The Injury Board Commentary - Nursing Home & Elder Abuse

For-Profit Nursing Homes Care is Lower Quality

Dottie Perry — Tue, 31 Jan 2012 16:24:35 GMT

For Profit Nursing Homes Care is Lower

The nation’s largest for-profit nursing homes deliver significantly lower quality of care because they typically have fewer staff nurses than non-profit and government-owned nursing homes according to an article published online in advance of print publication in Health Services Research.

The University of California- san Francisco analyzed the quality of care at nursing homes around the country. It is the first-ever study focusing solely on staffing and quality at the 10 largest for-profit chains. Those chains in 2008 were: HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

According to the article from 2003 to 2008, these chains had fewer nurse “staffing hours” than non-profit and government nursing homes. Their total nursing hours were 30 percent lower and they were below the national average for RN and total nurse staffing. The article also indicated they had the sickest residents- those that need more aggressive care.

These chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities in the country. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.

The authors indicated that more study is needed. They also suggested that greater accountability and quality oversight mechanisms would help improve nursing home care, along with effective funding incentives and sanctions for low staffing and poor quality.

The important message from this study to consumers considering putting a loved one in a nursing home is to look closely at the nursing homes before putting a loved one there. An excellent organization to obtain information about nursing homes is The National Consumer Voice for Quality Long-Term care (formerly NCCNHR; http://www.theconsumervoice.org/ )

Originally posted at InjuryBoard by Dottie Perry

Pennsylvania Proposal Seeks Cap On Punitive Damages In Nursing Home Claims

Scott Cooper — Wed, 25 Jan 2012 07:45:29 GMT

What do you think about a Governor and legislator supporting a law which places an arbitrary cap on punitive damages if you, or a loved one, are the victim of negligence in a nursing, long-term care, assisted living, and personal care facility? This even includes unlawful conduct! This is precisely what the Governor and many legislators in Pennsylvania are proposing and supporting.

The Pennsylvania House of Representatives passed a measure, last week, which will cap the punitive damages awarded in nursing home abuse lawsuits. House Bill 1907 (HB 1907) now goes to the Pennsylvania Senate where the Senate should be urged not to even consider this unconstitutional, unnecessary, and hurtful measure.

Specifically, the legislation caps punitive damages at 200 percent of compensatory damages awarded in medical negligence lawsuits that name nursing, long-term care, assisted living, and personal care facilities as defendants, even for unlawful conduct. The only exceptions are when a defendant intentionally or knowingly acted negligently.

The sole reason for passing the law is to bolster a nursing home’s profits at the expense of safety. Even more insulting to the elderly and victims is the fact that Pennsylvania’s Governor Corbett is endorsing this measure.

Don’t you agree that this Bill should not see the light of day?

Scott B. Cooper
Schmidt Kramer PC
209 State Street
Harrisburg, PA 17101
(717) 232-6300 – Telephone
(717) 232-6467 – Facsimile
scooper@schmidtkramer.com
Facebook.com/SchmidtKramer
Twitter.com/TalkToALawyer

Originally posted at InjuryBoard by Scott Cooper

Don't Get Duped by Luxurious Nursing Home Amenities When Making Your Decision

David Mittleman — Tue, 13 Dec 2011 09:31:40 GMT

The Detroit Free Press recently reviewed the state inspection reports for Michigan nursing homes and made several shocking discoveries. At least six individuals under the care of nursing home staff had died as a result of choking, falling, or medication errors. In some cases, staffers were clearly to blame. For example, Walter Polomoski, who was required to be on a pureed diet, choked to death on a meatball because nursing home staff failed to properly prepare his food. Similarly, Emeline Falls lived to the age of 99 even after suffering a broken arm, but later died at a Michigan nursing home because staffers inadvertently administered her roommate’s Diabetes medication to her instead.

In nursing homes, life is already very fragile. Combined with careless or negligent behavior, those attempting to recover from serious illness can be pushed over the brink into death. Overall, the Detroit Free Press reviewed a total of 30 cases and found that 3 out of 4 nursing homes had been cited for a serious violation that harmed residents or put them in serious jeopardy. An even bigger problem that they discovered was daily neglect, as an estimated 1 in 5 patients had been neglected while staying in a nursing home.

