Articles Posted in Neglect

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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An expert on pressure injuries, also called bedsores or pressure injuries, recommends nursing homes adopt a more individualized approach to preventing and treating the painful and sometimes deadly sores. In an opinion-editorial in McKnight’s Long-Term Care News, Jean Wendland Porter, Regional Director of Therapy Operations at Diversified Health Partners, discusses problems commonly associated with pressure ulcers and alternative approaches that will be more effective at reducing bedsores. In one example, Porter notes the common medical advice to “move a patient around every two hours” fails to take a patient’s ability to move by themselves or any aggravating factors that could make the patient more likely to develop a bedsore, such as a higher BMI or a weakened immune system. According to Porter, the “two hours” rule is not based in science at all and originates in World War II where it was deemed the most efficient method for delivering care to bedridden soldiers.

Instead of following arbitrary, “one-size-fits-all” medical recommendations, Porter likens pressure ulcer prevention measures to selecting a mattress – tailored to the patient’s comfort and healthcare plan. Porter says the best practice involves a “pressure-mapping” solution which displays any pressure points on the patient’s body. With those results, a healthcare plan is developed which includes pressure-relieving devices on areas of the body at high risk for pressure ulcers. This customized plan for each nursing home resident will need to be continually revised as mobility and healthcare needs change.

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After what one upstate nursing home doctor called the “worst bedsore ever seen” killed a once-healthy resident, the elderly man’s son is demanding accountability from the negligent nursing home. Four months after entering Safire Rehabilitation of Northtowns, the 82-year-old Frank L. Williams passed away from an entirely preventable bedsore, also called a pressure ulcer. According to The Buffalo News, Williams’ hospital records list cardiac arrest caused by sepsis, a deadly infection resulting from his bedsores, as the cause of death. According to the New York Department of Health, the number of residents developing bedsores at Safire Rehabilitation is almost double the state average. In the last few years, the number of bedsores has increased at the nursing home.

Speaking to The Buffalo News, Williams son describes his father’s experience at Safire Rehabilitation as a nightmare from the beginning. After suffering a stroke, Williams was released by the local hospital to Safire Rehabilitation. The nursing home apparently accepted the elderly man without having space to treat him, which caused him to spend his first three days in long-term care instead of the rehabilitation unit. Williams son describes the nursing home as windowless and reeking of urine. The nursing staff ignored his father’s pleas to move him around, necessary to prevent a bedsore from developing. After spending three months at Safire Rehabilitation, Williams doctors told his son there was a “little pressure sore” and refused to let the son see the wound.

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Two registered nurses and one certified nurse aid were convicted in a Nassau County courtroom for willful violation of health laws in a tragic case that led to the death of an 81-year-old nursing home resident at A. Holly Patterson Extended Care Facility in Unionville, NY, according to LongIsland.com. According to prosecutors, the elderly resident – both ventilator-dependent and in a wheelchair – somehow became disconnected from his ventilator, rending him unable to breathe.

In situations of life-and-death, the nursing home utilizes distinct auditory and visual alarms that sound throughout the unit. Despite the sounding of the alarm and its ubiquity across the entire nursing home, the two nurses, Sijimole Reji and Annieamma Augustine, along with the certified nurse aid, Martine Morland, did not respond for a full nine minutes. By the time the ventilator was reconnected, the elderly woman was unconscious and passed away the next day.

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New York State routinely allows nursing home owners with a record of poor care and government fines to operate more long-term care facilities in the state, according to a report by The Buffalo News. Speaking to the upstate newspaper, Toby Edelman at the Center for Medicare Advocacy described the problem as a “disturbing but all-too-familiar pattern” and joins elder advocates in demanding the New York Health Department provide more transparency and stricter scrutiny when selecting nursing home owners. In response to the criticism, the New York Department of Health, the state agency responsible for regulating nursing homes, drafted legislation intended to allow stronger and more effective government oversight of the long-term care industry.

The evidence uncovered during The Buffalo News investigation paints the portrait of a government agency whose incompetence is endangering elderly New Yorkers. Of the 47 nursing homes in the newspaper’s geographical area, sixteen were purchased in the last decade by for-profit nursing home corporations, which have a documented record of provider lower-quality care to their residents.

In one instance, the Department of Health approved the takeover of a nursing home by a group of New York City investors fined almost $90,000 in the last two years. In another example cited by the newspaper, a nursing home corporation with poor ratings and federal and state fines totaling “at least $325,000” was approved to purchase another nursing home in the state. In both cases, the state agency amazingly concluded that it had received “no negative information” about the nursing home owners. The deputy health commissioner told the newspaper that the agency now vets potential nursing home owners more thoroughly.

