Articles Posted in Infection

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The Inspector General for the Department of Health and Human Services (HHS) released a report stating that at least one in four instances of elder abuse or neglect are not reported. While horrific in scope, the results are not entirely surprising – other, smaller samples have found that 15 to 20 percent of elder abuse cases were not reported to the proper authorities or government agencies. The most recent study, released by the HHS Inspector General, based its findings on a large sampling of cases spanning 33 states. The study, which pegged the underreporting rate at exactly 28 percent, was released with a demand that Medicare take “corrective action right away.”

Despite mandatory reporting laws by both the federal government virtually all states, the rathelpe of under-reporting remains stubbornly high. On the federal level, nursing homes are required to report any incidents involving a suspected crime immediately and any other case of suspected elder abuse within 24 hours. The Centers for Medicare and Medicaid Services (CMS) can fine nursing homes up to $300,000 for failing to comply with the law. While such a strict timeline and the possibility of hefty fines would typically discourage non-compliance, the HHS report shows that the law requiring reporting of any elder abuse – whether physical, financial, sexual or otherwise – is mostly unenforced by CMS.
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As part of President Trump’s promise to roll-back federal regulations, the Trump administration has announced its intention to scrap a federal rule prohibiting nursing homes from requiring their residents to pursue legal claims through arbitration.

In the simplest terms, arbitration is a catch-all term for a dispute-resolution that, while legally binding, does not utilize the court system. The practice has exploded in popularity in recent decades – especially among larger corporations and nursing homes. These entities prefer arbitration because the costs are generally lower, the dispute resolution process moves much faster than the courts, and parties generally do not have a right to appeal thus providing both parties some finality to their dispwalking-out-300x225ute. Opponents of arbitration say the extra-judicial process favors corporate interests and curtails the rights of victims – from limiting discovery to removing the opportunity to appeal. Further, arbitration also removes the right for a person to have their case heard before a jury, and instead substitutes a so-called “neutral arbitrator.”
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A group home for the disabled, run by the State of New York, in Rome, N.Y. is facing calls for a federal investigation after an explosive report was leaked by the Associated Press detailing a resident who, on two separate occasions, was so severely neglected that he became infested with maggots. The resident, Steven Wenger, has been unable to walk, speak or breathe without a ventilator since a tragic car accident 26 years ago. According to the AP, both infestations were found in and around Wenger’s ventilator.

resident-left-in-empty-hallNew York State officials confirmed that the infestations had been caused by neglect. The officials also confirmed that the caregivers were not disciplined in any way, but that the state had “increased training.” In New York, which is responsible for providing care to over 1 million disabled people, the responsibility for neglect probes are overseen by the Justice Center for the Protection of People with Special Needs (“Justice Center”) who declined to provide any data or information about the particular case. Continue reading

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In a new study released by Columbia University School of Nursing, a quarter of nursing homes had a “significant presence” of multidrug-resistant bacteria. The study reviewed eight prior studies, and the reported rates of drug-resistant bacteria ranged from 11 percent to a whopping 59 percent – with 27 percent the average. Multi-drug resistant bacteria are especially dangerous to nursing home patients, where patients frequently have other medical ailments, a weakened immune system, and increased exposure to germs and bacteria. These drug-resistant types of bacteria can cause serious infections such as pneumonia, bloodstream infections and menangitis.

pills8-300x225Unfortunately these results are not surprising. The CDC warns that multi-drug resistant bacteria are on the rise throughout the world, owed largely to the widespread (and commonly unnecessary) use of antibiotics. The once easily-defeated bacteria have adapted and now built a resistance to commonly prescribed antibiotics. Unfortunately, drug makers are also pushing fewer new antibiotics to market. Put together, health experts warn of an impending health crisis. Continue reading

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Brooklyn nursing home Keser Nursing and Rehabilitation Center received deficient ratings in ten standard health inspection categories during a March, 2014 inspection conducted by the New York State Department of Health. Among the deficiencies reported by the DOH were failure to establish an infection control program, failure to inform of accidents and/or significant changes in resident status, and failure to ensure that a resident’s nutritional status remains unchanged unless unavoidable.

