Articles Posted in Nursing Home Violations

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The government recently adopted a more accurate measurement for determining when a nursing home has sufficient staffing levels and the results show a glaring problem across the nursing home industry. According to Kaiser Health News, the new method of recording hospital staffing shows a 12 percent decrease in hospital staffs. Further, there seems to be a severe fluctuation at many nursing homes which have sufficient nurses during the week but insufficient staff on the weekends. The new evidence shows that despite the minimal Medicaid requirements on the nursing staff levels at nursing homes, many nursing homes are still failing.

Under the previous method for calculating nursing staff, nursing homes would be required to provide all payroll information for the previous two weeks and government regulators would tally and report on the number of nurses employed during that time period. Because nursing homes sometimes knew when an inspection would occur ahead of time, this method was not generally considered accurate. Under the new method for calculating nursing staff, which Medicare began in April of this year, nursing homes must provide a report to Medicaid on staffing throughout the entire year.

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Over the past four years, the Franklin Center for Rehabilitation and Nursing received 26 citations from the New York State Department of Health. All of these citations related to violations concerning the treatment and health of the senior citizens at the Queens nursing home. Compared to the state average, this facility received approximately the average number of citations. However, residents of this facility were more likely to be physically restrained (4.6 percent of all residents) and more likely to have a catheter inserted (1.4 percent of all residents), according to the New York Department of Health. In addition to these issues, the government agency cited the elder care facility for the following violations:

1. The nursing home failed to adequately prevent pressure sores.

Franklin Center for Rehabilitation and Nursing did not adequately protect its residents from pressure sores, or bed sores in violation of Section 415.12(c)(2) of the New York Code. Under this New York regulation, each nursing home in New York must ensure that their residents do not develop pressure sores while at their facility, unless unavoidable.

For residents who enter the nursing home or elder care facility with pressure ulcers, or bed sores, the nursing home must provide “necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.”

Franklin Center violated this regulation when one of the residents, with a stage-four pressure ulcer, the most severe type, did not receive necessary treatment. Specifically, the health examiner noted that the nurse applied a “dressing appliance that was too small, and she dried the wound using improper technique.” When asked by the health examiner to explain her actions, the nurse admitted she should have “patted the wound dry instead of wiping in order to prevent tissue damage.”

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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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State investigators in Raleigh, North Carolina have captured several nurses cruelly abuse an elderly man at a retirement home on a hidden camera. The hidden camera was set up after an elderly man told his daughter that the orderlies had been “tormenting and neglecting him,” according to WRAL. In response to the incident, state investigators are investigating the nursing home.

According to the news station, the video shows Richard Johnson, 68 years old and recovering from a stroke, fall out of his bed. After crying out for help, several orderlies pass by and ignore the elderly man for over an hour. When staff members finally arrive they immediately begin berating and cruelly taunting the senior citizen, asking “What are you doing there? Why are you on the floor?” Another nurse joined in on bashing the vulnerable man, stating “You had to do something very wrong with your life. What did you do? You’re suffering so bad, so you’ve done something wrong. Yes, you did.”

According to Richard Johnson’s daughter, Johnson even went to the bathroom while on the floor waiting for help. This unfortunate incident prompted a third member of the nursing staff to scold him, saying “How old are you? One? You’re supposed to be enjoying your retirement. Instead, look what you are doing, pooping on yourself. Shame on you.”

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Between 2014 and 2018 Beach Gardens Rehab and Nursing Center in Queens, New York received 92 complaints by its residents and 19 citations by the New York Department of Health. The Department of Health inspects all nursing homes throughout the state every 9 to 15 months to ensure their compliance with all laws regulating nursing homes and the treatment of their residents. These are several of the citations the Queens nursing home received over the last few years:

1. The nursing home failed to prevent pressure ulcers or bed sores.
Beach Gardens Rehab and Nursing Center received a citation in June 2017 for failing to prevent its residents from receiving pressure ulcers. Under Section 483.25(c) of the Federal Code, all nursing homes must “ensure that a resident who enters the facility without pressure sores does not develop pressure sores…” Further, if a resident does have pressure sores then the nursing home is obligated to provide “necessary treatment to promote healing, prevent infection and prevent new sores from developing.” In this instance, the New York Health inspector randomly sampled three residents at the facility that had not entered with pressure ulcers. According to the inspector, one of these residents later developed a pressure ulcer on their left heel after the nursing home failed to use preventative measures, despite documentation that the resident posed a moderate risk for pressure ulcers.

