On August 12th, three teenagers in Detroit, MI have been charged with raping a 90-year-old woman. Maurice Randall, 17, Anthony Hardy, 18, and a 15-year-old boy whose name is not being released because he is a juvenile were arraigned immediately.
Continue Reading...In Plainfield, IN a former nursing home worker Brenda Chaney is claiming that discrimination played a part in her termination from the nursing home where she worked.
Continue Reading...According to a report from the Willows Journal in Willows, California, a woman was convicted and sentenced to three years of probation following misdemeanor elder abuse charges. The report states Susan Ivy’s sentence was originally set for 6 months in a county jail at the recommendation of the District Attorney, however, the court judge suspended the sentence pending Ivy’s completion of her probation sentence.
Continue Reading...According to a report by KMOV Channel 4 in St. Louis Missouri, a Jennings Missouri woman is charged with second-degree elder abuse and armed criminal action after she reportedly attacked her 69-year-old boyfriend with a trophy.
The Lexington, Kentucky NBC Affiliate, LEX18 has reported that an administrator for Hazard Nursing Home Incorporated and the company itself have been charged with failure to report suspected elder abuse. The report states that 61-year-old Sheila Noe was allegedly aware of a possible case of elder sexual abuse from one patient to another and did not report the incident to proper authorities.
Continue Reading...According to a report posted on presstelegram.com, a Long Beach woman wanted by police for stealing over $4 million from an elderly stroke victim has turned herself into authorities. 54-year-old Li Ching Liu entered a plea of not guilty to Long Beach Superior Court on charges of elder abuse and robbery.
Continue Reading...A 33-year-old man was found guilty of elder abuse in a case in Ventura County, CA according to a report posted by the Ventura County Star. 33-year-old Edmundo Prieto Ramirez was found guilty on five counts of elder abuse by theft.
Continue Reading...The CBS affiliate WRGB in Albany, New York has posted a report discussing the many signs that often point to elder abuse. According to the report, there are many signs that can indicate potential elder abuse.
Continue Reading...A report posted by the Paragould Daily News in Paragould, AR is reporting that a 44-year-old woman was arrested on June 2nd charged with neglecting her elderly mother. Joan Dollins faces charges of abuse of an adult – a class B felony charge. The report states that this charge includes negligence and abuse or exploitation of any endangered or impaired person, if the abuse causes substantial physical injury or risk of death.
Continue Reading...The Willows Journal has posted a report regarding police executing two search warrants in a possible elder financial abuse case. Both warrants were reportedly executed earlier this month, the first at the home of Jodene and Harry Sage, and the second at Butte Community Bank.
Continue Reading...According to a news report from WOWKTV in Charleston, WV, the YWCA has developed a program that will be used to assist women that are victims of elder abuse. Together with the YWCA, the Shanklin Center Apartments in West Virginia offer permanent housing to people that have been victimized and rendered homeless as a result of elder abuse.
Continue Reading...The website sfappeal.com is reporting that a San Francisco man – 50-year-old Michael Croslin – is facing 3 years in prison after a conviction of elder abuse and assault. The jury in the case deliberated for two days and the trial itself lasted for two weeks before the sentence was handed down to Croslin.
Continue Reading...84-year-old Emma Jean Sullan was hospitalized after a thief broke into her home in southwest Detroit. The intruder broke through Sullan’s back door and then attacked her and went through her belongings.
Continue Reading...In the early morning of August 7th, 2010 in Beverly, MA the Beverly police responded to a report of an assault at the Blueberry Hill Nursing Home. One of the nursing home residents allegedly attacked another resident is being taken to court on charges of attempted murder and assault and battery on an elderly person.
Continue Reading...Rgj.com has reported that an 87-year-old woman has been the victim of elder abuse when a neighbor of hers obtained power of attorney over the woman’s estate and wiped out the woman’s bank accounts. The 87-year-old woman reportedly saved an inheritance she obtained when her children died. The woman’s neighbor – Peggy Six – reportedly gambled part of the money that she stole from the woman and purchased a mobile home and a car with the rest.
Continue Reading...Summers in Phoenix can cause a number of different health afflictions. The police and fire department receive calls on a daily basis with heat related situations. Most of these accidents are preventable. Elderly are especially affected with heat related injuries, due to their various health afflictions and own vulnerability. On Saturday July 17, a 78 year-old man was taken to a Phoenix hospital suffering second degree burns on his feet.
Continue Reading...The California news website Mercedsunstar.com reports that a woman in Merced, CA was arrested on allegations that she robbed an elderly man. 49-year-old Denise Mayfield reportedly entered the house of an 86-year-old man, pushed him to the floor and robbed him. According to the report, the victim of the crime recognized Mayfield only by the sound of her voice as he had poor eyesight.
Continue Reading...A woman in Illinois has been charged with criminal neglect following the death of her mother. 53-year-old Brenda Tucker could potentially face up to 5 years in jail if she is convicted in the death of her 82-year-old mother Betty Tucker. According to the report, the prosecutors in this case argued that Tucker did not provide adequate care for her mother and should face criminal penalties for her death.
Continue Reading...A man in Coconut Creek, FL has been charged with felony elder abuse in connection with the death of his 62-year-old brother. The 62-year-old man was reportedly sleeping on a couch in his own waste for about three months until his death last week. The man was discovered emaciated covered with small sores all over his body.
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According to a report posted on therolladailynews.com, a Missouri nursing home worker faces one count of forgery, one count of stealing by deceit, and one count of abuse of a person receiving health care. Connie Jean Beckerman admitted to forging checks and stealing money from the Perryville Nursing Home and Rehabilitation Center.
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The Napa Valley Register in California reports that a man accused of trying to kill his parents using prescription drugs pleaded not guilty to the charges he faced. 49-year-old Jeffrey Niebling has been charged with several things including two counts of premeditated attempted murder, two counts of elder abuse with injury and one charge of poisoning.
Continue Reading...According to Mercurynews.com in California, a Los Angeles man was convicted of second-degree murder in the death of his mother in 2008. 48-year-old Richard Carlton Barbera faces the maximum sentence of 15 years to life in prison for the murder of 74-year-old Mary Barbera.
Continue Reading...A woman in Albuquerque, NM has been sent to jail for three years following an incident where she and her former husband stole approximately $40,000 from her mother-in-law. 32-year-old Christina Dreischmeyer will spend three years in prison on charges of fraud, neglect, residential abuse and attempted larceny against her 72-year-old mother-in-law.
Continue Reading...According to www.times-standard.com, an Arcata, CA bank employee was arrested on Tuesday after being charged with elder abuse and embezzlement. The report states that 32-year-old Elliot Shane has been booked on suspicion of embezzling a total of over $100,000 from 5 different customers, all of which were either unaware of changes in their bank account or were elderly people that may have been unaware of changes in their banking.
Continue Reading...According to a report posted by the Associated Press, six California nursing home workers have been arrested after attempting to play a prank on their co-workers. The workers covered many of the nursing home residents with cream in order for them to slip when other workers attempted to help them in any way.
Continue Reading...A Massachusetts elderly woman has died due to injuries she suffered resulting from severe neglect. Five residents of Fall River, MA reportedly left the 80-year-old woman lying in a recliner in her own urine and feces for over a month.
Continue Reading...A 67-year-old woman was left with a fractured eye socket and several other injuries following an attack against her from her son, 45-year-old Bradley Stewart. Stewart reportedly barged into his mother’s house while he was intoxicated and he threatened the woman’s life and the lives of her grandchildren.
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According to an article by CBS 4 in Tallahasse, FL, disturbing findings have been released that in almost all nursing homes and hospitals in Florida the food being served to the residents is not being inspected.
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In Jefferson, Indiana an elderly woman was victimized by her caregiver who stole approximately $30,000 over a period of six months while working for her. 86-year old Merlene Black has stated that the caregiver had isolated her from her friends and family, not allowing them to visit and even listening to her phone conversations.
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A wrongful death lawsuit has been filed against Vian Nursing Home in Sequeoyah, Oklahoma on behalf of the estate of one of its former patients – Raymond Foreman. Foreman died almost two years ago while he was a resident in the facility from December 2006 through July 2008. On July 20, 2008, Foreman died as a result of a maggot infestation.
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The website woai.com has reported that they have received several complaints about a San Antonio nursing home that reportedly has not had air conditioning for several weeks. The complaints stem from the fact that residents have been asked on numerous occasions to remain out of the dining room area and eat in their rooms because of the lack of air conditioning.
Continue Reading...The Illinois Government News Network has posted a report on their website discussing a bill that Governor Pat Quinn has signed that will protect elderly individuals in Illinois from suffering elder financial abuse. The report states that this new law will call for financial institutions to set stronger methods in place to identify and report financial abuse of elderly individuals.
Continue Reading...A Michigan group home for mentally disabled adults and adults with traumatic brain injuries has faced a series of investigations due to several complaints that have been made. According to the report, 21 complaints have been made to police in one year.
Continue Reading...Justicenewsflash.com reports that the family of a Florida woman has filed a wrongful death lawsuit against a residential treatment center where the woman was being treated for depression. The woman was found drowned two weeks before she was set to be released by the facility.
