California Personal Injury Blog - Nursing Home

Battle Against Bedsores Requires Teamwork

Walton Barber, LLP — Tue, 19 Feb 2008 23:42:24 GMT

New research shows that preventing and treating pressure ulcers in the nursing home setting requires a team approach, involving nurses, laundry workers, cafeteria and maintenance workers, and even the cosmeticians.

Large bedsores are a sight to behold. The larger ones - Stage III and IV - can result in a wound so deep that you can see the bone. Wounds like this can be very painful and can lead to serious and lethal infections, such as the one that killed Christopher Reeves.

It is estimated that a least two million Americans suffer from bedsores every year, most caused by poor nutrition, dehydration, immobility, and/or incontinence. A new study, however, suggests that using a team approach to the battle against pressure ulcers can greatly reduce the numbers.

In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent.
"Preventing pressure ulcers is a 24/7/365 kind of job," said Jeff West, a clinical reviewer at Qualis Health in Seattle, who helped to set up the collaborative in 2003. "It's not as if one person can get it all done. And if it fails just a little bit, just during the weekends, for instance, you're not going to get the results. It takes tremendous consistency."

Nursing homes are enlisting every department that can help play a role. The laundry workers look for ill-fitting clothes, the kitchen staff boost nutrition of those at risk, even the hair salon can help by repositioning the resident if sitting for too long.

According to West, the changes need to become hard-wired into the organization. "A lot of places do well when they have a lot of support," he said. "But it's hard to keep that momentum going. That's the real challenge."

Originally posted at InjuryBoard by Walton Barber, LLP

Long-term Care in Nursing Homes

Rick Patterson — Thu, 14 Feb 2008 16:41:12 GMT

An overhaul of Tennessee's state services to the elderly and disabled may not be in the too distant future. A long-term care study committee will be drafting recommendations to overhaul the current system. The state could pay Tennesseans to take care of relatives and friends rather than sending them to nursing homes. "Govenor Phil Bredesen said he will work with lawmakers to "fundamentally restructure" the long-term care system, and he included $12 million in new state money in his budget plan to begin the process."

It is believed that there are many benefits to having family and friends care for the elderly. It provides dignity to the elderly, while reducing costs to the state. On the flip side, there is no question that there can be pit-falls to giving someone a monthly check and saying "Go out there and hire your own caregivers" according to Ron Taylor, executive director of the Tennessee Health Care Association. It is easy to see there is a real potential for abuse. Many safeguards would have to be implemented to make such a system work. It remains to be seen whether Oregon is ready for these changes in the near future. If and when the system is implemented, Oregon will be a model state for such a system.

Additional Information Pertaining to Nursing Home and Elder Abuse

Originally posted at InjuryBoard by Rick Patterson

Nearly Half of California Nursing Homes Do Not Meet Federal Standards

Randy Walton — Mon, 11 Feb 2008 14:46:40 GMT

Medicare and Medicaid released a report this week listing nursing homes and hospitals from around the country that have fallen below benchmarks set for patient restraints, bedsores, and surgical infections. Of the 1400 California nursing homes, 674 made the list.

The purpose in releasing the specific nursing homes was to hold accountable the private contractors hired by Medicare and Medicaid to monitor quality standards and health care facilities the receive Medicare payments.

San Francisco-based Lumetra has monitored quality standards at California health care facilities that receive Medicare payments since 1984. Medicare and Medicaid spokesman Peter Ashkenaz said his agency released its facility lists to hold companies such as Lumetra more accountable for the work they do
This list is a tool to manage the quality-improvement organizations," Ashkenaz said. "This is not about facilities. This does not mean these are bad facilities.

It may not mean the facilities are bad, but it clearly means that nursing home residents are being neglected to some degree. Like most standards, the Federal standards are meant to be the minimum standards; the hope being that facilities will not just meet them, but exceed them. The unfortunate reality is that most facilities use the prevailing standards as the standard of care they are to provide, and just barely meet them, when for some residents the minimum standards will not do.

For the names of all San Diego, Orange, Riverside, Los Angeles and San Bernardino nursing facilities that made the list visit Medicare's website.

Originally posted at InjuryBoard by Randy Walton

California Budget Cuts May Endanger Elderly

Randy Walton — Fri, 25 Jan 2008 15:53:26 GMT

Governor Schwarzenegger's proposed cuts of the California budget may increase the risk of elder neglect and abuse to the nearly 150,000 elderly residents of nursing and residential care facilities.

