Injuryboard Commentary - Nursing Home Abuse

New Website to Help Families Learn About Nursing Homes

Billy Cunningham — Sat, 14 Nov 2009 08:40:00 GMT

The National Citizens for Nursing Home Reform (http://www.nccnhr.org/ ), a consumer advocacy group for nursing home residents and caregivers in nursing, homes, announced that the Brown University Center for Gerontology and Healthcare Research has introduced a website designed for nursing home researchers that provides data on nursing home care in the US. The website states that its goal is to allow researchers to trace relationships between state policies, local market forces and the quality of long-term care and enable policymakers to craft state and local guidelines that promote high-quality, cost-effective, equitable care for older Americans. NCCNHR believes the site will also be enthusiastically received by many consumer advocates looking for detailed data and more sophisticated comparison tools than provided on other website such as Nursing Home Compare.

The interactive database, www.LTCfocUS.org, incorporates information from a number of government sources-Medicare reimbursement claims, OSCAR (CMS's Online Survey, Certification and Reporting system), the MDS (Minimum Data Set), and Brown's own survey of state Medicaid policies Users can interact with the website by creating interactive maps and tables with comparative information about states, counties, or individual nursing homes. All data provided on the website are also available to download.

The website provides the type information that users can employ to choose up to five variables. It allows the user to create a chart comparing all nursing homes in a state. The broad range of variables from which to choose includes number of beds; for-profit and chain status; percent of Medicare and Medicaid beds; Alzheimer's units; occupancy rates; age ranges, gender and race of residents; direct care staffing (RN, LPN, CNA); acuity of care; certain MDS quality measures; source of admissions (hospital or home); and 30-day rehospitalization rates (a potential indicator of quality not found on Nursing Home Compare).

The website is sponsored by the National Institute on Aging-funded Shaping Long-Term Care in America project housed at the Brown center. While its stated purposes are to "allow researchers to trace clear relationships between state policies and local market forces and the quality of long-term care" and to allow policymakers "to craft state and local guidelines that promote high-quality, cost-effective, equitable care to older Americans," NCCNHR recommends that consumer go to this site to perform their researches about nursing homes in their areas before placing a loved one there. The more you can know about your options for placing loved one in a nursing home , the better equipped you'sll be to help prevent any nursing home negligence or abuse.

Originally posted at InjuryBoard by Billy Cunningham

Caps on Damages Make No Sense

Billy Cunningham — Sat, 07 Nov 2009 11:14:08 GMT

The Republican proposal on health care reform has provisions to limit compensation for non-economic injuries to persons injured or killed as the result of medical malpractice including residents of nursing home who are neglected or abused. Most of my practice over the past 23 years of my 35 year career has been representing nursing home residents. I began thinking of how I would tell clients and/or their families that nursing home neglect and abuse was included in the medical negligence bill proposed. How do I explain that injuries to the elderly, vulnerable members of our society are limited? Here are people who cannot protect themselves, who rely on nursing homes for their safety and well being, and to provide a quality of life that Congress knows what the limit of those injuries are? I thought of all the cases that I have handled involving injuries in nursing homes. The following are actual examples of victims of nursing home neglect and abuse that under the standard proposed by the Republicans would be limited in any award against the nursing home that caused the injuries or death the award.

Mr. A. who had a grapefruit sized vaginal malignant tumor that the nursing home never knew about- death case.

Mr. B. , an Alzheimer patient in a ‘special unit’ who despite no other physical diseases developed multiple state 4 pressure sores, contractures and severe weight loss – death case.

Mr. C., a smoker, who was strapped in a wheelchair and unwatched burned to death when a lighter caught his clothing on fire.

Mrs. D who was overdosed with psychotropic medications to keep her quiet and while trying to escape the torture fell in a bush and lost an eye. After this incident she was moved to a nursing home that properly cared for and weaned her off the psychotropic medications. She was discharged and the last I heard was playing the slot machines in Biloxi. Personal injury case.

Mr. E. who was beaten to death by another nursing home resident who had previously beaten other resident. No precaution was taken to protect any of these residents.

Mr. F. who was demented and known to have a desire to leave the facility and fell from an open window. death case

Mr. G. who went in a nursing home for a 21 days rehabilitation after hip surgery and developed a pressure sore so big on his leg that the leg had to be amputated- personal injury case.

