This blog has written about Maclean in the past for Department of Health violations ranging from pressure sore treatment to nutritional violations. Those violations did not rise to the level of criminal offenses, however. Had Clifford reported the incident to the proper authorities, most likely criminal charges would not have been filed. More importantly, perhaps the elderly dementia patient may have been found and returned to safety.

Maintaining effective levels of staff and security personnel is essential for nursing homes, particularly nursing homes with dementia wards. Often, elderly individuals suffering from dementia or Alzheimer's Disease will lose track of time and surroundings and attempt to wander from the facility. Staff trained with procedures for preventing elopement can often avert this problem before it occurs. If a resident is able to exit the nursing home, the staff should immediately notify family and the authorities who will be better able to locate the resident once outside the facility.

The original Daily News article can be accessed here.

In its report, the Health Department details a lack of education provided to the 82 year old male resident's "private companion." The nursing home failed to inform the companion that only nursing home staff was properly trained and authorized to transfer the resident. As a result, during an instance in which the companion attempted to transfer the man on her own, he sustained a fall resulting in a fractured hip. Although hired by the resident or the resident's family to provide assistance, facility protocol dictates that a private companion is not authorized to transfer the resident. The resident fell and was injured during an attempt to assist him to the bathroom.

In subsequent interviews, the health aide stated that she had, on prior occasions, aided the resident with toileting. The facility, however, did not make it clear to her that she was not authorized to do so while the man was a resident of the nursing home. The Director of Nursing confirmed this. She stated that while it was facility policy to educate and orient health aides as to facility policy, such was not done in this case. Further evidence of this is lack of a record that the private companion signed the nursing home's "Private Hire Companion Agreement Form." In the form, the facility itself mandates that this type of aide is not allowed to assist in resident transfers.

A fractured hip can be deadly for an elderly nursing home resident. In addition to the immediate physical impact that a fracture has, the long term effects can be devastating. Inability to ambulate can lead to decreased physical and mental capacity, pressure sores and infections, even potentially death. Had the nursing home relayed information on its own policies and procedures to the private companion, perhaps this fall and subsequent fracture may have been avoided. The DOH report does not give an update on the resident's condition except that after the fall he was transferred to the hospital for treatment of the fracture.

The Department of Health report can be found on its website here.

If you or a loved one has fallen due to the negligence of a nursing home, please contact the New York Nursing Home Attorneys at Gallivan & Gallivan to protect your rights.

According to federal regulations, a nursing home must ensure that a resident maintains his or her nutritional status unless the resident's condition renders this impossible. Also, if there is a nutritional problem with the resident, the facility must develop a therapeutic diet for the individual to mitigate these issues. The resident in question was a seventy-nine year old man who received care at The Osborne intermittently over the course of a month in September/October of 2012. Upon his first weighing by the staff, the man weighed 199 pounds. At his final weighing, only three and a half weeks later, the man's weight had dropped to 178 pounds--a loss of 21 pounds in 24 days. When interviewed, the resident's dietician admitted that, although she was aware of the man's weight loss throughout his stay at the Osborne, she did not investigate the reasons behind it.

This resident is also the subject of one of the home's deficiencies with respect to care plans. the Department of Health found that the care plan sought to maintain the resident's weight within three pounds. When the weight loss began, however, the staff did not revise the care plan to show the weight loss, nor did the staff institute interventions to quell further weight loss. This resulted in the aforementioned twenty-one pound weight loss over the course of less than one month.

Maintaining nutritional status in an elderly or infirm nursing home resident is an essential duty for the home and its staff. Weight loss can lead to increased frailty, pressure sores, infection, and decreased mental capacity. It is true that in some cases, weight loss is unavoidable for elderly residents. The lack of a care plan to document and potentially mitigate this weight loss is unacceptable. Coupled with the statements of the dietician, these two factors could certainly lead someone to believe that the facility did not do everything within its power to maintain this resident's nutritional status.

The Department of Health report on The Osborne can be found on the DOH website here.

The DOH report documents a 72 year old female resident who was noted upon admission to be at risk for the development of pressure ulcers. She was admitted with an abdominal wound but no other skin breakdown. Although the facility developed a care plan for the avoidance of pressure ulcers, the Department of Health did not find evidence that proper skin assessments were performed by the staff. Shortly after admission, the resident developed an unstageable pressure ulcer to the sacrum, or lower back. An unstageable pressure ulcer is one for which the depth of the ulcer cannot be determined due to infection, slough, or dead tissue in and around the wound.