Naturally, even with the best staff nursing homes cannot prevent every resident from getting sick or injured—elderly patients fall and come down with the flu, amongst other problems. However, experts urge families considering placing their loved ones in nursing homes to look past shiny hallways and luxurious amenities. One of the worst ranked nursing homes is Borgess Gardens in Kalamazoo, a 2-year old, $17-million facility with private bathrooms, a bird sanctuary, flat-screen TVs, an indoor garden, and a spacious dining area. In contrast, one of the best nursing homes is Romeo Nursing Center and Continuing Care, two dated buildings in Macomb County. Overall, a caring staff makes nursing homes safe for residents regardless of amenities.

Originally posted at InjuryBoard by David Mittleman

1 in 6 Deaths in New York Disability Homes are not Natural Causes

Mike Bryant — Sat, 03 Dec 2011 09:43:00 GMT

That numbers seems stunning. It accounts for more than 1,200 deaths in private and state run homes over the last decade. The examples are individuals who have drowned, fallen, and been over medicated over time. How is this happening?

This article in the New York Times is startling because it was a product of their investigation:

Through a Freedom of Information request to the State Commission on Quality of Care and Advocacy for Persons With Disabilities, The Times obtained data for all 7,118 cases of developmentally disabled people — those with conditions like cerebral palsy, autism and Down syndrome — who died while in state care over the past decade.

These are cases that often see immunity defenses and governmental caps here in Minnesota. They involve individuals who may not have anyone looking out for them. They are the weak and the disabled whose treatment is a true test of what kind of society we are.

If you or a family member is aware of this type of treatment and such a tragedy, it is important that early investigation be done to find out what happened. It's important that we protect those who are the most vulnerable.

Originally posted at InjuryBoard by Mike Bryant

Should Nursing Homes Do More to Prevent Burnout?

Shayna Slater — Thu, 01 Dec 2011 10:08:56 GMT

A Nursing Home facility can be an extremely stressful place to work. Often, employees are working long hours and are responsible for numerous patients that have various levels of need. There is no question that employee burnout often leads to patient neglect and abuse. It seems like common sense: stress combined with an employee being overworked can directly affect their job performance. However, this needs to be particularly addressed when the individuals’ job performance may have health consequences for patients.

According to a study published by the University of Pennsylvania, nurses who care for patients in nursing homes have higher burnout rates than individuals working in different professions. The study actually stated that “Nurses have long reported that their work conditions are not conducive to providing patient-centered care that is safe and of high quality.”. However, when an individual is admitted into a nursing home, the nursing home promises to provide the patient with excellent care. Yet, the nursing home may not be cultivating an environment that is conducive to receiving such care. There have to be limits set on the amount of hours an individual can work and the maximum number of patients they can care for. More importantly, these limits need to be enforced. Additionally, the nursing home should have programs in place that recognize and address the signs of burnout before it adversely affects their patients.

This study also noted that “37% of nursing home nurses reported feeling burned out in their current jobs compared with 22% of nurses working in other settings.” . Additionally, it found that “among nurses providing care directly to patients, 36% of nurses in hospitals and 47% of nurses in nursing homes, compared with only 21% of nurses in other settings, reported that their workload caused them to miss important changes in their patients’ condition.” Burnout is dangerous and can lead to abuse and/or neglect of residents.

Unfortunately, this does not affect a minority of nurses. The study found that “a substantial portion of bedside nurses in hospitals and nursing homes – the primary caregivers for patients in greatest need – reported being burned out.” Nursing homes must realize that this is a real problem that needs to be addressed or else patients are going to continue to suffer the consequences.

Originally posted at InjuryBoard by Shayna Slater

Low Staffing & Poor Quality of Care at Many For-Profit Nursing Homes

Pierce Egerton — Tue, 29 Nov 2011 13:32:09 GMT

The following news release from the University of California, San Francisco (UCSF), unfortunately, comes as no surprise to those of us who represent the victims of nursing home neglect. Understaffing continues to be a major problem as many nursing homes seek to maximize profits at the expense of resident care:

The nation’s largest for-profit nursing homes deliver significantly lower quality of care because they typically have fewer staff nurses than non-profit and government-owned nursing homes.