Continue Reading...According to a report on citizen-times.com, The 30th Judicial District Domestic Violence-Sexual Assault Alliance is currently sponsoring training sessions in North Carolina to recognize and prevent elder abuse. According to the report, training will not only be for the public but for law enforcement, medical personnel and agencies as well.
Continue Reading...A deadly fire in a Vallejo, CA retirement home killed 3 residents that were staying in the home. Five people pleaded not guilty in Superior Court on Tuesday. All five people own or operate the retirement home and each one faces two counts of manslaughter, two counts of elder abuse causing death and one count of elder abuse.
Continue Reading...An Illinois man has filed a lawsuit against a nursing home in the premature death of his mother. 66-year-old Neida Niles died after a fall in 2007. The suit claims that the nursing home did not properly assess her risk of a fall and did not treat the bed sores and skin infection that developed because of the fall.
Continue Reading...A New Jersey hospice worker has been accused of stealing money from a dying patient. Tristan Chang, 23, allegedly used the hospice patient's ATM card and PIN number to withdraw $700, the full amount the patient had in their account.
Continue Reading...Following a series of newspaper stories on the prevalence of nursing home abuse in Kentucky, an advocacy group is calling for the governor to appoint a special task force to combat the problem. A series in the Kentucky Herald-Leader has reported that Kentucky nursing homes have had more than 100 citations for serious violations over the past three years, but that few have been prosecuted as crimes.
Continue Reading...A former worker at an assisted living facility has withdrawn her guilty plea in an elder abuse case. The former worker, Iindia Weatherly, had originally plead guilty to a fourth-degree felony in the death of an 87-year-old resident at her facility last summer. Weatherly will now stand trial, as she admits she was careless but denies intentionally injuring the victim.
Continue Reading...While society has made great strides in highlighting and fighting abuse against women and children over the last 30 years, elder abuse has not gained the same amount of attention. A first-of-its-kind center at the University of California-Irvine is hoping to change that. The Center of Excellence on Elder Abuse & Neglect provides technical assistance, best-practices information, multidisciplinary training, and research to elder care professionals throughout the state.
Continue Reading...The state of Rhode Island has shut down a group home for teenage boys with behavioral or emotional problems amid allegations of inadequate facilities and improper confinement. The group home's license has been placed on probation pending further investigation and the boys have been moved to different homes.
Continue Reading...A Sacramento Superior Court judge has upheld a $29 million judgment against a Northern California nursing home. The judgment stems from the 2005 death of patient Frances Tanner and the judge ruled that there was "overwhelming" and "devastatingly powerful" evidence to support the large punitive damages judgment.
Continue Reading...According to the website newsobserver.com, a nurse at a North Carolina nursing home is facing murder charges following the death of one of her patients due to high levels of morphine. The facility where the nurse worked is also facing a lawsuit from two other patients because they suffered injuries resulting from negligence on the part of the facility.
Continue Reading...According to Newyourkinjurynews.com, a Florida woman has filed a lawsuit against a man claiming to be a doctor after she suffered burns to her underarms following inferior laser hair removal treatment. According to the report, 22-year-old Monica Jimenez is suing Larry DeJesus after she suffered second and third-degree burns from the treatment
Continue Reading...A 19-year-old worker at a Virginia hospice facility has been arrested for overmedicating a patient. Julie Ann Fischer is accused of putting a crushed pill into the patient's food in order to put him to sleep. The charge is a class three felony and carries up to 20 years in prison. This case highlights the prevalent problem of overmedication in nursing homes, hospices, and assisted living facilities.
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Jean Engstrom, a 51-year old woman living in Chicago, IL died as a result of a tragic drowning in her bathtub at a Rogers Park nursing home on Sunday night. She was taken to Saint Francis Hospital and at 9:15pm was pronounced dead according to the Cook County Medical Examiner’s office.
Continue Reading...A report by the state auditor has found that the California Department of Public Health has done a poor job of administering and collecting fines from nursing homes that violate regulations. The lax collection of fines has allowed nursing homes to go without punishment for violating regulations and has deprived the department of nearly $ 9 million in revenue that could have been used to fight nursing home abuse and neglect.
Continue Reading...A 93-year-old Alzheimer's patient at an assisted living facility in Delray Beach, Florida has died after accidentally swallowing diswasher detergent. The state agency is investigating and the facility may face a $10,000 fine for not properly securing its kitchen, which allowed this tragic event to occur.
Continue Reading...Officials in South Texas have formed a task force to fight elder abuse. Reported crimes against the elderly were up 15% in Texas last year, and the task force will attempt to fight this problem by focusing on training for nursing home staff and financial exploitation of the elderly.
Continue Reading...A report in the Cleveland Jewish News documents the growing problem of financial exploitation of the elderly. Americans aged 70-90 are the wealthiest age group in the country and new technologies such online banking have made financial exploitation easier than ever.
Continue Reading...An investigation by the Bristol Herald Courier in Bristol, Virginia has revealed that police failed to question a serial rapist in a nursing home sexual assault case three years despite strong evidence that he was a suspect. The newspaper's ongoing investigation has revealed that failures by both the nursing home staff and law enforcement allowed the rapist to remain free and sexually assault at least a dozen residents at two different long-term care facilities over a period of 10 years.
Continue Reading...Police in Howard County, Maryland are looking for a mentally disabled man who disappeared from his group home on Saturday, June 19. 42-year-old Everett Lee Clark left his group home on Saturday and has not been seen since. He does not have a cell phone or identification and may not be able to prove his address. Anyone with information on Mr. Clark's whereabouts should call 911.
Continue Reading...A former employee at a Los Angeles-area senior living facility has been sentenced to life in prison for abusing several elderly residents. 21-year-old Cesar Ulloa was convicted of toture and seven counts of elder abuse. The victims all suffered from dementia and were unable to speak or report the abuse.
Continue Reading...The New York Times reports on the frightening increase in a syndrome known as "hospital delirium." According to the American Geriatric Society, this condition, which can cause frightening and disorienting hallucinations, affects one third of hospital patients over 70. Though the causes are not fully understood, the Times says that many cases may be caused by doctors and nurses who do not know how to properly treat the elderly. Additionally, the syndrome is often misdiagnosed, leading to more complications later.
Continue Reading...Two New Jersey group home operators were arrested due to a fatal fire that killed one of their residents last August. After an extensive investigation, police and fire officials determined that the group home did not have proper safety measures in place to prevent the fire.
Continue Reading...An Orlando assisted living facility is being investigated for excessive use of restraints on a disabled man. The man, Bryan Barboka, 26, suffers from cerebral palsy and is paralyzed except for the use of his left arm. After being restrained, he suffered a fractured shoulder and severe bruising.
Continue Reading...Following the death of a nursing home resident who had been given a lethal dose of morphine, a North Carolina attorney is investigating the use of drugs in nursing homes. Attorney Carma Henson is representing three of the nine residents at Britthaven nursing home who tested positive for morphine following the death of Rachel Holliday on Feb. 16.
Continue Reading...Arizona Attorney General Terry Goddard has announced a Senior Anti-Crime University in Sedona on June 24. This free half-day seminar will feature classes on consumer scams, investment fraud, personal safety, elder abuse, financial exploitation and other issues affecting seniors.
Continue Reading...A North Carolina nursing home worker has been arrested for murder after allegedly giving an Alzheimer's patient a lethal dose of morphine. Angela Almore also faces felony abuse charges for overmedicating at least six other residents with morphine. It is believed that Almore overmedicated the residents in order to keep them docile and manageable.
Continue Reading...June 15 is the fifth annual World Elder Abuse Awareness Day. The event is organized by the International Network for the Prevention of Elder Abuse (INPEA) to raise awareness of elder abuse, neglect, and exploitation. The day will feature events around the country and the world designed to educate about elder abuse.
Continue Reading...NBC affiliate WOWT in Nebraska is reporting that Nebraska police officers are currently investigating a potential elder abuse incident. The report states a 74-year-old man was discovered in his apartment lying on a couch. Police said they discovered the environment was unsanitary, including discovering trash, rotting food, and cat and human feces in the apartment.
Continue Reading...Among the millions of missing person’s each year, many are elderly who had resided at a nursing home and wandered off. Accoding to an article by Enterprisenews.com, Thomas Gould, 54, was reported missing two weeks ago from Old Colony Rest Home where he had resided for several years.
Continue Reading...An employee at a nursing home repeatedly molested at least seven residents between 2000 and 2007. Now, an investigation by a local newspaper has shown that the abuse was allowed to continue even though there were warning signs. The investigation also documents the torment the abused residents must still live with, even though the molester is now in prison.
Continue Reading...Local police and officials at nationally renowned school for disadvantaged children in Pennsylvania failed to follow up on an allegation of molestation in 1998. This failure allowed the pedophile to continue visiting the school and molest at least 17 more children before finally being arrested in 2008.
Continue Reading...A couple in Tallahassee, Florida has been arrested for operating an assisted living facility without a license. The arrest came after an investigation that uncovered severe neglect of elderly residents.
