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False Nursing Home Staffing Levels Cause Families to Unwittingly Subject Residents to Poor Care

Posted in Documentation & Reporting, Elder Issues, Injuries, Levels of Care, Nursing Home Information

When deciding whether to place a loved-one into a nursing home, families attempt to determine whether the nursing home is capable of providing the necessary quality care. Most families visit the nursing home, as well as check the U.S. government’s Nursing Home Compare tool at Medicare.gov.

Despite their efforts, some nursing homes have purposefully misrepresented their ability to care for its residents.

Overstating Staffing Levels

According to the latest updated report from the Center for Public Integrity, over 80% of nursing homes have consistently overstated their staffing levels to Nursing Home Compare in an apparent bid for higher rankings at the site. The report explained that staffing overstatements occurred for all types of nursing positions, but were particularly high for registered nurses—the most skilled and highest paid workers.

Our nursing home negligence and abuse attorneys have long since understood that the amount of care, especially by registered nurses, is strongly connected to the quality of care provided to nursing home residents. For example, my associate Eric D. Dakhari, Esq. explained in a recent blog article that for understaffed facilities, evidence shows increased incidents of—among other critical issues—pressure ulcers, catheterized patients, urinary tract infections; as well as an increased likelihood of death.

As a nursing home lawyer, I have too frequently litigated nursing home negligence and abuse cases where the low levels of care were associated with a resident’s severe injury or death.

Nursing Home Compare: The Goal

The government website’s goal is to assist families in evaluating a nursing home’s ability to provide adequate “skilled-nursing” care, which is care given when you need skilled nursing or rehabilitation staff to manage, observe, or evaluate your care.

A Flawed Self-Reporting Process

The Nursing Home Compare website explains that each nursing home must self-report its staffing hours to its state survey agency and that the reported staffing hours reflect the staffing of RNs, LPNs, CNAs, and PTs from a two-week period just before the state inspection.

The government website displays the self-reported nursing home staffing hours as the number of staff hours per resident per day, which is the total number of hours worked divided by the total number of residents.

It is important to note that the website does not necessarily show the number of nursing staff present at any given time, or reflect the amount of care given to any one resident.

Our nursing home attorneys know that many nursing homes commit additional human and financial resources to prepare for the state inspections, and as a result, the self-reported staffing levels do not accurately reflect the typical staffing levels in the nursing home. This is particularly important because some nursing homes must provide more nursing staff due to the conditions of their residents, and other factors.

Recommendation to Families

Our nursing home negligence and abuse lawyers understand the difficulty that families face in selecting a nursing home based on false data. My partner, Michael A. Brusca, Esq., has previously recommended that families ask the nursing home about its CNA-to-Residents ratio. He explained that determining that ratio—as opposed to the RN or LPN ratio—is important because the CNAs are the frontline workers that provide the majority of the hands-on-care to residents.

If you or someone you know has been involved in a nursing home negligence or abuse incident, I recommend that you consult with an attorney immediately to discuss your rights.

Dementia and Alzheimer’s Patients: The Standard of Care of Nursing Homes

Posted in Elder Issues, Injuries, Nursing Home Information

In nursing-home neglect and abuse cases, the victims of the nursing-home negligence or abuse often suffer from some form of dementia, including Alzheimer’s, which is a specific type of dementia that accounts for 60 to 80 percent of dementia cases.

Alzheimer’s is a progressing disease. That means that it worsens over time, causing cognitive and behavioral problems. For example, cognitively, a person may have difficulty thinking and trouble understanding. They may also experience forgetfulness, confusion, and disorientation. And behaviorally, a person may exhibit irritability, agitation, lack of restraint, and difficulty with self care.

Behavioral Changes

For many, the behavioral changes present the most challenging and distressing symptoms from Alzheimer’s. The symptoms stem from a progressive brain-cell deterioration. Importantly, they may become worse through medication, environmental influences, and some medical conditions.

Environmental Triggers for Behavior Changes

Beyond the physiological reason for the behavior symptoms, changes in a person’s surroundings also often play a role in triggering those symptoms.

When I interview family members and nursing-home nurses in preparation for litigating a nursing-home negligence or abuse case, they often describe events or changes in the person’s surroundings that have created additional stress that can be difficult for an Alzheimer’s patient to manage. Some of those events and changes include:

  • Moving to a new residence, nursing home or new room within a nursing home;
  • Changes in a familiar environment or caregiver arrangements;
  • Misperceived threats;
  • Admission to a hospital; or,
  • Being asked to bathe or change clothes.

