Top brain specialist calls for ban on antipsychotic in elders

A senior neurologist at Beth Israel Deaconess Medical Center says many hospitals inappropriately use the antipsychotic Haldol "like water" in agitated elderly patients, putting them at risk for serious complications.
Dr. Louis Caplan, a neurology professor at Harvard Medical School, said a recent government report that found pervasive use of antipsychotic medications in elderly nursing home patents underscores the "overuse" problem with this class of drugs.
Caplan said Haldol is typically given to agitated patients to calm them quickly, but he said older patients, especially, can become over-sedated and stiff, putting them at risk for pulmonary and urinary infections, because they have trouble moving and couging.

"I would love to see Haldol banned from use in hospitals," Caplan said. "It has no role to play in hospitalized, agitated patients."
A report released this month by the Inspector General's Office of the federal Department of Health and Human Services found that 51 percent of Medicare claims for a newer class of antipsychotics, known as atypical, were prescribed inappropriately to nursing home patients.
The Inspector General reviewed medical records from 2007 and and found that 83 percent of Medicare claims for atypical antipsychotic drugs for elderly nursing home residents were associated with conditions not intended for that use. The report also found that 88 percent were associated with a condition that could produce serious side-effects, conditions for which federal regulators had specifically warned against such usage.
The use of such drugs is especially worrisome in nursing homes because a substantial number of residents suffer from dementia, a condition that puts them at greater risk of death when given antipsychotic medications.
The drugs were developed to treat people with severe mental illnesses such as schizophrenia, not dementia, which is the progressive loss of memory or other intellectual function than can result from aging or Alzheimer's disease.
Fderal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, including increased confusion, sedation, and weight gain
Haldol is an earlier class of antipsychotic drugs, but Caplan said it's just as problematical.

Top brain specialist calls for ban on antipsychotic in elders

High Fall Rates Among Short-Stay Nursing Home Patients

One in five short-stay nursing home patients sustains a fall after their admission, and certified nursing assistant (CNA) staffing is associated with decreased fall risk, according to a study led by USC researcher Natalie Leland. The study recently was published in the Journal of the American Geriatrics Society.
Though falls are unintentional, they hardly are insignificant: the Centers for Medicare & Medicaid Services reports fall rates as a quality indicator, and falls of nursing home residents have been associated with greater morbidity, mortality and health care costs.
Leland, who holds joint appointments at the USC Division of Occupational Science and Occupational Therapy and the USC Davis School of Gerontology, and colleagues from Brown University analyzed the 2006 Minimum Data Set (MDS) assessments of all first-time Medicare and Medicaid patients admitted to a nursing home

USC-Led Study Analyzes Fall Rates Among Short-Stay Nursing Home Patients | USC News

Neglect is cited in nursing home death

A Red Wing nursing home neglected a resident in September when the man was placed in the wrong wheelchair, took a tumble and died from the fall, according to an Office of Health Facilities Complaints report made public Wednesday.

The resident of Red Wing Health Care Center had dementia and had a history of trying to get out of his wheelchair, which was fitted with a self-release seat belt and an alarm that sounded when the man stood up. A worker put the man in his roommate’s wheelchair one morning. Workers heard him fall and found him lying under the wheelchair. He sustained a neck fracture and a head wound and died at the hospital. The nursing home now places initials on wheelchairs and has told staff to read care plans

Neglect is cited in nursing home death | StarTribune.com

More Abuse In Kentucky Nursing Homes

In fiscal 2011, state adult protection workers determined that abuse and neglect probably had occurred in about 28 percent of cases they investigated involving residents of Kentucky's nursing homes.That is up from fiscal 2010, when workers substantiated probable abuse in 18 percent of investigations involving long-term care residents, according to a report from the state."These are very disturbing statistics, and they reinforce the fact that we've got to get serious about elder abuse in nursing homes in Kentucky," Bernie Vonderheide, founder of Kentuckians for Nursing Home Reform said.The data comes from an annual report compiled in part by the Cabinet for Health and Family Services, titled Elder Abuse in Kentucky. The report says social workers conducted 2,090 investigations of adult abuse and neglect in nursing homes, assisted-living homes and other long-term care centers last year. Abuse and neglect probably occurred in 583 investigations, according to the report. Multiple investigations can involve a single resident.