That’s the finding of a new UCSF-led analysis of quality of care at nursing homes around the country. It is the first-ever study focusing solely on staffing and quality at the 10 largest for-profit chains.

The article is published online in advance of print publication in Health Services Research.

“Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit chains,” said first author Charlene Harrington, RN, PhD, professor emeritus of sociology and nursing at the UCSF School of Nursing. Harrington also is director of the UCSF National Center for Personal Assistance Services.

“The top 10 chains have a strategy of keeping labor costs low to increase profits,” Harrington said. “They are not making quality a priority.”

Low nurse staffing levels are considered the strongest predictor of poor nursing home quality.

The 10 largest for-profit chains operate about 2,000 nursing homes in the United States, controlling approximately 13 percent of the country’s nursing home beds.

In recent decades, nursing home chains have undergone a considerable expansion.A number of chains were publicly-traded companies until the early 2000s, when five of the country’s largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses.

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share.

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing.

Recent Medicare cuts in payment rates for nursing home residents – by 11 percent in October, 2011 – may further jeopardize the health and safety of residents if the chains respond by reducing staffing and wages, Harrington said.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse “staffing hours” than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.

The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

The authors said that more study is needed on the subject. They also said that greater accountability and quality oversight mechanisms would help improve nursing home care, along with effective funding incentives and sanctions for low staffing and poor quality.

Source: UCSF

Originally posted at InjuryBoard by Pierce Egerton

Throwing Grandma Under the Bus - No Nursing Home Watchdogs in Texas?

Greg Webb — Wed, 16 Nov 2011 08:00:00 GMT

According to an article by the Associated Press and posted in The Houston Chronicle’s online version recently, the economy (vis a vis budget cuts to government nursing home enforcement bodies), legislative changes and discouraged inspectors all appear to be working together to reduce the enforcement of regulations governing nursing homes in Texas.

In Texas presently, revoking a nursing home’s license, not to mention seeking a court-appointed overseer to examine nursing home infractions of the rules, is almost unthinkable. Inspectors, too, are discouraged from carrying out their duties to the letter of the law because there isn’t a budget for it. According to one stunning revelation in the article, “State budget cuts have reduced staff by about one-fourth since 2001, even as the number of nursing homes in Texas is virtually unchanged, at about 1,200.” And we are projecting that the number of people going to nursing homes (Baby boomers, take notice) is on the rise.

We suggest this is not only happening in Texas. This situation appears to be prototypical for several states just now—and it appears that it is not only the economy but the confusion over what is going to happen with health care legislatively, in general, which is fueling this reduction in enforcement. The players—the government health departments, nursing homes, physicians, hospitals, to name only a few-- don’t exactly know what cuts are in store for them and how the cuts will affect their organizations’ ability to participate in the healthcare system in the future. All of this trickles down in the form of big worries to the poor nursing home residents and those contemplating placing their loved ones in nursing homes.

While the Commissioner for the Texas Department of Aging and Disability Services, Chris Traylor, says that agency is not impeding tough enforcement of nursing home regulations, and the Texas Health Care Association representative Tim Graves will tell you he believes the system works, limits imposed on lawsuit damages have “virtually eliminated trial lawyers as de facto watchdogs of nursing homes.” Who is left to stand up to the large nursing home companies?

Due to some legislative changes, the State of Texas, itself, is even limited in its ability to fine nursing homes for infractions of the rules. So who’s protecting the residents of nursing homes in Texas these days? Where are the checks and balances in The Lonestar State? How about your state?

Originally posted at InjuryBoard by Greg Webb

Use of Physical Restraints With Elderly Patients Leads to More Harm Than Good

David Mittleman — Fri, 11 Nov 2011 10:00:00 GMT

Dealing with elderly patients can be difficult and unpredictable, but according to a growing body of medical research restraining patients to prevent them from pulling out tubes or falling can do more harm than good. In fact, most of these studies show that restraints cause more psychological or physical harm to elderly patients, who may already feel frightened in an unfamiliar medical setting.

