Articles Posted in Pressure Sores

The Trump Administrations deregulation effort has led to decreased oversight across the country’s nursing home industry. According to The Washington Post, President Trump’s deregulation agenda has indiscriminately removed “essential protections for vulnerable Americans.” Citing the Trump administration’s popular boast of removing 22 regulations for every single regulation added, the newspaper understandably questions the necessity of these regulations and the consequences of their removal.

Sadly, the nursing home industry has never been a priority for many Presidential administrations. Despite the highly regulated nature of the industry, nursing homes have often escaped the scrutiny lodged at hospitals and other healthcare providers. Late in his second term, President Barack Obama attempted to change that and directed the Centers for Medicare and Medicaid Services (CMS) to aggressively pursue nursing homes flouting the law. Beginning in 2014, nursing home violations would not result in a one-time fine. Instead, the nursing home would be fined every single day until the violation was rectified. By 2016, over two-thirds of nursing home violations resulted in a per-day fine. Unfortunately, the Trump administration reversed this change – which was viewed by elder care advocates as broadly effective and necessary.

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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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State prosecutors charged seven nursing home employees with involuntary manslaughter after a patient died from a bedsore in 2017. The nursing home employees, which includes one nurse, are collectively charged with 37 crimes for their gross mistreatment and neglect of two nursing home patients during their time working at Whetstone Gardens and Care Center in Ohio. Announcing the charges, Attorney General Dave Yost says, “Evidence shows these nurses forced the victims to endure awful mistreatment and then lied about it.”

Yost says first patient “literally rotted to death” after developing a preventable bedsore or “pressure injury” in 2017. The patient, who entered the facility on a short-term basis, developed several bedsores after nursing staff failed to move the patient every few hours. Once the bedsores developed, the staff continued to ignore the nursing home resident and failed to treat the sores, also called pressure injuries or ulcers. Within weeks of developing the bedsore, the patient’s bedsores became infected with gangrene. The nursing home resident passed away just weeks later after the staffers at the nursing home failed to take “any medically appropriate steps.”

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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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The Department of Veteran Affairs released its first report on the status of its nursing homes this month and the results show widespread neglect and abuse at the government-run facilities, perhaps even worse than the well-documented problems seen in its private-care counterpart. The federal government is responsible for caring for the country’s 40,000 veterans and, according to its own report, is doing a poor job. The report analyzed 99 VA nursing homes across the country and reported the findings of surprise inspections conducted by outside contractors. The VA spokesperson said that releasing the report in its entirety is part of a new push by the agency for transparency and accountability.

The findings of the report are daunting. Eleven of the 99 nursing homes were so unsafe that veteran safety was in “immediate jeopardy.” More than half of the nursing homes (52) were deficient enough to cause “actual harm” to their veteran residents. “That is really bad. It’s really bad,” Richard Mollot, executive director of the Long Term Care Community Coalition, a nursing home advocacy nonprofit told USA Today.

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New York’s Department of Health appears unable to adequately monitor the nursing homes across the state and hold poor performers accountable. Elder care advocates say the state agency must reform to protect senior citizens from poor care and nursing home abuse. Thankfully, legislators in Albany appear to finally be listening.

According to The Buffalo News, Assembly Majority Leader Crystal Peoples Stokes is co-sponsoring a bill regulating the number of nurses at each assisted care facility in the state. The appropriately named Safe Staffing for Quality Care Act would mandate that each nursing home have RNs (registered nurses) and that practical nurses and CNAs (certified nursing assistants) spend a minimum of 291 minutes with each resident. According to federal data, nursing staff levels are the largest indicator of whether a nursing home is providing quality care to its residents. Unfortunately, the same federal data shows that most nursing homes are grossly deficient when it comes to staffing. According to a study released in January 2019, only 7.5 percent of nursing homes across the state currently satisfy the requirements laid out in the Safe Staffing for Quality Care Act.

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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 or pressure injuries, 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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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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Recent data published by Nursing Home 411 shows America’s nursing homes continue to struggle with low levels of nursing staff. Adequate staffing is one of the most important factors in providing quality care to nursing home residents. Unfortunately, the nursing home industry has a widespread problem in staffing their facilities with a sufficient number of nurses and medical personnel. The data analyzed by the nonprofit group included all nursing homes receiving Medicare in 2018. The highlights published by Nursing Home 411 include:

  • Nursing homes spend an average of just 3.5 staff hours with each resident, per day. According to the nursing home advocacy group, the federal government states a minimum of 4.1 hours is required for the average resident.

 

  • Nursing homes spend only 0.5 registered nurse staff hours with each resident, per day. A registered nurse is typically more capable and better educated compared to certified nursing assistants. Another federal study cited by Nursing Home 411 recommended increasing registered nurse hours by 10 to 50 percent each day to satisfactorily meet each nursing home resident’s healthcare needs.

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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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