So, while the patient is trying to make sense out of an increasingly confusing world, those environmental factors increase the patient’s fear and fatigue while exacerbating the patient’s exiting irritability, agitation, lack of restraint, and difficulty with self care.

Standard of Care for Nursing Homes

Nursing homes and the nursing-home corporations that operate them know, and have reason to know, that environmental changes place the Alzheimer’s or dementia patient at greater risk of experiencing a serious nursing-home injury.

When I depose a Director of Nursing in a nursing-home neglect and abuse case, the nursing director admits and acknowledges the serious risk of injury that Alzheimer’s patients face while in the nursing-home facility. Also, the nursing director admits that the nursing-home corporation and its nursing staff must provide those patients with treatment and services that meet a specific standard of care.

The standard of care requires that the nursing home develop an individualized care plan to promote the patient’s health, protect the patient’s safety, and secure the patient’s dignity. The nursing-home staff must implement the treatment and care, from the care plan, on a daily basis—without fail. And then, the nursing home must evaluate that treatment and care to ensure its effectiveness and make changes to the plan when appropriate.

Nursing Home Negligence and Abuse

When a nursing-home corporation and its nursing-home staff follow the required standard of care, the nursing home can prevent the patient from experiencing preventable catastrophic falls, avoidable pressure ulcers, and other serious injuries.

If the nursing-home corporation and the nursing-home staff fail to follow the required standard of care, then the patient may experience serious physical injury, and the nursing-home corporation is responsible for the harms and damages that follow. If you or someone you know has been involved in a nursing home negligence incident it is recommended that you consult with an attorney immediately to discuss your rights.

Moderate Drinking NOT for the Elderly

Posted in Elder Issues, News

While the risks of drinking moderately in adults is the subject of debate, a new study published by the American Heart Association and reported on by NDTV.com confirms that for the elderly, the debate is over – put the alcohol away.

The study showed that alcohol caused cardiomyopathy – a condition where the heart scars or grows thicker and more rigid – in the elderly population with moderate drinking. Moderate drinking is defined as one or two drinks a day. Women were more susceptible than men to this damage.

If you would like to read the full article, please click here.

Assisted Living Facilities Must Not Expose Residents to Unnecessary Risks of Harm

Posted in Elder Issues, Levels of Care, Nursing Home Information

In New Jersey, Assisted Living encompasses providing various coordinated supportive personal and health services, available 24 hours per day, to residents who need those services. Its purpose is to promote resident self-direction and participation in decisions, with an emphasis on independence, individuality, privacy, dignity, and homelike surroundings.

And thus, corporations that operate Assisted Living Facilities (ALF) must provide, at a minimum, services for:

  • Nursing
  • Recreation
  • Medical Transportation
  • Personal Care
  • Social Work
  • Activities
  • Housekeeping
  • Dining
  • Pharmacy

Indeed, ALFs and our nursing-home lawyers know that potential residents have the right to live in an ALF that does not admit more residents than it can safely accommodate while providing those services and other care. And for persons who currently live in an ALF, the corporations operating the ALFs know that those residents have the right to receive care and services at a level that addresses the residents’ changing physical and psychosocial status.

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New Jersey Nursing Homes Must Protect Resident Rights

Posted in Elder Issues, Protecting Your Rights

Our nursing-home lawyers frequently explain that in 1976, the New Jersey Legislature expressed a broad policy and goal for protecting nursing-home resident rights. And in doing so, it empowered the Commissioner of the New Jersey Department of Health with setting the path and rules that nursing home corporations must follow to ensure that they do not violate their residents’ rights.

Nursing Home Mandatory Resident Rights

In fact, New Jersey nursing-home law holds nursing home corporations responsible for developing and implementing policies to protect, preserve, and guarantee nursing-home resident rights. Our nursing-home lawyers understand that those rights, as provided by New Jersey nursing-home law, include the following Mandatory Resident Rights:

  • To live in a nursing home that does not admit more residents than it can safely accommodate while providing adequate nursing care, N.J.A.C. 8:39-4.1(a)(11);
  • To live in a nursing home that does not subject the resident to neglect, N.J.A.C. 8:39-4.1(a)(5);
  • To live in a nursing home that does not subject the resident to physical and mental abuse; N.J.A.C. 8:39-4.1(a)(5); and
  • To live in a nursing home where the nursing staff protects the resident’s dignity and individuality by treating the resident with courtesy, consideration, and respect, N.J.A.C. 8:39-4.1(a)(12).