A nursing home must establish and maintain an infection control program to minimize and help prevent the spread of infection. During its inspection of Keser, the DOH encountered several situations for which it cited the facility. First, a resident’s nasal tubing was not properly secured behind his ears, but rather allowed to hang in such a way that it was touching the floor. Inspectors also noted several instances in which garbage pails and trash bins were left uncovered in common eating areas, subjecting eating residents to a potential spread of infection from the refuse.

scale4.jpgThe remaining two deficiencies referenced above involve a single resident, a sixty year old male with multiple underlying conditions including diabetes, hypertension, and epilepsy. Per the report, the resident also displayed “severely impaired cognitive skills for daily decision making.” During routine weight checks, it was noted that the man had lost eighteen pounds, nearly eleven percent of his total body weight, in the several months prior to late October, 2013. The dietary note for this resident also documented conflicting information, at one time stating that the patient’s appetite was “fair to good,” yet at another stating that he was eating less than 75% of his meals. Despite this weight loss and the differing information in the notes, no new interventions were ordered for the resident. The physician’s notes from the relevant time period list the resident’s weight as steady at 170 pounds, again in conflict with the weight records. During an interview with the Department of Health regarding this patient, the current physician informed investigators that the doctor who had written the notes for August, September, and October 2013 was no longer employed by the nursing home.

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Saints Joachim & Anne Nursing and Rehabilitation Center, a nursing home located in Brooklyn, NY, was cited in an October, 2013 certification survey issued by the Department of Health. Among the several deficiencies noted by the DOH was a failure to establish an infection control program at the facility.

hospital corridor.jpgA nursing home must ensure that it investigates, controls, and prevents infections within the facility. This includes proper disposal of bedclothes and linens of infected individuals when the situation warrants. During this investigation by the DOH, it found an individual who had been admitted to the rehabilitation center with numerous diagnoses, one of which was Possible Scabies. Although one of the most common ways to spread scabies is through used personal items, such as bedding or towels, the facility failed to properly place a “red bin” inside the resident’s room in order to properly monitor potentially infectious materials. The nursing home also failed to isolate the resident’s supplies from those of other inhabitants of the home.

Individual treatment of the possibly infected resident also deviated from the facility’s own procedures and protocols. Per a Registered Nurse at the nursing home, when treating an individual for a possible outbreak of scabies, contact precautions are to be taken, including wearing gloves and a protective gown at all times. Additionally, a sign should be posted outside the resident’s room as a warning that the resident is potentially infested. Although it appears from the report that gloves were worn while administering treatment, at least on Certified Nursing Assistant did not wear a gown while in close contact with the individual.

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The New York State Department of Health (DOH) cited the East Neck Nursing & Rehabilitation Center, a 300-bed facility located in West Babylon, New York, for failing to respect patients’ dignity by not providing timely and adequate incontinence care. According to a DOH report issued in April 2013, the nursing home failed to “promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity.” In one instance, a resident diagnosed with bipolar disorder repeatedly asked a certified nursing assistant (CNA) to change her incontinence brief. However, the CNA ignored the patient’s requests for care, and the patient urinated in her bed. Staff members had to change the resident’s soiled clothes and linens as a result of her lack of care.

In another case, a resident’s care plan stated that he needed assistance while using the toilet to prevent him from falling. On the night of April 8, 2013, the resident asked a CNA if she could help him to use the bathroom. The CNA stated that she would be back in a few minutes to assist him. After repeatedly asking for help for over an hour, the resident stated that the CNA told him to “just wet the bed.” The patient was incontinent in bed due to the CNA’s neglect. As a result of the incident, the resident’s linens, clothes and wound dressing covering a bedsore were soaked with urine. When staff members finally came to clean him and change his bed, they simply threw the dirty linens in the corner of his room.

syringe1.jpgDuring the same certification survey, the DOH also cited the Long Island nursing home for not preventing “the development and transmission of disease and infection.” On April 12, 2013, a DOH inspector observed a licensed practical nurse (LPN) administer a blood glucose test to a diabetic patient. The patient had recently been diagnosed with a contagious infection, and a physician ordered that staff members follow certain contact precautions when entering the patient’s room. However, after administer the glucose test, the LPN failed to change her gloves or wash her hands and began touching items on the medication cart. The same LPN also failed to sterilize the top of a vial with an alcohol wipe before she inserted a syringe into it. When questioned about these two incidents, the LPN told a DOH inspector that she “forgot” to follow infection precautions because she was “nervous” about being observed.

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According to a June 2013 report issued by the New York State Department of Health (DOH), the Saratoga Hospital Nursing Home, a 36-bed facility located in Saratoga Springs, New York, failed to maintain a safe, clean and homelike environment for its residents. In particular, DOH inspectors stated that the shower room used by many residents was dirty and not properly maintained. For instance, inspectors noted that mold was on the shower tiles and floor. A metal shelf, the shower door, and a grab bar had peeling paint and were rusty; a ceiling tile was also missing. In addition, inspectors noticed that an air vent was covered with plastic wrap and cut tape, preventing the air in the shower room from being properly circulated. The maintenance director and an administrator of the facility stated that they were unaware of the shower room’s condition. The nursing home fixed the room in July 2013 as a result of the DOH inspection.