Continue Reading...The former CEO of a Milwaukee nursing home who stole from her nursing home while patients were neglected is going to prison for tax evasion. The CEO is alleged to have stolen over $1 million from her nursing home while patients were denied baths and clean sheets and one resident jumped to his death after the staff ignored his threats of suicide.
Continue Reading...A new study suggest that seniors who live in assisted living facilities and nursing homes may be at a higher risk for suicide than those that live alone. This study highlights the importance of nursing home and assisted living staff watching out for signs of suicidal thoughts in residents. Neglectful staff can miss such signs and even contribute to a resident's risk for suicide.
Continue Reading...The family of a woman in Bakersfield, CA is accusing her nursing home of not treating severe burns and allowing them to spread over a large portion of her body. Doctors believe the burns were a result of medication the woman was taking, but the failure of the nursing home staff to notice and take proper action caused the problem to become much more severe. This case highlights what can happen when nursing home staffers are inattentive and neglectful.
Continue Reading...This article in the Pittsburgh Post-Gazette details efforts by groups around the country to change the culture of nursing homes. The culture change movement focuses on increasing choice and independence for the elderly and moving away from the traditional institutional nursing home model.
Continue Reading...An Oregon mental health worker is suing the state for $1 million, claiming that she was verbally abused after she complained about the abuse of group home clients. The woman claims that co-workers at the State Department of Health Services verbally attacked her and used racial epithets after she raised concerns about abuse and improper care at the state-run group homes and the stress caused by these attacks eventually forced her to leave her job.
Continue Reading...The ABC15 Investigators are investigating Arizona adult guardian group Sun Valley Group of Tempe after several allegations of abuse and possibly criminal behavior. Adult guardians are court-appointed representatives who are entrusted with protecting the rights and interests of adults who cannot make decisions for themselves, such elders who suffer from dementia or Alzheimer's disease. In addition to the many complaints from family members documented by ABC15, Sun Valley Group is also the subject of two separate criminal investigations.
Continue Reading...A nursing home near Sacramento, California has been ordered to pay $28 million in punitive damages for the death of a resident. The nursing home was found to be deliberately understaffed and to provide substandard care. The large punitive damages amount is a record for Sacramento county and was meant to send a message to the home that they can no longer save money by cutting corners.
Continue Reading...A North Carolina nursing home worker has been accused of sexually assaulting an elderly resident. The assault allegedly took place in February, but the victim only recently came forward.
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Tucson nursing home Devon Gables has reached a settlement in wrongful death lawsuit bought by the family of a hospice patient who died from sepsis after developing severe pressure sores. It is one of three lawsuits for neglect and abuse that the Tucson nursing home currently has pending against it.
Continue Reading...A nursing home in Brooklyn that neglected a 76-year-old man and caused him to get more than 20 bedsores will be required to pay nearly $19 million to the victim’s family. 76-year-old John Danzy lost nearly 100 pounds and suffered from a serious infection as a result of his bedsores after six months of staying at the Brooklyn Queens Nursing Home. It was also discovered that the nursing home had doctored records to cover up their neglect. As a result, the jury awarded $3.5 million for pain and suffering and $15 million in punitive damages for the doctored records.
Bed sores are one of the most common and most serious results of nursing home neglect. They are caused when a patient is forced to lay or sit in the same position for a long period of time. Nursing homes are required to turn or move patients on a regular basis to prevent bed sores from occurring and keep records of these movements to ensure that they are done properly. Bed sores can erode skin and cause holes in the body and lead to serious infections and even death. If you have a loved one in a nursing home, you should check for bed sores and ask to see records to ensure that bed sores are not developing.
A former nursing home worker in Lufkin, TX was recently sentenced to 20 months in jail after pleading guilty to abuse of a 77-year-old nursing home patient. The victim’s husband had noticed signs of abuse, but due to his wife’s mental state, it was difficult to prove that abuse was taking place. The husband then planted a hidden camera in his wife’s room and recorded two instances of the worker abusing his wife by grabbing her arm and twisting it violently and striking her repeatedly on the arm.
This case illustrates several problems that nursing home residents and their families must deal with. Since many nursing home residents suffer from Alzheimer’s, dementia, and similar disorders, they may not be able to report abuse themselves, so family members must be vigilant in looking for signs of abuse. In addition, since this abuse happened repeatedly, after the husband had noticed it, the administrators of the nursing home may be found liable for the abuse, as they allowed it to happen on multiple occasions despite there being signs that abuse was taking place. If you believe your loved one is being abused in a nursing home, you should contact a nursing home abuse attorney to discuss your case and decide on the best course of action.
A former nursing home worker in Lufkin, TX was recently sentenced to 20 months in jail after pleading guilty to abuse of a 77-year-old nursing home patient. The victim’s husband had noticed signs of abuse, but due to his wife’s mental state, it was difficult to prove that abuse was taking place. The husband then planted a hidden camera in his wife’s room and recorded two instances of the worker abusing his wife by grabbing her arm and twisting it violently and striking her repeatedly on the arm.
This case illustrates several problems that nursing home residents and their families must deal with. Since many nursing home residents suffer from Alzheimer’s, dementia, and similar disorders, they may not be able to report abuse themselves, so family members must be vigilant in looking for signs of abuse. In addition, since this abuse happened repeatedly, after the husband had noticed it, the administrators of the nursing home may be found liable for the abuse, as they allowed it to happen on multiple occasions despite there being signs that abuse was taking place. If you believe your loved one is being abused in a nursing home, you should contact a nursing home abuse attorney to discuss your case and decide on the best course of action.
According to a recent report in the Washington Post, Washington, D.C. is severely lagging in investigating abuse at group homes for people with developmental disabilities. The report found that the city had not filed timely reports for over 400 cases. This report illustrates the problem of group home abuse investigations throughout the country, as underfunded and overworked government agencies cannot keep up with the number of abuse cases. Additionally, these are just the cases that are reported. Many cases of group home abuse go unreported.
Here in Arizona, our government agencies face similar problems properly overseeing group homes that care for adults with developmental and physical disabilities. Therefore, if you have a friend or loved one in such a facility, it is important to be diligent in looking for signs of abuse. These signs could include depression, welts, lethargy, or other sudden and unexplained changes in mood or behavior. If you believe your loved one is being abused, you should contact an experienced group home abuse attorney to discuss your case and decide the best course of action.
An Albuquerque group home for children with hearing impairment may be shut down due to excessive calls to the police. The Albuquerque news reports that the police have been to the home "dozens of times," responding to violence and threats. Some of the teens reportedly threatened to kill staff members, broke windows and slapped their caregivers.
The operators admit the situation is not appropriate. They claim to have taken steps towards a better environment, including giving staff "additional training." This begs the question, "why wasn't the staff trained properly to begin with?" Additionally, one wonders how healthy this environment can be for the teens when the staff can't control the situation and police must be called. A group home is supposed to be a supportive environment that helps its members adapt and function in society. This level of chaos and stress would surely hinder that kind of development
This article indicates the importance of a properly trained staff and safe group home environment. If a member of your family is in a group home, be sure to make sure they caregivers manage issues constructively. And, always be aware of the signs of abuse or neglect that may be occurring.
When loved ones enter the hospital or assisted living centers, we expect them to receive quality care from experienced professionals. But what if your family member was actually being ignored by a recently hired nurse whose license was suspended in another state? A recent report by the LA Times detailed that exact situation, and reveals similar situations occur more than we realize.
The problem the article explores is the lack of oversight in the temporary nurse staffing industry. Staffing companies provide temp nurses to hospitals and nursing homes when demand increases or if the nursing home prefers to use temp staffing. While these companies are needed to help keep nursing homes and hospitals staffed, problems arise when neither the temp company nor the nursing home perform background checks on the temp nurse.
The Arizona Republic reported that these temp nurses have been known to steal medication, fall asleep on the job, and even fail to perform critical tests on patients. Nurses can be disciplined at other hospitals and even lose their licenses, but moving to another state lets them get hired again, putting patients at risk.
This study illustrates that seniors in nursing homes rely on quality care from the institution as well as their individual caregivers. A normally decent home could unwittingly hire a neglectful nurse who doesn't give your loved one the proper care or attention needed and deserved. When visiting family in a nursing home, it is critical to know the signs of neglect and prevent such problems from escalating to serious health concerns.
During the holiday season it is only natural for thoughts to drift to family and friends. Unfortunately, seniors living in nursing homes sometimes feel isolated from family who have limited time to visit or live out of state. These feelings are only intensified by the lack of activities in a nursing home setting. Thankfully, a group of college students in Yuma put together a project to reach out to seniors in nursing homes this holiday season.
The Yuma Sun reports that these NAU-Yuma students went above and beyond their assignment and actually implemented their class project. Wanting to help their community, they collaborated with local businesses to bring entertaining performances and informative workshops to local nursing homes. The workshops teach hobbies and skills seniors can use to stay connected and engaged with the community.
This student project will go a long way to help Yuma seniors stay connected and engaged. Their efforts are especially helpful in nursing homes, where seniors can feel isolated and idle. Lack of adequate staffing or materials leaves residents with little to do with their time. If you visit family in a nursing home this holiday, you may want to ask what kind activities are offered, as well as making sure their basic health and comfort needs are being met.
