Admitting Past Felons into Nursing Homes

The Desmoine Register had this article the same day I wrote about placement of past felons in nursing homes and how they increase risk of crimes upon nursing home residents.
State officials say doctors did not view convicted sex offender William Cubbage as a sexual predator when they recommended moving him to an Iowa nursing home where he’s now suspected of sexually assaulting an elderly woman. At one time, a psychologist hired by the state believed Cubbage had victimized “a large number of female children” without being charged or prosecuted for those offenses, according to court records.
Two decades of sex crimes in nursing home abuse suspect’s past The Des Moines Register DesMoinesRegister.com

With violent attacks by felons living in some nursing homes, some facilities are scrambling to comply with disclosure laws required in some states to notify state public health officials when they admit offenders. The number of felons reported to be living in the facilities increased last month in some states. Past reported felonious acts have included rape, theft, assaults, illegal drug use and violence. Some former felons also have serious psychiatric conditions.
http://www.lawfirmnewswire.com/2011/11/massachusetts-elder-abuse-lawyer-warns-of-danger-of-admitting-past-felons-to-nursing-homes/

Elder Pain Study Shows Disparity in Races

According to a study conducted to measure pain in elderly nursing home residents showed a marked disparity between racial groups:
- About one-quarter of all nursing home residents reported or showed signs of pain.
- Forty-four percent of nursing home residents with pain received neither standing orders for pain medication nor special services for pain management (i.e., appropriate pain management).
- Among residents with dementia and pain, nonwhite residents were more likely than white residents to lack appropriate pain management.
- a significantly greater proportion of residents without dementia reported pain compared with residents with dementia.

Over 40% of all nursing home residents with pain received neither standing orders for pain medication nor special services for pain management. Among residents with dementia and pain, there were differences in appropriate pain management between nonwhite and white residents, with nonwhite residents being more likely than white residents to lack appropriate pain management. Questions exist as to the disparity of adequate pain relief for non white residents. Is it because the facilities they are in are inferior and lack adequate resources?

Products - Data Briefs - Number 30 - March 2010

Pressure Ulcers v Deep Tissue Injury vs Blisters ll

Afte publishing the post about Pressure Ulcers v Deep Tissue Injury vs Blisters I received an excellent email from Sue Hull, MSN, RN, CWOCN, who operates WoundConsultations.com
"The reason DTI is discussed along with pressure ulcers in the NPUAP document is because it is caused by pressure. If it occurs while a person is a resident of a nursing home, it would indicate negligence in that the measures had not been taken to prevent pressure. I believe it is standard care that a pressure ulcer risk assessment is done on admission and at predetermined intervals thereafter in nursing homes (as in home health, where I work). Based upon the findings of the risk assessment, interventions are to be implemented to prevent skin breakdown. If DTI develops, something was missed in the process, or something is wrong with that particular nursing home's process.

If there were factors that truly did make the DTI unpreventable, those factors should be copiously documented. It should never be a surprise when a pressure ulcer develops. Eg. if a resident MUST have the head of the bed in a high Fowler's position to breathe, it should be heavily documented along with the skin assessment, and a sacral DTI should be watched for. It should not be a surprise.
Also, when there is DTI, it is not undectible, even in persons of color. There are changes, such as warmth, bogginess, blood filled blisters, and color changes. If boney prominence are routinely checked for these things, the DTI will be detected."
Thanks for your input Sue.

http://malpractice.blogspot.com/2011/11/pressure-ulcers-vs-deep-tissue-injury.html

Nursing homes report more felons

What happens when an elder applies to a nursing home who is a convicted felon or a dangerous criminal? What safety meassures are taken by the nursing home to protect the elder residents from predatory actions such as sexual assaults and criminal assaults? Shouldn't they be screened for the protection of all residents? Shouldn't residents families be warned about these types of admissions?
Nursing homes report more felons - chicagotribune.com

Pressure Ulcers vs Deep Tissue Injury vs Blisters

Our law office has handled several Pressure Sore, Pressure Ulcer cases where the defense tries to categorize a pressure ulcer as a "deep tissue injury" which was hidden and not visible to caregivers thereby excusing the caregivers from observing and treating the wound. They usually contend  that the wound popped up out of nowhere suddenly and in an advanced stage. In other words this wound was unpreventable and untreatable in its earlier stages because it was hidden under the surface of the skin. This defense distorts the definitions and progression of each type of wound.  Usually the actual progression of most skin disorders I have handled were in fact pressure ulcers and not hidden "deep tissue Inujury". Mischaracterizing a pressure ulcer as a deep tissue injury is usually an attempt to skirt the mandate of federal regulations regarding the prevention of bed sores. They are seperate and distinct skin wounds.

