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

One of the greatest obstacles to helping victims of abuse and neglect is the failure of nursing homes to self police. More often than not, we see a complete lack of investigation - even in light of serious allegations against staff. One way for families to overcome this is to immediately call the Ombudsman's office for their state.

The work doesn't end there, though. Families should remain in constant communication with the investigator. DO NOT ALLOW THE INVESTIGATION TO BE LIMITED TO THE NURSING HOME OR ASSISTED LIVING'S SIDE OF THE STORY. MAKE SURE THAT THE INVESTIGATOR GETS BOTH SIDES.

Our office has had great success over the years in utilizing these investigations to both improve the quality of care and help our clients achieve justice.

Here is a link to a helpful site which provides phone numbers for the Ombudsman's office for each state. And here is a direct link to New Jersey's Ombudsman's home page.

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Here is an article I recently read, which outlines not only allegations of abuse, but also retaliation against a whistle blower who reported the abuse. The article contains helpful links for families looking to research nursing homes.

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Serving as an example of how regulators can effectuate change, the Altoona, Pennsylvania nursing home, Laurel Crest, is not only undergoing tremendous scrutiny for surveyors to ensure quality, but outside consultants are being brought into the facility to make sure that the right changes are made.

These changes could have a huge effect on the level of care to be provided to its residents. You can read more about these changes here.

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By Ben Whitford

Posted Sunday, Sept. 23, 2007, at 3:31 AM ET

The New York Times leads with a report on profiteering at nursing homes; thousands of institutions have been bought up by private investment companies, often to the detriment of care standards. The Washington Post leads with news that the Bush administration's $150 million campaign to tackle human trafficking has produced remarkably few arrests, suggesting that the extent of the problem—at least in the United States—may have been significantly overestimated. The Los Angeles Times leads local, with a look at the financial troubles plaguing many L.A.-area hospitals.

In recent years, Wall Street investors have snapped up thousands of nursing homes across the United States, cutting costs and slashing staffing levels in the hope of reselling at a hefty markup. That's led to plummeting standards, according to government data, with elderly residents receiving less care than they need and increasingly suffering from bedsores and preventable infections. Worse still, the companies' Byzantine corporate structures make it hard for disgruntled residents to sue—or for regulators to impose meaningful fines.

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After being bought out by private investors in 2002, along with 48 other nursing homes in Tampa, Florida, Habana Health Care Center began to suffer, and so did it's residents. Within the first few months the number of clinical nurses at the facility had been cut by half in an effort to cut costs by the facility's new management.  And, according to Florida’s Agency for Health Care Administration, budget cuts were made for nursing supplies, resident activities and other services.

Meanwhile, the investors and operators of the 49 homes throughout the state were making millions. As if that wasn't bad enough, over the three years of budget cuts, 15 Habana residents died from what their families feel was negligent care and since have filed suits in state court. In addition to a severely understaffed team of caregivers, reports found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.

Due to the ever-increasing number of Americans needing elder care, nursing home facilities across the country are being bought out by large investors, who can only see dollar signs as our baby-boomers enter through their doors. The more people admitted to each facility should mean increased support and resources for the home. However, more and more this is not the case.

The severely neglected residents of these homes need more attention and care than ever. Federal and state regulators also said in interviews that budget cuts help explain why serious quality-of-care deficiencies — like moldy food and the restraining of residents for long periods or the administration of wrong medications — rose at every large nursing home chain after it was acquired by a private investment group from 2000 to 2006, even as citations declined at many other homes and chains.

While the suit is still in the beginning stages for the 15 families at Habana Health Care Center, similar cases continue to arise across the country. You can read more on the Habana and other facilities' stories in the New York Times article, At Many Homes, More Profit and Less Nursing.

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The following is a list of the four stages of pressure ulcers, otherwise known as decubitus ulcers or bed sores, with a general description of each stage:

Stage I - Non-blanchable redness of intact skin, the heralding lesion of skin ulceration. Discoloration of skin, warmth, edema, indurations or hardness may also be indicators.

Stage II - Partial thickness skin loss involving epidermis, dermis or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater.

Stage III - Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissues.

Stage IV - Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures (e.g. tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage IV pressure ulcers.

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A nursing home facility must identify each resident at risk of accidents and provide supervision and assistance devices to prevent accident. These include a thorough intake review of the resident’s pre-existing admission records. Those records are to be examined for the following existing risk factors:

(1) Previous falls;

(2) Cardiac arrhythmias;

(3) Stroke;

(4) Central nervous system disorder such as Alzheimer’s disease, Parkinson’s disease, dementia and others;

(5) Problems with mobility and gait;

(6) Low blood pressure on standing up;

(7) Bowel or bladder incontinence;

(8) Dizziness;

(9) Dehydration;

(10) Visual impairment.

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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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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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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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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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An interesting study recently revealed an exorbitant amount of money is being spent on an annual basis for insomnia. Specifically, it has been estimated that as a nation, we spend approximately fourteen billion dollars a year on the direct costs of insomnia. This includes treatment, healthcare services, hospital and nursing home care. Insomnia represents a significant problem in the long-term care industry, in that multiple health issues arise from the inadequate sleep patterns that many nursing home residents suffer from. It is imperative for family members to work closely with nursing home personnel to address this important health issue.

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Immigrants are quickly taking on greater and greater roles as caregivers in this country for weak and infirm seniors. Interestingly, as the demand for such care rapidly increases, the demands from naturalized U.S. citizens have greatly diminished. Immigrants, both documented and undocumented, have been making up the shortfall. In many circumstances, these undocumented workers form tremendous bonds with the families. These caregivers need to be strong and have the appropriate skills to care for people who often cannot provide for their own personal needs, such as grooming, bathing and eating. This always has been and always will be a very human endeavor, which technology simply cannot address. An often ignored side effect of the raging debate in this country on immigration is its impact on the needs of our most infirm citizens.

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