According to the California Advocates for Nursing Home Reform (CANHR), the proposed cuts will reduce inspections and will further cripple an already struggling program. Moreover, a reduction in the budget of the Department of Social Services Community Care Licensing Division - which currently is only required to inspected residential facilities once every five years - while assisted living care is growing rapidly is a set up for disaster.

"Inspecting RCFEs once every five years or less is a recipe for neglect and abuse," said Patricia McGinnis, CANHR's executive director. "Care standards and residents' rights become virtually meaningless when inspections are so rare. Issuing a license under these conditions deceives consumers who assume the state is conducting regular inspections or offering oversight and protection to residents."

Currently there are more than 7,500 assisted living facilities for the elderly in California, a 25% increase since 2000. Yet the state inspection system of these facilities, once the model for other states, has continually diminished.

An increase in oversight and enforcement is needed now more than ever. The present oversight system does not ensure the basic care and safety of elderly residents. At the very least, each RCFE should be inspected every two years. Facilities with poor compliance histories should be inspected annually or more often.

For more information contact Pat McGinnis at CANHR, (415) 974-5171.

Originally posted at InjuryBoard by Randy Walton

Woman Dies in Nursing Home Due to Lack of Care

Rick Patterson — Wed, 26 Dec 2007 17:35:09 GMT

Nursing home care has long been a concern. Families leave their loved ones in the care of others and many times that care falls short of what one would expect. Recently a nursing home known as Pacific Coast Manor was issued the most severe citation under state law. In addition to the citation, they were fined $100,000 after a state investigation concluded inadequate care led to the death of a female resident at that nursing home.

Apparently Pacific Coast Manor failed to monitor the elderly woman's drug intake and combination of drugs. As a result, she died. The nursing home has since filed an appeal. Nursing homes are a huge businesses in the United States, and there are many big chains out there. Pacific Coast Manor is owned by Covenant Care of Aliso Viejo.

To find out more information on wrongful death, please visit our site.

Originally posted at InjuryBoard by Rick Patterson

Nursing Home Citations Up 22% Nationwide

Randy Walton — Thu, 20 Dec 2007 23:44:20 GMT

Recent studies show that citations for serious violations issued against nursing homes is up 22% nationwide.

A USA Today analysis, examining records from the Centers for Medicare and Medicaid, shows that from 2000 through 2006, the number of citations for putting patients in "immediate jeopardy" had increased 22%. Those citations are considered the most serious and often follow cases in which patients were physically or sexually abused or left without medications.

Inspectors found nearly 2,000 violations last year that jeopardized patients at nearly 850 of the nation's 16,000 nursing homes, according to the records. They account for about 6% of the total violations uncovered in nursing homes.
New York issued 131 immediate jeopardy citations last year, up from 41 in 2000. This year it cited one home for not stopping two elderly patients from hitting others, and another for not doing enough to check on patients who fell down, a common source of nursing home injuries.
"We have a new mind-set," said Jeffrey Hammond of the New York health department. "It's not that the quality of care has gone down, but we are being more rigorous in our enforcement."

As expected, the industry is nonplussed. The CEO of the American Health Care Association said in a statement that care is improving despite the increase in serious citations. Figure that one out.

Originally posted at InjuryBoard by Randy Walton

Fancy Nursing Home, Shocking Death

Randy Walton — Thu, 20 Dec 2007 15:32:26 GMT

Because part of my law practice involves representing seniors in nursing homes who have been subjected to abuse or neglect, I am frequently asked for recommendations for a "good" nursing home. I respond that I don't know any. But on the other hand, I tell the person asking, I don't necessarily know the "bad" ones either. One thing I have learned, in cases against fancy chain homes or the mom-and-pops - the price one pays for care is not necessarily indicative of the quality of care one receives.

Take this tragic elder abuse story in Los Angeles County.

When Elmore Kittower's wife placed him an upscale nursing home in Calabasas called Silverado Senior Living it was the first time in their 49 years together that they lived apart. The disabilities Elmore suffered because of a stroke made it too difficult for Rita Kittower to care for her husband at home.

And when Elmore died in the facility approximately two weeks after his 80th birthday, Rita had been told his death was a peaceful one. She believed his death was meant to be. Then she received a jolting phone call the day after Elmore's funeral.

She had bade a tearful goodbye to her mate of 49 years, who had passed away in an exclusive assisted living facility in Calabasas. "He just stopped breathing," Kittower said she was told by a staff member.
A woman claiming to be an employee of the nursing home told Rita that her 80-year-old husband's death had been anything but peaceful. She said Elmore Kittower had been beaten to death by someone on the staff.
"She just couldn't stand what she saw," Rita said. "She had to tell me what happened."
The woman said a staff member had punched Elmore in the eye and wrapped a towel around his head in an apparent attempt to suffocate him.
"I felt like I was going to throw up" Rita recalled. "I said I can't listen to this."
She hung up the phone, but not before getting the woman's number. Rita asked her son to call the woman back. He elicited more details from the caller. When Rita asked about it, he said, "You don't want to know."

