Wednesday, December 29, 2010

Injunction in Nursing Home Injury lawsuit

Timeline of events:

May 4, 2006: Complaint filed alleging a violation of patients' rights under Health and Safety code section 1430 (b)

Nov. 30, 2009: Trial begins

June 14, 2010: Closing arguments begin

June 17, 2010: Closing arguments conclude, jury breaks for deliberation

July 6, 2010: Jury returns verdict of $618 million in statutory damages and over $58 million in restitution

July 7, 2010: Skilled Healthcare stock hits record low as prices more than 75 percent to just $1.52 a share

July 15, 2010: Attorneys opt to forgo punitive damages phase; jury released after nearly seven months of service

July 25, 2010: Parties enter mediation talks

Aug. 6, 2010: Defendants file motion for mistrial on grounds of juror misconduct

Aug. 26, 2010: Court finds no evidence of juror misconduct

Sept. 7, 2010: Parties reach initial settlement agreement

Nov. 30, 2010: Court approves final settlement agreement

Jan. 6, 2011: Deadline for class members to file a claim

Feb. 3, 2011: Injunction goes into effect

'Business as usual': Injunction looming for Humboldt County facilities in lawsuit -

Monday, December 20, 2010

NC Nurse Aide accused of Elder Abuse

CHARLOTTE, NC - Police are investigating a case of alleged abuse involving a senior resident at a nursing facility in east Charlotte.

The alleged incident happened at Emeritus Senior Living Center located at 3610 Randolph Road.

A report was filed with the Charlotte-Mecklenburg Police Department on Sunday, Dec. 19.

The victim is an 85-year-old woman who was allegedly assaulted by an employee who kicked the victim on her legs. The victim suffered minor injuries which included bruises and scratches, the police report indicates. The police report was filed by the resident's daughter.

The alleged assault happened sometime between Saturday, Dec. 18 at 4:15 p.m., and Sunday, Dec. 19 at 4:02 p.m.

WBTV spoke with an official at the facility on Monday who said there had previously never been a report alleging abuse of a patient at this facility.

"We are cooperating with the CMPD and are conducting our own internal investigation regarding this resident, and, by law, we have to notify the state that there has been an allegation of abuse," said Kristi Anthony-Keeter a spokesperson for Emeritus Senior Living Center. "Our residents are like family and we hate when there are allegations like this."

WBTV 3 News, Weather, Sports, and Traffic for Charlotte, NC- - Home

Grant County nursing assistant charged with patient abuse

LANCASTER, Wis. -- A Grant County woman is charged for allegedly abusing an Alzheimer's patient at a nursing home Lancaster.

21-year-old Tiffany Krantz of Lancaster is charged with one count of abuse of a patient, or resident.

According to court documents, Krantz, a Certified Nursing Assistant at Lancaster Care Center, and another woman were checking on residents when an Alzheimer's patient pressed an alarm while trying to get out of bed.

After going into the woman's room, Krantz was heard forcefully telling the woman to lay back down.

The woman pressed her alarm again a short time later, and Krantz and the other woman went back to the patient's room.

Krantz allegedly grabbed the woman and swore at her while assisting her into a wheelchair. As Krantz was leaving the woman's room, they also allegedly "cuffed" the woman on the head and pulled her hair.

Krantz no longer works on Lancaster Care Center. She is scheduled to appear in court January 25.

Grant County nursing assistant charged with patient abuse - WKBT News 8 - La Crosse, WI -

Thursday, December 16, 2010

Did Nursing Home’s neglect cause actor Gene Barry’s death?

The children of film actor Gene Barry have alleged in a state court lawsuit that a Los Angeles area nursing home caused his death by neglecting to monitor his condition after a debilitating fall.

According to the complaint filed in the Los Angeles County Superior Court, Sunrise of Woodland Hills admitted Barry in 2009 despite knowing it was not equipped to meet his needs as an Alzheimer’s and dementia sufferer.

Michael, Frederic and Elizabeth Barry allege the facility neglected to notify a physician after their father suffered a fall that left him in “excruciating pain” and ultimately caused his death.

