Often, elderly people are prescribed blood thinners, otherwise known as anti-coagulants, like Coumadin and several others. While these drugs can significantly help with conditions such as DVTs (deep vein thrombosis) and strokes, they also present unanticipated dangers. If you have a loved one who is on one of these medications, it is important to know the dangers that can occur with their regular use.

It shouldn’t be much of a surprise to learn that the number one issue safety issue for the elderly is the risk of falling. When the elderly fall, it can be very dangerous for two primary reasons. First, they can suffer bone fractures, most particularly to the hip. Hip fractures lead to immobility and many times death as a result. Second, if there is a head trauma, there can be internal bleeding in the brain. This is called either a subdural hematoma or epidural hematoma, depending on where the blood is pooling in the skull.

Continue Reading The Lurking Dangers of Blood Thinners in Nursing Homes

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, 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.

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.

Last month, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced a framework for tackling the challenges to elder-abuse prevention and prosecution. In doing so, the departments called on all Americans to take a stand against elder abuse, neglect, and financial exploitation.

The framework, known as the The Elder Justice Roadmap, directly addresses “a problem that has gone on too long . . . by offering comprehensive and concrete action items for all of the stakeholders dedicated to combating the multi-faceted dimensions of elder abuse and financial exploitation,” explained Associate Attorney General Tony West.

But as the Stark & Stark Nursing Home Litigation Group has continued emphasize: we must do more in New Jersey and Pennsylvania.

Accordingly, the DOJ has developed an interactive, online curriculum to teach legal aid and other civil attorneys to identify and respond to elder abuse. And HHS is developing a voluntary national-adult protective-services (APS) data system, which collects national data on adult mistreatment. The system will “help to identify and address many gaps about the number and characteristics of adults who are the victims of maltreatment and the nature of services that are provided by APS agencies to protect these vulnerable adults.”

Here—in New Jersey and Pennsylvania—local communities, families, and individuals can take the following important steps:

1.      Learn the signs of elder abuse. The National Center on Elder Abuse, a program of the Administration on Aging at ACL, has developed a helpful Red Flags of Abuse Factsheet that lists the signs of and risk factors for abuse and neglect; and

2.      Report suspected abuse when you see it. Contact your local adult protective services agency. Phone numbers for state or local offices can be found at the National Center for Elder Abuse website (New Jersey, Pennsylvania), or call 1-800-677-1116.

Associate Attorney General West said it best: “We must take a stand to ensure that older Americans are safe from harm and neglect. For their contributions to our nation, to our society, and to our lives, we owe them nothing less.”

If you or a loved one has any questions regarding elder abuse or neglect, contact Stark & Stark today.

Experience shows many seniors that develop pressure ulcers begin a downward spiral in their health.  Without proper care, a pressure ulcer can develop into a mortal condition.  The wounds are painful and require surgery when large and infected.  Once the skin is compromised, it never regains its original integrity.  Broken skin presents a significant opportunity for infection, especially when a senior is using adult diapers.  
 
A recent article from UCLA Newsroom discusses the findings of a UCLA study of 51,000 randomly selected hospitalized Medicare beneficiaries.  The study basically confirms what most already know – that seniors who develop pressure ulcers “were more likely to die during their hospital stay, to have longer stays in the hospital, and to be readmitted to the hospital within 30 days of their discharge.”
 
It is paramount that when a person is immobile or sitting in a wheelchair all day that there is adequate staff to turn and reposition residents, and that the skin is kept clean and dry. 
 

I just happened upon an excellent website (http://www.neverevents.org/), promoting the value of 11 years of “Never Events” as establishing safer practices in our hospitals. This site is authored by a physician and notes that another physician, Ken Kizer, MD, former CEO of the non-profit, National Quality Forum (NQF), first introduced this term in 2001. 

Since then, insurance companies, health organizations and later, the U.S. government, came on board – to support the notion that failing to protect the consumer public from preventable errors has devastating consequences for this nation. Topping the list on this site are preventable pressure ulcers.

A new study confirms that a large percentage of nursing home residents are prescribed anti-depressants, or selective serotonin reuptake inhibitors (SSRIs). While in most cases, anti-depressants are beneficial to the well being of the residents, in patients suffering from dementia, they can significantly increase the risk of falls – leading to serious injuries, and even death.

Researchers from the Netherlands recently reported that a study, which included 248 nursing homes, shows that anti-depressants were used on over 13,000 patients of which more than 650 sustained injuries. These falls occurred in 152 out of the 248 nursing homes included in the study. Additionally, 38 residents fell once during the time of the study, while 114 had multiple falls. Of those 650 falls, 220 resulted in serious injury, or even death.

It is imperative that these facilities conduct interdisciplinary care meetings to ensure that the proper protocols are followed, in order to reduce the risk of life-threatening accidents.

While nursing homes should always look to prevent bed sores – a painful and sometimes deadly condition – a recent study conducted revealed that the prevention of bed sores is also cost effective.

Foam mattresses which reduce pressure were found to be cost-effective 82% of the time as opposed to using standard mattresses. This simple change could save on average $115 per resident. Additionally, foam cleansers for incontinence were found to be cost-effective 94% of the time, as opposed to traditional soap and water, which results in an average savings of $179 per resident.

On average, roughly 10% of residents in long-term care facilities have a pressure ulcer. And for those residents, treatments are critical early on in order to prevent a serious, and even life-threatening condition. A better solution to this problem is prevention. Nursing homes and assisted living facilities can, and should, prevent these problems from happening rather than treating them after the fact. Most importantly, not only are these prevention techniques the right thing to do, but they also save money for the facility!

Earlier this year, I reported about the potential dangers posed to senior citizens (and others) who were potentially exposed to bacteria from antiseptic wipes. Reports indicate that a child may have died from such exposure and we are aware of seniors who appear to have potentially met the same fate.  Now, Federal regulators say that although Professional Disposables International (PDI) of Orangeburg, New York promised to recall the product this past June, it has since failed to launch that recall nearly four months later.

 

The U.S. Food and Drug Administration issued a second statement last Wednesday saying the agency was not backing down on its assertion that PDI failed to follow through on its promise to conduct a recall in June. A follow up story from the Journal Sentinel Online addresses some of the recent developments in the enforcement action.
 

The Centers for Medicare and Medicaid Services (CMS) have recently designated certain injuries in hospitals “never events” – or injuries that should not happen. These injuries include Stage III and IV bed sores and falls with fractures. The penalty to hospitals when these injuries happen is that CMS will not pay for treatment rendered for these injuries. The result is that many hospitals are reporting the incidence of these events has gone down, and in some places tremendously.

Now, the Obama administration is doing a similar thing to nursing homes according to an article in Forbes magazine.

According to the article, a recent study showed that 25% of nursing home hospital admissions may be preventable. A further congressional review panel estimates that 14% of hospital patients sent back to nursing homes return to a hospital for a preventable condition. The Obama administration wants to penalize nursing homes that have unnecessarily high hospital admissions for preventable conditions by reducing their Medicare payments.

So, why are these residents being sent to the hospital to be paid for with your tax money? The author of the article documents that, “I’ve seen hospital emergency rooms filled with very frail seniors on Friday afternoons. Why? Because nursing homes know they won’t have enough weekend staff to care for their sickest residents, so they simply send them back to the hospital. The new rules could stop those practices.”

Perhaps hitting substandard nursing homes in the pocketbook will force them to take better care of their residents.