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Monitoring and reporting of elder abuse is one of the most important responsibilities delegated to New York regulators. However, recent news reports have cast a light on the accuracy and effectiveness of these reports. Advocates for elder care say the data collected by regulators does not effectively represent the harm caused to nursing home patients when the facilities violate state or federal regulations. Based on the evidence provided, it appears these advocates may be correct.

According to the Centers for Medicare and Medicaid Services (CMS), only 4 percent of all regulatory violations result in “actual harm” to a resident at its facility. While the data is collected at a federal level, state regulators are required to perform the inspections and relay the information to CMS. In New York, the legal entity responsible for inspecting nursing homes is the New York Department of Health.

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A Pennsylvania judge allowed a lawsuit against a nursing home seeking punitive damages over a patient’s pressure ulcer to proceed to trial, according to Law360.com. The lawsuit, filed in 2016, alleges that a nursing home’s reckless behavior allowed for a resident to develop multiple pressure sores. Sadly, these pressure ulcers, now referred to as pressure injuries, caused the nursing home resident’s death only months afterward.

The nursing home resident, Mary Ann Miller, entered the nursing home in November 2015 after a broken hip. According to nursing home regulations, Miller’s broken hip and resulting immobility qualified her as “high-risk” for developing pressure ulcers, or bedsores. Unfortunately, the nursing home did not sufficiently monitor Miller, who was originally only intended for a short-term stay while her hip healed. Unable to move and not properly cared for by the retirement home, Miller developed multiple pressure ulcers on her back and heels. After causing the pressure ulcers through its negligence, the lawsuit further alleges the nursing home failed to adequately treat the bedsores.

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A recent report released by Kaiser Health News shines a light on the diminished quality of care received by many senior citizens at for-profit nursing homes. The Kaiser Health study found that the average for-profit nursing home receives twice as many complaints by its residents and their families. Further, the research group also found that:

For-profit nursing home chains had an average of 8 percent fewer nurses per residents when compared to independent nursing homes.  Nursing homes that operated for a profit received almost twice as many validated complaints.  For-profit nursing homes received 22 percent more fines, and the fines levied against them were 7 percent higher.

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Mirroring national trends, elderly Americans are beginning to use more addictive prescription drugs. In a report by the New York Times, the number of prescriptions for benzodiazepines, a class of anxiety drugs which includes Xanax and opioids have markedly increased in the last couple decades. Not only do these addictive drugs have serious side effects, they can be deadly to the user, sometimes even when taken as prescribed.

According to the newspaper, the number of benzodiazepine prescriptions for Americans over the age of 65 increased 8.7 percent between 2003 and 2010, the year with the most recent data available. A 2008 study indicated that about 9 percent of adults between 65 and 80 took one of these anti-anxiety drugs. The Centers for Disease Control (CDC) paints an even more ominous picture of the problem – the number of deaths caused by benzodiazepines in Americans over the age of 65 rose from 63 deaths in 1999 to 431 in 2015. In 1999, opioids were a contributing cause of 29 percent of these deaths. A mere fifteen years later, opioid drugs now contribute to two-thirds of deaths caused by benzodiazepines.

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antipsyhotic-and-elderlyBetween 2013 and 2017, the Northern Manor Geriatric Center in Rockland County, New York received more than double the average number of citations by the New York Department of Health, the entity responsible for performing yearly inspections at all nursing homes in the state.  Compared to the statewide average of 34 citations- relating to either standard health or life safety violations – Northern Manor Geriatric Center received 73 citations by the government agency. Of these 73 citations, two were related to “actual harm or immediate jeopardy” – the most serious of violations issued by New York State.

The following are some of the most serious or most recent violations found by the New York State Department of Health: Continue reading

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