Articles Posted in Pressure Sores

The Inspector General for the Department of Health and Human Services (HHS) released a report stating that at least one in four instances of elder abuse or neglect are not reported. While horrific in scope, the results are not entirely surprising – other, smaller samples have found that 15 to 20 percent of elder abuse cases were not reported to the proper authorities or government agencies. The most recent study, released by the HHS Inspector General, based its findings on a large sampling of cases spanning 33 states. The study, which pegged the underreporting rate at exactly 28 percent, was released with a demand that Medicare take “corrective action right away.”

Despite mandatory reporting laws by both the federal government virtually all states, the rathelpe of under-reporting remains stubbornly high. On the federal level, nursing homes are required to report any incidents involving a suspected crime immediately and any other case of suspected elder abuse within 24 hours. The Centers for Medicare and Medicaid Services (CMS) can fine nursing homes up to $300,000 for failing to comply with the law. While such a strict timeline and the possibility of hefty fines would typically discourage non-compliance, the HHS report shows that the law requiring reporting of any elder abuse – whether physical, financial, sexual or otherwise – is mostly unenforced by CMS.
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As part of President Trump’s promise to roll-back federal regulations, the Trump administration has announced its intention to scrap a federal rule prohibiting nursing homes from requiring their residents to pursue legal claims through arbitration.

In the simplest terms, arbitration is a catch-all term for a dispute-resolution that, while legally binding, does not utilize the court system. The practice has exploded in popularity in recent decades – especially among larger corporations and nursing homes. These entities prefer arbitration because the costs are generally lower, the dispute resolution process moves much faster than the courts, and parties generally do not have a right to appeal thus providing both parties some finality to their dispwalking-out-300x225ute. Opponents of arbitration say the extra-judicial process favors corporate interests and curtails the rights of victims – from limiting discovery to removing the opportunity to appeal. Further, arbitration also removes the right for a person to have their case heard before a jury, and instead substitutes a so-called “neutral arbitrator.”
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With toothless regulations and ineffective oversight, many nursing homes are still failing the neediest patients. With its budget for overseeing nursing homes slashed in half, the Center for Medicare and Medicaid Services (CMS) has failed to identify failing nursing homes and keep them accountable. As a consequence, some nursing homes are choosing to accept the infrequent fines instead of changing their behavior.

helpCMS is responsible for overseeing all nursing homes that receive benefits from these federal entitlement programs. CMS routinely inspects nursing homes for any violations, if a violation is found, then CMS has two options. First, CMS can put the facility on “special focus” status – reserved for the worst offenders. A nursing home with this designation would be routinely inspected more often and, supposedly, would be punished more severely for any violations. Unfortunately, federal budget cuts have blunted the amount of nursing homes that can be put under “special focus.” Since 2012, the budget for inspecting facilities with this designation has dropped by half. Consequently, despite regulators identifying 435 facilities that warranted this designation, only 88 nursing homes were actually put on the watchlist. Further, once a Continue reading

On June 17, 2013, a patient at Barnabas Nursing Home passed away from complications arising from her pressure ulcers. Her family has sued the nursing home and hospital and believes that their family member received negligent treatment and that the hospital and nursing home should be held responsible for her death. Continue reading

Pressure ulcers, commonly referred to as “bed sores”, are a growing problem among elderly and immobile patients, according to a study by the University of Michigan. According to the study, the amount of pressure ulcers may be up to ten times as common as the Medicare program reports.

The different rates proffered by Medicare and the University of Michigan study derive from the different methods used to detect pressure ulcers. Medicare uses billing data – which is sourced from an administrative team interpreting notes on medical records left by doctors and nurses. Because hospitals receive financial penalties for a higher number of pressure ulcers, there is an incentive for hospital administrations to downplay the number of sores within their hospitals.

The University of Michigan study, however, compared the data given by the hospital administration to “surveillance data” – basically, monitoring the skin assessments given by nurses at hospitals. This data showed that pressure ulcers were up to 10 times more common than the “administrative data” offered by Medicare suggests. According to Jennifer Meddings, M.D., M.Sc. and assistant professor in the Department of Internal Medicine, this information shows the need for a standardized approach to diagnosing bedsores – so the data provided is both accurate and uniform across hospitals.

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A new wireless scanner may be able to detect pressure ulcers (commonly known as “bedsores”) earlier than current methods. The new technology was developed by Bruin Biometrics, a California company, and uses NASA technology. According to Bruin Biometrics, the new scanner can detect pressure ulcers up to four days earlier. Currently, pressure ulcers are mainly identified by visual inspection where nurses roll over patients and inspect their skin – a archaic and intrusive method.

Pressure ulcers are chronic wounds to a local area of skin and tissue, generally seen in patients that are bedridden or otherwise immobile. Pressure ulcers are a common, expensive, and frequently deadly medical condition. An estimated 11 percent of patients in “regulated care settings” (or, nursing homes) will develop pressure ulcers. In Ireland, pressure ulcers account for a full 4 percent of the country’s healthcare budget. Sadly, advanced pressure ulcers (stage three and stage four) can frequently be fatal and the number of fatalities caused by these ulcers is on the rise. Across the world, deaths attributable to pressure ulcers have increased almost 33 percent between 2000 and 2010.