When you look at the data which shows that medical malpractice is a very miniscule part of the cost of health care, you have to ask yourself whether proposed limits are fnecessary for health care reform or fair to the victims.

Originally posted at InjuryBoard by Billy Cunningham

The Consumer's Role in the Nursing Home/Healthcare Reform Battle

Billy Cunningham — Sat, 24 Oct 2009 12:10:28 GMT

Health care reform is the big issue today- as it should be. But how will it affect our elderly in nursing homes? Nursing home owners say they are looking at $16 billion dollars in cuts from Medicare over the next 10 years. Is that so? The Washington, DC-based Center for Medicare Advocacy (http://www.medicareadvocacy.org/ ) reviews reports from the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) and advises that those reports show that Medicare overpays nursing homes billions of dollars a year. MedPAC found that the aggregate profit margins for freestanding nursing facilities exceeded 10 percent for seven years in a row. In 2007, their profit margin was 14.5 percent. Moreover, they didn’t add staff. So the Center for Medicare Advocacy believes that the nursing home operators are pocketing much of the profits, rather than reinvesting them. The reports also cannot account for money paid out to associated groups who own the property, manage the facility etc.

We read every day about Congress wrestling with health care reform. Hand in hand with Congress are the groups we refer to as lobbyist- there to make sure their particular industry is protected. One of those groups, of course, is the nursing home industry, which claims it is facing a $16 billion cut in direct support from Medicare over the next 10 years, as well as Medicaid cuts in many states.

The nursing home operators warn that further cutbacks in Medicare-which are part of the reform legislation– will drive many facilities out of business. Some homes are laying off employees now, and a few have recently closed. We are also seeing the nursing home reduce Registered Nurses with Licensed Practical Nurses in many areas. Meanwhile, the need for these institutions is increasing. As the number of people going into nursing homes increases so does the level of nursing care.

Are the nursing home owners trying to defeat healthcare reform because Medicare benefits reduction will affect care .or their bottom line? Is the advocacy center right that profits are really higher than reported? Nursing home owners have been known to put their own profits before people. There are cuts in Medicaid. We should all be concerned about the care our elderly will receive.

Knowing what is going on in your local nursing homes is probably the best each of us can do on an individual level. Check them out carefully before placing your loved one in a nursing home. The earlier you know what to look for to prevent nursing home neglect or abuse, the better for your loved one. Here are some cites that will give you information about getting good care: the National Coalition for Nursing Home Reform http://www.nccnhr.org/ , a governmental agency, the National Center Elder Abuse Http://ncea.aoa.gov , and Medicare web site http://www.medicare.gov/nursing/overview.asp.

There are warning signs that nursing home abuse or neglect may have occurred. It is not uncommon to hear reports of various forms of violence and irresponsible, inhumane treatment being inflicted upon residents, including: physical assault and battery ; sexual assault and battery; rape; deprivation of food and water; unreasonable or unwarranted physical or chemical restraint; withholding of needed medication ; overmedicating; suspicious injuries; appearance of untreated wounds, cuts, bruises, welts; reports by residents of being slapped, struck, pushed, shaken, beaten or likewise mistreated; improper confinement; serious injuries requiring emergency treatment or hospitalization; and incidents that result in broken bones, especially a fractured hip.

Originally posted at InjuryBoard by Billy Cunningham

Nursing Home Residents Death Caused By Abuse

Mike Bryant — Mon, 12 Oct 2009 16:31:00 GMT

A Minnesota Department of Health report found that White Community Hospital and Nursing Home staff in Aurora dropped a resident several feet while being moved in a sling from her bed to a wheelchair. As a result she suffered broken bones that contributed to her death. The hospital's internal investigation said the employee failed to follow the resident's care plan, which said such a transfer required two staff members.

Hubert Humphrey talked about the way a society is doing could be judged by the way they cared for their elderly. This story is a example of treatment at it's lowest.

Nursing Homes are often medical necessary for many families. They can be very expensive. They are the residents homes surrounded by professionals in charge of caring for them. The place they should always feel safe.

If you have a family member in a nursing home , it is important to look around on each visit. Be vigilante in certain areas. Look for signs of Physical Abuse, Neglect, and Verbal/Emotional abuse. If you see signs of abuse:

Contact the Nursing Home Administrator and tell them your concerns.
Contact the Minnesota Board of Aging.
Contact the police department in the municipality where the abuse occurred.