Read more here: http://www.kentucky.com/2012/06/29/2243063/report-shows-more-abuse-and-neglect.html#storylink=cpy

Florence nurse charged with neglecting patient

A 54-year-old registered nurse has been arrested in connection with the death of a patient at a local nursing home.
Elizabeth Rush, of 816 Marion St., was arrested Tuesday and charged with neglect of a vulnerable adult, according to Florence County Detention Center booking reports.
Rush's arrest was the result of an ongoing investigation into the death of a 76-year-old nursing home patient, Florence Police Maj. Carlos Raines said.
The patient's roommate and another staff member at the nursing home told police they informed Rush that the victim was having chest pains and needed assistance but she did nothing to help. The patient later went into cardiac arrest and died, according to the arrest warrant.
Rush was released from the detention center on a $25,000 personal recognizance bond Tuesday afternoon. The investigation is ongoing, Raines said.
http://www2.scnow.com/news/pee-dee/2012/jul/03/florence-nurse-charged-neglecting-patient-ar-4079160/

Feeding tubes may worsen pressure ulcer risk

A new study led by Brown University researchers reports that percutaneous endoscopic gastric (PEG) feeding tubes, long assumed to help bedridden dementia patients stave off or overcome pressure ulcers, may instead make the horrible sores more likely to develop or not improve.
The analysis of thousands of nursing home patients with advanced dementia appears in the May 14 edition of the Archives of Internal Medicine.
“This study provides new information about the risks of feeding tube insertion in people with advanced cognitive impairment,” said lead author Dr. Joan Teno, a gerontologist and professor of health services, policy, and practice in the Public Health Program at Brown. “We see a substantial risk of people developing a stage II and higher pressure ulcer. We believe these risks should be discussed with family members before a decision is made to insert a feeding tube in a hospitalized nursing home resident with advanced cognitive impairment.”
In the new study, Teno and her team asked two basic questions: “How does having a gastric feeding tube affect the chances of preventing a stage II or greater pressure ulcer?” and “Does having a gastric feeding tube help heal an existing pressure ulcer?”
Previous studies, which were much smaller in scope, had produced inconclusive findings. By using a combination of federally gathered data from nursing homes and Medicare claims, the researchers essentially mimicked a randomized controlled trial through the use of “propensity match cohort” study. Over a particular timeframe, they compared thousands of patients with and without ulcers who received a feeding tube to three times as many statistically similar patients with and without ulcers who did not get a tube.

The risk of feeding tubes

What they found was that among patients who did not start with an ulcer, 35.6 percent of those with a feeding tube ended up with at least a stage II ulcer, while only 19.8 percent of patients without a feeding tube did. After statistical adjustment, they found that the chance of getting an ulcer was 2.27 times higher for people with feeding tubes than for those without. The risk of developing a more serious stage IV ulcer was 3.21 times higher for those with feeding tubes compared to hospitalized nursing home residents without a feeding tube.
Meanwhile, among patients who already had an ulcer, the researchers found that 27.1 percent of patients with a feeding tube saw short-term improvement, but 34.6 percent of those without a feeding tube experienced healing in a comparable timeframe. The adjusted odds of an ulcer getting better for people with a tube were 0.7 times as high for people without a tube, meaning their chances for improvement with a tube were less than for people without a tube.
The conventional wisdom among physicians — three-quarters of them according to one study — is that if anything, the nutrition delivered by feeding tubes should help patients resist ulcers. Perhaps with the idea of such a benefit in mind, physicians frequently don’t discuss the risks of feeding tubes with patients’ families, Teno has found.
The study did not measure how feeding tubes could cause ulcers, but Teno and her co-authors posit that because many patients become agitated by having a tube, they are often physically restrained and sedated with drugs. At the same time, feeding tubes can also increase the incidence of diarrhea. These circumstances, she said, may account for the development and worsening of pressure ulcers.
The new findings should lead doctors and families to ask more questions about whether feeding tubes are appropriate treatments, compared to careful hand feeding, for patients who have become so cognitively impaired that they can no longer eat independently, Teno said.
“To me this article is a game changer,” Teno said. “It provides solid evidence that there is a risk and that we need to discuss it. I’m hoping that people now can use this study to make better decisions in light of a patient’s goals and values.”
In addition to Teno, other authors of the paper were Pedro Gozalo, Sylvia Kuo, and Vincent Mor of Brown; Susan Mitchell of the Hebrew Senior Life Institute for Aging Research in Boston; and Ana Fulton of Butler Hospital.
The National Institute on Aging funded the study.
Feeding tubes may worsen pressure ulcer risk | Brown University News and Events
http://archinte.jamanetwork.com/article.aspx?articleid=1151405

