Bridgewater nursing home sued by family of ill woman killed

The family of a Bound Brook woman killed trying to cross Route 22 in 2010 is suing the nursing care facility where she was living at the time.Anastasia Zavitsanos was a 74-year-old resident of Brandywine Assisted Living at Middlebrook Crossing when she “eloped” through a side door of the facility about 1:15 a.m. May 12, 2010, according to the lawsuit filed late last month in Superior Court in Somerville.
The lawsuit claims Zavitsanos, who was admitted to the facility in 2004, was known by the staff to suffer from schizophrenia, psychosis, short-term and long-term memory loss and to be “an elopement risk” who “wanders with exit-seeking behaviors.”
The lawsuit accuses the facility and its officers of negligence, deviation of standard care and gross neglect, improper management, resident rights violations and consumer fraud and seeks unspecified damages for Zavitsanos’ death.
Bridgewater nursing home sued by family of ill woman killed crossing Route 22 | MyCentralJersey.com | MyCentralJersey.com

No procedure for flu detection at Nursing Home

A report into the nursing home where seven residents died following a flu outbreak has found there was no procedure for an early detection of influenza.
The Health Information and Quality Authority (HIQA) published a report into the Nazareth House nursing home, Fahan after nine elderly residents died between March 22 and April 8. Seven of the deaths have been classified as possibly caused by an influenza related illness.
Two inspections by HIQA found deficits in the standard of nursing home cleanliness and hygiene and the maintenance arrangements for equipment. A number of shower chairs and commodes were not in a satisfactorily clean condition and were rusty. The report was also critical of communication procedures at the home, which can accommodate 48 residents. It found that senior management was not communicated with in a timely manner and there was a lack of clarity and accountability about how information on the outbreak had been reported.
No procedure for early flu detection at Nazareth House - HIQA - Local - Donegal Democrat

Holding VT. nursing home owners accountable

Glori Law and Susan Petrie's father was living in a nursing home just 10 days when they learned he was being attacked by another resident who was mentally unstable.

"My dad had bruises on his face when he was in the funeral home," Law said. They later discovered it wasn't a first time offense. "This person was quite violent and had been doing this. There were a lot of people that had been attacked," Petrie said. A medical examiner ruled the attacks were the cause of their father's death.

But on Tuesday there was change in the nursing home law. "Today is closure," Petrie said. "I felt very guilty because I was the one who made the decision for him to go into the nursing home."

Holding nursing home owners accountable - WCAX.COM Local Vermont News, Weather and Sports-

Nursing Home Owner Cheats Government, Neglects Residents

Not enough food for nursing home residents. Little air conditioning or heat. Roofs leaking to the point that barrels and plastic sheets were used to catch rain water. Trash that piled up in dumpsters. Flies and rodents everywhere, along with rampant mold and mildew.
These were just some of the abusive conditions that elderly residents of three Georgia nursing homes lived under for several years.
The primary culprit: the owner of these nursing homes who, despite having received more than $32.9 million in payments from Medicare and Medicaid for residents’ care, elected to pocket much of the money instead.
FBI — Nursing Home Abuse: Owner Cheats Government, Neglects Residents

Camera Catches Abuse in Nursing Home

A woman used a high-resolution video surveillance camera to record a nurse beating her mother in a nursing care home. She placed the camera in her mother's room after she noticed she had bruises on her arms and hands only six weeks after moving into the home.

The camera disguised as a table clock, caught Jonathan Aquino, 30, hitting the old woman six times on the face, arms and abdomen. Another footage showed the old woman, who had severe arthritis, being man-handled by caregivers. The Daily Mail reports Aquino was jailed for 18 months for assault, and four other staff at the care home were sacked after Jane Worroll showed the nursing home manager footage of nursing staff abusing her 81-year-old mother, Mary Worroll, at the care home.