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Four nursing home staff members were arrested for neglecting to provide care to a 94-year old resident at Focus Rehabilitation and Nursing Center, Cooperstown, NY. The elderly female resident was diagnosed with a 4cm x 2cm pressure sore after allegedly being left in the same recliner for 41 hours over Memorial Day weekend this year. The female resident, identified as “M.P.” received only one meal, one medication administration, and only one time was incontinence care provided by staff over the nearly 2 day window, as captured by facility surveillance footage. Not until the resident was removed from the recliner was she diagnosed with a pressure sore.

The NY Attorney General Eric T. Schneiderman announced the arrest and arraignment of four Focus Rehabilitation and Nursing Center employees on charges alleging they each failed to provide care to a resident. The four staff members, including 2 Licensed Practical Nurses (L.P.N.) and 2 Certified Nurse Assistants, (C.N.A.) were arraigned on 8/2/16 in Otsego Town Court in Fly Creek, NY. According to Schneiderman’s press release, Lorraine Caldwell, L.P.N., Amanda Gus, L.P.N., and Sarah Schuyler C.N.A. were arraigned on various felony charges including Falsifying Business Records, Endangering the Welfare of an Incompetent or Physically Disabled Person in the first degree, and the misdemeanor charge of Wilful Violation of Health Laws. Donna Gray, C.N.A., was arraigned only on the misdemeanor charge of Wilful Violation of Health Laws. New York Penal Law 260.25, Endangering the welfare of an incompetent or physically disabled person in the first degree, states that “A person is guilty of endangering the welfare of an incompetent or physically disabled person in the first degree when he knowingly acts in a manner likely to be injurious to the physical, mental or moral welfare of a person who is unable to care for himself or herself because of physical disability, mental disease or defect.”

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The Centers for Medicare & Medicaid Services (CMS) created the Five-Star Quality Rating System in order to help consumers, families, and caregivers compare nursing homes easily and help identify areas they may have questions about. The site rates each nursing home on a scale of 1 to 5; nursing homes with 5 star ratings are considered to be above average quality and homes with a 1 star rating is considered to have lower than average quality.  In order to obtain a high rating from CMS it is important to have adequate measures in place in order to that focus on prevention and early detection for wound/skin care, falls, and urinary incontinence. It is also important to have measures in place that focus on weight loss, dehydration, infection, and dementia care.

A bill proposed in October 2015 called The Nursing Home Accountability Act set forth guidelines that would make a nursing home facility with two or less stars ineligible for a future mortgage/loan.  This method is far more stringent than the  current Housing and Urban Development (HUD) standards.  HUD is a major lender for nursing home facilities.  Although this legislation is not likely to pass, it provides a glance into possible future legislation surrounding this topic.
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Monroe County nursing homes have been cited for numerous deficiencies that often place residents at risk, yet they are still open for business; a Rochester nursing home remained open for two years after receiving chronic violations from the government. Democrat and Chronicle, a newspaper in Rochester, NY found that more than 1/3 of violations received have been cited by Department of Health (DOH) inspectors during previous or checkup inspections (repeat offenses). In some instances, the conditions that led to repeat citations were the basis of wrongful death lawsuits.

reportThere are 34 nursing homes in Monroe County, all of which were cited for a total of 768 state and federal violations during the period of 2012 to 2015; 38% of those citations were repeat deficiencies. The DOH is supposed to ensure that nursing homes comply with regulations of minimum standards of care by making random visits every nine to 15 months and posting the results of inspections online.  However, many believe this method is not enough and the state should do more as a means of enforcement. Rose Marie Fagan, a citizen of the town of Victor said that there is no reason for less than excellent nursing home care and that the community should demand better for the elderly. Continue reading

The Department of Justice (DOJ) announced the creation of regional task forces whose objective will be to toughen enforcement against nursing homes providing substandard care. This initiative was launched in accordance with the DOJ’s Elder Justice Initiative and is expected to include members from the U.S. Attorney’s Office, Medicaid Fraud Control Units, state and local prosecutor’s offices, Department of Health and Human Services, state Adult Protective Services, Long-Term Care Ombudsman, and law enforcement. These groups will come together to exchange information and share their concerns on substandard nursing homes with hopes of resolving these issues in a timely and effective manner.

Benjamin Mizer, Principle Deputy Assistant Attorney General, used the 2014 Extendicare Health Care Services case as an example of a similar collaboration that was successful. Extendicare and its subsidiary were billing Medicare and Medicaid for substandard nursing care, unnecessary rehabilitation therapies, not following protocol to prevent pressure ulcers and falls, and not having enough nurses to care for patients; the company was able to work with the federal government and eight states and settle the case for $38 million. The DOJ worked closely with other agencies and state governments in this case to come to an agreement and Mizer hopes to expand this model of federal-state collaboration through the task forces. Continue reading

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