During the same certification survey, the DOH also cited the nursing home for failing to “maintain practices that provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infection.” For example, while talking to the nurse in charge of the facility’s infection control program, a DOH inspector observed a maintenance worker wheeling a large uncovered trash bin filled with garbage through the hallway; the infection control nurse stated that the trash bin should have been covered. When questioned by a DOH inspector, the worker wheeling the bin stated that he usually covers it but that he was “behind” that particular day and was in a rush.

hospital lady.jpgIn another related finding, a DOH surveyor determined that the facility failed to provide staff members and visitors with detailed instructions pertaining to patients who had Contact/Isolation Precautions due to sickness and infections. There were four such residents in the facility. Signs outside the doors of two of these patients instructed visitors to wear a mask, gloves and a gown. Two different residents with such precautions did not have detailed instructions outside of their rooms. The infection control nurse stated that she was not aware of this matter and needed to look into the issue.

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Two certified nursing assistants (CNAs) at the Barnwell Nursing and Rehabilitation Center, a 228-bed facility located in Valatie, New York, were caught on camera taunting and abusing an elderly dementia patient in August 2013. According to a New York State Department of Health investigation report, the two CNAs kicked, hit and yanked at dolls that the dementia patient carried; he believed that the dolls were his grandchildren. The video shows the elderly resident becoming visibly upset and starts kicking at one of the CNAs, who then runs into a closet while laughing. The resident then began kicking at the closet door.

After conducting an internal investigation when the resident’s son complained about the incident, the facility concluded that the CNAs failed to “maintain an environment that protects the resident from abuse, neglect or mistreatment.” While the incident occurred on August 19, 2013, the facility didn’t notify the DOH or the police until a week later. Moreover, even though the facility terminated both of the employees over the incident, one of the CNAs continued to work at the nursing home as a private aide. As a result, a high-functioning resident reported that she saw the CNA taunt the dementia patient again by “hitting and throwing” his dolls. An administrator told investigators that she had instructed her staff not to allow the CNA back into the building. Moreover, DOH investigators revealed that the dementia patient was never assessed by staff members for physical or psychological harm after being taunted.

In another instance, a CNA threw a bedpan at a resident twice. On August 24, 2013, a CNA was helping a resident who suffered from spinal stenosis go to the bathroom in a bedpan. After the CNA adjusted the resident’s body, the resident became upset and threatened to throw the bedpan at the CNA. After the CNA said, “go ahead, I dare you,” the resident picked up the bedpan and threw it at the staff member, who then threw the bedpan back at the resident. The resident then tossed the bedpan back at the CNA, who threw the bedpan at the resident for a second time. The CNA then walked out of the room. The facility reported the incident to the DOH three days later.

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During a certification survey performed by the Department of Health in March of this year, Cobble Hill Health Center, a Brooklyn nursing home, received deficient ratings in several areas of care. Among these areas was a failure to properly establish an infection control program, in violation of federal regulation.

The violation documented by the DOH at Cobble Hill involves the treatment and cleansing of an elderly resident’s pressure ulcers. The resident was suffering from two pressure ulcers at the time of the incident: a Stage II wound of the right knee, and a Stage IV sore of the left ankle. The policy for cleaning pressure ulcers in place at Cobble Hill is very specific, as noted in the DOH report. It provides a step by step process, including when and how the staff member must wash his or her hands and change sterile gloves during treatment. During this particular wound cleansing, the nurse failed to follow this procedure. While treating the two wounds, the nurse failed to follow the procedures in place both for washing her hands and for changing her gloves. She also failed to provide a sterile area on which to rest the wounds while in the process of cleansing them.

As has been noted numerous times in the past here, the the development of pressure ulcers for an elderly nursing home resident is extremely painful and potentially deadly. Proper treatment of these wounds is essential to heal them as quickly as possible, and prevent possible infections from developing. In an interview with the Department of Health after this survey, the nurse acknowledged that she failed to follow protocol. She also relayed to the DOH that she would request further instruction regarding tending for these types of wounds. Fortunately her breach of protocol did not lead to any further harm for the resident. Perhaps this incident will lead to a more stringent application of the facility’s policies and procedures moving forward.

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