The Washington Post reported Saturday that hundreds of cases of group home abuse in Washington D.C. are going uninvestigated due to a lengthy backlog of reports. This backlog was created when the Department on Disability Services reformed its oversight methods and began investigating privately run group homes, thus discovering many cases of neglect and abuse that had gone on with impunity.
The department reported a 60 percent increase in serious incidents, up to 1057 in 2009, and will be hiring additional investigators to resolve the claims. But, this inability to protect some of our most vulnerable citizens in our nation’s capital speaks to the difficulties faced by those living in group homes.
As Arizona’s budget crisis deepens, deep cuts will be made to the Arizona Department of Economic Security and Department of Health Services, negatively affecting the care and wellbeing of group home residents. With government agencies falling behind, it is now more important than ever for family members to know the signs of neglect in group homes and nursing homes. Families serve as the first and best line of defense to protect the health and happiness of their loved ones.
Arizona is one of the few states in the country that has a unique statutory definition of “abuse” of nursing home patients.
“Abuse” means:
1. Intentional infliction of physical harm.
2. Injury caused by negligent acts or omissions.
3. Sexual abuse or sexual assault.
This definition is broader than the common definition of abuse and therefore includes what would ordinarily be classified as simple negligence. This expanded definition is helpful in asserting claims for poor care given to Arizona nursing home patients.
Many patients remain in the nursing home setting for the balance of their lives. Their final years can either be comfortable or tragic depending on the quality of care they receive.
It is difficult for an individual family to influence the nursing home’s management to improve patient care.
The best opportunity for success in improving patient care is through the nursing home’s Family Council.
Members of the council are the families of the residents. They can set their own agendas and present the facility with their concerns which must be addressed by management.
There are care issues that are common in nursing homes. The following is an outline of several of them and how they can affect nursing home patients’ quality of life.
1. Nutrition. When there is a shortage of staff in the facility, patients who are unable to feed themselves independently, suffer.
2. Hydration. A lack of adequate fluid intake is a cause of significant problems for residents including confusion, falls, and urinary tract infections.
Residents must have water conveniently located in their room. The water container must be regularly filled. Patients must be encouraged to drink water throughout the day.
Once again, inadequate staffing is usually the underlying problem when patients are dehydrated.
3. Assistance with Activities of Daily Living. Another area of concern is the insufficient number of nursing assistants to provide patients with assistance in their activities of daily living.
These activities include: bathing, dressing, grooming, transfers to bed and chair, ambulation, toileting, and eating (as discussed above).
The Family Council through its family members can provide factual accounts of care concerns at the facility and request that the facility provide adequate staff to attend to their vulnerable patients.
If cooperation isn’t forthcoming, the Council should then request the Arizona Department of Health Services to investigate the inadequacy in the facility’s level of care.
The adage “there is safety in numbers” is particularly true in the nursing home setting. Federal nursing home regulations provide a vehicle for enhancing patient safety, by requiring nursing homes to have “family councils”.
Family councils are made up of resident’s family members that meet regularly to discuss issues pertaining to resident care at the facility.
The nursing home must assist the council by making a “private” space available for the families to meet. In addition, a facility representative may only attend the meeting by invitation of the council, and must respond to council concerns.
If you have a loved one in a nursing home, participating in the family council is a must. If there isn’t an active council, start one!
Placing a family member in a nursing home is painful and difficult, yet necessary when the medical and physical demands make other options unacceptable.
The nursing home environment and staff procedures may be overwhelming for the family as well as the patient. In order to function in this new environment the family must learn a new set of rules and procedures.
The Nursing Home Family “Toolkit” is a structure that families can utilize to get their bearings in an otherwise confusing situation.
The “Toolkit” is a protocol for gathering information about the facility, its caregivers, management, and the other residents and their families.
Caregivers, Management, Residents and Families
There are many caregivers in the nursing home setting. It’s important for the family to know the names, positions and shifts of all caregivers in order to understand which caregiver is responsible for the delivery of care during each shift.
To the extent possible, it is advisable for the family to meet each of the patient’s caregivers to establish a personal relationship between the family and the facility staff.
Obtaining the names of all supervisory staff and their shifts enables families to understand the chain of command.
The family should learn the name of the Director of Nursing, the Medical Director, and the Administrator and the times they are in the building.
Since there is considerable turnover in nursing homes, the information should be updated quarterly.
Finally, the name of the treating physician, the days and times he is usually in the building is also important.
Other Residents and their Families
You and your loved one are now in the new “community” with other residents and their families. There is a lot to learn and the other residents and families can be very helpful.
They will have information and opinions about the staff and administration which they can share with you. They can keep an eye on your loved one when you are not there and call potential problems to your attention.
Make sure to get the complete names of the other residents and their families, as well as their addresses and phone numbers.
Keeping a Diary
As a lawyer, I review many nursing home neglect and abuse cases. It is very helpful to visit with a family that has kept a diary of the events surrounding the care of their loved one. Details about the problems confronting the family and their efforts to obtain necessary care can go a long way in establishing nursing home accountability.
Contained in a joint draft bill of the House Ways and Means, Energy and Commerce, and Education committees are provisions that eliminate the secret ownership of Nursing Homes.
If these transparency provisions remain in the eventual legislation, patient advocates will score a significant victory on behalf of patients and their families.
Nursing Homes would be required to disclose ownership and organizational information, as well as their regulatory compliance and ethics programs.
Additional disclosures, involving financial expenditures for direct and indirect care, capital assets, and administrative costs will be also required to be disclosed.
Skilled nursing facilities provide vital services to our most vulnerable patients. In order to deliver quality care, facilities must allocate sufficient resources to nursing, dietary, oversight and safety services.
There is a direct correlation between dollars spent and the services provided to patients. Mandating full public disclosure of expenditures and ownership will advance owner accountability and help ensure quality patient care.
It is always difficult to tell a family that I am unable to represent them regarding the loss or severe injury of their loved one in a nursing home.
However, arriving at the right decision as to whether to accept a nursing home neglect and abuse case is the foundation of a nursing home practice.
Difficult decisions are made at the junction where emotion and intellect intersect.
Emotion is the first to weigh in when a death or life changing event is presented to me for review. It is difficult not to become incensed at the poor care given to our most vulnerable patients or to become attached to a family that has lost a loved one.
Since intellect, in the form of practical considerations, are slow to appear, caution in the decision process is well advised.
Nursing home, assisted living, and group home cases are expensive, labor intensive and emotionally draining for an attorney. They are also difficult for families because they take a long time to resolve and therefore there is delayed closure of the emotional wound.
The first consideration is whether the neglect or abuse resulted in significant injury or death.
The second consideration is whether the injury or death was the result of neglect or abuse.
Having said that, my analysis as to whether to move forward is based on a broad view of the nursing home (including both the specific facility and the parent organization).
I examine the history of the nursing home to determine whether they have had similar problems in the delivery of patient care. Have they learned from their prior mistakes or are they continuing with the same conduct?
I determine whether the harm was the result of a systemic failure such as inadequate staffing, training or oversight. These systemic failures are evidence that the facility was incapable of providing quality care.
I then determine whether the systemic failures were the result of corporate business decisions. In other words, did the nursing home corporation decide to place profits over quality patient care and did that decision lead to the injury or death?
The answer to this question will determine whether the facility’s conduct warrants an award of punitive damages. Punitive damages are assessed against a facility to punish it for outrageous conduct.
Going through these considerations in the case selection process enables me to decide whether to accept or reject a nursing home case. However, it doesn’t make it any easier to tell a family that I am unable to help them.
The United States Government Accounting Office (GAO) recently completed a study of public and private schools and reported to Congress on the abuse of vulnerable children who were students at those institutions.
The GAO first testified that there were no federal laws restricting seclusion or restraints in public or private schools and that state laws were widely divergent.
Most significant was their report that found hundreds of cases of alleged abuse and death related to the use of restraints on school children during the last 20 years.
The use of restraints on vulnerable adults in the nursing home setting has been band except under very limited circumstances with physician supervision. There is no good reason to continue this dangerous practice with disabled children in the school setting.
Assisted Living Facilities are private pay organizations where fees can cost $6,000 or more per month.
They are not skilled nursing facilities and are unable to provide care to residents with complex nursing or medical needs.
In order to fill empty beds, assisted living managers may stretch, in terms of promises they make to families, as to the level of care their facility is equipped or competent to provide.
It may be difficult for a family to place a loved one in a nursing home when they believe that an attractive assisted living facility is willing to accept the patient. However, it is the quality of care that is critical not the quality of the ambiance.
So beware of promises made by assisted living admission representatives and inquire of your loved one’s treating physician about the level of care necessary before making this important decision.
Senators Grassley and Kohl have sponsored a bill that would require drug companies and manufacturers of medical equipment to publicly disclose payments to physicians that exceed $500 per year.
In discussing the need for this legislation, Senator Grassley reported that drug companies are paying fees and expenses to physicians who are supposed to be objectively reviewing the effectiveness of medications.