It's important that we protect all of those that have contributed to society and who are the most vulnerable.

Originally posted at InjuryBoard by Mike Bryant

Florida Has Weak Protection Laws for Our Seniors

Sandy Grinnell — Mon, 28 Sep 2009 10:23:09 GMT

The Orlando Sentinel has an excellent article today on the pitfalls of the state of Florida's control over who is taking care of the elderly in nursing homes, assisted living facilities and adult day care centers. Among the problems reported are:

State law requires that facilities perform criminal background check on employees just in the state of Florida, not nationwide (there are a few exceptions).
In all but nursing homes, employees can begin work before the criminal report is returned from the screening process.
The state has screening inspectors who review employee files for background checks but only get to visit nursing homes about one time per year and assisted living facilities once every two years.
Investigators have found some employees who have been on the job for seven years and still have no background check in their personnel file.

The law covering who is and who is not allowed to care for our senior citizens is finally being expanded this week. While the law has always excluded those charged in a criminal activity, the new statute also covers theft, fraud and forgery.

Originally posted at InjuryBoard by Sandy Grinnell

Nursing Home Direct Care Givers are Essential to Good Care

Billy Cunningham — Sat, 05 Sep 2009 11:44:04 GMT

The SCAN Foundation, a California philanthropic organization which was established to advance the development of a sustainable continuum of quality care for seniors released a paper which confirmed that direct care workers (“DCWs”) are essential to quality nursing home and home health care for the elderly. Having well trained direct care workers reduces the chances of nursing home abuse or neglect. The paper is authored by Sarah Wells, the Executive Director and Alice Hedt, Consultant with NCCNHR, the National Consumer Voice for Quality Long-Term Care.

The paper involved a study of California nursing home and home health patients who are dependent on DCWs to address their most fundamental human needs. These DCWs often act as liaison to the nursing staff, reporting the care-receiver’s medical and emotional status to key nursing and medical personnel. The DCWs are likely the patient’s key connection to the outside world. Older adults who need assistance with almost every aspect of their lives often each morning are seen a greeted by a DCW who is assigned to them and who may spend only 20 to 40 minutes but who in that short time directly affect :

• When and whether they get out of bed

• How long they have to lie in wet pants

• What they want to wear

• Whether teeth are brushed, nails filed and body washed

• If the curtains are closed to protect privacy

• If the nurse is notified of the red spot on a heel that could easily become a bedsore

• Whether there is enough to eat and the patient is positioned correctly so not to choke

• Whether the water by the bed can be reached and if there is a straw that if needed

• Whether there is access to morning activities

• If the patient hears a few kind words

• Whether the patient is rushed or relaxed

• Whether the patient can call for help the rest of the morning by providing a telephone or call button

This scene is replayed daily in 1.6 million nursing home residents’ rooms throughout the country and in thousands of homes where older adults receive much needed medical care and assistance from home health care providers. No matter what laws and regulations are in place, no matter if the care is from a for-profit or not-for-profit organization no matter the amount of money being paid by the individual or by the State’s Medicaid program -- the experience of the older adult is determined by his or her interactions with the DCW.

The paper reiterates the 1985 NCCNHR study which identified the key components of quality from the consumer’s perspective. Nursing home residents throughout the country explained that the most important elements of quality in their day-to-day lives were the accessibility and attitude of the DCW. Since the 1985 study NCCNHR has actively and consistently studied how nursing home residents, individuals receiving care in their homes, family members and advocates have stressed that a good long-term care experience is dependent on having enough DCWs who are well trained and have a positive attitude. Training of the DCW is essential to providing this care. Poor training about dementia and mental health issues has been identified as a factor that contributes to nursing home neglect and abuse.

The paper cited that, for example, the third highest complaint in California is about staff attitudes - staff not treating residents with respect and dignity. The number one complaint category handled by California ombudsmen is another important DCW competency - handling roommate and resident conflict. Other important ‘non-medical care’ that promote quality of life as well as DCW job satisfaction include resident/care receiver rights, organizing work, empowerment, teamwork, stress management and cultural sensitivities. In other words, how a long term patient feels about their day to day existence and how a DCW feels about her job can affect how the patient responds both physically and emotionally. One long-time CNA summarized the link between quality of life and quality of care when she addressed a Career Nursing Assistants’ meeting saying, “We have all been taught how to clean up messes. The trick of being a good CNA is how to clean up messes and not make the resident feel bad, how to be supportive in my tone of voice and attitude.”