A National Institute of Health report (.pdf) cited five major concerns over the use of restraints, particularly for elderly patients. First, restraints don't actually prevent patients from falling and instead can cause strangulation, pressure sores, and decreased physical functioning if used for long periods of time. These are just some of the adverse side effects of restraints to patients, but nurses also experience deleterious effects. For example, in acute medical settings where restraints are used nurses often suffer from anxiety, feelings of inadequacy, hopelessness, and guilt, amongst other negative emotional responses. Finally, the use of physical restraints also goes against nurses' codes of conduct of beneficence and autonomy--or the pledge to only do good for the patient and the right of the patient to choose their own course of action.

Rather than using physical restraints, with their abundance of problems, it is suggested that medical staff use other alternatives to help patients in nursing homes. Specifically, wandering is a frequently reported problem in nursing home settings (.pdf), but with proper monitoring, assessment of the patient and the environment, electronic surveillance systems, and specific interactions to limit patients' wandering behaviors this problem can be remedied without the use of physical restraint.

Originally posted at InjuryBoard by David Mittleman

National Hospice Month: “We Listen, We Care”

Kimberly Barone Baden — Fri, 04 Nov 2011 09:41:49 GMT

November is National Hospice Month, a time to advocate for people who suffer grave illness and deserve to have the best end-of-life care possible. It is also a time to recognize the hospice caregivers who dedicate their lives to this mission.

An estimated 1.5 million Americans receive help and support from hospice care providers each year. The National Hospice Foundation (NHF) spearheads efforts to improve end-of-life research, education, consumer involvement and caregiver services.

Consumer research conducted by the NHF found that 80 percent of Americans would prefer to have end-of-life care in their homes and home-care providers make this possible for an estimated 70 percent of patients. This success is especially valuable when we consider that, although the majority would wish to be at home, 25 percent of Americans will pass away in an assisted living facility.

This reality is especially startling as an estimated 30 percent of nursing home facilities are cited for physical or emotional abuse. Even more disturbing, this percentage does not encompass the numerous incidents of nursing home abuse that go unreported. Although nursing home and assisted living residents require the help and care of others, their dignity and treatment should not be compromised under any circumstance, and they deserve the highest quality of care.

The theme for this year’s National Hospice Month, “We Listen, We Care,” reflects the goal to increase public awareness of end-of-life care and encourage communities to increase their understanding of both the emotional and physical burden that life-limiting illnesses can cause for individuals and their loved ones. NHF encourages citizens to get involved with community activities and programs in observance of National Hospice Month.

Join us in raising awareness for the value of quality end-of-life care and in recognizing the hospice and palliative caregivers who are committed to this effort. For a list of events and inspiration, visit the Get Involved section of the NHF website.

Originally posted at InjuryBoard by Kimberly Barone Baden

Jury Awards $90 Million to Son of Nursing Home Abuse Victim

David Mittleman — Thu, 27 Oct 2011 09:34:47 GMT

A Charleston, West Virginia jury awarded the son of an 87-year-old women $90 million in damages after she died just weeks after being transferred to a temporary nursing home. In spite of the medical malpractice caps in place in West Virginia that limit medical malpractice awards to $500,000, the jury found that only 20% of the nursing home's negligence was medical.

Tom Douglas filed a lawsuit after his mother, Dorothy Douglas, died in 2009 just three weeks after being admitted to the Heartland nursing home of Charleston. Prior to arriving at Heartland, Dorothy was able to speak, walk around, and appeared to have recovered from some of her worst symptoms associated with her Alzheimer's Disease and other ailments. Dorothy was staying at Heartland temporarily, while waiting for a bed to open up in a more permanent facility. However, within just three weeks of her stay at Heartland, she was confined to a wheelchair, could not feed herself, and was seriously dehydrated. She died a few hours after being transferred to the permanent facility.

Lawmakers in West Virginia passed the medical malpractice cap about ten years ago in response to doctor groups' complaints that "frivolous lawsuits" were increasing the price of insurance and forcing doctors to leave the state. Other proponents of capping medical malpractice awards argue that the nursing home industry is highly regulated and therefore there is no need for jury awards such as that awarded to Tom Douglas. However, if the industry were as well regulated as some suggest, there would be much fewer deaths in nursing homes.

Originally posted at InjuryBoard by David Mittleman