Suit alleges neglect of residents at San Pablo nursing home

Five people have sued Creekside Health Care Center in San Pablo and its parent corporation, Mariner Health Care, alleging that patients in the nursing home are subjected to abusive conditions because of inadequate staffing levels.

The lawsuit, filed Monday by San Francisco law firm Stebner & Associates, alleges that Creekside residents are regularly left unattended for long periods, often in soiled garments, are overmedicated and develop preventable bed sores because of poor care.
The suit also alleges that inadequate staffing and security allowed a man visiting the facility to sexually assault four residents between January and May 2010.
Julio Mestre was arrested May 9, 2010, and later convicted of four counts of sexual battery on an institutionalized victim, according to the suit.
"During the assaults, residents screamed for help, sometimes for more than 30 minutes, but no one came," the lawsuit states.
"The reason for the lawsuit is to try to bring about change at this facility in a systemic way," attorney Kathryn Stebner said. "Our case includes small statutory damages, but the main focus is to force the owners of the facility to follow state and federal regulations."
Suit alleges neglect of residents at San Pablo nursing home - San Jose Mercury News

Family alleges relative was victim of abuse at St. Louis nursing home

The family of a resident at a St. Louis County nursing home says their 68-year-old relative had to be taken to the hospital after suffering horrific injuries from alleged nursing home neglect. The news comes within days after a criminal elderly abuse investigation was launched against St. John’s Place.
While the Missouri Department of Health is not officially talking about the allegations, police have confirmed they were told of the incidents.
Gail Drmacich, the family member of a now former resident, saw a News 4 story and said she wanted to paint a troubling picture of what’s really going on inside the St. John’s Place facility.
“This is more neglect, I would say more neglect,” said Drmacich, who cleaned out her mother-in-law’s room out Tuesday. “She’s got bruises on her, could be from a fall I can’t tell you.”Another family alleges relative was victim of abuse at St. Louis County nursing home | KMOV.com St. Louis:

National Quality Forum: Serious Reportable Events; Formerly "Never Events"

NQF: Serious Reportable Events: Preventing adverse events in healthcare is central to NQF's patient safety efforts. To ensure that all patients are protected from injury while receiving care, NQF has developed and endorsed a set of Serious Reportable Events (SREs). This set is a compilation of serious, largely preventable, and harmful clinical events, designed to help the healthcare field assess, measure, and report performance in providing safe care

Elderly woman claims she was sexually abused at nursing home

An elderly nursing home patient is staying in a New Albany nursing home after family transferred her for her own safety. The elderly woman claims she was sexually assaulted at Kindred Transitional Care and Rehabilitation Center in Corydon, Ind. .

"Where this goes is unclear. I will say our victim is reported to have early onset dementia which makes things a little more challenging from the law enforcement side," Otto Schalk, Harrison County Prosecutor, said.
Serious allegations of elder sexual abuse were made by an 84-year-old woman. Schalk says despite her illness it's not something detectives take lightly. Corydon's Police Chief, James Kendall, and Indiana State troopers have Kindred Transitional Care in Corydon under a microscope.
The elderly woman said she was sexually abused in the nursing care facility at 150 Beechmont Drive, Monday of last week.

