Articles Posted in Medication Errors

The federal government fined a Buffalo nursing home $47,827 for erroneously administering insulin to a resident. According to The Buffalo News, the fine against Humboldt House represents the sixth largest in New York for 2018. The newspaper reports that a physician at the nursing home administered insulin to a diabetic resident in February 2018 despite a hospital discharge report warning the nursing home staff to “PLEASE AVOID GIVING THIS PATIENT INSULIN” – in all capital letters.

The nursing home resident, who was not named by the newspaper, was found unresponsive multiple times over the next few days. After reviving the elderly woman with medication and fruit juice, the nursing home finally realized its mistake. Federal officials determined this medication error caused “actual harm” to a patient, the most serious type of violation for a nursing home.

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As part of a broader push to deregulate the nursing home industry, the Trump administration has proposed rolling back regulations on antipsychotic use in nursing homes. Under current nursing home regulations, doctors who prescribe antipsychotics to the elderly on an “as needed” basis may only write a prescription for 14 days. At the end of 14 days, the physician must reexamine the nursing home patient and write another prescription, if necessary. The Centers for Medicare and Medicaid Services (CMS) is proposing new regulations that would change the 14-day window to 70 days.

Antipsychotic use in the elderly has remained unnecessarily high and controversial, with public health experts and elder care advocates describing the practice as elder abuse. According to these experts, nursing homes who put their residents on antipsychotics lack a valid medical reason and are simply drugging these patients. Antipsychotics, such as Seroquel and Zyprexa, commonly sedate patients, especially at higher doses. In addition to doping up the residents, these mind-altering drugs also have serious side effects. The medications commonly interact with other drugs and increase the risk of everything from slip and fall accidents to death.

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The New York Health Department confirmed an antibiotic-resistant ‘superbug’ was found at Palm Gardens Center for Nursing and Rehabilitation in Brooklyn. State health officials say that Candida auris, a highly contagious, drug-resistant fungus infected 38 patients at the Brooklyn nursing home. Since arriving in the United States in 2015, 800 Americans have been diagnosed with C. auris. According to public health officials, the victims of this contagious disease are typically elderly and more than half die from the disease within 90 days.

Public health officials believe that Maria Davila may have brought the ‘super bug’ into the nursing home. After arriving at the nursing home several years ago, Davila suffered from recurrent bacterial infections – which were treated with heavy doses of powerful antibiotics. During those trips in-and-out of the hospital, bacteria that responded to the medication was eradicated. C. Auris, however, is resistant to antibiotics and therefore followed Davila back to the nursing home. The contagious disease then spread to 38 other residents.

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Almost three-fourths of nursing homes in the United States “almost never” have the minimum number of nurses on staff, according to McKnight’s Long-Term Care News. The new study, which utilized a year of payroll data, found that 75 percent of facilities self-reported a number of nurses that are “almost never in compliance with” the federally required minimums. The study was produced by researchers at Harvard University and Vanderbilt University who then published their findings in Health Affairs.
The study comes on the heels of new federal guidelines on reporting nursing staff. Previously, nursing homes would provide a sample of their time-sheets to local regulators when their facility was inspected. Unfortunately, nursing homes commonly knew when inspections would occur and would respond by increasing the number of nurses on staff in the weeks before an inspection. Further, local regulators – who are typically from the state’s health department – did not always scrutinize or authenticate the time-sheets provided by the nursing home. For these reasons, the federal government created a computer system that requires nursing homes to upload payroll information on staffing levels. This new system benefits from live-updates and 24/7 monitoring of the nursing home.

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After addressing the shortage of nursing staff in hospitals, healthcare advocates have set their sights on implementing “Safe Staffing” policies in New York’s nursing homes. Safe Staffing policies would legislate minimum levels of nursing staff across the state’s nursing homes. Currently, New York State law only requires “sufficient staffing” which grants nursing homes wide discretion to determine whether its facility has sufficient levels of staffing. Elder care advocates lobbied state legislators to include safe staffing requirements in the budget this year. Lawmakers in Albany declined their request.

Instead, lawmakers opted to study the staffing levels at nursing homes. According to The Buffalo News, the budget passed earlier this year in Albany included a directive to the New York State Health Department to begin a study on May 1 analyzing “the range of potential fiscal impacts of staffing levels, other staffing enhancement strategies, and other potential quality improvement initiatives,” according to WHEC. The health department will then issue a final report to lawmakers at the end of the year. Given the timing of the report, it appears unlikely that any legislation will pass this year establishing mandatory staffing levels at nursing homes. Studies in Albany can frequently go in two directions. In some situations, studies are meant to endlessly shelve an unpopular idea. In other circumstances, studies can empower government agencies to develop their own policy proposals that will then be quickly passed into law.

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Employees at an Illinois nursing home stole more than $750,000 from a 96-year-old woman, according to The Chicago Sun Times. After the appalling theft, the thieves are now trying to delay the nursing home patient’s lawsuit trying to recover the stolen funds. According to attorneys for the elderly woman, the former nursing home employees are deliberately stalling in hopes that the woman passes away before the lawsuit’s conclusion. “I think they’re hoping they’ll get off the hook if she dies,” Cook County Public Guardian Charles Golbert told the Chicago newspaper. Because the nursing home resident, whose name is Grace Watanabe, does not have a spouse or any children, the money was willed to two non-profits in the local area. If Watanabe were to pass away before the conclusion of the lawsuit then those organizations would have the legal right to “step in” to her shoes and finish litigating her civil lawsuit.

