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

Social media policy considerations for long term care providers

A single photo of a resident’s decubitus ulcer on Facebook and/or YouTube is perhaps one of a long term care facility’s worst nightmares.Social media policy considerations for long term care providers – a sword or a shield? - Lexology

Verdict against Rosewood Care Center upheld

The Fifth District Appellate Court has upheld a Madison County plaintiff's verdict in a case that was tried twice against Rosewood Care Center nursing home of Edwardsville.
Jurors awarded $149,115.13 to Paul Graves, administrator of his father's estate in April 2009. Paul Graves contended that Rosewood was negligent in caring for his father, Alfred Graves, during a January 2003 stay at the facility. On the first day of his stay, Alfred Graves fell and broke his hip. Paul Graves claimed that the nursing home violated its own procedures and did not give his father adequate care.
On appeal, Rosewood raised five issues: (1) whether the verdict was against the manifest weight of the evidence, (2) whether the court erred in its issuance of an instruction on the definition of neglect, (3) whether the trial court erred in its issuance of instructions on regulations promulgated pursuant to the Act, (4) whether the trial court abused its discretion by giving an instruction based on IPI 5.01 (Illinois Pattern Jury Instructions, Civil, No. 5.01 (2000)), and (5) whether the trial court erred by admitting into evidence a bill from another nursing home.
Verdict against Rosewood Care Center upheld at Fifth District | Madison/St. Clair Record

Suit alleges woman's hip fractured at Baptist Hospital

A woman has filed suit against Memorial Hermann Baptist Beaumont Hospital, alleging she sustained a hip fracture while staying in the intensive care unit.
Sheila Antoine claims an ambulance transported her to Baptist Hospital on Feb. 10, 2010, after she began complaining of severe shortness of breath, cough and fever.
Medical personnel decided to take an X-ray of Antoine's chest. While the hospital staff was positioning Antoine on the table, she began to feel discomfort in her legs, according to the complaint filed March 15 in Jefferson County District Court.
Antoine's pain continued for the next few days and was so severe that she could not rotate her hip, the suit states. When medical staff was eventually able to take an X-ray of Antoine's left leg and hip on Feb. 17, 2010, they discovered that she had suffered from a fractured left hip, the complaint says.
"No indication is made in the plaintiff's records of how or when she sustained this fracture from the time she arrived at the facility and through her admission," the suit states.
In addition to the fracture, Antoine claims she suffered from decubitus ulcers while hospitalized.
Suit alleges woman's hip fractured at Baptist Hospital | Southeast Texas Record

Senior Living: How to watch for and avoid pressure sores

Pressure sores are easier to prevent than to treat. Pay attention to sensitive areas of the skin. Reposition to remove pressure. Keep skin clean and moisturized. Note that too much moisture however, can contribute to bed sores. Skin areas can be kept dry with body powder. Good nutrition and adequate hydration are key to skin integrity
Senior Living: How to watch for and avoid pressure sores » Redding Record Searchlight

nursing home worker accused of taking nude picture of resident

A case of elder abuse is surfacing in southwest Iowa. An Atlantic woman is accused of taking a picture of a nude nursing home resident earlier this month. Thirty-five-year-old Amanda Sedina, who works at the Salem Lutheran Nursing Home in Elk Horn, faces a serious misdemeanor charge of invasion of privacy-nudity.
Shelby County Chief Deputy Sheriff Rod McMurphy says Sedina allegedly took an inappropriate picture of the bathing 78-year-old female resident. McMurphy says another employee of the nursing home received a text message from Sedina with a picture of the woman attached to it.
The employee notified Salem administrators, who called the sheriff’s office. McMurphy could not comment on Sedina’s motive for allegedly taking the picture. He says the case is extremely unusual for Shelby County.
Elk Horn nursing home worker accused of taking nude picture of resident