According to the lawsuit, Barry, 90, was in stable physical condition when he entered Sunrise of Woodland Hills in June 2009. He fell at the facility Dec. 5 and injured his head, suffering brain damage and a subdural hematoma. He also sustained fractured ribs and a hip injury.

Sunrise employees “utterly and completely ignored” Barry for four days after the fall by failing to notify his physician and children and neglecting to monitor his deteriorating condition, the complaint says.

Barry died Dec. 9.

His children claim that Sunrise and its management, staff and corporate operators are liable for elder abuse, negligence, wrongful death and fraud in connection with the incidents that led to his death.

According to the suit, the facility willfully neglected to properly assess Barry during the pre-admission process. In doing so, Sunrise allegedly violated Cal. Code Regs. tit. 22, § 87582(f), which prohibits elderly residential care facilities from admitting patients whose “primary need for care and supervision results from dementia.”

In addition administrators and managers at the facility made false representations to Barry’s children that they would provide the proper standard of care even though they knew the facility was ill-equipped to meet Barry’s needs, the complaint says.

The defendants violated Barry’s rights as an elder to be free from abuse and neglect under Cal. Welf. & Inst. Code § 15610 when they failed to follow physician’s orders and neglected to monitor and respond to his condition after the fall, the suit says.

Barry’s children say they suffered loss of comfort, love and emotional support because of their “doting and dutiful” father’s untimely death. They also incurred expenses for his funeral and liability for estate taxes, the complaint says.

The Barrys seek unspecified general and special compensatory damages, pecuniary and punitive damages, and prejudgment interest.

Home’s neglect caused actor Gene Barry’s death, family says

Saturday, November 20, 2010

Blood poisoning

Blood poisoning: What does it mean? -


Definition By Mayo Clinic

Sepsis is a potentially life-threatening condition, in which your immune system's reaction to an infection may injure body tissues far from the original infection.

As sepsis progresses, it begins to affect organ function and eventually can lead to septic shock — a sometimes fatal drop in blood pressure.

People who are most at risk of developing sepsis include:

■The very young and the very old
■Individuals with compromised immune systems
■Very sick people in the hospital
■Those who have invasive devices, such as urinary catheters or breathing tubes
Early treatment, usually with large amounts of intravenous fluids and antibiotics, improves chances for survival.

Sepsis -

Septic Shock:

Multiorgan Dysfunction Syndrome
Sepsis is described as an autodestructive process that permits the extension of normal pathophysiologic response to infection (involving otherwise normal tissues), resulting in multiple organ dysfunction syndrome. Organ dysfunction or organ failure may be the first clinical sign of sepsis, and no organ system is immune to the consequences of the inflammatory excesses of sepsis.


Central circulation

Regional circulation


Pulmonary dysfunction

Endothelial injury in the pulmonary vasculature leads to disturbed capillary blood flow. As many as 40% of patients with severe sepsis develop acute lung injury.

Acute lung injuryThe acute lung injury may be reversible at an early stage, but, in many cases, the host response is uncontrolled, and the acute lung injury progresses to ARDS.
Gastrointestinal dysfunction and nutrition

The gastrointestinal tract may help to propagate the injury of sepsis. Overgrowth of bacteria in the upper gastrointestinal tract may aspirate into the lungs and produce nosocomial pneumonia. The gut's normal barrier function may be affected, thereby allowing translocation of bacteria and endotoxin into the systemic circulation and extending the septic response. Septic shock usually causes ileus, and the use of narcotics and sedatives delays the institution of enteral feeding. The optimal level of nutritional intake is interfered with in the face of high protein and energy requirements.