483.25(c) Quality of Care - Pressure Sores (also called Tag F314):
"Based on the Comprehensive Assessment of a resident, the facility must ensure that-
(1) A resident who enters the facility without pressure sores does not develop
pressure sores unless the individual’s clinical condition demonstrates that they were
unavoidable; and (2) A resident having pressure sores receives necessary treatment and services
to promote healing, prevent infection and prevent new sores from developing."

The National Pressure Ulcer Advisory Panel in 2007 redefined the definition of a pressure ulcer and
the stages of pressure ulcers, including the original 4 stages and adding 2 stages on deep tissue
injury and 1 on unstageable pressure ulcers.
A Pressure sore is defined in 2007 by the National Pressure Ulcer Advisory Panel (NPUA) as a
"A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony
prominence, as a result of pressure, or pressure in combination with shear and/or friction."
Pressure ulcers develop when capillaries supplying the skin are compressed enough to impede perfusion, leading ultimately to tissue necrosis. Without pressure over a bony prominence you don't have a pressure sore.

NPUA stated in 1998 that a Stage I pressure ulcer is an observable pressure related alteration of intact skin with indicators, as compared to an adjacent or opposite area on the body, which may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.  A pressure sore is visible or it is not a pressure ulcer by the 1998  definition.

A "Deep Tissue Injury", by contrast is defined in 2007 by NPUA as "Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear." The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue. Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

Note the distinction created by these definitions when examining a stage 2 pressure ulcer versus a "deep tissue injury":  A stage 2 pressure ulcer: "Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation." Note that NPUA indicates that *Bruising indicates suspected deep tissue injury.
Note also that Stage 2 pressure ulcers can appear as "blisters" but they are indeed stage 2 pressure ulcers not common or benign blisters.
 
The Hamill Law Group has 34 years experience advocating for injured people including those who have suffered from nursing home neglect, abuse or wrongful death. The Hamill firm represents elders victimized by criminal assaults,  pressure sores , falls , sepsis and malnutrition.  For more information contact the Hamill group at (617) 479-4300 or use the law firm contact form.

See update to Pressure Ulcers vs Deep Tissue Injury vs Blisters

Elder Abuse: Late-in-Life Surgery Excessive?

11-11-11
Surgery is ridiculousy common in older people during the last year, month and even week of life, researchers reported Wednesday. Are these types of surgery just another form of Elder Abuse?
The most comprehensive examination of operations performed on Medicare recipients in the final year of life found that nationally in 2008, nearly one recipient in three had surgery in the last year of life. Nearly one in five had surgery in the last month of life. Nearly one in 10 had surgery in the last week of life!
Do doctors too often operate on an elder who is a dying patient? And if so what pain and anguish does surgery entail? Who profits? The health care industry? At whose expense? The frail elderly patient who is dying? What dignity is lost by end of life unnecessary surgery? Will the the surgery improve or destroy the quality of their life at the end?
Lancet Report Cites Rate of Late-in-Life Surgery - NYTimes.com

Sweet Book of Williamstown Rehab (CareOne LLC) faces possible civil claim

Family of fallen resident recently hired the Hamill Firm to represent them to investigate a possible civil action against Sweet Book of Williamstown Rehab (CareOne LLC) .  John S., a 72 year old  resident died from fall related injuries in 2011 according to an autopsy.
Sweet Brooks latest nursing home performance surveys are discussed here. Sweet Brook scored in the lowest 5% percentile according to state performance survey results for 2011.The Hamill firm has successfully suited nursing homes for wrongful death and fall related cases.

Federal safety regulation 42 CFR §483.25(h) (Ftag 323)  "Accidents" requires that
The facility must ensure that -
(1) The resident environment remains as free from accident hazards as is
possible; and
(2) Each resident receives adequate supervision and assistance devices to
prevent accidents.