Through the paper, NCCNHR proposes that the DCW be taught the importance of cultural diversity, individualized care plans, systemic issues( pay issues, staffing issues, etc), dementia training and adult learning. The paper also points out the importance of supervisor training to learn and follow these same principles needed for these DCWs to perform their job. Utilizing these tools will help nursing homes and home health workers to provide better care for the patients and reducing nursing home neglect and abuse issues.

The paper can be read in its entirety at http://www.thescanfoundation.org/documents/reports/Convening%20Paper.pdf Please go to http://www.nccnhr.org/ for a review of all the many services NCCNHR can assist family members

Originally posted at InjuryBoard by Billy Cunningham

Nursing Home Caregivers Strike

Billy Cunningham — Sat, 08 Aug 2009 12:45:53 GMT

Over 300 union members at the four OMNI nursing homes in New Jersey have been without a contract since 2007. Two years ago, the owner of these homes, Avery Eisenreich, walked away from the negotiations and unilaterally implemented a number of changes including a loss of pension payments. He is currently being investigated by the National Labor Relations Board’s regional office in Newark for ‘bargaining in bad faith.

This news caught my eye because at a recent nursing home seminar I became aware of a lawsuit recently settled in New Jersey against one of the nursing homes purportedly owned by OMNI. I say purportedly owned by OMNI because during the course of that litigation a New Jersey lawyer, Saul Gruber, discovered a multitude of legal entities set up by Eisenreich to suck money away from the actual nursing home operation by setting up management companies, real estate investment trust and lease arrangements favorably to him.

The union news release reports that the workers at these home work hard to care for the elderly, but because of the low wages, many of them have to work two jobs just to make ends meet. While many Omni workers are paid wages that are less than $7.90 an hour – barely over the minimum wage, the union claims their employer, Avery Eisenreich, pays himself more than $1,500 an hour!

I posted a blog on 2009 about the problem of nursing home owners setting up these multiple legal entities to avoid liabilityand to syphon money away from the operation of the nursing homnes and into their own pocketbooks. I reported that Congress was considering legislation called the “Nursing Home Transparency and Improvement Act which is a part of the draft health care reform bills that the House and Senate are considering. The bills would make nursing homes disclose their owners and operators. At that time I reported that several large chains have been bought out by global private equity investors. Now we are seeing entrepreneurs like Eisenreich taking advantage of the elderly and their caregivers for the sake of making more money. InjuryBoard member Jessica Smagacz posted a blog yesterday on the report from the British Medical Journal that the best care is given at non-profit nursing homes. We now know that a majority of nursing homes are owned by for profit corporations. While our economic system encourages investing and making profits, it should not do so at the expense of elderly patients and without fairly compensating the care givers. The system can work. We have all seen it work and seen excellent care given. There is no excuse for nusring home abuse.

There are few, if any, unions in the South to protect workers in nursing homes. I hope the strike will make Mr. Eisenreich come to the table, treat the workers fairly and allow them to provide the proper care for the elderly. Maybe the word will get out to other owners who are in the buiness of operating nursing homes.

Originally posted at InjuryBoard by Billy Cunningham

Want to Find a Good Nursing Home? Look for Non-Profits

Dan Frith — Thu, 06 Aug 2009 11:25:28 GMT

This story should not surprise anyone. A nursing home focused on resident care and not just making money will usually provide the best care.

Canadian researchers (at McMaster University in Hamilton, Ontario) have concluded that non-profit nursing homes provide better care than for-profit facilities after reviewing the results of 82 studies from 1965 to 2003.

The review authors calculated that if all nursing homes were non-profit, nursing home residents in the United States would receive 500,000 more hours of nursing care per day. Just imagine how good the care could be with the increased staff!

Who are the non-profit nursing homes in Southwest Virginia. Try these facilities:

1. Our Lady of the Valley

2. Roanoke United Methodist Home

3. Brandon Oaks

4. Kendal at Lexington

5. The Summit (Lynchburg, VA)

6. Westminster-Canterbury (Lynchburg, VA)

7. King's Grant Retirement Community (Martinsville, VA)

8. Kroontje Health Care Center (Blacksburg, VA)

9. Warm Hearth Village (Blacksburg, VA)

My Take: Give these nursing homes your "first look" in you are searching for a good facility.