Furthermore, New Jersey’s nursing-home law requires nursing homes to inform and explain the mandatory resident rights, and many other rights, to a nursing-home resident, the resident’s next of kin, and the resident’s guardian, N.J.A.C. 8:39-4.1(b).

Nursing Home Rights Include Following the Standard of Care

Empowered by the New Jersey Legislature, the Commissioner has created the Mandatory Resident Rights, above, as well as rules and standards intended to assure that nursing-home corporations deliver high quality care to the residents who live in their long-term care facilities. The rights, rules, and standards address access to care, continuity of care, comprehensiveness of care, coordination of services, humaneness of treatment, conservatism in intervention, safety of the environment, and professionalism of caregivers.

Voicing Complaints About Nursing Homes

Importantly, nursing-home residents also have the right to voice their complaints without being threatened or punished. A nursing-home corporation must provide residents and their families with the names, addresses, and telephone numbers for the government agencies that will accept and document any nursing-home complaints of abuse and neglect. Here are two nursing-home government agencies that families may contact

  • New Jersey Department of Health, Health Facilities Evaluation & Licensing, P.O. Box 358, Trenton, NJ 08625-0358; and
  • Office of the Ombudsman for the Institutionalized Elderly, P.O. Box 852, Trenton, NJ 08625-0852.

Residents and families may file a complaint by calling the hotline at 1 (800) 792-9770, Select #1; but anyone may use the hotline, even nursing-home corporation employees and other members of the public. Or they may file a complaint online here: online complaint. Finally, anyone can submit a complaint by downloading and completing form AAS-60, located here: [.pdf] or [.doc]; and then faxing the form to (609) 943-4977 or (609) 633-9060.

The State of New Jersey created the Mandatory Resident Rights, rules, and standards in order to protect nursing-home home residents from neglect and abuse. When nursing-home corporations refuse to follow the rules and the standards of care, which protect and preserve those rights, our nursing-home lawyers litigate cases against them on behalf of caring families whose loved ones have suffered catastrophic harm and loss.

Yes, Nursing Homes Can Prevent Pressure Ulcers (or so-called Bedsores)

Posted in Elder Issues, Practice Tips

Pressure ulcers, which people sometimes call bedsores, develop when a person spends too much time in the same position while lying in bed or sitting in a chair. During that prolonged time, the person’s body weight and bones create pressure by pressing the skin and soft tissue against the—harder—bed or chair surface. The pressure reduces blood supply to that area, and damages or destroys the skin tissue.

Without immediate intervention, pressure ulcers will develop, and then progress through the soft tissue located between the bone and the skin. In the most advanced stage, a pressure ulcer, which is an open wound, exposes muscle and bone, which can lead to osteomyelitis (a bone infection).

Nursing homes can prevent pressure ulcers and bedsores from developing.

In our Nursing Home Litigation Practice, our nursing home lawyers have long since understood that nursing home staff can detect the early changes occurring in a patient’s health status that indicate that the patient’s skin is about break down and develop a pressure ulcer—if they fail to immediately implement well-recognized and accepted interventions for avoiding pressure ulcers.

Tn order prevent a pressure ulcer from developing, the nursing home staff must routinely perform the process of inspecting the patient’s body from head to toe—every day. Nursing homes typically call that process the Daily Skin Assessment or, when pressure ulcers already exist, the Wound Care Assessment. This is the standard of care that nurses in the community, and nursing experts across the nation, recognize and accept when our nursing home lawyers litigate nursing home negligence cases involving pressure ulcers or bedsores. By merely inspecting the patient’s body, nursing home staff will detect the occurrence of the following early signs that indicate that a pressure ulcer will develop: skin redness (nonblancable), warm areas, spongy or hard skin, and breakdown in the skin’s top layers.

If the nursing home management adheres to the recognized and accepted standard of care for detecting those early signs, it can easily ensure that its nursing staff immediately implement the necessary interventions to prevent a pressure ulcer or bedsore from developing; and more importantly, spare the patient the unnecessary and avoidable pain, complications, and prolonged healing process that accompany a pressure ulcer or bedsore.

When the nursing home management fails to follow the recognized and accepted standard of care for detecting the early signs of a developing pressure ulcer or bedsore, it has committed nursing or nursing home negligence by failing to ensure that its staff is able to provide the necessary interventions.

That nursing home negligence will often cause the avoidable and unnecessary occurrence of a pressure ulcer or bedsore. And when left undetected and untreated, the pressure ulcer or bedsore progresses into a serious health problem for the patient. That is so, because when a patient has a break in the skin, the patient will have all of the issues associated with healing broken skin, plus the problems of caring for an open wound, including preventing life-threatening infections.

