Nursing Home Law Blog : Nursing Home Lawyer & Attorney : Stark & Stark Law Firm : Elder Care, Senior Care

As the entire country bore witness with the decline of Ronald Reagan, Alzheimer’s disease is an insidious illness, which often is nearly as debilitating for the loved ones as it is for the patient. An extraordinarily high percentage and ALF residents suffer from Alzheimer’s and/or other dementia related illnesses, including vascular dementia. Sadly, a recent study involving the medications Zyprexa, Risperdal and Seroquel questioned the ethicacy of these anti-psychotic drugs with most Alzheimer’s patients who suffer from delusions and aggression. The study questions whether the risks of these drugs outweigh their benefits. Three-quarters of the 4.5 million Americans with Alzheimer’s disease develop aggression, hallucinations or delusions, which can lead them to act out against caregivers or even harm themselves. This type of behavior typically leads families to place such individuals in a nursing home. The study involved 421 patients at 42 medical centers and was conducted for people living outside of the nursing home population. As reported in the October 12, 2006 New England Journal of Medicine, about 4 out of 5 patients stopped taking the pills early on average, generally within 5 to 8 weeks, because the medications were either ineffective or had side effects which rendered their continued use problematic. In the study, five deaths were reported among the patients on the medication versus two in the placebo group. Although symptoms improved in approximately 30% of the patients taking the drugs, 21% on the dummy pills also improved.

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Resident falls often involve nursing home negligence. Falls are not entirely preventable, but measures can be taken to lessen their occurrence. The happening of a fall does not always indicate negligence. However, the nursing home has an obligation to properly assess all residents. These assessments are done in conjunction with the resident’s particular risk factors. The resident’s physical, mental, psychological and medical conditions are all relevant when properly assessing a resident’s risk for falling.

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As a general rule, the caring staff of nursing homes and assisted living facilities (ALF) provides compassionate care with the best of intentions. However, it is equally important to have administrative processes to not only provide that care, but also to recognize and respect the wishes of nursing home residents. A recent lawsuit in New Jersey reflect against Sunrise of Westfield Assisted Living Center in Westfield, New Jersey involves the allegation that an assisted living facility administered CPR and revived its resident, despite the fact that a living will and do not resuscitate order were allegedly filed with the facility. The case contains the allegation that the resident survived another eighteen months and suffered the “horrific” and “progressive” final stages of Alzheimer’s Disease and thus resulted in suffering which was not only unneeded, but directly against the wishes of the resident. Although the facility denies liability, it was cited by the New Jersey Department of Health and Senior Services for reviving the resident against her expressed wishes.

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Pressure ulcers, otherwise known as bedsores or decubitus ulcers, can occur in residents who spend a good deal of their time in a bed or in a wheelchair. These sores can develop at the bony prominences of the body such as the sacral bones, the hip bones, shoulder blades and the heels. The primary causes of bedsores are immobility, malnutrition, dehydration, incontinence and failure of the nursing home staff to properly and timely reposition the nursing home resident. When the skin is subjected to prolonged and unrelieved periods of pressure in these bony prominence areas of the body, it can cause underlying tissue damage. The pressure ulcers range in severity. A Stage I pressure ulcer is least severe and presents itself as a small red wound about the size of a quarter. Stage IV bedsores are the most severe and can involve a gaping wound with complete skin tissue breakdown including necrotic tissue. Stage IV heel ulcers, in certain instances, result in amputation.

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In the year 2005, the Department of Health and Senior Services awarded approximately 136 million dollars to whistleblowers across the United States. In cases filed under an area of law known as qui tam lawsuits, the federal government aggressively pursued both healthcare and non-healthcare providers who were accepting federal funds, but fraudulently billing them. Employees and private citizens with enough courage to do so, reported these improper actions to the federal government, allowing the Department of Justice to right a significant number of wrongs and recoup money that had been wrongfully taken from them. A beneficial byproduct of this area of litigation involved a number of CRIPA claims against nursing homes, centers for developmental disabilities and other institutions which provides healthcare services to our most vulnerable citizens. In a number of these cases, including two which I personally worked on, lawsuits and settlements directly resulted from the cooperation of families, attorneys and other concerned individuals. For more information on these claims and to learn where you can report mistreatment or fraud, feel free to visit the Department of Justice website.

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The Chester Observer Tribune reported that some very generous gardening enthusiasts make it a practice to send lovely flower arrangements to a local nursing home. Little touches like this greatly uplift the spirits of folks whose lives often can be very dismal. Local Boy Scout and Brownie Troops often visit nursing home residents, as do religious groups. All of these activities provide the spiritual shot in the arm that nursing home residents need.

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Contrary to popular belief, Medicare does not cover cost of long-term care. Medicare only provides limited coverage for long-term care with many rules to qualify, such as requiring a pre-day hospital stay. Medicaid, the health insurance program for the poor, pays for almost 65% of the patient’s nursing facilities, yet offers only limited, if any, funding for assisted living services in many states. Long-term care insurance, depending on the policy, pays a daily rate and may cover a variety of long-term care settings, possibly including home care.