As is often the case in incidents involving the development of pressure sores, here the facility's record keeping is spotty. At times treatments noted in the records are not initialed, preventing reviewers from determining who, if anyone, was providing specific care. Additionally, the resident's records note that she was non-compliant with preventative care. However the CNA, when interviewed, stated that she could not remember these refusals. She also could not remember specific interventions being applied, such as positioning devices. The LPN stated that the resident actually was compliant with care.

Based upon statements from the Registered Nurse Supervisor, it appears that the facility's policy for someone non-compliant is to develop an additional care plan to deal with this. It is unclear based on the DOH report if this additional care plan was ever developed. Of course, based on the statements of the CNA and the LPN, it is also unclear whether the resident actually was non-compliant.

Preventing the development of pressure sores is a crucial task for nursing homes and long term care facilities. A great risk of infection and death that accompany such wounds. They also make day to day life extremely painful for residents suffering from them. When a resident who is a known risk enters, the facility must do all within its power to prevent these sores from developing. That does not appear to be the case in this incident at Bishop Hucles.

The DOH report can be read here in its entirety.

As would often be the case with an individual suffering from autism, the resident was unable to describe what had happened to him. Actual physical abuse can be easier to recognize than emotional or sexual abuse, because often symptoms are visible. Often, group home residents are mentally deficient in some capacity. This can lead to difficulty communicating abuse to family or loved ones. Emotional and sexual scars are rarely visible. As such, family members must be diligent in ensuring that their mentally challenged loved ones in group homes are not victims of abuse or neglect.

The full story can be found here on NY1's website.

If you feel that a loved one may be the victim of abuse in a group home facility, contact the attorneys at Gallivan and Gallivan today.

In the original Detailed Deficiency report filed by the Department of Health regarding this incident, Andrus received the highest possible score for harm to a patient--four stars, or "immediate jeopardy." The DOH found that the facility failed to provide necessary care for the highest practicable well-being of its residents, and that the facility was not effectively administered to obtain this highest practicable well-being. The Department found that the substandard quality of care being administered at Andrus posed the threat of serious harm to the health and safety of the fifty-three residents at the facility who were under CPR orders.

The incident itself occurred when a resident suffering from cardiac arrest was improperly identified as a DNR (Do Not Resuscitate) by the staff at Andrus. Because of this mistake, life saving procedures were not performed and the resident died as a result. The events unfolded as they did due to a change in facility record keeping. Prior to January of 2011, Andrus labeled a resident's records with a white face to indicate that the resident was a DNR. Following January, however, the use of this white face was extended for use in all records, not simply DNR's. The DOH found that Andrus did not properly and sufficiently train its staff regarding CPR and DNR orders. Subsequent staff interviews confirmed the DOH findings, as multiple staff members were unable to determine DNR status when questioned.

Unfortunately for the resident detailed in the report, any changes in training and policy at Andrus occurred too late. It is unclear from the lohud article and the DOH deficiency report whether or not the family filed a wrongful death suit against the facility. The article can be found here, and the detailed deficiency report can be found here on the Department of Health website.

A facility must ensure that residents who enter without pressure ulcers do not develop such ulcers unless it is unavoidable. The DOH report details a seventy year old woman who was admitted with several warning signs for the development of pressure sores. After a partial leg amputation, and the associated diminished mobility, this risk became even greater. As such, the facility implemented a care plan calling for the use of a seat cushion when the resident was out of bed, and also anytime the resident was in a wheelchair. On at least two occasions, the resident was observed out of bed without the assistance of a seat cushion. When interviewed, the Certified Nurse Aide stated that she was not aware of the seat cushion intervention. During the same interview, the same CNA found the seat cushion called for in the care plan. It had been in the resident's closet.

During examinations of the resident in December of last year, it was discovered that she had developed a stage III pressure ulcer on the sacral area of her lower back, as well as a stage II pressure ulcer on her left buttock. The DOH observed a nurse improperly applying a healing ointment to the area in contravention of accepted practices. The cream was meant to be applied to areas of skin that had healed, yet she applied it to the open, stage II pressure ulcer.

In many cases, the elderly and infirm are powerless on their own to prevent pressure sores from developing. These nursing home residents require the assistance of staff with simple interventions included in the care plans of almost all residents deemed to be at risk for pressure ulcers. These interventions, including turning and positioning, incontinence care, and implementation of seat cushions, cannot be performed by the residents themselves. Unfortunately, as appears to be the case at Somers Manor, at times the nursing home staff fails to follow the protocols laid out for them in these care plans. And, as has been discussed previously on this blog, a pressure sore, once developed, can lead to infection, tremendous pain and suffering, and even death.

Somers Manor was cited for several other deficiencies in the Department of Health survey, including failure to properly establish an infection control program, and failure to keep the facility free of accident hazards. To read about these and the other deficiencies detailed in the December report, visit the Department of Health website here.