Liver dysfunction

Renal dysfunction

Central nervous system dysfunction

Mechanisms of Organ Dysfunction and Injury

Hypoxic hypoxia

Direct cytotoxicity

Apoptosis (programmed cell death)



Characteristics of Sepsis that Influence Outcomes
Clinical characteristics that relate to the severity of sepsis include the following:
•An abnormal host response to infection
•Site and type of infection
•Timing and type of antimicrobial therapy
•Offending organism
•Development of shock
•Any underlying disease
•Patient's long-term health condition
•Location of the patient at the time of septic shock

United States
Since the 1930s, studies have shown an increasing incidence of sepsis. In 1 study, the incidence of bacteremic sepsis (both gram-positive and gram-negative sepsis) increased from 3.8 cases per 1000 admissions in 1970 to 8.7 cases per 1000 admissions in 1987. The incidences of nosocomial blood stream infection in 1 institution from 1980-1992 increased from 6.7 to 18.4 cases per 1000 discharges. The increase in the number of patients who are immunocompromised and an increasing use of invasive diagnostic and therapeutic devices predisposing to infection are major reasons for the increase in incidences of sepsis.

The incidence of sepsis syndrome and septic shock in patients admitted to a university hospital was reportedly 13.6 and 4.6 cases per 1000 persons, respectively. In the United States, 200,000 cases of septic shock and 100,000 deaths per year occur from this disease.

A recently published article reported the incidence, cost, and outcome of severe sepsis in the United States. Analysis of a large sample from the major centers reported the incidence of severe sepsis as 3 cases per 1000 population, and 2.26 cases per 100 hospital discharges. Out of these cases, 51.1% received intensive care admission, an additional 17.3% were cared for in intermediate care or coronary care unit. Incidence ranged from 0.2 cases per 1000 admissions in children to 26.2 cases per 1000 admissions in individuals older than 85 years. The mortality rate was 28.6% and ranged from 10% in children to 38.4% in elderly people. Severe sepsis resulted in an average cost of $ 2200 per case, with an annual total cost of $16.7 billion nationally.5

The mortality rate in patients with sepsis varies in the reported series from 21.6-50.8%. Over the last decade, mortality rates seem to have decreased. In some studies, the mortality rate specifically caused by the septic episode itself is specified and is 14.3-20%.

Septic Shock: eMedicine Critical Care

Sepsis - Danger to Nursing Patients

Sepsis is a serious medical condition that is characterized by a whole-body inflammatory state (called a systemic inflammatory response syndrome or SIRS) and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues. A lay term for sepsis is blood poisoning, more aptly applied to septicemia, below.

Septicemia (also septicaemia or septicæmia [sep⋅ti⋅cæ⋅mi⋅a], or erroneously septasemia and septisema) is a related but sometimes deprecated medical term referring to the presence of pathogenic organisms in the bloodstream, leading to sepsis. The term has not been sharply defined. It has been inconsistently used in the past by medical professionals, for example as a synonym of bacteremia, causing some confusion. International medical consensus, since 1992, is that the term "septicemia" is problematic and should be avoided.

Sepsis is usually treated in the intensive care unit with intravenous fluids and antibiotics. If fluid replacement is insufficient to maintain blood pressure, specific vasopressor medications can be used. Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively. To guide therapy, a central venous catheter and an arterial catheter may be placed. Sepsis patients require preventive measures for deep vein thrombosis, stress ulcers and pressure ulcers, unless other conditions prevent this. Some patients might benefit from tight control of blood sugar levels with insulin (targeting stress hyperglycemia), low-dose corticosteroids or activated drotrecogin alfa (recombinant protein

Prognosis can be estimated with the MEDS score. Approximately 20–35% of patients with severe sepsis and 40–60% of patients with septic shock die within 30 days. Others die within the ensuing 6 months. Late deaths often result from poorly controlled infection, immunosuppression, complications of intensive care, failure of multiple organs, or the patient's underlying disease.

Prognostic stratification systems such as APACHE II indicate that factoring in the patient's age, underlying condition, and various physiologic variables can yield estimates of the risk of dying of severe sepsis. Of the individual covariates, the severity of underlying disease most strongly influences the risk of dying. Septic shock is also a strong predictor of short- and long-term mortality. Case-fatality rates are similar for culture-positive and culture-negative severe sepsis.

Some patients may experience severe long term cognitive decline following an episode of severe sepsis, but the absence of baseline neuropsychological data in most sepsis patients makes the incidence of this difficult to quantify or to study. A preliminary study of nine patients with septic shock showed abnormalities in seven patients by MRI.