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After receipt of all known medical records, conduct a review of those to determine what records they reveal which are not yet available. Put all of this together to complete the timeline of all medical treatment. When developing a full chronological set of records, comparing discharge to admissions from various facilities will sometimes reveal diverging assessments of the patient. This is especially true in cases surrounding skin integrity issues. Specifically, many times the facility in which the skin breakdown was acquired will understate the severity of a bedsore, while the admission papers from the very same day at the facility where the problem did not arise will accurately assess it. This, subsequent admission records can serve as a check on the accuracy of previous discharge records.

You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

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Although expensive, it is often advantageous to actually obtain three copies of a chart. The first copy should be obtained by the plaintiff or plaintiff’s family without attorney intervention, while the second would be the attorney pre-suit and the third by the attorney during litigation. The inherent advantage is that the charts are obtained during periods of widely varying levels of concern from the putative defendants. Comparing each of these copies will very frequently reveal alterations to the chart itself.

You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

 

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If you are concerned that a loved one may be suffering from Alzheimer’s, there are many warning signs you can look for. For instance, memory loss begins to affect daily activities like managing household finances. The individual may become confused, exercise poor judgment, and begin to experience a lack of zest for life, or become lost easily. Often a person’s memory troubles progressively increase and their attention span shortens. An individual suffering from Alzheimer’s may have difficulty recognizing friends and family, organizing thoughts and speaking logically. Other characteristics may include your loved one developing a level of suspicion. For instance, he or she may begin hiding their belongings. They also may become restless, especially in the late afternoons and evenings. This is commonly referred to as Sundown Syndrome. Eventually, people with Alzheimer’s cannot recognize family members or even their own reflection in the mirror. Even with good nutrition, weight loss will occur along with the loss of verbal communication and bowel or bladder control. Ultimately, Alzheimer’s is a fatal disease.

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Many concerned family members of elderly and decompensating loved ones must face the challenging decisions regarding the healthcare option known as “Hospice.” The task of addressing these issues must first be viewed in the context of what wishes may or may not be known by the resident, him or herself. The law firm of Stark & Stark always recommends that all adults who are capable to do so should prepare and execute both living wills and healthcare powers-of-attorney. Living wills allow people to have a say in their own future while their mental faculties still allow them to do so. Thus, when one has the benefit of a living will, issues about resuscitation and other needs of the resident have been made by them before their deterioration preventing them from making such a decision. When the end of one’s life is approaching, Hospice often represents the most appropriate and compassionate option. Sometimes the role of a Hospice nurse is simply to hold the hand of patient. Other times, physical comfort is the paramount need. An excellent resource to learn more about Hospice can be found on the National Hospice Palliative Care Organization homepage, .

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Finding the right assisted living or residential care facility for you or a loved one is an important decision. After you have determined the kind of services you or your loved one need, you should obtain or develop a list of assisted living facilities in your area offering those services. Your hospital discharge planner, social worker, personal physician and clergy may be familiar with facilities in your area. Additionally, you may want to contact New Jersey’s Department of Health and Senior Services.

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Do not ever take a statue of limitations determination for granted prior to a full evaluation of a claim. Very often, issues, which appear to be beyond the statue of limitations, are not. Conversely, many claims which seem to enjoy significant additional time before the state of limitations will expire do not in actuality. An exhaustive analysis at the outset of a case to determine this otherwise seemingly simple issue can prove invaluable.

You can read more practice tips in my chapter Screening the Nursing Malpractice Case, in a text edited by Patricia Iyer, RN MSN LNCC. More information about Nursing Malpractice, Third Edition, 2007 may be found at here.

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According to the 2006 MetLife market survey of assisted living costs, the rate of private pay averaged approximately $35,616.00 yearly. This represented a 2.2% increase from 2005 and more significantly, a 17.6% increase from 2004.  As we have posted on this site in the past, assisted living is increasing in popularity as an alternative to other forms of long-term nursing care.

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The fourth annual Patient Safety in American Hospitals Study was released recently, and contains very insightful information for patients and their families when choosing a hospital. Safety in hospitals has recently become an overwhelming concern due to the rise of injuries suffered to patients during their hospital stays.

Often times this process can be quite daunting and somewhat confusing if you are not familiar with the all of the available resources provided to assist you. The study provides patient safety incident rates and associated mortality among Medicare beneficiaries, gives an overall patient safety indicator hospital performance assessment, and provides a list of the best-performing hospitals for overall patient safety across the country.

You can read the full April 2007 report here.

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Assisted living facilities provide relatively independent seniors with assistance and limited healthcare services in a homelike atmosphere. Assisted living services include twenty-four hour protective oversight, food, shelter and a range of services that promote the quality of life of the individual. The philosophy of assisted living emphasizes the right of the individual to choose the setting for care and services. Assisted living customers share the risks and responsibilities for their activities and well-being with a staff geared toward helping them enjoy the freedom and independence of private living. Assisted living facilities are licensed by state governments and can be known by several different names including residential care, board and care, congregate care and personal care. Assisted living is not a substitute, but rather a compliment to nursing facility care.

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