Elderly woman claims she was sexually abused at Corydon nursing home | WHAS11.com Louisville:

Nursing Supervisor Found Guilty Of Attempted Neglect

An Ohio nursing supervisor accused of failing to provide help for an injured resident of the Monroe County Care Center was found guilty on one count of attempted patient neglect Tuesday.
Kathy Schwaben pleaded no contest to the charge. A judge sentenced her to a suspended 10-day jail sentence and imposed fines and court costs. She will remain on required probation for one year.
Agents with the attorney general's health care fraud section began investigating Schwaben in August 2011.
Investigators said an 81-year-old patient was thrown from her wheelchair and sustained several fractures while riding in an MCCC van when its driver swerved to avoid hitting a deer.
The victim did not receive immediate medical treatment because Schwaben failed to perform a physical assessment of the woman after the crash, investigators said.
The investigation also showed that the woman was not properly secured in the seat of her wheelchair with a lap or shoulder restraint. Instead, an employee of the nursing facility used a bungee cord as a restraint by placing it across the front of her wheelchair’s arm rests.

Recognizing Elder Abuse Awareness Day

On May 31, 2012, the Centers for Medicare & Medicaid Services (CMS) announced an initiative to reduce the rampant misuse and overuse of antipsychotic drugs in nursing home facilities. The Center for Medicare Advocacy has been working to educate policy makers, advocates, and the public about the misuse of antipsychotic drugs for many years, and is part of an ad hoc coalition of advocates working with CMS and Congress to address the problem that both harms nursing home residents and costs the Medicare program billions of dollars.
CMS's press release announcing the "Partnership to Improve Dementia Care" describes several steps that CMS is taking:

• Enhanced training: CMS has developed "Hand in Hand," a training series for nursing homes that emphasizes person-centered care, prevention of nursing home abuse, and high-quality care for residents. CMS is also providing training focused on behavioral health to state and federal surveyors;
• Increased transparency: CMS is making data on each nursing home's antipsychotic drug use available on Nursing Home Compare starting in July of this year, and will update the data;
• Alternatives to antipsychotic medication: CMS is emphasizing non-pharmacological alternatives for nursing home residents, including potential approaches such as consistent staff assignments, increased exercise or time outdoors, monitoring and managing acute and chronic pain, and planning individualized activities.

At the May 31, 2012 press briefing announcing the initiative, Shari M. Ling, M.D., CMS's Deputy Chief Medical Officer, identified additional CMS strategies – raising public awareness, strengthening regulatory oversight, and research. Dr. Ling said that residents' advocates working on the issue of antipsychotic drugs for many years had brought the issue to the forefront of public attention. She said, "We would not be here today without them."
Antipsychotic Drug Deficiencies Are Cited, But Enforcement Is Timid
Speaking earlier this month at a symposium on dementia care without drugs, sponsored by California Advocates for Nursing Home Reform (CANHR), Jonathan Evans, M.D., a geriatrician and president-elect of the American Medical Directors Association, described the CMS plan as reasonable but primarily “‘an effort to try to educate people rather than to regulate.’” CANHR attorney Tony Chicotel agreed with the need for increased enforcement. The Center for Medicare Advocacy agrees with their concerns.
Since the Nursing Home Reform Law (enacted in 1987) was implemented in October 1990, federal law and its implementing regulations and guidance have contained strong restrictions on the use of antipsychotic drugs.  Two survey and enforcement issues, however, undercut the law's effectiveness.

1. "Level of Harm" Coding Assigns a Value to Deficiencies that is Too Low Either to Provide a Meaningful Sanction for Poor Care or to Lead to Better Facility Practices.

Although some drug deficiencies are cited each year, their significance is understated and undercoded. The federal enforcement system assigns a scope and severity level to each deficiency that is cited, using a federal scope and severity grid. The grid was published in 1994 as part of the final enforcement regulations.  There are four levels of severity. Two levels indicate no harm (substantial compliance and no harm) and two indicate harm (harm and immediate jeopardy). Generally, when states cite deficiencies at a no-harm level, no financial penalty is imposed.
State survey agencies typically cite antipsychotic drug deficiencies at the no-harm level. In fiscal year 2012, 1,213 unnecessary drug deficiencies, 42 C.F.R. §483.25(l), (F329), were cited nationwide. (F329 is the tag where antipsychotic drugs are cited.) However,

• 1185 (98%) nationwide were cited at a no-harm level;
• Only 13 deficiencies nationwide (0.01%) were cited at a harm level; and
• Only 12 deficiencies nationwide (0.01%) were cited at the highest level of harm, immediate jeopardy.

