Articles Posted in Miscellaneous

According to a February 2014 New York State Department of Health Inspection report, the Katherine Luther Residential Health Care & Rehabilitation center, a 280-bed nursing home located in Clinton, New York, failed to respect the dignity of patients and did not follow proper procedures to prevent infections. In one instance, a resident suffering from dementia, osteoporosis and COPD was observed eating oatmeal with her bare hands. The resident, who needed help with her personal hygiene, wiped the oatmeal in her hair and on her clothes. After sitting for three hours with dried food in her hair, the resident finally got the attention of a CNA who simply brushed the oatmeal from the patient’s clothes and hair. When asked about the incident, a supervising nurse stated that the CNA should have immediately washed the patient’s hair and changed her clothes.

gauze.jpgIn another instance, a resident who suffered from dementia, anxiety and depression was observed sitting in the hallway with dried blood between his nose and lip. The patient’s care plan mandated that staff members monitor the resident because he was at risk of bleeding due to his anticoagulation medication. However, while the elderly resident sat in the hallway with dried blood on his face, staff members ignored him; one CNA said “hi” to the patient and kept on walking. When asked about the incident, a supervising nurse stated that the CNA should have stopped to clean the man’s face. In addition, the CNA should have asked a nurse to assess the man’s condition to ensure that the bleeding had stopped.

The facility was also cited for incidents in which staff members failed to follow policies to prevent infections. For instance, one resident had developed a stage II pressure sore. While eating in the dining room, inspectors for the DOH observed that the resident’s wound dressing had fallen off. A nurse stated that she would replace the dressing as soon as the patient was done eating. The nurse did not change the dressing until two hours later. When she finally did change the dressing, the nurse touched a floor mat in order to move it. She then touched the sterile gauze that was going to be used to clean the wound with the hand she used to touch the dirty floor mat. The inspector told her to change her gloves and find a new piece of gauze. The nurse later stated that she should have changed the dressing sooner, and that she should have changed her gloves and the gauze after touching the floor mat.

wheelchair4.jpgAccording to a New York State Department of Health citation report, staff members of the Suffolk County Center for Rehabilitation and Nursing center, a 10-bed nursing home located in Patchogue, Long Island failed to monitor a patient who was found dead in a bathroom with a seatbelt around his neck. The report indicated that the patient, who had turned blue, “was found unresponsive without pulse and respiration–no sign of life.” The resident, who suffered from dementia and was required to wear a seatbelt in his wheelchair, was trying to get out of his wheelchair in order to use the toilet. However, while attempting to slip under his seatbelt, the restraint became wrapped around his neck, strangling him to death.

Investigators reported that because the patient had a history of wandering, his care plan required that he wear a seatbelt in his wheelchair. If the patient tried to undo the seatbelt, an alarm would sound. In addition, his care plan required that an assigned staff member check on him every 15 minutes and document that the check was performed. On July 15, 2013, a certified nursing assistant was assigned to watch the patient. At 1:15 p.m., the CNA left the resident in the dayroom which was being monitored by another staff member. The CNA told investigators that he thought that the dayroom supervisor would watch the resident.

At 1:28 p.m., the patient was caught by a surveillance camera wheeling himself out of the dayroom and a nurse placed him in front of the nursing station. The nurse stated that he was unaware of the fact that the resident needed to be monitored every fifteen minutes. At 1:33 p.m., video footage showed the resident wheeling himself towards the bathroom, which staff members claimed to have locked. At 2:12 p.m., another resident of the facility found the patient in the bathroom with the seatbelt around his neck. After the resident alerted staff members, a code blue was called. At 2:20 p.m., a nurse practitioner noted that the resident had died. The DOH report concluded that staff members failed to follow the patient’s care plan by not monitoring the resident every 15 minutes.

Seven elderly residents of the Prospect Park Residence, a 120-bed assisted-living facility in Brooklyn, New York, filed a lawsuit in May 2014 to prevent the facility from shutting its doors in June 2014. The lawsuit, filed in State Supreme Court in Brooklyn, is seeking a preliminary injunction and a temporary restraining order to delay the facility’s closing. The lawsuit claims that the owner of the facility, Haysha Deitsch, and the Department of Health did not give the residents adequate time to move and are not helping them find new places to live. The suit further alleges that the owner mislead them by accepting new residents while he was talking to the Department of Health about shutting the site down. In addition, the residents are complaining that the facility is cutting back on essential services and that many of the staff members are leaving. Families of some residents stated that they plan to file a separate lawsuit seeking damages.