Originally posted at InjuryBoard by Dan Frith

North Carolina Releases a Rating System for Nursing Homes

Jim Lewis — Thu, 30 Jul 2009 10:05:42 GMT

North Carolina (NC) has started a rating system for nursing homes. So far, 585 of the 1,300 nursing homes registered in North Carolina (NC) have been reviewed. The rating system gives nursing homes zero to four stars based on nutrition, personal care, supervision and building safety.

Megan Lamphere, the ratings administrator for the state Division of Health Service Regulation's Adult Care Licensure Section told reporters this week, “Anything that puts more information out there for the public is great. There's lots of care options out there for people, and that's why it's important to see if it's a good fit for you or your loved one."

As a personal injury attorney, I couldn’t agree more. Nursing home abuse and neglect have been on the rise in recent years and this new rating system for North Carolina (NC) may help to improve those statistics. Of the 585 nursing homes inspected, seven have already received zero stars, including Floyd McKissick Assisted Living Center in Warren County, North Carolina (NC).

After the Floyd McKissick Assisted Living Center received zero stars in the ranking, inspectors shut down the building and relocated its 30 elderly residents. A new management team has been brought in to try and reopen and claim a higher ranking.

While this ranking system will go along way in helping loved one’s choose where to place their elderly family members, they should still keep a watchful eye. My colleague, Emily Mapp Brannon, wrote an article recently shedding a light on some of the realities of nursing home abuse; The Harsh Realities of Nursing Home Abuse. This article is an eye opener to what can go one with our elderly loved ones behind closed doors.

If you have elderly family members residing in a North Carolina (NC) nursing home and suspect they may be a victim of nursing home neglect read this article from my colleague John Cooper; Helping an Elderly Family Member That Has Been Neglected. John Cooper’s article will help you determine if your loved one is being abused and show you what you can do about it.

Shapiro, Cooper Lewis & Appleton personal injury law firm is based in Virginia (VA), with an office also in Elizabeth City, in Northeast North Carolina (NC), practicing primarily in the southeastern U.S. and handles only injury law, including car, truck, railroad, and medical negligence cases and more. Our Carolina injur law website is: http://carolina.hsinjurylaw.com, the firm edits the injury law blogs Virginia Beach Injuryboard, Norfolk Injuryboard, as well as the Northeast North Carolina Injuryboard and also hosts a YouTube injury law video library covering many FAQ’s on personal injury subjects. Lawyers licensed in: VA, NC, SC, WV, DC, KY.

Originally posted at InjuryBoard by Jim Lewis

Nursing Home Abuse More Common than Statistics Indicate

John Cooper — Sat, 18 Jul 2009 22:35:00 GMT

Some people think nursing home abuse is a “once-in-a-blue-moon” event. Unfortunately, it’s much more common occurrence than one would expect. The official data indicates between one to two million citizens over the age of 65 have been injured, exploited, or mistreated by someone they rely on to take care of them, according to National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect.

These numbers don’t fully reflect the actual number of nursing home abuse and elder abuse cases since there is no uniform reporting system and no comprehensive national data. The definition of nursing home abuse is another grey area since it’s challenging to categorize what would be construed as abuse, according to the National Center on Elder Abuse.

Here’s a shocking video, and clear example, of elder abuse…

http://www.youtube.com/watch?v=4YEuivTYI64&feature=fvw

As a personal injury attorney with over 20 years of experience representing clients who’ve been the victims of nursing home abuse, I understand this area of law. For example, in 2004, the Adult Protective Services Act was enacted which expands the number of “mandatory reporters” (i.e. people who are legally obligated to report abuse if they suspect such abuse is occurring). All individuals licensed, certified, or registered by health regulatory boards, excluding the Board of Veterinary Medicine, are “mandated reporters.” This includes dentists, pharmacists, emergency service personnel, and guardians.

About the Editors: Shapiro, Cooper Lewis & Appleton personal injury law firm is based in Virginia (VA), near the NE North Carolina (NC) border and handles car,truck,railroad, and medical negligence cases and more. Our lawyers proudly edit the Virginia Beach Injuryboard, Norfolk Injuryboard, and Northeast North Carolina Injuryboard as a pro bono public information service. Lawyers licensed in: VA, NC, SC, WV, DC, KY.

Originally posted at InjuryBoard by John Cooper