As a consequence of the no-harm, no-penalty practice, FY2012 data show that most facilities cited with unnecessary drug deficiencies are unlikely to have had any financial penalty imposed.

2. The Financial Remedies that Have Been Imposed Are Trivial, In Light of the Seriousness of the Harm that Residents Suffered.

Recognizing Elder Abuse Awareness Day: Working Together to Curb Misuse of Powerful Antipsychotic Drugs in Nursing Homes || CMA

Project to reduce antipsychotic use in nursing homes loses federal funding

Kay Lazar, a writer with the Boston Globe Staff today posted this article about the proposed program to reduce the overuse of physchotic drugs in Massachusetts Nursing Homes:

"Massachusetts nursing homes, which recently pledged to lower their rate of antipsychotic use by 15 percent this year, found out Friday that they will not be receiving a coveted federal grant that would have helped fund the initiative to drive down inappropriate use of the powerful sedatives."
Project to reduce antipsychotic use in nursing homes loses bid for federal grant - Boston Medical News - White Coat Notes - Boston.com

Presidential Proclamation -- World Elder Abuse Awareness Day, 2012 | The White House

Every American deserves the chance to live out the full measure of their days in health and security. Yet, every year, millions of older Americans are denied that most basic opportunity due to abuse, neglect, or exploitation. On World Elder Abuse Awareness Day, we call attention to this global public health issue, and we rededicate ourselves to providing our elders the care and protection they deserve.

Victims of elder abuse are parents and grandparents, neighbors and friends. Elder abuse cuts across race, gender, culture, and circumstance, and whether physical, emotional, or financial, it takes an unacceptable toll on individuals and families across our Nation. Seniors who experience abuse or neglect face a heightened risk of health complications and premature death, while financial exploitation can rob men and women of the security they have built over a lifetime. Tragically, many older Americans suffer in silence, burdened by fear, shame, or impairments that prevent them from speaking out about abuse.

We owe it to our seniors to expose elder abuse wherever we find it and take action to bring it to an end. Two years ago, I was proud to sign the Elder Justice Act, which was included in the Affordable Care Act, and marked a major step forward in the fight against elder abuse, neglect, and exploitation. With the Department of Health and Human Services, we are partnering with State and local authorities to ensure seniors can live their lives with dignity and independence. With the Consumer Financial Protection Bureau, we are working to empower older Americans with tools and information to navigate safely through financial challenges. And with the Department of Justice, we are protecting older Americans by prosecuting those who would target and exploit them.

Every day, State and local agencies, protective services professionals, law enforcement officers, private and non profit organizations, and leaders throughout our communities help protect older Americans from abuse and provide care to those who have already been affected. Together, all of us can play a role in addressing this public health crisis that puts millions at risk. Today, let us keep faith with a generation of Americans by speaking out against elder abuse, advancing justice for victims, and building a Nation that preserves and protects the well being of all who call it home.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim June 15, 2012, as World Elder Abuse Awareness Day. I call upon all Americans to observe this day by learning the signs of elder abuse, neglect, and exploitation, and by raising awareness about this public health issue.

IN WITNESS WHEREOF, I have hereunto set my hand this fourteenth day of June, in the year of our Lord two thousand twelve, and of the Independence of the United States of America the two hundred and thirty-sixth.
Presidential Proclamation -- World Elder Abuse Awareness Day, 2012 | The White House

Celebrate World Elder Abuse Awareness Day!

On World Elder Abuse Awareness Day, individuals and organizations from across the world are urged to raise awareness of the various types of abuse to which older individuals are subjected. This year, take a stand in the fight against elder abuse and take a stand for dignity and respect of our elders.
To support the ongoing work that you’re doing to protect the rights of older people, the National Center on Elder Abuse (NCEA) has made available a virtual ‘toolkit’ that includes creative ways your state and local communities can get involved in raising awareness of this issue, as well as support materials such as factsheets that can be handed out during your World Day activity. These materials are available at:
The National Consumer Voice for Quality Long-Term Care :: Celebrate World Elder Abuse Awareness Day!