Our nursing home lawyers litigate nursing home negligence cases for caring families whose loved ones have developed pressure ulcers or bedsores, only against nursing homes that refuse to employ enough trained nursing staff on the recognized and accepted standard of care for preventing pressure ulcers or bedsores.

Healthcare Whistleblowers, the Role of the Nursing Home MDS Coordinator, and the Role of the Lawyers in Whistleblower Cases

Posted in News, Nursing Home Information, Protecting Your Rights

Eric Dakhari, Esq., member of the firm’s Nursing Home Litigation Group, was featured on WIMG and WPHY’s Trenton Talks – In the Public Interest, which was hosted by Shareholder David Cohen, Esq.

The program discussed at length the rights and role of healthcare whistleblowers, the role of the nursing home MDS Coordinator, and the role of the lawyers in whistleblower cases. Check out the clips below:

Eric Dakhari, Esq. explains the rights of healthcare whistleblowers and why they should be wary of non-disparagement clauses.

Eric Dakhari, Esq. explains the role of healthcare whistleblowers and the duty of care responsibility.

Eric Dakhari, Esq. talks Abraham Lincoln, the False Claims Act, and the role of lawyers in healthcare whistleblower cases.

Eric Dakhari, Esq. explains the role of the nursing home MDS Coordinator in financial fraud.

New Report Suggests Ways for Elderly to Stay Mentally Sharp

Posted in Elder Issues, News, Practice Tips

Placing someone in a long-term care facility is a very difficult decision to make. Many times, this decision is not due to physical limitations, but mental ones. Older folks who suffer from dementia or Alzheimer’s may be physically mobile, but due to cognitive issues, they require 24-hour supervision. They may forget where they are, get lost driving, forget to eat and drink or take their medications.

A new report was released by the Institute of Medicine and reported by ABC News and study co-sponsor AARP. The study examined the aging process and the brain. Not surprisingly, AARP found that staying mentally sharp was a top concern for its members.

The study recommended many things, including:

  • Avoid isolation and keep socially active;
  • Avoid excessive alcohol consumption;
  • Get a good night’s sleep;
  • Be physically active;
  • Participate in the arts; and,
  • Maintain a healthy diet.

You can read the articles by ABC News (click here) and AARP (click here). Download the full report for free from the Institute of Medicine by clicking here.

New Article Slams Harborview Nursing Home for Rodents

Posted in Documentation & Reporting, Elder Issues, Levels of Care, Nursing Home Information

Harborview, a defendant in a case we took to trial last year, is back in the news.  During the trial, the ownership and management spoke of the facility in glowing terms – terms that were contradicted by state inspections and other testimony.  The article recounts rodent problems – and even chronicles a resident that bought his own glue traps.

You can read the full article here.

 

 

When on Antibiotics in Nursing Home or Hospital Watch for Diarrhea – It Could Be C-Diff

Posted in Elder Issues, Medication, Nursing Home Information, Support & Resources

One of the most common illnesses I see in nursing homes is C-Diff – a bacteria that can cause severe dehydration or death.  C-Diff is most common in nursing homes and hospitals, and 80% of fatalities from C-Diff are in people over 65.  A recent article in the LA Times reports a recent study and gives the important statistics.

Anytime a person receives antibiotics C-Diff can become a problem.  C-Diff is resistant to most antibiotics (C-Diff is short for the Latin name Clostridium difficile – a Latin word meaning difficult, stubborn, or unreasonable).  We all have lots of bacteria in our gut, but when a person is on antibiotics the rest of the bacteria in the gut are killed, leaving the C-Diff as the only bacteria.  There is nothing to compete with the C-Diff and it proliferates.  Unfortunately, one of the side effects of the C-Diff breaking down food in the gut is toxic, and the body tries to rid itself of the poison with diarrhea.

If you have a loved one who just got antibiotics, be on the lookout for diarrhea.  Many times a person suffering from C-Diff will have diarrhea that is green or black, and it most likely has a very strong distinctive odor.

The most important thing is to be sure your resident is properly hydrated.  By knowing the symptoms of C-Diff you may save your loved one’s life.  We’ve had cases where un-trained staff miss these obvious symptoms, and in some cases even give people suffering from C-Diff anti-diarrhea medication so the toxins stay in the body, further poisoning a person.  Any diarrhea after antibiotics should be of concern. Stark & Stark’s Nursing Home Litigation Group has handled many cases of neglect and issues that arrise such as this, contact us today for a free consultation.