A nursing home facility located in Clawson, Mich is being investigated for a recent outbreak of an illness in their facility. An outbreak of an gastrointestinal virus was reported at Cambridge North Health and Rehabilitation Center after several of the residents had symptoms of vomiting and diarrhea.
Continue Reading...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.
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.
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.
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.
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.
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