Read more: http://www.digitaljournal.com/article/323488#ixzz1stYOhABP

Nursing home residents with dementia improperly given antipsychotics

From April 29th Boston Globe: an article about excessive medication of our nursing home elders who should not be on anti-pyschotic med:
"Ledgewood Nursing home is one of many nursing homes that have commonly used antipsychotic drugs to control agitation and combative behavior in residents who should not be receiving the powerful sedatives. Nineteen percent of such Ledgewood residents - those without a diagnosis for which the drugs are recommended - received the medications, anyway, exposing them to the risk of dangerous side effects.
“There is a lot of guilt about putting your mom in a nursing home, and I felt I made a competent choice,’’ Weingartner said. “I wish that what I know now, I would have known then.’’
The situation she encountered at Ledgewood is alarmingly common in Massachusetts and across the nation, a Globe investigation has found. Federal data show that roughly 185,000 nursing home residents in the United States received antipsychotics in 2010 contrary to federal nursing home regulators’ recommendations - often elderly people like Murphy who have Alzheimer’s or other dementias.
The drugs, which are intended to treat severe mental illness such as schizophrenia, can leave people in a stupor. The US Food and Drug Administration has issued black-box warnings - the agency’s most serious medication alert - about potentially fatal side effects when antipsychotics are taken by patients with dementia.
Nursing home regulators have for years collected data about individual homes’ use of antipsychotics but have not publicly released facility-specific information, citing patient privacy concerns. The government finally provided the data to the Globe, 19 months after the newspaper submitted a Freedom of Information Act request.
The data show that in more than one in five nursing homes in the United States, antipsychotics are administered to a significant percentage of residents despite the fact that they do not have a psychosis or related condition that nursing home regulators say warrants their use. The proportion of homes using antipsychotic drugs in this fashion is even higher in Massachusetts


Nursing home residents with dementia often given antipsychotics despite health warnings - The Boston Globe

Nursing home violence

Two years into the state's fight to close a troubled South Side nursing home, the facility remains open and even has successfully booted out two state-appointed monitors who were installed to ensure patient safety.
Police reports and state health department inspections allege a pattern of patient-on-patient violence at the Rainbow Beach Care Center, a 200-bed facility that houses and treats indigent adults with mental illness.
In the most serious episode in July, two male residents were accused of pinning down a 45-year-old female patient and raping her. When police arrived at Rainbow Beach to investigate that allegation, they learned that the two men had allegedly attempted to sexually assault a second seriously disabled female resident just weeks before.
The state, which had moved to revoke the facility's license in April 2010, placed monitors at Rainbow Beach in the wake of those attacks. But earlier this year, an attorney for the facility persuaded a Cook County judge to issue a temporary restraining order barring them from the premises.
State authorities say the push-back from Rainbow Beach underscores how vigorously some nursing home operators are using the courts to contest enforcement efforts, even as the industry presses for legislation that patient advocates say could water down nascent state reforms.
Nursing home violence: Troubled Chicago facility expelled two state monitors - chicagotribune.com

Consumer Group Bashes SNF Industry for Inferior Care Despite “Astonishing” Profits

Nursing homes remained “highly profitable” despite Medicare reimbursement cuts, but they’re still providing inferior elder care, says citizen advocacy organization Families for Better Care—a claim that the American Health Care Association (AHCA) was quick to counter.
Despite “astonishing” recent nursing home earnings reports for publicly traded nursing homes, resident care remains “mediocre at best” with too many residents troubled by untreated pressure sores, falls, abuse, or other negligent medical practices, contends Brian Lee, executive director of Families for Better Care.
“The industry’s analysts framed the Medicare adjustment as an eventual doomsday for the nation’s nursing home market. But the industry’s own reports show quite the opposite, revealing surging revenues, strong profits, and expansion through acquisitions,” said Lee in a statement. “The industry is wallowing in strong profits while failing to consistently provide quality care.”
Even after the average 11.1% Medicare cuts to skilled nursing facility payments that went into effect last October, the industry remained a “thriving enterprise” with many companies reporting better than expected operating results, according to Lee. The resident advocacy organization cited one company’s annual revenues spiking nearly 200%, while another called 2011 an “exceptional year.”
“The reason care declines in nursing homes is that executives unnecessarily target labor costs to offset any reimbursement adjustments,” Lee said. “While this obviously maintains a robust bottom line for investors and cushy CEO salaries, the decline in frontline staff puts residents in jeopardy for harm while simultaneously creating dangerous working conditions for employees.”
A study released last November shows a steady decline in nursing hours for Medicare-licensed facilities and what Families for Better Care calls an unacceptably high level of deficiencies.
Consumer Group Bashes SNF Industry for Inferior Care Despite “Astonishing” Profits : Senior Housing News

