Articles Posted in Neglect

Nursing home residents may need family members or advocates to report cases of elder abuse. According to The National Elder Abuse Incident Study, only 20 percent of neglect, exploitation, abuse or self-neglect is reported to state authorities. The nonprofit agency which conducted this study, The Center for Elder Abuse, said that an estimated 2.5 million cases of elder abuse occurred at nursing homes across the country in just the last year. This means that 2 million nursing home abuse cases go unreported and unpunished. This eye-wateringly high number indicates a substantial problem on its own but considering the aging population in America, unreported elder abuse could increase to even higher levels.

While victims can be any age, race, gender, or with any kind of diagnosis, the nonprofit elder care group said that common characteristics of nursing home abuse victims include anyone over the age of 80, elderly women, people with cognitive impairments, and people who are physically or psychologically aggressive. Nursing homes are the most common place for unreported elder abuse, although adult day care centers and hospitals are common locations for this horrific crime, too.

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The federal government fined a New Jersey nursing home for $600k after a deadly adenovirus outbreak killed 11 children and infected 37 other residents, according to NJ.com. The nursing home, Wanaque Center for Nursing and Rehabilitation, is a long-term care facility in northern New Jersey with senior citizens and children who require around-the-clock care and monitoring. According to federal regulators, insufficient safety protocols led to the deadly outbreak and permitted its rapid spread across the assisted living facility.

In a scathing report released last week, the federal government cited numerous safety violations that enabled the rapid spread of the virus. The protocols at the retirement home were so insufficient that medical staff did not even realize an outbreak was occurring until the fourth child died. The federal report details violations including a lack of infection control plan, a “void of leadership,” and an off-site medical director who was so disengaged she only checked on the facility weekly.

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Victims of nursing home abuse and industry stakeholders gathered in Washington this month for a Senate hearing on the nursing home industry. In addition to hearing testimony from the families of nursing home abuse, the federal legislators sounded the alarm over a looming fight over Medicaid funding. According to Skilled Nursing News, the Trump administration will propose its plans to convert Medicaid funding into a “block-grant model.”

According to proponents of the new model of funding, Medicaid spending has spiraled out-of-control and the federal health insurance scheme is no longer sustainable. Instead of continuing with the current open-ended model, the federal government will fund a predetermined amount each year for a state’s Medicaid program. The amount will likely depend on the number of Medicaid beneficiaries in the state, among other factors. The idea for overhauling Medicaid’s open-ended funding model into a block grant system has been favored by Republicans for a long time and finally reached a fever-pitch during the Affordable Care debate in 2017.

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In an exhaustive report by Care.com on the current state of America’s nursing home industry, the well-researched guide compiles data from various private studies, data published by the government, and even included a recent analysis of approximately 1,000 Medicare patients. While the detailed and illuminating guide to elder care facilities is worth reading in full, these are the highlights:

  • The Scope of the Nursing Home Industry. According to the report, there are 1.7 million nursing home beds in America and 79 percent of these are occupied each day. Nursing home residents receive an average of four hours of personalized care each day. Of these four hours, only 45 minutes are spent with a registered nurse each day.
  • Nursing Home Visitors. A nursing home resident can expect six visits from their relatives each month and spend an average of 1 hour and 27 minutes each visit. A majority – 55 percent – of nursing home patients wish their family would visit them more frequently. Nursing home patients satisfied with their family’s visitation habits report an average of nine visits each month. Apparently, family members feel guilty about their infrequent visiting habits – 14 percent described feeling “extremely guilty” and 21 percent felt “moderately guilty” for rarely visiting their loved one.

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Sen. Chuck Grassley issued a statement demanding that the Centers for Medicare and Medicaid Services (CMS) provide the Senate with a thorough report on the “comprehensive review” the agency plans to conduct on its nursing home oversight. Last month, the Republican Senator held a hearing on nursing home abuse and excoriated the nursing home industry and its grossly inadequate government oversight. In response to the spectacle on Capitol Hill, Administrator Seema Verma announced the agency would perform a “comprehensive review” of its nursing home oversight. In a statement issued by his office, Sen. Grassley described the news as “encouraging” but also directed the government to prepare a report on its planned changes.