On March 5, 2014, managers told the residents that the facility is closing and that they have 90 days to move. However, family members of residents suffering from Alzheimer’s and Parkinson’s disease said that they haven’t been offered any help to find new residences for their loved ones. In addition, family members pointed out that moving, especially on such a short notice, is stressful for seniors suffering from illnesses. One family member stated, “Any move will be extremely traumatic for my mother and will sever her ties to important services and support groups. We have not been able to find an alternative residence for her.”

Paul Larrabee, a spokesperson for the owner, stated that the building is becoming too costly to run and maintain. He said, “Despite concerns to the contrary, the closure plan and the transfer of residents to alternate living arrangements has been compliant and seamless. Any claims of deception or fraud are without merit and we will vigorously defend our actions.”

What is the Nurse Aide Registry?

According to various federal and state laws and regulations, states must create and maintain a nurse aide registry that is available to nursing homes and the general public. The registry must contain the following information:

• The full name of the individual nurse aide and his or her certification status in the state.

The Long Term Care Community Coalition (LTCCC), a private New York based organization dedicated to improving care and conditions in nursing homes, is calling upon state and federal legislators to pass laws requiring nursing homes to meet staffing standards to improve the quality of care in the industry. In a June 2013 report titled, “Nursing Home Policy Brief: Mandatory Minimum Safe Staffing Requirements Needed to Protect Nursing Home Residents Now & in the Future,” the LTCCC points out that many studies have indicated that there is a direct link between staffing levels and the quality of care residents receive in nursing homes. By mandating that nursing homes maintain minimum staffing levels, the report contends that such laws will reduce the number of injuries and hospitalizations among elderly residents due to lack of care.

woman hospital.jpgThe report states that based upon recommendations provided by the Center for Medicare and Medicaid Services (CMS), nursing homes should be required to maintain staffing levels that allow for residents to receive 4.1 hours of direct care per day. In a CMS report to Congress, it was determined that residents who received less than two hours of nurse aide care per day had much higher rates of avoidable hospitalizations and bed sores. From 1999 to 2005, registered nurse hours in facilities fell by 25 percent while licensed practical nurse hours fell by 22 percent and certified nurse’s hours decreased by seven percent.

The LTCCC’s report indicated that decreases in staffing levels results in poor care. For instance, because many residents have limited mobility, they need to be repositioned periodically to prevent pressure sores, which can lead to complications such as cellulitis, infections or osteomyelitis. Improving staffing levels would reduce such incidents. Moreover, facilities with a low number of staff often have patients who are malnourished, which can lead to infections and even death. In addition, improving staffing levels would lead to better incontinence care. When patients’ incontinence briefs are left unchanged, such a lack of care degrades their dignity and increases their chances of developing pressure sores. As a result, the LTCCC argues that mandatory minimum staffing requirements in the nursing home industry would prevent residents from suffering harm or injury due to negligence.

According to a 2013 study conducted by The Long Term Care Community Coalition (LTCCC), an organization dedicated to improving nursing home care in New York, the state’s new Managed Long Term Care (MLTC) policy may reduce the overall quality of care in nursing homes. The report, titled “Mandatory Managed Care in New York State Nursing Homes,” also concluded that the new managed care initiative will likely limit where consumers can go to receive long term nursing home care. In some instances, consumers may be forced to stay in facilities that aren’t equipped to meet their needs or have a history of fraud, neglect or abuse.

In 2011, New York’s Medicaid program spent $8 billion on nursing home care. New York currently has the largest nursing home population in the United States; one in ten nursing home residents are from New York. In response to the growing and costly program, Governor Cuomo announced in 2011 that his administration was going to redesign the state’s Medicaid policies to improve care, reduce costs and achieve a more “efficient administrative structure.” Because one-third of the state’s Medicaid funding goes to nursing homes, the nursing home industry will be greatly affected by the new changes, which will be implemented in 2014.

Under the old Medicaid program, in what was known as a “fee for service” policy, Medicaid would pay for any costs incurred when a service was provided by a health care facility, including nursing homes. Under the new program, known as Managed Long Term Care, the state will pay private health insurance companies a set rate to cover patient care. The insurance companies can then determine which nursing homes they want to include in their networks.

According to a federal report titled “Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries,” one in three nursing home residents experienced harm during their stay at a facility. The study, authored by the Office of Inspector General (OIG) in February 2014, investigated adverse incidents in nursing homes from 2008 through 2012. Of those who experienced hard, 59 percent of the incidents were “clearly or likely preventable.”

Among the findings, the report concluded that “Physician reviewers…attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care. Over half of the residents who experienced harm returned to a hospital for treatment, with an estimated cost to Medicare of $208 million in August 2011. This equate to $2.8 billion in hospital treatment for harm caused in SNFs [Skilled Nursing Facilities] in FY 2011.