Grassley explained that a physician had recently been paid in excess of a half a million dollars in fees and expenses by a major drug company during the time the physician was the lead physician on a study evaluating the company’s new drug.
Treating physicians must be able to rely on independent studies to make medical decisions regarding treatment. Even the suggestion of impropriety can have serious treatment implications. We hope Congress will implement this legislation in this new era of recapturing public trust.
When a loved one dies while receiving care in a nursing home, the family is entitled to know whether the death could have been avoided by good nursing care.
According to an article in the New York Times, after a death occurs at a nursing facility, it is not uncommon for the family to mistrust what they have been told by the facility as to the cause of the death.
In my experience, this is particularly true of deaths occurring at nursing homes where the history of care has been questionable.
It may not be helpful to rely on the nursing home treating physician for answers, as many of the treating physicians in nursing homes are also the facility’s medical director.
Even a death certificate stating the cause of death may be suspect as the physician signing the certificate may have only limited information as to the circumstances surrounding the death.
What is a family to do?
The answer may be an autopsy, either performed by the county medical examiner or by a private pathologist.
The county medical examiner will usually only perform an autopsy if the circumstances surrounding the death calls into question whether the death was by natural means.
To have a private autopsy performed in Arizona can cost between $3,500 - $4,500. However, it may be the only way to determine the cause of death and give the family closure they deserve.
A nursing home is a nursing institution that is managed by an Administrator, who is not a medical professional.
The highest level of medical management in the nursing home is the Medical Director.
It is also common for the Medical Director to be the primary treating physician for his own patients in the facility.
Under Federal Regulation, the nursing home Medical Director is responsible for “the coordination of medical care in the facility.” This means that the Medical Director is responsible for assuring that the nursing staff is providing appropriate care to its patients.
In addition, the Medical Director is a member of the clinical care oversight committee which is charged with addressing all facility deficiencies as identified by the state’s Department of Health Services.
The role of the Medical Director requires an investment of time for the analysis of the facility’s operations and should not be taken lightly by any physician. The Medical Director must become familiar with the system of healthcare delivery within the facility and assure that it functions properly.
With this responsibility comes accountability which means liability, should the Medical Director fail to perform as required.
Can I do anything to improve the care my loved one is receiving at the nursing home?
This is a common question. Today I would like to discuss what I believe is a reasonable methodology to assist families in playing a positive role in the care of their nursing home patient.
Family participating in their loved ones care is becoming more important every year. However, there is little information available to inform and educate families as to how they can successfully advocate for their loved one. The following is an introduction to Family Advocacy 101.
Inadequate Communication in the Nursing Home
One of the major impediments to good care in the nursing home is inadequate communication among health care providers (nursing assistants, nurses, physicians, and nursing home management).
The nursing staff is responsible for continually assessing patients for changes in condition and for the accuracy and completeness of charting the patients’ condition. Facility understaffing places many hurdles in the path of staff-to-staff communication.
It is not the family’s job to facilitate staff communication in the nursing home. However, a family that is knowledgeable enough to understand the weakness in the nursing home’s system of communication is able to provide a communication bridge between the patient and the nursing home staff.
The family can thus make a significant contribution to the patient’s well being by facilitating awareness and understanding of the patient’s condition.
The Nursing Home Chart
The “chart” is a collection of records, first created when the patient is admitted to the nursing home and supplemented throughout the patient’s stay.
The purpose of the chart is to enable any healthcare provider to obtain a history and current status of the patient.
Understanding the Chart
This is not as difficult as you may think. Families with the patient’s permission may examine the patient’s chart.
There are certain documents in the chart that are key to evaluating care. We’ll briefly discuss each and also how it can be utilized by the family.
Hospital Transfer Records
The patient is usually accompanied to the nursing home with Hospital Transfer Records. These are records which explain the patient’s condition upon discharge from the hospital. The records also include a list of the medications the patient is taking, and any physician orders for continued medication and care.
The Admission Record
When a patient is admitted into a nursing home an Admission Record is completed by the admitting nurse. The Hospital Transfer Records are reviewed and incorporated into the admission records for the consideration of the nursing home admitting physician.
The admitting nurse must review the hospital transfer records, examine the patient, obtain information from the patient, and educate the patient’s family regarding the patient’s needs and abilities.
The Family re: Admission Process
The family should read the patient’s Hospital Transfer Records and the Admission Records in order to make sure that they accurately reflect the patient’s condition at the time of admission to the nursing home.
Advising the nursing staff about any discrepancies or omissions will facilitate an accurate understanding of the patient. It also ensures that the staff and admitting physician will be in a better position to address all of the patient’s needs.
Treatment / Medication Administration Records
The Treatment Record documents all the treatments that the patient’s physician has ordered for the patient. There is a place on the Treatment Record for the nursing staff to document when each treatment is provided.
The Medication Administration Record documents all the medications that were ordered for the patient and there is a place for the nurses to document when each medication is administered.
The timely performance of treatments and administration of medication is important to the welfare of the patient. Failure to provide either may result in patient debility or death.
The Family: Treatments and Medication
The family should examine the treatments ordered for the patient and the medication to be administered and verify that the patient is receiving the treatments and medications as were ordered.
Pay particular attention to any new treatments and medications and tell the nursing staff and the physician if there are any changes in the patient’s condition once the new treatments and medications have been given.
A change in treatment or medication can sometimes have a negative consequence and therefore patients should be closely monitored when new therapies are implemented or new medications are administered.
Vital Signs and Weight Records
The nursing assistants commonly record the patient’s vital signs (temperature, blood pressure, pulse, and respiration) and weights. Weights are usually taken monthly unless ordered otherwise.
Any unusual readings must be retaken to allow for the possibility of error and timely reported to the patient’s physician in the event it is determined that the reading was accurate.
An elevated temperature may be a sign of infection or dehydration and must be addressed with the patient’s physician immediately.
Any unplanned weight loss must also be addressed immediately with the patient’s physician and the dietitian. In addition, a patient who has lost weight should be placed on a weekly weight plan.
It is not uncommon for recording the vitals and weights to be neglected by nursing when they are understaffed and overworked.
The Family: Vitals and Weights
Once again, the family can play an important role in assuring that the patient’s vitals and weights are regularly recorded by the staff.
By examining the vitals and weight records weekly and reporting any failures of entry to the nurse in charge and the patient’s physician, the family can help avert potential problems.
Nursing Assistant Flow Sheets
Nursing assistants provide much of the hands on care in the nursing home. They document certain elements of the care that they provide on Nursing Assistants Flow Sheets.
One of the more important aspects of their charting responsibility is to document the percentage of meals and fluids consumed by the patient.
The flow sheet forms have columns for the days of the week and cross-columns for breakfast, lunch, dinner and snacks. Each box for a particular date and meal should be filled in with the accurate meal and fluid percentages that the patient consumes.
In a busy nursing home, that lacks an adequate number of nursing assistants, it is not unusual for Flow Sheet charting to be incomplete. Unfortunately, it is also not unusual for the meals percentages documented to be fabricated, especially at times when the facility is short staffed and the percentages are recorded at a later date.
The Family: Flow Sheets
As stated before, any unplanned weight loss in an elderly patient is a serous condition and must be addressed as quickly as possible.
The family should examine the patient’s Nursing Assistant Flow Sheet weekly and report any blank boxes to the Director of Nurses.
The family should also examine the percentages of meals consumed in light of the patient’s physical condition.
For example, when a patient has unintentionally lost weight and the Nurse Assistant Flow Sheet indicates that the patient has been eating 100% of his meals, the family should be suspicious. The weight loss may be the consequence of a medical condition or may be a situation where the nursing assistants are fabricating the meal percentages that the patient has eaten.
Becoming aware of this conflict between the weight loss and the meal percentages enables the family to call this matter to the attention of the Director of Nursing and the patient’s physician.
Families place their trust in the nursing home to provide quality care. Although the nursing home staff should be an advocate for the patient, this rarely occurs because the facility is understaffed and the staff is overworked just trying to provide basic services to all the patients.
There is an increased risk of falling among the frail patient population of nursing homes. The risk even exists for patients while they are in bed and roll off onto the floor.
Bed rails are the first thing a lay family member may suggest; however, a leading cause of strangulation of patients in nursing homes is bed rails. It may be counterintuitive that a bed rail, customarily thought of as protecting patients from falling out of bed, can cause more harm than good.
Yet, it’s a fact that a poorly designed bed rail is a deadly instrument when a patient’s body is caught between the bed rail and the mattress. This configuration constricts the patient’s chest thereby causing death by strangulation.
There are safer and more efficient ways of minimizing the risk of a patient falling out of bed, such as lowering the mattress or placing the mattress on the floor.
An important yet overlooked consideration in the care of the elderly is the impact of medication on nutrition.
It is not uncommon for nursing home residents to be taking 9 or more medications. It is also not uncommon for physicians and nurses caring for nursing home patients to fail to consider the impact that medications may have on their patient’s appetite and their ability to absorb nutrients.
The remedy is simple and simply overlooked.
There is a dietary guide (Drug-Nutrient Resource) available in nursing homes and used by dietitians to assist them in evaluating unplanned weight loss.