Sweet Book of Williamstown Rehab (CareOne LLC)

Hospital Delerium a Hazard for the Elderly

20 percent of the 11.8 million elderly patients in hospitals develop delirium.
Distinguishing between delirium and dementia, which even medical professionals often mix up, is critical. Delirium signals that something in the body is seriously wrong and needs attention, fast. Dementia, not so; it’s chronic confusion and memory loss that comes on gradually and gets worse. Delirium is confusion that comes on suddenly, often within hours, brought on by such triggers as infection, the stress of a disease or operation, not getting enough food or water or sleep, or medications often administered in the hospital.
How to know if your family member is suffering delirium? Caregivers who know the patient in normal times are the best judges of when things are not right. Look for any of these four signs:
Acute change of mental status: Not making sense when he or she talks? Disoriented, illogical, unable to focus? Trust your instincts. Let the staff know this is not normal behavior.
Inattention: As you hold the patient’s hand, ask him or her squeeze every time you say the letter A, as you clearly spell out “save a heart.” “If they miss two, or squeeze on the wrong letter, that is a sign of delirium,” said Dr. Michele Balas, assistant professor in the College of Nursing at the University of Nebraska Medical Center.
Altered level of consciousness: You’re looking for two possible extremes. In hyperactive delirium, patients are anxious, agitated, aggressive, picking at clothes or IVs. In hypoactive delirium, they’re lethargic, sleepy and not making eye contact.
Confusion and disorganized thinking: Can the patient track a conversation? “Ask simple questions, like, ‘Does one pound weigh more than two pounds?,’ or ‘Will a stone float on water?’” .
Another Hospital Hazard for the Elderly - NYTimes.com

NY State Elder Abuse Study Finds Abuse

A recent New York Study on Elder Abuse found that:

■ The findings of the study point to a dramatic gap between the rate of elder abuse events reported by older New Yorkers and the number of cases referred to and served in the formal elder abuse service system.
■ Overall the study found an elder abuse incidence rate in New York State that was nearly 24 times
greater than the number of cases referred to social service, law enforcement or legal authorities who
have the capacity as well as the responsibility to assist older adult victims.
■ Psychological abuse was the most common form of mistreatment reported by agencies providing data on elder abuse victims in the Documented Case Study. This finding stands in contrast to the results of the Self-Reported Study in which financial exploitation was the most prevalent form of mistreatment reported by respondents as having taken place in the year preceding the survey
■ Applying the incidence rate estimated by the study to the general population of older New Yorkers,
 an estimated 260,000 older adults in the state had been victims of at least one form of elder abuse in
 the preceding year (a span of 12 months between 2008-2009).
 
Study

The Elder Justice Act lacking Effectiveness

One Year after passage of the landmark Elder Justice Act, reforms and enforements have not been instituted due to lack of funding!

The Act would have addressed Elder care in Nursing Homes and promoted "coordinated planning among all levels of government; generating and sharing knowledge relevant to protecting elders; providing leadership to combat the abuse, neglect, and exploitation of the Nation’s elders; and providing resources to States and com munities to promote elder justice. The problem of elder abuse, neglect, and exploitation requires a comprehensive approach that integrates the work of health, legal, and social service agencies and organizations;"

Elder Justice Act - full text

The Elder Justice Coalition - Home Page

Elder Justice Act

The historic health care reform bill that President Obama signed into law includes the Elder Justice Act, the Nursing Home Transparency and Improvement Act, the Patient Safety and Abuse Prevention Act, the CLASS Act and provisions designed to improve the ability of people to get needed long-term care services at home.
It took three years to enact Nursing Home Transparency and Improvement, seven to pass the Elder Justice Act, and a dozen to create a national program of criminal background checks on long-term care workers. They all became law when President Obama signed the Patient Protection and Affordable Care Act.
Following are some important long-term care highlights of the new legislation:
Nursing Home Transparency and Improvement
- Establishment of a consumer rights information page on Nursing Home Compare, including services available from the long-term care ombudsman.
- A requirement for nursing homes to make surveys and complaint investigations for three years available on request and to post a notice that they are available.
- A requirement that states maintain a website with information on all nursing homes in the state, including survey reports complaint investigation reports, plans of correction, and other information that the state or CMS considers useful.
Elder Justice Act
See summary of Elder Justice Act from ABA. See full text of act here: Elder Justice Act
Patient Safety and Abuse Prevention Act
this legislation creates a national program of criminal background checks on employees of long-term care providers who have access to residents of facilities or people receiving care in their own homes.
CLASS Act
Home and Community-Based Services

Obama Signs Elder Justice Act

Massachusetts Elder Abuse Lawyer Advises on Nursing Home Safety Culture Factors

Boston Massachusetts nursing home abuse attorney Bernard J. Hamill says a 2011 federal study of safety “culture” in nursing homes highlights the need to consider certain factors in choosing the right facility for a loved one.