Nursing Home Layoffs Can affect Care

Boston Massachusetts nursing home abuse attorney Bernard J. Hamill says families need know that there is a correlation between staffing levels and the adequacy of elder care in nursing homes. It is common sense and it is backed by state and federal regulations. The challenge is in interpreting data provided by nursing homes to the government regarding staffing adequacy to insure nursing home residents receive the high quality of care mandated by federal and state regulations. Federal regulations state that staffing must be sufficient to provide the “highest” level of care. 42 CFR Sec.483.30 states: “The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as
determined by resident assessments and individual plans of care.”
Each nursing home reports its staffing hours to its state survey agency. These staffing hours are from a two-week period just before the state inspection. The Centers for Medicare and Medicaid Services (CMS) gets nursing home staffing data from the states. Staffing hours per resident per day is the average amount of hours worked divided by the total number of residents. It doesn't necessarily show the number of nursing staff present at any given time, or reflect the amount of care given to any one resident. Attorney Hamill notes an important warning about staffing levels given by Medicare: “These staffing numbers are based on information reported by the nursing home. Currently there is no system to fully verify the accuracy of the staffing data that nursing homes report. Because of this limitation and because staffing levels may have changes since the last inspection, you should be cautious when interpreting the data.”
Attorney Hamill says that to determine staffing sufficiency, you should always look at the state inspection results, particularly any quality of life or quality of care deficiencies. The best way to interpret the staffing levels is use a results driven analysis. Go see for yourself what the quality of care is. No matter what the staffing statistics say, if a loved one is sitting in unclean clothing or poorly hydrated or neglected, then the care is inadequate. If the care is inadequate, then according to federal definitions the cause could easily be understaffing of sufficient well trained aides.
New Study Shows Nursing Homes Increasing Layoffs

Mandatory Binding Arbitration Article From CJ&D

According to the Center for Justice in Democracy Factsheet on Arbitration, "Mandatory binding arbitration is a process by which parties “agree” (although consumers rarely know they have “agreed”) to have a third party arbitrator (single arbitrator or a panel), instead of a jury or judge, resolve a dispute. Arbitrators are not required to have any legal training and they need not follow the law. Court rules of evidence and procedure, which tend to neutralize imbalances between the parties in court, do not apply. There is limited discovery, making it is much more difficult for individuals to have access to important documents that may help their claim. Arbitration proceedings are secretive. There is no right to public access. Arbitrators do not write or publish detailed written opinions, so no legal precedent or rules for future conduct can be established. Their decisions are still enforceable with the full weight of the law even though they may be legally incorrect. This is especially disturbing since these decisions are binding so victims have virtually no right to appeal an arbitrator’s ruling."
Fact Sheet: Mandatory Binding Arbitration -- A Corporate End Run Around the Civil Justice System centerjd.org

Drug Deaths Rising in Nursing Homes

In a nursing home on the southern end of California's Central Valley, three elderly dementia patients died during 2007. Normally, that would not make the headlines. But these patients died after being given powerful antipsychotic drugs to control elders behavior--despite warnings the drugs increase the risk of death in elders with dementia.
Mae Brinkley, 91, Joseph Shepter, 76, and Alexander Zaiko, 85, died at the Kern Valley Hospital, a 74-bed skilled nursing facility in rural Lake Isabella, about 30 miles northeast of Bakersfield. Their cases came to light after a long-term care ombudsman reported to the state Department of Public Health that a patient had been held down and forcibly injected with an antipsychotic medication.
Investigators later found the nursing facility had given 22 patients, some with Alzheimer's disease--the most common form of dementia--high doses of antipsychotic medications to control them for the convenience of staff, according to court papers and the Center for Medicare Advocacy.
Now facing criminal charges are Hoshan Pormir, MD, the patients’ physician, Gwen Hughes, director of nursing, and Debbi C. Hayes, a pharmacist. The charges include three counts of elder abuse resulting in death, five counts of nonfatal elder abuse and two counts of assault with deadly weapons--the psychotropic medications Zyprexa and Risperdal, according to the state's criminal complaint.

Abuse of Mind-Altering Drugs Rising in Eldercare Facilities - New America Media

Nurse at Southern Cross home did not call doctor and Joyce Wordingham died, court hears

SYSTEMATIC failures at a Tyneside nursing home saw a pensioner in desperate need of medical attention left to die. Dementia sufferer Joyce Wordingham had become so ill it should have been obvious to staff at her nursing home that she needed to see a doctor. However, Daphne Joseph was the only nurse looking after 29 residents at St Michael’s View, in South Shields, and she had not been trained properly amid a “culture of neglect”. So, instead of calling an ambulance, Joseph simply sponged Mrs Wordingham and made a note she looked frail and ill. The next morning, just two weeks after moving into the home, she was found dead in her bed after Joseph handed over to the day shift. Joseph pleaded guilty to neglecting a person who lacked mental capacity but a judge suspended her prison sentence after being told of the conditions she was working in at the Southern Cross-owned home. Mr Justice Coulson, at Newcastle Crown Court, said: “Your neglect was part of an endemic culture of neglect. You had not been trained properly and that failure, which was not your responsibility, was directly relevant to the tragedy that happened.” The judge said the failings included management and leadership
http://www.chroniclelive.co.uk/north-east-news/evening-chronicle-news/2012/03/03/nurse-at-southern-cross-home-did-not-call-doctor-and-joyce-wordingham-died-court-hears-72703-30452504/#.T1Ifo3ZoGqY.blogger