Articles Posted in Pressure Sores

Between 2015 and 2019, Adira at Riverside Rehabilitation and Nursing received 37 citations for violations of public health laws, according to records accessed on November 2, 2019. The Department of Health is the public entity responsible for inspecting nursing homes every 9 to 15 months to ensure compliance with state and federal health and safety laws. Adira at Riverside’s 37 citations, which resulted from three inspections, were five more than the statewide average of 32. The Yonkers nursing home’s citations include the following:

1. The nursing home failed to provide proper provide treatment and services sufficient to prevent and heal pressure ulcers and bedsores. A citation issued on December 2017, found that Adira at Riverside failed to ensure that one of three residents inspected was provided with appropriate care of pressure ulcers. Section 483.25 of the Federal Code requires that nursing homes provide residents with care adequate to prevent pressure ulcers unless otherwise unavoidable given their condition, and further, that residents suffering from pressure ulcers receive necessary treatment and services to prevent infection or the development of new ulcers. The Department of Health states specifically that the facility did not properly inflate an air mattress to the manufacturer’s recommended amount so as to provide the patient with “optimum pressure relief” while they were in bed. A surveyor found that whereas the resident’s weight was recorded as 109.6 pounds, the control box regulating the air mattress was set at 200 pounds, and that facility staff were unaware who had set the air pressure at that level or who was responsible for ensuring proper mattress inflation.

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A federal judge ruled against SensotaCare, the largest nursing home provider in New York, saying the agency violated human trafficking laws with its meager wages and “threat of serious financial harm” designed to prevent anyone from quitting. According to Newsday, Judge Gershon of the federal Eastern District of New York also found that the owners of SensotaCare, Benjamin Landa and Bent Philipson, could be held personally liable for violating the anti-trafficking laws. 

The ruling continues a decade-long saga between the corrupt owners of the nursing home and the Filipino nurses who say they were required to pay $25,000 if they ever quit their job. At one point, Suffolk County District Attorney Thomas Spota charged thirty nurses who quit en masse with endangering the welfare of children for leaving  their position. The charges were overturned by a state court because they violated the rights of the nurses to be “free from slavery.”  

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New York State agreed to pay more than $6 million to victims of abuse at a state-run nursing home in The Bronx. The settlement comes after a protracted legal battle that began more than five years ago after a series of news reports detailing physical abuse and widespread neglect at the nursing home. According to The New York Times, staff members would spit on the nursing home patient’s faces, force them to take cold showers, and physically attack the helpless patients. One family member of a nursing home resident, which is known as Union Avenue I.R.A., told the newspaper that the front desk answered the phone with, “Good morning, Bronx Zoo.”

As part of the legal settlement with New York, the nursing home abuse victims forced the state to surrender control of the facility to a private nonprofit agency. “We lost all faith that the agency can run this house effectively,” the victims said in a statement to The New York Times. Indeed, the misconduct of the nursing home was not the only problem at Union Avenue I.R.A. The lawsuit describes a dysfunctional culture where anyone who reported misconduct faced retaliation. After a state investigation found 13 instances of nursing home abuse at the Bronx facility, New York State did not fire anyone. A state-mandated arbitration process protected the confidentiality of the employees and the state merely transferred the abusers to a new facility.

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Senators released a list of 400 nursing homes with a ‘persistent record of poor care,’ according to the federal legislators. These nursing homes are not included in the federal government’s “special focus facilities” a list of nursing homes released by the government each year indicating poor care and unsafe conditions. According to the Senators, the list of 400 facilities is “virtually indistinguishable” from special focus facilities and the elder care facilities are not all lumped together only because a 2014 law imposed a cap on the number of so-called special focus facilities. Consequently, this left 400 facilities subject to heightened government scrutiny without public knowledge.

According to the Centers for Disease Control and Prevention, approximately 1.3 million Americans are nursing home residents at 15,600 facilities across the country. The federal government identified 3 percent of these nursing homes as problematic in April. In New York, these nursing homes include New Roc Nursing and Rehabilitation Center in Rochester, The Knolls in Valhalla, and Cayuga Ridge Extended Care in Ithaca, according to LoHud.com. In addition to these nursing homes, fourteen other New York long-term care facilities were included in the list of 400 released by the Senate.

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Almost three-fourths of nursing homes in the United States “almost never” have the minimum number of nurses on staff, according to McKnight’s Long-Term Care News. The new study, which utilized a year of payroll data, found that 75 percent of facilities self-reported a number of nurses that are “almost never in compliance with” the federally required minimums. The study was produced by researchers at Harvard University and Vanderbilt University who then published their findings in Health Affairs.
The study comes on the heels of new federal guidelines on reporting nursing staff. Previously, nursing homes would provide a sample of their time-sheets to local regulators when their facility was inspected. Unfortunately, nursing homes commonly knew when inspections would occur and would respond by increasing the number of nurses on staff in the weeks before an inspection. Further, local regulators – who are typically from the state’s health department – did not always scrutinize or authenticate the time-sheets provided by the nursing home. For these reasons, the federal government created a computer system that requires nursing homes to upload payroll information on staffing levels. This new system benefits from live-updates and 24/7 monitoring of the nursing home.