Hamill, founder of the Massachusetts personal injury lawyers of Hamill Law Group, says the multiple factors were looked at in the study to evaluate the atmosphere regarding elder safety in nursing homes. The safety culture factors measured included:
perceptions of resident safety
communication about incidents
supervisor actions promoting resident safety
organizational learning
management support for resident safety
training & skills
compliance with safety procedures
communication openness between staff
nonpunitive response to error
adequate staffing

Two overriding factors in the study eclipsed all other variables: first, whether the nursing facility was a private for-profit corporation or whether it was governmental or non-profit; the second variable was the size of the nursing home. For-profits fared significantly worse in promoting a culture of safety. Larger nursing homes were worse than smaller facilities in promoting a safe culture for elder residents.
The report found nonprofit/government nursing homes:
had a higher average percent positive response than for profit nursing homes on all 12 patient safety culture composites.
had a higher percentage of respondents who indicated they would tell their friends that this is a safe nursing home for their family
had a higher percentage of respondents who gave their nursing home an overall rating on resident safety of “Excellent” or “Very Good”
The study on resident safety revealed that 3 times more residents of large nursing homes (over 200 beds) described the safety culture as “poor” as compared with smaller nursing homes (under 49 beds).

Massachusetts Elder Abuse Lawyer Advises on Nursing Home Safety Culture Factors

Michigan authorities deny "Disgusting" neglect occuring in MI nursing homes

An advocacy group says many patients in MI have experienced severe nursing home neglect and abuse.
The Michigan Protection and Advocacy Service says one of the worst cases involves a resident who had to have maggots suctioned out of her throat, after she was taken to an emergency room because she was having trouble breathing.
Another resident had maggots infesting her body near her catheter.
But state officials say these are isolated cases, and most nursing homes do a good job caring for residents.
Mike Pemble is with the Department of Licensing and Regulatory Affairs.
"Certainly these are two disgusting cases, and these kind of thing should not happen -- and I would not make excuses why they happened," says Pemble. "But I don't think it's fair to hold it up and say this is happening in all nursing homes."
Pemble says he does not think the state’s oversight of nursing homes needs major changes.
The advocacy group says the state needs to increase penalties against nursing homes where abuses occur.
State: "Disgusting" neglect cases not typical in MI nursing homes Michigan Radio

Nursing Home Survey on Patient Safety Culture: 2011 User Comparative Database Report

Based on data from 226 nursing homes in the United States, the Nursing Home Survey on Patient Safety Culture: 2011 User Comparative Database Report provides initial results that nursing homes can use to compare their elder patient safety culture to other U.S. nursing homes. The report consists of a narrative description of the findings and four appendixes, presenting data by nursing home characteristics and respondent characteristics for the database nursing homes.

Patient Culture Survey Part 1 2011

Patient Culture Survey Part 2


Nursing Home Survey on Patient Safety Culture: 2011 User Comparative Database Report

Fayette jury awards more than $1 million in nursing home injury case | Voiceless & Vulnerable: Nursing Home Abuse

A Kentucky jury ruled Monday that Lexington's Cambridge Place Nursing Home should pay more than $1 million in damages to a resident who fell and was found severely injured in an equipment storage room.
Irene Hendrix was found in January 2009 after she went missing while moving up and down the hall in a Merry Walker, a type of walker that includes a seat. She had broken bones in her face, there was bleeding in her brain, and she had a 4-centimeter cut on her forehead, a cut on her lip and a swollen eye, according to state documents.
Hendrix, who was in her late 80s at the time and who had been diagnosed with Alzheimer's disease, had to be hospitalized. She has since moved to another nursing home.
In 2009, Hendrix's daughter and guardian Mary Gullette filed a lawsuit against N&R of Cambridge Place LLC, identified in state records as the owner of the nursing home, and Health Systems of Kentucky LLC, identified in state records as the management company for the nursing home. The lawsuit alleged negligence, which nursing home officials denied.
The jury deliberated about two hours Monday before awarding $1 million for Hendrix's physical pain, suffering and mental anguish and $27,473.48 for her medical costs.
"A jury spoke today regarding the level of care they expect for their loved ones in nursing homes in Fayette County," one of Gullette's attorneys, Scott Owens, said after the verdict was returned.
Fayette jury awards more than $1 million in nursing home injury case Voiceless & Vulnerable: Nursing Home Abuse Kentucky.com