The Guardian Blog : Arizona Nursing Home Lawyer & Attorney : Solomon & Relihan Law Firm : AZ Assisted Living Neglect & Abuse : The Guardian Blog

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.
 

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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.
 

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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.
 

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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.
 

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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.
 

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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.

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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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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:

• Medicare.gov -- Nursing Home Compare
• Long Term Care Provider Search Form

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.
 

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