“If you didn’t chart it you didn’t do it.” Part 1 | Pat Iyer.com

Incomplete documentation can dramatically affect a malpractice case. In the ideal world all pertinent observations and interventions are recorded. But is “If you didn’t chart it you didn’t do it” true? For a variety of reasons, medical records may be incomplete. Emergency situations, such as cardiac arrests, often result in gaps in documentation as patient needs take priority. Ideally the nurse tries to record detailed notes after the emergency is over, but this does not always happen because the nurse must direct attention to the other patients who took a back seat to the crisis. Sketchy documentation complicates the defense of a case and provides the plaintiff’s attorney with an opportunity to advance theories of liability.
Plaintiff’s attorneys may use the phrase, “If you didn’t chart it, you didn’t do it” to convince the jury that essential care was not given. Defense attorneys sometimes attempt to preempt the anticipated attack on the nurse’s credibility or documentation. This is brought up on direct examination of the nurse during trial by having the nurse testify about the impossibility of recording every detail or observation of the patient. Another defense technique is to have the nurse testify about the nurse’s usual practice which may or may not be recorded in the medical record.
Missing documentation coupled with a poor outcome complicates the defense of cases no matter what strategy is employed, and it provides the plaintiff with an opportunity to successfully argue that care was not rendered. In the case below, the nurses could not prove they contacted the physician, if they did.
The plaintiff, age sixty-three, suffered a back injury and could not to return to work as a nurse. She decided to have an anterior approach lumbar fusion of the spine. This was to include surgery to the spine from the front of the body and then a day or two later, surgery from the back. For the anterior approach the plaintiff’s abdomen was opened and her internal organs were moved in order to get to the spine. After surgery the plaintiff had fluctuating blood pressure and no pulse in the left leg. The nurses noted the lack of pulse in the leg but did nothing about it.
The next morning, when Dr. Brown arrived to perform the second part of the surgery, he discovered her problems and had her rushed for a CT scan which showed internal bleeding in her abdomen and a blockage of the artery which supplies blood to the left leg. The plaintiff was transferred to another hospital by helicopter, but the surgeons there were unsuccessful in salvaging the leg and an above-knee amputation was performed. The plaintiff had been unaware of the problem with the leg overnight due to being heavily medicated. The plaintiff’s abdomen took four years to heal because the surgical incision wouldn’t fully close due to the swelling of her organs and the internal bleeding. The plaintiff also had infections and required repeated surgeries to repair the damage to her abdomen. The matter settled for $5.25 million. (1)
Good documentation is consistent, concise, chronological, continuing, and reasonably complete. (2)
“If you didn’t chart it you didn’t do it.” Part 1 | Pat Iyer.com

Long-term care facilities seniors at higher risk for assaults

It's always a tough decision to put a loved one in a nursing home. For Sandra Croteau it was made even more difficult by the fact that her mother had recently died and her 58-year old developmentally disabled brother, Keith, had taken a turn for the worst.
"Him and my mom were very close and he just went downhill (after she died). He wouldn't eat, he wouldn't wash, his life skills were gone" she said.
After much thought, Sandra placed her brother in a long-term care facility in Sudbury, Ont. She found a room at Extendicare York, a home normally reserved for the frail and elderly, but she didn't have any other options.
"We didn't know what else to do" she said.
On January 24, 2007 Keith was brutally assaulted and killed by his roommate, Bryan Belliveau. Croteau discovered too late that her brother's roommate was a 55-year old man diagnosed with chronic schizophrenia, psychopathic personality disorder, who had a history of not complying with his medication. Years after the murder, Sandra Croteau also learned that Belliveau was on a suicide watch.
"He's on suicide watch and they were arguing and nobody comes? Who was watching him?" she said.
Sandra believes the long-term care system needs an overhaul so that this type of tragedy doesn't happen again: "The system failed my brother and also failed Bryan. He should not have been there either. " she said.
W5 asked Extendicare what changes have been made to make their homes safer since Croteau's murder. Rebecca Scott, Director, Communications and Government Relations at Extendicare Inc. responded by email.  "We are all deeply saddened by the tragic incident that occurred at Extendicare York in 2007," said Scott.
W5 asked Extendicare if they had increased staffing in their homes to prevent future tragedies. They wouldn't comment directly on staffing numbers but said they have taken steps to increase safety in the home.  "Since 2007, we have undertaken a number of initiatives to assist in preventing something like this from happening again," wrote Scott.
Common problem
Resident-to-resident abuse in long-term care is far more common than you might think. Through access to information, W5 obtained the number of resident-to-resident assaults in Ontario nursing homes. There were 1,788 incidents in 2010.
The statistics include everything from shoving and pushing to, choking, punching and even sexual assaults. With the help of a statistician, W5 analyzed the data and discovered that the rate of assault in long-term care is four times higher than in the population at large.