The guide outlines the nutritional side effects of medications including appetite changes, weight changes, edema, altered taste, thirst, dry mouth, the risk of dental problems, GI distress, nausea/vomiting, diarrhea, constipation, blood pressure changes, drowsiness/weakness, etc.
However, in nursing homes, where communication among disciplines is poor; physicians, nurses and dietitians don’t customarily discuss common interactions between medications and nutrition.
Informed advocates and families may be the only source of information pertaining to this risk.
The Centers for Medicare and Medicaid Services (CMS) announced a pilot program for nursing homes based upon incentive payments according to a report by Todd Neal, a staff writer for MedPage Today.
Participation in the pilot program will be offered to nursing homes in four states (Arizona, Mississippi, New York and Washington).
Nursing homes that show the greatest improvement in the quality of their care will be awarded monetary payments.
Quality will be measured by improvement in staffing, avoidable hospitalizations, resident outcomes and survey deficiencies.
It is gratifying that quality of care is finding its way back into fashion now that we have a new administration in Washington.
Every time I interview a nurse in one of my nursing home neglect and abuse cases, I find myself sympathizing with the position in which they find themselves.
Nurses know that their facilities are short staffed and they also know that their patients are not receiving needed care. Many of them are ashamed at working in such an environment and have lost the spark that once made their work enjoyable.
The essence of caregiving has always been supportive and nurturing. Even though nursing is hard work, and many times thankless, nurses continue to provide care because of the heartfelt joy that caregiving provides them.
However, what takes the joy out of nursing home caregiving is the knowledge that the nursing staff is not receiving the support they need from management to properly care for their patients.
In many respects, nurses as well as patients are the victims of corporate indifference and greed.
When nursing home owners limit the number of nursing staff at their facilities, the remaining nurses must struggle, and many times fail, to provide adequate care.
When patients suffer so do their nurses.
When checking mom into a nursing home, in addition to telling them about her favorite foods, you are likely signing away her rights.
Buried in the stack of documents you will be signing is a promise not to sue the nursing home in court if they harm or kill mom.
It's called an "Agreement to Arbitrate" and it is underhanded and a pitiful abuse of trust.
An arbitration is a non-judicial proceeding where an "independent" third person (arbitrator) is given the facts of a dispute and decides the dispute impartially.
However, there is nothing impartial or independent about these nursing home arbitration agreements.
They are one-way agreements giving nursing homes the right to have any dispute, no matter how serious, decided by an "arbitrator" of their choice and they get to decide the rules by which the arbitration will be conducted.
These agreements have been used to prevent courts from holding nursing homes accountable for the injuries and deaths they cause to nursing home patients.
Now there is a bill before Congress that will stop these tactics. It is called The Fairness in Arbitration Act of 2009 (H.R.1237)
This proposed legislation will make these one-sided agreements unenforceable.
Write your Congressman and ask them to support this elder friendly legislation.
For us Arizonans, write to your Congressman:
86303 - 1st District - Kirkpatrick, Ann
85308 - 2nd District - Franks, Trent
85016 - 3rd District - Shadegg, John
85004 - 4th District - Pastor, Ed
85251 - 5th District - Mitchell, Harry E.
85204 - 6th District - Flake, Jeff
85364 - 7th District - Grijalva, Raul
85635 - 8th District - Giffords, Gabrielle
The Patient Safety and Abuse Prevention Act was reintroduced into the Senate this week. The bill is intended to prevent workers with criminal histories from working in skilled nursing facilities.
The bill requires each state to establish coordinated systems that include checks against neglect and abuse registries, the FBI database and state police records.
The bill had been introduced last year but failed to make it out of Congress.
State background investigation requirements are checkered and lack any uniformity making it easy for someone with a criminal conviction in one state to escape detection in another.
If this legislation becomes law, it will go a long way in reducing violence to nursing home residents.
The world of nursing home care changed in 1987 when Congress enacted the OBRA (Omnibus Budget Reconciliation Act) regulations.
OBRA is a comprehensive set of rules created by clinicians and designed to be a blueprint for quality nursing home care.
I’ve studied and worked with these regulations for over ten years, and I believe that there are four principal regulations that form the backbone of quality care.
The four are:
1. Quality of Life (42 USC 483.15)
2. Quality of Care (42 USC 483.25)
3. Nursing Services (42 USC 483.30)
4. Administration (42 USC 483.75)
1. Quality of Life
“The facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.” (42 USC 483.15)
What does “quality of life” in a nursing home mean?
It means that each resident is entitled to:
1. Dignity
2. Self-determination
3. Participation in resident and family groups
4. Accommodation of needs
5. Activities
6. Social Services
7. Safe, clean and comfortable physical environment
Dignity
Each resident must receive care in a manner and in an environment that promotes dignity and respect.
Self-determination
Each resident must be given the opportunity to make their own choices of activities and services.
Participation in resident and family groups
Each resident must be given the opportunity to organize with other residents to discuss issues of common interest and concern.
Families of residents must also be given the opportunity to meet with other families to discuss grievances.
Under both circumstances, the facility must be responsive to concerns and grievances that are raised by these groups.
Accommodation of Needs
Each resident is to receive services in a manner that recognizes any special resident needs such as food choices or accessability requirements.
Activities
Each resident must be offered a program of activities that meets the interests, physical, mental and social abilities. Residents must be afforded the opportunity to participate in social, religious, and community activities of their choice.
Social Services
Each resident must receive medically related social services.
Safe, Clean and Comfortable Physical Environment
Each resident must be provided with a clean, safe and well lighted and ventilated living space.
2. Quality of Care
“Each resident must receive the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being based on each resident’s assessment and plan of care.” (42 USC 483.25)
This requirement is fashioned to ensure that the resident’s outcome, and not the facility’s capacity, is paramount.
Resident Assessment
Each resident must be comprehensively assessed and evaluated on abilities, needs and risks, among them are the following:
Activities of Daily Living
The resident’s ability to bathe, dress and groom himself; to transfer and ambulate; eat and toilet independently.
Mental and Psychosocial Functioning
The resident’s mental and psychosocial strengths and weaknesses.
Nutrition
The risk for malnutrition must be determined and addressed.
Pressure Sores
The risk of pressure sores must be determined and addressed.
Plan of Care
Every resident need, as well as how the facility will address them, must be outlined in a Plan of Care.
3. Nursing Services
“Each resident must receive the nursing and related services to attain their highest practicable physical, mental and psychosocial well-being.” (42 USC 483.30)
There are no minimum national staffing levels, however, the facility must have sufficient nursing staff to provide each resident with assessments, planning, evaluation, direct care needs and supervision.
4. Administration
“Facilities must be administered in a manner that enables them to use their resources effectively and efficiently to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident.” (42 USC 483.75)
This is where the buck stops. The facility’s management must administer the facility so that it complies with all federal and state laws and regulations. The governing board sets policies and appoints the Administrator who is the general manager of the nursing home.
The Center for Medicare-Medicaid Services (CMS) rolled out its new quality nursing home five star rating system on December 18, 2008.
The five star system awards points to nursing homes based on performance in three areas:
1. Inspection Surveys
2. Staffing
3. Quality Measures
The highest rating is five star which means the facility is “much above average”.
A four star rating means that the facility is “above average”, and a three star rating means the facility is “about average”.
A two star rating means the facility is “below average”, and a one star rating means the facility is “much below average”.
According to CMS’s national data, twelve percent (12%) of the nursing homes receiving medicare or medicaid dollars score five stars. Twenty two percent (22%) receive a one star rating and the rest are evenly divided between two, three, and four stars. However, facility rankings may differ somewhat from state to state.
The new five star rating system can be found on Medicare’s Nursing Home Compare website.
As with all rating systems, the five star system is of general use and is just a place to start a search for a quality nursing home.
If you work in a nursing home, be sure to ask about your facility’s ranking.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialogue with and among its readers.
Who is in the best position to report abuse and neglect in a nursing home? The nursing staff, of course. A great many nurses and nurse aides are dedicated caring professionals. Then why aren’t they reporting?
One reason may be is that there isn’t much patient neglect and abuse in nursing homes. However, we know that just isn’t true, so we must look further for the answer.
As it turns out, there is a recent article in the Journal of the American Medical Directors Association (AMDA) which discusses this very issue.
The AMDA article reports on a study done in Iowa and concludes that, although nursing home staff is aware of their duty to report as well as the mechanism for reporting, there is little reporting of neglect and abuse by staff (53% admitted suspicion yet only 35% reported abuse).
The article concludes that the reasons for under-reporting are:
1. Inadequate education and training as to whether actions by fellow caregivers rise to the level of a reportable event.
2. Fear of lack of anonymity.
3. Fear of retaliation by fellow workers and the employer.
4. Inexperience of co-workers in dealing with difficult residents.
5. Staff fatigue resulting from being overworked.
6. Lack of comfort with the reporting agency.
Whatever the reason for inadequate reporting, it is vital to all our welfare that nursing home staff be encouraged and supported in fulfilling their duty to report suspected abuse and neglect.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialogue with and among its readers.
Nursing homes receiving Medicare or Arizona Long Term Care funds must comply with federal nursing home health and safety regulations.