Of the harmful incidents that occurred, two-thirds of them were considered serious and one-third were considered temporary. Serious incidents include those that required a longer nursing home stay or hospitalization; incidents that caused permanent injury; incidents that required life-sustaining intervention, or incidents that resulted in death, which occurred in six percent of the adverse events. Temporary harm includes pressure sores, falls that resulted in minor injuries, and medication-induced delirium resulting from misuse of atypical antipsychotic drugs. Moreover, the study revealed that “[a]n estimated 4 percent of Medicare SNF residents experienced at least one ‘cascade’ adverse event, wherein multiple, related events occurred in succession.”

lock.jpgRosewood Heights, a Syracuse nursing home that houses 242 beds in a six story building, is slated to be shut down and converted into an apartment building in 2014. In March 2012, the nursing home was placed on the Centers for Medicare and Medicaid Service’s (CMS) Special Focus Facility (SFF) list for providing poor care to its residents. Facilities on the SFF watchlist receive twice as many Department of Health inspections and have 24 months to implement changes to improve the quality of care. However, in 2013, the CMS fined Rosewood Heights $16,000 for a long list of deficiencies uncovered at the facility during three inspections conducted in 2012. The 42-year-old nursing home is considered a “safety net” facility that provides care to elderly patients who have nowhere else to go.

Rosewood Heights is slated to close its doors in 2014 after a new nursing home with 156 beds is opened. The new facility will be named The Cottages at Garden Grove and will take many of Rosewood Heights’ current residents. The Cottages at Garden Grove will be an 18-acre site owned by Mandorla Gardens Housing Development Fund Co. Plaza Nursing Home Co., the owner of Rosewood Heights, is a member of Mandorla. The residents will be spread through twelve one story houses built on the site.

According to city documents, the Rosewood Heights building will be purchased by Bill Reckmeyer, a developer who currently owns five apartment buildings that house 270 people, most of whom are college students. In addition to being converted into 94 apartments, the Rosewood Heights building will also house a restaurant, a management office and storage space. Reckmeyer’s attorney told city officials that most of the tenants will be college students.

Four workers from the Independent Group Home Living facility in Hampton Bays, New York were arrested in February 2014 for allegedly forcing and encouraging two developmentally disabled adults to fight each other. One of the workers recorded the incident with a cellphone, which shows the two disabled men fighting as workers encourage them and laugh in the background. The four workers, who have since been fired from the group home, faced felony charges of endangering the welfare of an incompetent or physically disabled person. If convicted, the workers could face jail time. The defendants are Erin McHenry, 28, of Brookhaven, Justin McDonald, 19, of Lindenhurst, Stephen Komara, 58, of East Moriches and Rosemary Vanni, 44, of Eastport.

fight.jpgThe incident was brought to the attention of authorities after one of the workers emailed the cellphone video to someone who then called New York’s Justice Center Hotline, which was recently created to protect people with special needs. The video, which shows to developmentally disabled men in their 50s being encouraged by workers to fight each other, was then turned over to the Southampton Police Department, which then launched an investigation into the video. According to authorities, although the men fighting in the video are adults, they have the mental capacities of young children.

Jacqueline Kagen, special prosecutor of the New York State Justice Center for Protection of People with Special Needs, said, “These defendants encouraged two developmentally disabled adults to participate in, what I said on record, is a developmentally disabled fight club.” Kagen continued, “They encouraged them to strike each other–one knocking over the other in the wheelchair–and then rewarding them with praise.”

According to a 2012 report published by the AARP Public Policy Institute and the United Hospital Fund, family members caring for a sick loved one or elderly family member are now providing more complex medical care than in the past. The report, titled “Home Alone: Family Caregivers Providing Complex Chronic Care,” was based upon an online survey of 1,677 family caregivers who provided unpaid care to a family member over the past twelve months. In almost all cases, family members performed tasks associate with traditional caregiving. For instance, family caregivers assisted with bathing, dressing, cooking, shopping and doing chores around the house.

wheelchair.jpgHowever, 50 percent of the family caregivers surveyed reported that they provide some type of medical and nursing care that is normally provided by a trained health care professional. For example, one-third of family caregivers who provide medical and nursing care reported that they provide wound care, such as tending to bedsores, changing postsurgical dressings and ostomy care. Of those family members who provided such critical wound care, 75 percent of them stated that they were uncomfortable performing such invasive procedures and were afraid of making a mistake while providing such care.

In addition, the report revealed that 75 percent of family caregivers administer and manage medications for a loved one. In some cases, caregivers administered such medications intravenously or by injection. Some caregivers reported that they administer five to nine medications on a daily basis. Twenty percent of caregivers who manage medications said that they administer ten or more prescriptions daily. Many family caregivers said that they were afraid of making mistakes while administering medications, especially in cases in which a loved one is uncooperative.

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