After a fiery attack on the nursing home industry, Sen. Grassley does not plan on letting the government-funded industry to continue with its blatant violations. Speaking to McKnight’s Long Term Care News, Sen. Grassley said, “As chairman of the Senate Finance Committee, I’ll continue conducting diligent oversight of the nursing home industry. Once these reports are available and I’ve had time to review their findings, I intend to hold another hearing to learn the facts and find workable solutions.” The Senator from Iowa directed both the Department of Health and Human Services and CMS to prepare reports for a Senate hearing later this year.

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Outrage continues to grow at the poor quality of care being delivered at a New York nursing home. According to an investigation by News10NBC, Sodus Rehabilitation and Nursing Center in Sodus, New York is still violating numerous state regulations about the treatment of its senior citizens. The local news agency began investigating Sodus Rehab several years ago and, unfortunately, it does not appear that the quality of care has improved over time. According to the New York Department of Health, the nursing home received 90 citations for health and safety violations in just the last four years. In New York, the average number of violations per nursing home is approximately 30.

After undercover investigations by News10NBC last year showed unsafe and unsanitary conditions, Sodus Rehab says they “cleaned house” and brought in new administrators. Unfortunately, the new staffers do not appear to have fixed any of the nursing home’s problems. In one particularly egregious example cited by the news, Bill Tanner, a nursing home resident with leukemia, dementia and “other health issues,” developed bedsores that one doctor described as “some of the worst” he had ever seen. Bedsores, also called pressure ulcers, could have been easily prevented in Tanner, according to the doctors. Perhaps even more horrifically, the bedsores were only noticed because a former neighbor visiting Tanner noticed a foul smell in the room. According to the neighbor, she asked for a registered nurse and a licensed practical nurse to attend to the elderly man. Sodus Rehab staff said that neither was on-duty at the time.

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The federal government designated New Roc Nursing and Rehabilitation Center as a Special Focus Facility (SFF) after racking up more than five times the average number of violations in the last couple years. According to WHEC, the nursing home has a troubled history dating back to 2014 when an undercover investigation found a “pattern of patient neglect” so horrific that ten nursing home staffers were charged with criminal neglect. Since 2014, the problems have only “continued to pile up,” according to local news agency.

After “a persistent pattern of poor care was identified during its last three inspection surveys,” the New York Department of Health recommended regulators designate the Rochester nursing home as an SFF. An SFF is inspected twice as much as other nursing homes and subject to increased fines and penalties for any violations. According to Jennifer Lewke, spokeswoman for New Roc Nursing and Rehabilitation Center, this creates a “downward spiral.” Money necessary to fix the cause of numerous violations are instead used to pay the fines and penalties. Further, designating a nursing home as SFF sharply reduces the number of residents, who understandably choose facilities with records of better care. This causes a further drain on resources and leads to more violations and poor care.

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The Centers for Medicare and Medicaid (CMS) announced it will launch a ‘comprehensive review’ of nursing home regulations across the country. According to Health Leaders Media, CMS Administrator Seema Verma announced the new initiative last week in response to mounting criticism by states and federal legislators. Administrator Verma said the government agency will seek $45 million in additional funding from Congress for its review.

CMS says the review will focus on several primary areas. First, CMS will work with state agencies across the country to strengthen oversight of the country’s nursing homes. According to CMS, federal and state agencies will work together to ensure CMS health and safety requirements are being followed and ever nursing home is inspected at least once a year. Second, the federal agency plans to increase enforcement of nursing homes by, according to Administrator Verma, “developing new ways to root out bad actors and repeat offenders.” Administrator Verma says nursing homes with insufficient nursing staff will be targeted will begin receiving more “unannounced inspections” to encourage compliance. Finally, nursing homes will now be more severely penalized for poor patient outcomes and less severely penalized for failing to follow CMS protocols. In addition to improving outcomes for current nursing home patients, the focus on patient outcomes will also be more helpful to prospective nursing home residents by providing a more meaningful metric to judge nursing homes.

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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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