The sheriff has investigated the matter, but the district attorney has decided not to prosecute the employee of the facility, who has since been let go for "policy violations." A spokesman for Silverado Senior Living said the company had completed its own investigation and "found nothing to substantiate any wrongdoing."

Originally posted at InjuryBoard by Randy Walton

Abuse of Antipsychotic Drugs Found in U.S. Nursing Homes

Randy Walton — Tue, 04 Dec 2007 19:35:27 GMT

Studies show that Medicaid spends more money on antipsychotic drugs for Americans than any other prescription drug. Why? Because nursing homes across the country are giving these powerful drugs to elderly residents for the purposes of "quieting" them.

The Wall Street Journal is reporting that nearly 30% of the total nursing home population is receiving antipsychotic drugs in a practice that is known as "off label" use of prescription drugs. It's no surprise to lawyers who practice this area that studies also reveal that nearly 21% of nursing facility residents being given these drugs do not have a psychosis diagnosis.

The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing-home industry.
"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Many Southern California nursing homes are committing the same offense. Here at Walton Barber we frequently get calls from families angry at nursing providers for over-medicating loved ones. It's usually a similar story. The family stops by the facility for a visit, only to find their loved one non-communicative and listless, and sometimes incontinent.

The Centers for Medicare & Medicaid -- the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor -- has "initiated a more rigorous process to oversee appropriate use of medicine," says Chief Medical Officer Barry Straube. He says the number of nursing-home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.
Dr. Straube says CMS -- which both funds and oversees nursing homes -- "is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications."
High use of antipsychotics in a nursing home can be an indicator of inadequate staffing, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. "We know the more staffing there is and the higher quality of care, the less the antipsychotic usage," he says.

If you have concerns that someone you know is being over-medicated contact the resident's primary physician immediately. If the use of the medication has caused harm, you may also want to consult an attorney.

For more information on this subject, please refer to the section on Drugs, Medical Devices and Implants.

Originally posted at InjuryBoard by Randy Walton

Abuse of Antipsychotic Drugs Found in U.S. Nursing Homes(2)

Randy Walton — Tue, 04 Dec 2007 19:35:27 GMT

The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing-home industry.
"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

The Centers for Medicare & Medicaid -- the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor -- has "initiated a more rigorous process to oversee appropriate use of medicine," says Chief Medical Officer Barry Straube. He says the number of nursing-home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.
Dr. Straube says CMS -- which both funds and oversees nursing homes -- "is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications."
High use of antipsychotics in a nursing home can be an indicator of inadequate staffing, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. "We know the more staffing there is and the higher quality of care, the less the antipsychotic usage," he says.

Originally posted at InjuryBoard by Randy Walton

Riverside County Nursing Home Fined After Death of Resident

Walton Barber, LLP — Mon, 03 Dec 2007 10:58:09 GMT

Our firm represents individuals and families all over Southern California in cases involving nursing home neglect and abuse, and has seen first hand just how bad care can be in certain nursing homes. But I still get shocked at some of the carelessness that occurs by those taking care of some of our most fragile citizens. Take this story elder neglect just up the freeway in Fontana.

Regulators from the California Department of Health Services issued a AA citation and a $100,000 fine against Citrus Nursing Center in Fontana. The citation and fine came after a 91-year-old resident was dropped on her head and died last March. The AA is the most severe citation given.

According to reports, last February a nursing assistant negligently tried to transfer the resident from her wheelchair to her bed with a portable lift. The woman fell, striking her head on the floor. She died nine days later of blunt force trauma to her head.

It's unclear why it took eight months for the state to complete its investigation.

Mike Connors, spokesman for the consumer watchdog group California Advocates for Nursing Home Reform, said Friday he doesn't understand why it took the state so long to fine Citrus Nursing Center after inspectors finished their investigation.
"That's totally unacceptable, especially for a death," Connors said. "The state is not working for consumers when it takes eight months to issue a citation in a death."

This wasn't the first time Citrus Nursing Center has been subject fines. In 2006, inspectors issued the nursing home two A citations and fine totaling $25,000.

For more information on this subject, please refer to the section on Nursing Home and Elder Abuse.

Originally posted at InjuryBoard by Walton Barber, LLP