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After addressing the shortage of nursing staff in hospitals, healthcare advocates have set their sights on implementing “Safe Staffing” policies in New York’s nursing homes. Safe Staffing policies would legislate minimum levels of nursing staff across the state’s nursing homes. Currently, New York State law only requires “sufficient staffing” which grants nursing homes wide discretion to determine whether its facility has sufficient levels of staffing. Elder care advocates lobbied state legislators to include safe staffing requirements in the budget this year. Lawmakers in Albany declined their request.

Instead, lawmakers opted to study the staffing levels at nursing homes. According to The Buffalo News, the budget passed earlier this year in Albany included a directive to the New York State Health Department to begin a study on May 1 analyzing “the range of potential fiscal impacts of staffing levels, other staffing enhancement strategies, and other potential quality improvement initiatives,” according to WHEC. The health department will then issue a final report to lawmakers at the end of the year. Given the timing of the report, it appears unlikely that any legislation will pass this year establishing mandatory staffing levels at nursing homes. Studies in Albany can frequently go in two directions. In some situations, studies are meant to endlessly shelve an unpopular idea. In other circumstances, studies can empower government agencies to develop their own policy proposals that will then be quickly passed into law.

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Elder abuse is a growing problem in America that often goes unreported. According to a recent article in NPR, healthcare workers and government regulators are failing to report cases of suspected elder abuse to local authorities. The article analyzes a recent report by the Office of Inspector General which found that despite evidence of abuse or neglect severe enough to warrant medical attention, healthcare providers rarely alerted authorities. Under both federal and state law, healthcare professionals are legally required to report cases of suspected abuse.

Elder care advocates are unsurprised by the federal agency’s report, saying that elder abuse is widespread and unreported in the United States. The report only further confirms the severity of the elder abuse and the indifference to tackle the problem. One study relied upon by the federal agency that authored the report analyzed nursing home residents who end up in an emergency room. The researchers looked for potential signs of neglect or elder abuse, such as head injuries, body bruises, bedsores, or any diagnosis that may indicate sexual or physical abuse.

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Webcams are becoming popular in nursing rooms across the country as families see it as an easy way to check on their loved ones and prevent neglect and elder abuse. Driven by the increased use of security cameras across the country and their reduced prices, webcams are popping up across the country and, when used discreetly, can sometimes catch cases of horrific elder abuse. The legality of webcams inside of nursing homes is sometimes questionable. A Minnesota court ruled in 2017 that a family had a right to set up a webcam in their loved one’s room after nursing home staffers kept unplugged and moving the camera – apparently not wanting to be recorded. Since 2017, seven states have passed legislation allowing families to place webcams in nursing home rooms.

While states move to legalize the use of webcams, privacy advocates have some concerns about the widespread use of webcams in elder living facilities. First, since nursing home residents are particularly vulnerable and prone to cognitive impairments then the decision to set up a webcam usually falls on their guardian or family. Given the serious privacy implications of being constantly filmed, family members would hopefully consult their loved one. Unfortunately, studies reported by Medical Xpress show that families tend to value “keeping the peace” over discussing these important matters.

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Over one-third of nursing homes in the country saw their star rating drop last year after the Centers for Medicare and Medicaid retooled their star-based rating system, which judges nursing homes based on the quality of care provided to their patients. A nursing home receives a rating between one and five stars, with five stars representing the highest quality of care. While the majority of nursing home ratings changed for the worse, the retooled metrics used by the nursing home regulator did increase the ratings of approximately 15 percent of nursing homes in the country, according to Skilled Nursing News.

According to the industry watchdog, the new rating metric emphasizes whether a sufficient number of nurses are staffed at the nursing home. According to multiple studies and elder care advocates, the number of nurses is the strongest predictor of the quality of care provided to nursing home residents. The federal agency’s revision came after a report last summer by The New York Times showed that many nursing homes suffered from a nursing shortage and often inaccurately reported their staffing to government regulators. In addition to changing its rating system, CMS also said it would conduct more unannounced inspections on weekends when staffing shortages were reportedly more common.

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The national nursing home chain Skyline Health finally collapsed last year after years of aggressive growth fueled by debt and shady business practices. The aftermath of the chain’s collapse is far-reaching – the chain once ran nursing homes in almost every state in the country, according to NBC News. Further, the disastrous financial situation that plagued the company has now fueled lawsuits against the company by employees seeking unpaid wages and residents who say they were neglected because the company could not afford basic medicine or utilities at their nursing home. This does not even touch upon the upheaval that the chain’s closure caused to countless senior citizens across the country.

As more horror stories come out about Skyline Health’s treatment of its residents, families of displaced residents are searching for answers about how the doomed nursing home chain continued its nationwide expansion while its problems piled up. Skyline started with less than 20 nursing homes in 2015 and expanded to more than 200 in just a couple years, all while state regulators levied substantial fines against the negligent and cash-starved corporate chain.  During the debt-fueled acquisition period, Skyline Health’s owners pillaged the company with lavish payouts and told nursing homes to enact draconian cuts. According to NBC News, the staff at a Skyline Health nursing home in Massachusetts started bringing their own toilet paper for the residents. A corporate memorandum instructed another Skyline Health nursing home to only provide two disposable briefs to each resident per day, cruelly leaving residents to sit in their filth.

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