Special kudos to the Reading Eagle on its recent series on nursing homes – in particular the editorial We Must Demand Better from Nursing Homes, Regulators, published on December 11, 2016. For those of us who work hard to hold nursing home corporations accountable when seniors are neglected, abused, seriously injured, or die, this series of articles is a vindication.
In our practice, we represent individuals, who are often diagnosed with Alzheimer’s and dementia, and their families. It is not uncommon for individuals with Alzheimer’s and dementia suffer from poor safety awareness and poor decision making. This can lead to devastating results and injuries if a nursing home does not properly care for the resident’s individual needs and safety. Due to the debilitating nature of Alzheimer’s and dementia, researchers have been studying the disease and there appears to be some good news on the horizon.
A November 21, 2016, article by Liz Szabo posted on CNN.com discussed how a recently published study showed that dementia rates have fallen nearly 24% from 2000 to 2012. The significant rate of decline is attributed to Americans’ rising educational levels and better heart health.
The study, which was published in JAMA Internal Medicine, began in 1992 and focused on people over 50 years old. The researchers collected data from the participants every two years. The data included interviews, physical tests, body measurements, blood samples, and saliva samples.
Researchers are not certain why dementia rates are declining, but the evidence is mounting that higher education and better heart health are related to the decline.
This is promising news because currently, according to Alzheimer’s Association of America, as many as 5.1 million Americans suffer from Alzheimer’s disease and dementia. It is also estimated that a half million Americans under 65 have some form of dementia.
It was recently reported by ABC27 News that the Pennsylvania Attorney General Office has brought a lawsuit against Grane Healthcare and their facilities individually for understaffing and not providing basic services to its residents.
More troubling is the fact that the state alleges that “Grane’s business practices are deceptive and misleading because it advertises that it strives for a very high staff-to-patient ratio.”
After doing nursing home neglect and abuse claims day in and day out, it is encouraging to see state agencies stepping up and holding these facilities to task as well.
Urinary Tract Infections (UTI) can be a serious problem for the elderly in nursing homes. Those afflicted with UTIs can have delusions, dementia-like symptoms, and will feel the urge to urinate all the time. This can be a recipe for disaster for a person that requires help to get to the bathroom. Many serious and fatal falls occur because residents with UTIs will constantly feel like they need to get to the bathroom, forget to use the call bell, and will get up on their own.
Additionally, if UTIs are not treated they can lead to sepsis and death.
One of the historically typical and easiest solutions to avoid UTIs was to just drink cranberry juice. Unfortunately, a new study published in the Journal of the American Medical Association and reported by KFOR places this common wisdom into doubt.
Although drinking cranberry juice was not discouraged, the study showed taking cranberry capsules (pills with cranberry extract) had a “limited potential effect.”
Families know their loved ones best, and many times it is families that diagnose UTIs and not a facility. Watch for signs of increased urination, delusions or odd behavior, fever, or general lethargy. With quick treatment, most UTIs clear up, but if they go untreated they can be lethal.
During much of the 20th century, hospitals did not have a duty to treat patients who entered emergency departments. Without any given reason, they could refuse to treat certain patients. The practice of “patient dumping” arose from that lack of duty.
Patient dumping refers to situations when hospitals deny emergency medical screening and stabilization services. It also refers to instances when a hospital transfers an individual to another hospital after discovering that the individual does not have insurance or a means to pay for treatment.
To correct that wrong and in an effort to ensure that individuals received needed emergency care, in 1986 Congress enacted EMTALA, which was designed to protect all individuals seeking evaluation or treatment at hospital emergency departments that participate in Medicare. Continue Reading
I was recently speaking with someone about a woman who worked for a non-profit nursing home for many years. She liked it there and the facility provided good care. Then the facility was sold to a for-profit corporation. Overnight, staff hours were cut, pay was cut, and care declined. The person I was speaking with could not believe this could happen–I was not surprised as sadly I’ve seen this occur many times.
If an administrator at a non-profit tells her board of directors she made a little money that year and gave great care, she’s applauded. However, if that same administrator tells the same thing to a for-profit board, she’s getting fired. The replacement knows that staffing is the biggest expense and that’s where you will see the cuts.
I’ve written before about how important it is to know what prescription medications are being administered in nursing homes and long term rehab facilities. Many do not have good efficacy, may be dangerous, or may cause problems when mixed with other medications. A new study indicates it is now also important to find out what over the counter (OTC) medications are being given.
The study, reported in the Observer, showed a link between certain medications in the class called anticholinergics and cognitive impairment in the elderly. OTC medications in this class include Dimetapp, Dramamine, Benadryl, and Unisom. This class of medications also includes the prescription medications Toviaz, Paxil and Seroquel. In the study, people using these types of medicines exhibited reduced brain function and increased brain atrophy. Specifically, the study showed that use of these meds affected immediate memory recall and cognition, and may also induce cell death.
According to Medicare fraud reports by the U.S. Department of Human Health and Services (HHS), the U.S. Department of Justice’s Medicare Fraud Strike Force team has investigated $7 billion in fraudulent billing since 2007 and prosecuted over 2400 medical professionals and administrators. Part of that amount comes from nursing homes that bill for unnecessary services or for services that have not been provided to the residents that depend on them.
And that fraudulent activity harms nursing home residents as well as our government’s bottom line.
Throughout the country, trusting families are signing nursing home, rehab, and assisted living admission paperwork for someone they care deeply about. These documents are technical, long, and complicated. Hidden in many of these agreements is language that significantly curtails a family’s ability to hold a facility accountable if something terrible happens – including rape, assault, neglect, and death. This language is called “pre-dispute” or “forced” arbitration language.
Pre-dispute forced arbitration is where a person agrees to give up their right to sue in court if an injury or death happens. To be clear, your loved one’s admission to the facility cannot be denied if you don’t agree to arbitration and you get absolutely, 100%, nothing in exchange for agreeing to pre-dispute arbitration.
Often, many of the problems that occur in nursing homes are a direct result of terribly insufficient staffing. This knowledge is born out in studies that show a direct correlation between staffing ratios and quality of care.
Despite all of this clear evidence, many facilities only meet the bare minimum hours required under state regulation. Some aides have told me the ratio on their day shift at a nursing home was as high as 1 aide to 14 residents. For those unaware, aides are the people who feed, bathe, and transfer residents, and they are also responsible turning and repositioning any residents who are at risk for developing bed sores. Having only 1 person in charge of caring for 14 patients at the same time is a catastrophe waiting to happen.