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The nursing home industry continues to reshape itself as small, independent nursing homes focused on providing high-quality care are rapidly replaced with corporate conglomerates seeking to maximize the profits. Predictably, the harmful effects of the profit-seeking model have only amplified in the last year. According to industry analysts, the ownership structure of nursing home conglomerates – where multiple nursing homes are owned and operated by the same owners – combined with riskier financial decisions are causing a slew of bankruptcies and closings across the country. In addition to removing America’s senior citizens from their nursing home, investigations into for-profit care providers have raised serious concerns about the quality of care provided to financially stable nursing homes.

Last November, The Washington Post reported on HRC ManorCare, a massive nursing home chain owned by Carlyle Group, reportedly one of the “richest private-equity firms in the world.” Despite an owner flush with cash, the nursing home chain struggled financially for five years and eventually filed for bankruptcy. The five years of financial instability exposed HRC ManorCare’s 25,000 nursing home residents to increased health risks, according to the newspaper. The number of health code violations at the nursing home chain rose by 26 percent, which includes serious health violations for failing to prevent bedsores, medical errors, and failing to provide proper nutrition and hygienic care for residents. Serious health code violations – violations that either caused “actual harm” or put patients in “immediate jeopardy” – rose 29 percent between 2013 and 2017, the year HRC ManorCare filed for bankruptcy.

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Elder abuse is one of the most widespread and under-reported problems in the country. However, despite the prevalence of elder mistreatment, the federal government does not gather data or require reporting for the crime against America’s senior citizens. With the population of Americans over the age of 65 expected to double by 2050, elder care advocates are urging the federal government to stiffen enforcement and begin tracking elder abuse cases across the country.

Elder abuse encompasses a wide range of illegal behaviors, from sexual abuse and financial exploitation to outright neglect by family members, caretakers, or nursing homes. Unfortunately, the federal government has not provided states with a precise definition of what behaviors constitute “elder abuse” and therefore, the exact definition varies depending on the state. When the federal government attempted to gather data on the subject for the first time this year, federal bureaucrats described the data received from states as incomplete, according to USA Today.

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A jury in upstate New York awarded a victim of nursing home abuse $1.2 million for its wanton neglect of an elderly resident. The jury found that 72-year-old Shirley Burrows was horrifically neglected by Newfane Rehab & Health Care Center, a long-term care facility in Niagara County. According to The Buffalo News, Burrow’s damages include $775,000 for pain and suffering and $475,000 for violating state public health laws meant to protect nursing home residents. Lawyers for the profit-making nursing home said that insurance will fully cover the settlement.

The mistreatment of Burrows began in May 2015 when she was discharged from the hospital with several “superficial” bedsores. Bedsores, also called pressure injuries or pressure ulcers in the medical community, develop when a person is pressed against a surface for an extended period of time. Due to decreased mobility and a higher rate of hospitalizations, the elderly are highly susceptible to bedsores. When bedsores are minor, they can heal quickly. However, minor bedsores can quickly turn into deep and painful sores when left untreated. Bedsores, especially serious ones, are usually preventable.

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Over a decade after a scathing article in the New York Post about the low-quality of care provided in many New York City nursing homes, the problem continues unabated at many nursing facilities. In 2006, the New York Department of Health fined 48 nursing homes in the five boroughs – including eight with violations so severe that nursing home residents were in “immediate jeopardy.” These nursing homes included:

  • United Odd Fellow and Rebekah Home. According to the Department of Health, a resident choked to death because the facility lacked adequate staffing. An inspection report from that year concluded that more than half of the staff at United Odd Fellow and Rebekah Home did not know how to perform the Heimlich maneuver.
  • Split Rock Rehab and Health Care. During 2006, this Bronx nursing home allowed a resident to die from lack of oxygen.

The federal government announced this month that it will begin performing more surprise inspections at nursing homes in an effort to crack down on nursing homes with inadequate staffing. According to the government, these surprise inspections will be done on Saturdays and Sundays at nursing homes with records of insufficient nursing staff on the weekends. According to the federal Centers for Medicare and Medicaid Services (CMS), nursing staff levels are directly correlated with the quality of care received by the nursing home residents.

Over a decade after the federal government mandated CMS collect payroll data and publicize each nursing home’s results, the federal agency finally overhauled its information technology system and began publicizing the information this year. While staffing levels at nursing homes were previously determined by “spot-checking” during yearly inspections, the new method for calculating uses payroll data from the entire year. Consequentially, the new method employed by CMS provides a more accurate and complete picture of staff levels.

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