Pat Masters has first-hand knowledge of those statistics. Her father was assaulted by a fellow resident at The Perley and Rideau Veterans' Health Centre in Ottawa.
The person who attacked Pat's father wasn't a typical frail and elderly nursing home resident. Pat describes him as a man in his 70s who was diagnosed with aggressive dementia.
"He was a very physically fit individual. He had no weakness in how he walked. (He was) a very vigorous man," she said.
Experts argue that residents with aggressive behaviours should not be placed in care facilities alongside the frail elderly. However, with the closure of psychiatric hospitals and group homes, there really is nowhere else for these patients to go.
The CEO of the Perly and Rideau Veteran's Health Centre, Greg Fougere, acknowledges that resident-to-resident altercations can occur but, in an interview with W5, insisted that they are not a common event at his facility. However he does admit that nursing homes in general need more staff to deal with these new and challenging patients.   "We don't have enough staff to provide as much care as we would like to. And really our seniors deserve it," said Fougere.
In order to ensure her father's safety at the Veteran's Health Centre Pat is now paying an extra $63,000 a year for a personal support worker to take care of him. She's one of the lucky few that can afford it.
"I'm happy and able to do it. What about those people who aren't able to do it? What do they do?"
Top Stories

Nursing home whistleblowers fired

More than a month ago two nurse assistants at Bandera Road's Princeton Place nursing home started noticing problems. Sandra Lujan, a four-year veteran of the facility, claimed she saw elderly patients with abnormal and excessive bruising, including bruises in the shapes of fingers and torn skin on faces. Sonia Roman, a nurse assistant at Princeton Place for two years, also saw similar bruising. She also questioned whether there was enough staff to care for all 134 patients, saying many were routinely left unattended. She even confronted one nurse she saw verbally abusing and threatening an elderly patient.Last month both brought reports of abuse and neglect to the nursing home's administration. Within hours both were suspended for insubordination and eventually fired.
Firing employees who come forward with abuse or neglect allegations is not new. It is a pattern I have seen in Nursing Home litigation. Although the term "whistleblower" may not apply to all employees who complain about adequacy of care, the reaction by some nursing homes is the same. In litigation against a Kindred facility involving complaints of abuse by a CNA (certified nurse aide), the complaining persons eventually left because they felt ostracized by their co workers after reporting deficiencies. Some feel threatened. Nursing homes sometimes in-service the reporting individuyal rather than the alleged offender! This is a clear sign of a culture that does not put the care of residents first.

The QueQue: Nursing home whistleblowers fired, Lamar Smith's 'Holiday on ICE', TCEQ tracking emissions in the Eagle Ford - News and Politics - San Antonio Current

Things Hospitalists Should Know about Infectious Diseases

Never swab a decubitus ulcer unless that ulcer is clearly infected.