The judge overseeing the case is to frustrate the nursing home’s attempts at delaying the case. Last week, the judge imposed a $400 fine as part of a contempt order aimed at executives of Symphony Residents of Lincoln Park. These executives are refusing to sit down for a deposition and answer questions about the treatment of Grace Watanabe. The employees who are accused of stealing money from Watanabe, who is diagnosed with advanced stage dementia, have invoked their Fifth Amendment right against self-incrimination when asked about the alleged crimes over the past few months. Criminal charges are expected to be filed against the fraudster in the next few weeks, according to Cook County District Attorneys.
 
The illegal scheme to defraud Watanabe was discovered by federal authorities after the bank alerted them of suspicious withdrawals coming from the nursing home resident’s bank account. Unfortunately, this type of financial fraud is a common form of elder abuse, which has been on the rise across the country and remains sadly under-reported. Employees of a nursing home or caretakers discover the financial information of an elderly person, typically with limited cognitive abilities, and then take advantage of their position of trust by swindling the person out of their money. In this instance, it appears the lowlife criminals will not be able to get away with it, though. In addition to the $400 daily fine, which the nursing home says it will appeal, an entire community of Japanese-Americans have rallied support for Watanabe and promise to keep her case in the spotlight and hold the thieves responsible, whether Watanabe lives to see that result or not.

Government regulators and lawmakers appear finally ready to do something about the widespread use of antipsychotics at nursing homes. These powerful drugs are often prescribed to residents diagnosed with Alzheimer’s or dementia by nursing homes hoping to sedate them. Not only are these drugs not an approved treatment for these conditions, but antipsychotic drugs also have a range of serious side effects and drug interactions. In the elderly, antipsychotic medications substantially increase the risk of falls. Sadly, the practice of prescribing dangerous, unnecessary antipsychotic medication is widespread in the nursing home industry. The federal government reports that approximately 16 percent of nursing home residents take antipsychotics.

Thankfully, the government appears ready to tackle widespread nursing home abuse. In a letter to US Centers for Medicare and Medicaid Services (CMS), the government agency responsible for regulating nursing homes, Rep. Richard Neil excoriates the nursing home industry’s illegal prescribing habits and the government agency for inadequate enforcement. Rep. Neil described instances of nursing homes who “falsified diagnosis” and failed to attain informed consent, all for the purpose of sedating a patient with unnecessary antipsychotics. The Democrat then sharply criticized CMS saying that “nursing facilities are getting away with this practice.” According to Rep. Neil, nursing homes are “neither being cited nor penalized.”

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Following several scathing investigations and reports, veterans’ groups are demanding better care at the nursing homes run by the beleaguered Department of Veteran Affairs. While public condemnation has mounted for the past few years over the VA’s ability to care for the country’s 20.4 million veterans, criticism of the nursing homes run by the government agency began last summer when a report found that 70 percent of the VA’s nursing homes received failing grades. Perhaps even worse, more than half of these nursing homes received the lowest grade possible. According to news organizations, the government has collected quality reports and grades for each nursing home run by the federal agency each year. Until the rankings leaked this year, the government had chosen not to publish the results.

In a follow-up investigation reported by The Boston Globe this week, news reporters found a VA nursing home filled with sleeping staffers and a closed cafeteria. Other examples the substandard level of care found at VA nursing homes include a veteran with undiagnosed scabies, a veteran who had sat in soiled sheets for hours, and a veteran writhing in pain because he had not received his scheduled medication, according to USA Today. The national newspaper also reported that a nursing home in Alabama declared a Navy Veteran dead after he simply walked out of a supposedly secure nursing home one night and did not return. Rege Riley, national commander of American Veterans, told USA Today that the “stories being reported about the treatment of some individual veterans at these facilities are nothing short of horrifying.”

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Medicare recently lowered the overall ratings of almost one-fourth of the country’s nursing homes due to insufficient staff levels. The move comes after Medicare adopted a new, objective measurement for staffing nursing homes. Previously, Medicare relied on unverifiable data submitted by the nursing homes. Medicare ratings, which can range between one and five stars, are provided for several categories of nursing home care, such as its rating of pressure ulcers or slip-and-falls, along with an overall rating for the nursing home. Medicare now gives the lowest rating, a single star, to 1,387 nursing homes across the country, according to The New York Times.

Medicare requires all nursing homes to have a licensed nurse working at all times and a registered nurse working at least eight hours every day. The payroll data submitted to Medicare by the nursing homes show that the registered nurse requirement produced the majority of compliance problems. Registered nurses, who have the highest level of training and education requirements, are typically able to provide medical services, such as diagnosing illnesses or prescribing medicine.

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According to the Kaiser Health News, an average of 21 percent of nursing home residents are readmitted to the hospital within 100 days of returning to their nursing home. Now, Medicare plans to crack down on these nursing homes who either allow nursing home residents to return too quickly or fail to properly administer the resident’s post-hospitalization care. According to Medicare, most nursing home patients are readmitted for mostly preventable problems, such as dehydration, bedsores, infections, and medication errors. While patient advocates believe there can be significant room for improvement in these re-hospitalization rates, they also caution against punishing nursing homes who send their elderly residents to the hospital.

According to a government report, cited by NPR, a full 10.8 percent of re-hospitalizations are preventable. The causes for the high rate of unnecessary hospitalizations are numerous. First, the nursing home may not follow the hospital’s post-hospitalization care routine for their resident. In one example cited by the news organization, nurses at a nursing home in North Carolina injected a patient with a blood thinner twice a day – despite written instructions from a hospital doctor to cease all blood thinning medication. The second cause concerns overloaded hospitals, which would prefer to offload patients onto nursing homes in an effort to free-up space for more patients.

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