresponsive and slumped over in his wheelchair. The patient died.

The facility was well aware that the resident had swallowing problems and was at risk for choking.  His physician had ordered a strict diet to avoid problems with chewing and swallowing.
On two occasions in November, the facility's dietary supervisor, registered dietitian and a nurse wrote in the patient's file that he was having difficulty chewing and that he was coughing while drinking “thin liquids.”   No records exist to show that any staff member alerted the resident's doctor or tried to alter the man's diet or supervise it more closely.

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The American Association of Homes and Services for the Aging (AAHSA) developed a Task Force on Survey, Certification and Enforcement.  In June 2008, they issued a report titled Broken and Beyond Repair: Recommendations to Reform The Survey and Certification System.

The AAHSA Task Force on Survey, Certification and Enforcement believes strongly that
despite some measurable, specific successes, the nursing home oversight system has,
overall, failed to fulfill its 20-year-old goals to ensure a nursing facility’s “sustained
compliance” with regulations and to enhance quality of care and quality of life for
residents living in those facilities. The Task Force’s year-long examination has convinced
each of its members not only that the system is not working today – but also that the
system will not work in the future, when a growing number of older Americans with
increasingly complex care needs will seek care in nursing homes. Now is the time – not
tomorrow or next year or five years from now – to take bold steps to design a new system
for ensuring quality of care and quality of life in this country’s nursing homes.

The National Commission for Quality Long-Term Care, a bipartisan study group,
suggested in its December 2007, report that the long-term care system can no longer
depend on “the old ways of doing things.”19 In this report, the Task Force on Survey,
Certification and Enforcement urges AAHSA to take the lead in advocating for steps that
will introduce “new ways of doing things” into the survey and certification system. We
urge the association to consider our recommendations carefully and to act on them
boldly.

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Numerous media outlets have discussed the recent report from the Inspector General that shows that 92% of all nursing homes violate the standards established by the federal and state governments.  ABC News had a good article here.

A government report released found extensive problems in America's nursing homes. Nearly one in five of the nearly 15,000 nursing homes examined were cited for violations that put patients in immediate harm in 2007.   92 percent were cited for some type of deficiencies during each of the last three years.

The quality of care in nursing homes was the focus of those deficiencies. Experts also found that  far too many residents waited too long to get the help they needed.

"Very few of these deficiencies ever result in a financial penalty," said Wes Bledsoe, founder of A Perfect Cause, a non-profit group that advocates for the reform in long-term care. "And if they do, they are not collected. The system has no teeth."

"It's a priority for me in this office because sometimes it's a double crime," New York State Attorney General Andrew Cuomo said. "First of all, it's a fraud against the taxpayer. In many cases, taxpayers are actually funding these organizations and these institutions and they're being defrauded. And secondly you are literally affecting the most vulnerable in our society. And that's our first priority -- to protect those people who literally can't protect themselves."

This week's report revealed that for profit homes are actually more likely to have problems than facilities run by local governments or non-profits despite having more resources and making substantial profits.
 

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The NY Times had a recent article about the prevalence of violations in the vast majority of nursing homes. National for profit chains seem to get more violations than others.  The article cited that more than 90 percent of nursing homes were cited for violations of federal health and safety standards last year.   About 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.

Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.  Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.

About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.  The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.

“For-profit nursing homes had a higher average number of deficiencies than the other types of nursing homes,” Mr. Levinson said. “In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.”

On Monday, Mr. Levinson issued a compliance guide for nursing homes that says some homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.” Researchers have found that people receive better care at homes with a higher ratio of nursing staff members to patients.

The inspector general said he had found some cases in which nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all.”

More than 1.5 million people live in the nation’s 15,000 nursing homes. The homes are only inspected once a year and must meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.

Medicare pays a fixed daily amount for each nursing home resident, with higher payments for patients who are more severely ill. Mr. Levinson said some nursing homes had improperly classified patients or overstated the severity of their illnesses so the homes could claim larger Medicare payments.

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