Dr. Allen says it’s important to know that it doesn’t make sense to culture a pressure ulcer that doesn’t have any signs of infection, such as pus or redness—although he sees it happen routinely.
“Just because a patient has a bedsore doesn’t mean it’s infected,” Dr. Allen says. “Usually, they’re not infected. But they’re going to have a dozen different germs growing in them.”
Culturing and treatment without signs of infection, he says, often leads to “inappropriate antibiotic use and probably increased length of stay."10 Things Hospitalists Should Know about Infectious Diseases :: Article - The Hospitalist

Victim critical in nursing home assault

A 42-year-old man has been charged with aggravated malicious wounding after police say he attacked an elderly resident at a nursing home Thursday evening.
Debbie George with the City of Suffolk said William K. Ruffin, a resident at Oakwood Assisted Living Facility on East Washington Street, attacked a 92-year-old woman sometime before 6:30 p.m. She sustained severe facial injuries and was transported to Sentara Norfolk General Hospital by Nightingale.
 Friday morning, George said the victim was in critical condition at the hospital.
 Police arrested Ruffin and have charged him with aggravated malicious wounding of a nursing home resident. He is being held at Western Tidewater Regional Jail without bond at this time.
Victim critical in nursing home assault | WAVY.com | Suffolk

Wrongful death claim cannot be arbitrated

I waas quoted in this weeks Lawyers Weekly article on Arbitrations in the nursing home context. In an article by Eric T. Berkman, an attorney and freelance writer for Massachusetts Lawyers Weekly, Published Wed, April 25, 2012

A mandatory arbitration agreement that a man signed on his mother’s behalf when she was admitted to a nursing home did not bar his wrongful death suit against the facility, a Superior Court judge has ruled. Judge Troy's ruling essentially voided an arbitration agreement that had been signed by a health care proxy. The judge found that a health care proxy exceeded his permissable authority by signing away the residents right to a jury trial.
The defendant nursing home had argued that the plaintiff was authorized to sign the arbitration agreement under a health care proxy executed by his mother before she was transferred to the facility and thus the agreement was enforceable.

“Under [Chapter 201D, the Massachusetts Health Care Proxy Act], an agent has authority to make ‘any and all health care decisions on the principal’s behalf that the principal could make,’” Troy said in denying the defendant’s motion to compel arbitration. “However, in the view of this court, a waiver of the principal’s legal right to seek redress in court for improper medical treatment does not fall within the statutory definition of a health care decision.”

The 17-page decision is Licata v. GGNSC Malden Dexter LLC, Lawyers Weekly No. 12-066-12. The full text of the ruling can be ordered by clicking here.

Bernard Hamill, an attorney in Quincy who represents plaintiffs in nursing home negligence and abuse cases, welcomed Troy’s ruling.
“Think of it in terms of common sense,” said Hamill, who was not involved in the case. “A health care proxy could never bring a lawsuit [on behalf of a nursing home resident], so why on earth would one be deemed valid enough to waive the ability to bring a lawsuit? That would make no sense.”
Hamill was also gratified that the judge seemed to recognize the reality facing people in the plaintiff’s situation.
“You have a nervous family member sitting down in an admissions office with a huge stack of documents, trying to get their loved one admitted for their own safety. And frequently it’s the only nursing home to accept the candidate,” he said. “Someone in that situation is not going to be reading every document, questioning them and refusing to sign things.”
If nursing homes do not want arbitration agreements challenged, they should not make them part of the admissions process, Hamill added.
“Why not make it truly separate and send it out several days later when the [person acting on the patient’s behalf] isn’t in an emotional state, trying to get their loved one admitted?” he said.

South Florida Abuse

Southwest Florida can be a retiree’s paradise — but that also makes it an ideal place to prey on the elderly.
At a public forum Tuesday, the Lee Elder Abuse Prevention Partnership shared stories of elder abuse and discussed ways to prevent it.
“Our own parents and grandparents are being taken advantage of,” said co-chairwoman Dotty St. Amand. Part of the problem is Florida does not require private home caregivers to be licensed, according to John Morano, CEO of JT Private Duty Home Care. The state oversees companies such as Morano’s, which require their employees go through background checks. Independent caregivers can be licensed as Certified Nursing Assistants by the Florida Department of Health. But it’s not required.
http://www.news-press.com/article/20120425/CRIME/304250020/Advocates-try-find-ways-prevent-elder-abuse?odyssey=tab