Nursing homes that are unwilling or unable to provide quality care must not be allowed to retain their license to engage in business in the State of Arizona.
In Arizona, the Department of Health Services (DHS) is the enforcement agency, acting on behalf of both the federal and state governments.
DHS is responsible for ensuring that Arizona nursing homes follow state and federal regulations and provide quality care to their patients. DHS is supposed to be an advocate for nursing home patients.
Nursing homes are required to be inspected at least once every fifteen months and are to be cited for any deficiency in patient care. Inspections must occur more frequently, however, in the event a complaint is filed against a nursing home for poor care.
Poor Enforcement Equals Poor Care
When health and safety regulations are not strictly enforced, nursing homes are encouraged to neglect patient care in their pursuit of profit.
Strict Enforcement Equals Good Care
On the other hand, when nursing homes are held accountable through strict enforcement, patient care and quality of life improve.
Nursing Homes Promise to Mend Their Ways
Although cited nursing homes promise the DHS that they will correct and improve patient care, many of these same nursing homes continue to provide poor patient care.
It is up to the DHS to prevent repeat offenders from providing bad care to our most vulnerable citizens.
Failure to Strictly Enforce Regulations
All too often, however, the DHS fails to act as an advocate for quality patient care and permits nursing homes with repeat violations to continue to retain their Arizona license.
Generally, the most important health and safety regulations are those that require each nursing home have sufficient nursing staff to provide quality care to patients.
However, in Arizona, there is no minimum staffing level required. This makes the DHS inspector’s role most important and difficult. They must determine whether the facility they are inspecting has enough nurses and nurse aides while considering the medical acuity and functional level of each patient.
This is a big job and the inspectors do not uniformly take the time necessary to perform this analysis.
It is up to us to demand patient protection through strict agency enforcement of health and safety regulations.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialogue with and among its readers.
I look forward to the evenings my wife and I go out to dinner. I confess that I enjoy food. But, it wasn’t until I represented my first nursing home patient that I began to appreciate the central role food and water play in skilled nursing case.
Good nutrition is vital for the well-being of nursing home patients. It provides the calories, protein, vitamins, and minerals necessary for improving and maintaining the quality of life. The elderly do not have the reserves nor the immunity that a young person has. So, it doesn’t take long for an elderly patient to lose ground without proper nutrition.
By the same token, inadequate nutrition cannot only diminish the quality of life, but may also begin a downward spiral resulting in death.
Understanding “nutrition” in the nursing home requires us to consider the physical act of eating, the quantity of food consumed, and the quality of the food consumed.
The Act of Eating
Eating three well-balanced meals a day can save your life if you’re a nursing home patient. You may be thinking, “doesn’t every nursing home patient get three meals a day”?
“Eating” is the operative word. When a nursing home is short staffed, which is not an uncommon event, patients who are unable to feed themselves suffer.
Feeding a stroke patient or a patient with dementia a meal takes time, as long as an hour in certain cases but mealtime is a scheduled event which begins and ends on a schedule. Attempting to rush a disabled patient with feeding can result in choking or the aspiration of food into the lungs, which can lead to pneumonia.
When a facility lacks adequate staffing, patients unable to feed themselves may go without eating meals. Food trays placed in front of disabled patients may be taken away untouched without regard to the patient’s nutritional needs.
The most productive thing the family of such a patient can do is to visit and observe during lunch and dinner.
Percentage of Meals Eaten
Nursing homes keep track of the percentage of meals eaten on a “flow sheet”. This information is documented by the nurse assistants. The quantity of food served is calculated to provide a certain amount of calories and protein at each meal. A patient who consistently fails to eat meals will neither receive sufficient calories nor protein.
Given the lax nature of documentation in nursing homes, any notation as to percentage of meals eaten must be suspect. The scale is a patient’s best friend.
Unplanned Weight Loss
Patients who are unable to feed themselves should be weighed once a week to determine whether there is loss of weight.
Any unplanned weight loss must be addressed by nursing administration, the dietitian, and the patient’s physician immediately.
Protein: The Building Block of Life
Consuming an adequate amount of protein is important for every nursing home patient. It becomes a matter of life or death for patients recovering from surgery or patients who have developed pressure ulcers (bed sores). Protein is used by the body to repair damaged tissue, so inadequate protein results in the body’s inability to heal wounds.
Every nursing home is required, by federal regulation, to have a dietitian. Families of new patients should meet the dietitian to discuss the patient’s nutritional needs. Families should also meet with the dietitian at any time the patient isn’t eating well or is losing weight.
We may live to eat, but in a nursing home you eat to live. Enjoy your next meal.
Our Next Article
Our next article will discuss the importance of strict nursing home regulation and enforcement.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialog with and among its readers.
Pressure ulcers, also known as bed sores, are an all too common occurrence in nursing homes. Fortunately, however, they are always preventable with good basic nursing care.
What Are They?
Pressure ulcers are caused by unrelieved pressure to the skin which compresses underlying blood vessels causing multiple levels of tissue damage and tissue death.
Patients who are permitted to remain in bed or in a wheelchair for an extended period of time get pressure ulcers. This is because their skin is compressed between the bed mattress or wheelchair cushion and the underlying bone structure.
The most common pressure ulcer locations are the back of the head, the spine, low back (sacrum), buttocks, heels, hips, knees and ankles.
They Go From Bad To Worse
Pressure ulcers are diagnosed as “Stages” based on their severity. They start as red marks and are classified as Stage I.
These are the easiest pressure ulcers to eliminate by merely turning and repositioning the patient at regular intervals in order to relieve the pressure.
If the patient isn’t turned and repositioned, the pressure ulcer moves to a Stage II, where the skin is blistered and broken.
Once again, the nursing staff, by turning and repositioning the patient, can stop the progression of the pressure ulcer and allow the skin and tissue to heal.
Failing to address the pressure at this stage permits the ulcer to progress to Stage III, which means that more tissue underlying the skin will die enabling the wound to deepen until it reaches close to the underlying bony structures.
Continued unrelieved pressure will cause the wound to deteriorate ever further until it reaches Stage IV, which is where healthy tissue is destroyed down to the bone.
Open pressure ulcer wounds are breeding grounds for infection. Many of the infections, in Stage IV pressure ulcer wounds, result in blood poisoning (sepsis) and patient death.
Preventable, Preventable, Preventable
Pressure ulcers are preventable with good basic nursing care, nothing extraordinary, just plain old fashioned basic nursing care.
However, nurses and nurse aides have limits as to the number of patients they can properly care for at any given time. Corporate failure to provide enough nurses and nurse aides (short staffing) accounts for the explosion in the number of pressure ulcers in nursing homes.
The Government Stops Paying Hospitals for Preventable Pressure Ulcers
Beginning October 1, 2008, Medicare stopped paying hospitals for hospital-acquired pressure ulcers. Medicare prohibits hospitals from billing patients for these costs.
Medicare calls these hospital-acquired pressure ulcers “never events” which means these pressure ulcers are preventable and should never occur to hospital patients.
Hopefully, Medicare will impose a similar non-payment regulation on nursing homes where most of the facility-acquired pressure ulcers occur.
Our Next Article
Our next article will discuss the importance of nutrition to the life expectancy of nursing home patients.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialogue with and among its readers.
You be the judge.
There are far too many families who are cast into the world of long term care without a lifeline or even a compass.
In my experience, there are no primers on what families can expect when a loved one is in long term care. Nor are there any guides to enable families to protect their loved ones from nursing home neglect or abuse.
This blog is for them.
There are also far too many nurses and nursing aides, working in long term care, who are victims of corporate financial decisions that make it impossible for them to provide quality care.
These health care professionals often have limited access to vital information thus preventing them from providing optimal patient care. There are also few opportunities for these caregivers to engage in candid dialog with other professionals in a non-threatening environment.
This blog is for them.
Our Next Article.
Our next article will discuss the risks to patients in nursing homes and the principal causes of those risks.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialog with and among its readers.
Is it possible that a nursing home patient, in the United States, could starve to death while under the care of health professionals?
Well, to my dismay, I learned that the answer was yes. It is now over 12 years since two adult children came to my law firm and told me the story of their father. He was a stroke patient, in an Arizona nursing home, who died because he wasn’t given adequate assistance with eating.
So began my journey, representing families of injured and deceased nursing home patients who were neglected and abused.
No one chooses to live in a nursing home. It only becomes necessary when poor health or advanced age demands skilled nursing or rehabilitative care.
Quality Care.
“Quality Care” are words that have more than passing importance to families of nursing home patients. But what can families do to obtain that level of care for their loved ones?
Nursing homes, by federal mandate, are required to deliver quality care to every patient. That means every patient deserves attentive and professional nursing care as the primary purpose of a nursing home is to provide skilled nursing care.
As you will see, the greatest threat to quality care is inadequate nursing care.
Who is at Risk in a Nursing Home?
Although any patient in a nursing home can be at risk of not getting quality care, it is those patients who are non-ambulatory or who are unable to feed themselves that are at the greatest risk of being neglected and abused.
Frail patients, incapacitated patients or patients with dementia are also vulnerable to abuse and neglect because they lack the ability to protect themselves.
Appropriate Staffing is the Key of Good Care.
Nursing homes are dependent on nurses and nurses' aides to provide patient care. The appropriate number of nurses in a facility is dependent on the acuity and functional ability of the patients needing care. The greater the patient needs, the greater the number of nurses and nurses' aides required to care for those needs.
Patients who are unable to perform activities of daily living, such as dressing, walking, or eating independently, require more nursing and nurse aide hours per day than patients who are able to perform these tasks independently.
By accepting patients who are unable to care for their own needs, nursing home owners promise to provide enough nursing staff, both in quality and quantity, to deliver the appropriate care to each of those patients.
Poor Staffing Equals Poor Care.
Nursing home profits are tied to income and expenses. There are some expenses that are variable, which means they are not fixed and can be increased or decreased as the nursing home owners wish. Nursing hours are one of the most important variable expenses in running a nursing home.
Some of the other expenses that are variable are: food, supplies, and support staff (such as dietitians and rehabilitation specialists).
Nursing homes become dangerous places when their owners, in an effort to increase profits, fail to provide enough nurses or nurses' aides to care for the needs of their patients.
Our Next Article.
Our next article will discuss staffing specifics and provide a method of assessing the adequacy of staffing.
The “Guardian Blog” will continue to provide information to help families assess the quality of nursing home care in Arizona and the Guardian Blog will encourage dialog with and among its readers.
You’ve been told that your spouse or parent needs nursing home care. You know that the nursing staff is important but what do you do next? First, you start by realizing that not all nursing homes are created equal.
Always evaluate several nursing homes to determine which facility best meets the needs of your loved one.
Although no single criteria should be the deciding factor, staffing levels are an important consideration in choosing a facility.
In evaluating staffing levels at the various facilities, there are a series of steps one must take. It is not easy but with some effort you can minimize the risk that your loved one will be placed in a facility that is unable to properly care for them.
Patient Needs.
What are the patient’s needs? Has the patient suffered a stroke, and now requires assisted feeding and assistance with ambulation? Does the patient suffer from dementia with a tendency to wander requiring a secured facility?
Use the following rule of thumb: The greater the need, the greater the number of staff necessary to care for the patient.
Nurse and Nurse Aides Available to Care for Patient Needs.
Arizona has no minimum requirement for the number of nurses or nurse aides a facility must have on duty at any given time.
Based on Arizona’s failure to require a minimum staffing level, Arizona nursing homes rank low nationally in the number of nursing staff available to care for patients.
The average number of nurses and nurse aides reported for Arizona facilities is 3.5 nursing hours per patient day. As a means of comparison, 82% of the states have a higher average number of nursing staff available to care for patients. Harrington, Carrillo, and Blank, Department of Social and Behavioral Sciences, University of California, September, 2008.
How to Calculate Nursing Hours per Patient Day.
1. Add the total nursing hours for all nurses on duty on any given day.
2. Divide the total nursing hours by the patient census (number of patients at the facility) for the same period of time.
Example: 2 nurses each working 8 hours in a facility that has 10 patients.
2x8=16 divided by 10 patients = 1.6 nurse staffing hours per patient day
Where to get the Staffing Schedules.
Every nursing home is required to post its current staffing schedule in the facility for the public to view.
The staffing schedule will contain information such as how many nurses, nurses' aides, and patients there are in the facility on any given day.
If after calculating the number of combined nurses and nurses aide hours at the facility, and if you arrive at a number less than 3.5 nursing hours per patient day, then you know that your facility does not even meet the staffing level of the average Arizona nursing home.
Visit the Facility.
There is no substitute for personally visiting the nursing home. Try to visit on a Sunday afternoon, as that is when most families are there to see their loved ones. Speak with several families and ask them whether they believe there are enough nurses or nurse’s aides there to be attentive to the patients.
Other Factors to Evaluate.
There are two government websites that you should look at for each facility you are considering. Each will give you information based upon inspections made by the Arizona Department of Health Services:
Finding the right nursing home is not based on a scientific formula, but instead is dependent on research and common sense. Even under the best of circumstances, family members must be attentive to the condition of their loved ones as well as the condition of the facility.
Our Next Article.
Our next article will discuss how to be attentive to the condition of your loved one in a nursing home.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialog with and among its readers.
When an Arizona parent needs nursing home care, overseeing that care usually falls on whichever child happens to live in Arizona. This article is for that “responsible” child who just happens to live here.
The first question one must ask is whether any patient can receive quality care in a nursing home. We’ve all heard the horror stories about the warehousing of nursing home patients, who are just waiting to die.
Although nursing home care in Arizona is often less than adequate, I believe that it is possible for nursing home patients to receive quality care. However, in order to receive that level of care, patients must have a knowledgeable advocate.
Nursing Home Advocacy 101.
Nursing home advocacy doesn’t require a degree in nursing or medicine, just time, tenacity, and a little information.
Communication is the First Lesson.
One of the major problems in the nursing home is lack of communication between and among families, nursing staff, and physicians.
So how do you, as the patient’s advocate open channels of communication?
Become Aware of the Patient’s Needs.
Become aware of your loved one’s needs. Are they bed bound? Can they feed themselves? Are they taking a new medication?
Communication Just Doesn’t Happen by Itself.
Very few families understand that they have to become involved in facilitating communication within the nursing home.
Families are led to believe that the nursing staff will provide the physician with all the information about the patients. Families are also led to believe that the nursing staff will provide all the nursing care the patient requires. Unfortunately, both of these assumptions are not correct.
Nurses and nurses' aides are short staffed in nursing homes and are unable to provide all the necessary care the patients require. Physicians, who are responsible for the care of patients at nursing homes, rely too heavily on the nursing staff to follow physician orders or to perform adequate nursing care.
Meet with the Patient’s Nursing Home Physician.
Discuss your loved one’s needs, in person, with the nursing home's primary care physician. Find out when the physician plans to be at the facility for his regular visits with the patients, and meet him there.
Patient advocates must take steps to encourage physicians to personally take a close look at their loved one’s condition and ensure that the nursing staff is functioning as intended.
So, when meeting with physicians at the nursing home, ask them to check the condition of the patient. For example, if the patient appears to be losing weight, ask the physician to weigh the patient. If the patient has in fact lost weight, ask the physician to meet with you, the dietitian, and the nursing staff to discuss how to encourage weight gain.
The advocate may become a “pest”, but the physician won’t be able to say that he had no idea that his orders weren’t being followed or that he was unaware that the patient’s condition has changed.
It is the primary physician’s responsibility to know the care your loved one is receiving at the nursing home. If the patient is losing weight, the physician should determine why the patient is losing weight. The physician must ensure that his patient is eating his meals and if not, the reason why not. The physician must then take action to ensure adequate nutrition.
If the patient is bed bound, the physician needs to examine the patient’s skin in order to determine whether his patient is developing pressure ulcers (bed sores). And, if the patient has pressure ulcers, the physician must ensure that his patient is being turned and repositioned regularly and is also receiving adequate nutrition.
The advocate must be the vehicle by which the physician is encouraged to completely check the patient’s status, during each visit, and not merely rely on what he is being told or not being told by the nursing staff.
Make Regular Visits to the Nursing Home.
When you visit your loved one in the nursing home, visit during the morning, lunch, and evening meals which are the busiest times of the day. This will give you the opportunity to determine whether the nursing staff is able to attend to patient needs during stressful situations.
During your visits, check the following and report any changes you observe to the nursing staff and the patient’s physician:
1. Patient’s weight.
2. The percentage of breakfast, lunch and dinner the patient has eaten.
3. The patient’s skin condition (twice a week) for signs of red, blistered, or broken skin on hips, buttocks, shoulders, or any place that comes into contact with the mattress or wheel chair cushion.
4. The patient’s medication record documenting medications that were supposed to be given.
5. Look for any change in the patient’s condition including eating patterns, sleep patterns, falls, bowel movements, agitation, etc.
Meet the Director of Nursing.
The Director of Nursing (DON) is the highest level of nurse management in the nursing home. Introduce yourself to the DON and explain what you know about your loved one’s needs, likes, and dislikes. The DON is responsible for making sure there are enough nursing staff at the facility and is the “go to” person when nursing care isn’t up to par.
If, as a result of your observations, the patient is not receiving adequate care, speak with the DON and the patient’s physician.
If matters don’t improve, speak with the Administrator, who is the general manager of the nursing home.
If there still is no improvement, consider moving the resident to another facility. If matters are such that you decide to move the patient you should inform the Arizona Department of Health Services (ADHS) which is the regulatory agency in Arizona responsible for overseeing nursing homes.
The patient advocate is the additional oil that keeps the nursing home engine running well. When the oil is low and the engine spurts, the advocate is there to move things along.
It is unfortunate that nursing home patients need an outside observer and facilitator to get the care that Medicare and Arizona Long Term Care have paid for, and that patients are entitled to receive.
Our Next Article.
Our next article will discuss avoidable pressure ulcers (bed sores), a principal killer of nursing home patients.
The “Guardian Blog” will continue to provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialog with and among its readers.
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