Sepsis in elderly individuals can have lasting impact

Sepsis is a medical emergency in which an infection overwhelms the body. Unless antibiotics and life support are delivered quickly, the condition can lead to organ failure and death. Most of those who recover do so gratefully and move on with their lives. However, elderly people who survive a bout of sepsis may not be so lucky.

Research published Tuesday suggests, for the first time, that sepsis can leave some elderly individuals with long-term physical or cognitive problems. Researchers analyzed data from 1,194 elderly patients who were hospitalized with severe sepsis and compared them with 4,517 elderly people who experienced a hospitalization but did not have sepsis. Examining data from up to eight years after the hospitalization, the researchers found sepsis patients had a threefold higher risk for developing cognitive problems, such as forgetfulness, compared with the people who were hospitalized for other reasons. Moreover, the sepsis patients were more likely to have at least one new physical limitation, such as walking, dressing or bathing, after the hospitalization.

"[A]n episode of severe sepsis, even when survived, may represent a sentinel event in the lives of patients and their families, resulting in new and often persistent disability, in some cases even resembling dementia," the authors wrote.

It's not uncommon for elderly people to experience some long-term effects from a hospitalization. But the much higher rate of subsequent functional problems in sepsis patients suggests there is something about the illness that takes a particular toll on an older person. It's likely that the effect of the infection can degrade muscle fibers to the extent that the patient's physical strength declines. How sepsis contributes to dementia is less clear. It could be that the massive inflammation that occurs with sepsis causes some brain damage, the authors wrote. Delirium is common in severe sepsis, and delirium has been linked with an increase in cognitive decline in people with Alzheimer's disease.

Sepsis in elderly individuals can have lasting impact -

Severe Sepsis Associated With Development of Cognitive, Functional Disability in Older Patients

Severe Sepsis Associated With Development of Cognitive, Functional Disability in Older Patients
CHICAGO -- October 26, 2010 -- Older adults who survived severe sepsis were more likely to develop substantial cognitive impairment and functional disability, according to a study published in the October 27 issue of JAMA.

"Although severe sepsis is the most common non-cardiac cause of critical illness, the long-term impact of severe sepsis on cognitive and physical functioning is unknown," the authors wrote.

Theodore J. Iwashyna, MD, University of Michigan Medical School, Ann Arbor, Michigan, and colleagues examined whether an episode of severe sepsis increased the odds of subsequent worsened cognitive impairment and functional disability among survivors.

The study involved 1,194 patients with 1,520 hospitalisations for severe sepsis from the Health and Retirement Study -- a nationally representative survey of US residents (1998-2006). A total of 9,223 respondents had a cognitive and functional assessment at the beginning of the study and also had linked Medicare claims; 516 survived severe sepsis and 4,517 survived a non-sepsis hospitalisation to at least 1 follow-up survey and were included in the analysis. The presence of cognitive impairment was assessed, as was the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance. The mean age of survivors at hospitalisation was 76.9 years.

The researchers found that the prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, and their odds of acquiring moderate to severe cognitive impairment were 3.3 times higher. Also, a high rate of new functional limitations was seen following sepsis, with an additional average increase of 1.5 new functional limitations per person among those with no or mild to moderate pre-existing functional limitations.

Nonsepsis general hospitalisations were associated with no change in moderate to severe cognitive impairment and with the development of fewer new limitations.

"Cognitive and functional declines of the magnitude seen after severe sepsis are associated with significant increases in caregiver time, nursing home admission, depression, and mortality," the authors wrote. "These data argue that the burden of sepsis survivorship is a substantial, underrecognised public health problem with major implications for patients, families, and the healthcare system."

The authors added that given published dementia and sepsis incidence rates for those aged 65 years or older in the United Slates, their results suggest that nearly 20,000 new cases per year of moderate to severe cognitive impairment in the elderly may be attributable to sepsis. "Thus, an episode of severe sepsis, even when survived, may represent a sentinel event in the lives of patients and their families, resulting in new and often persistent disability, in some cases even resembling dementia."

"Future research to identify mechanisms leading from sepsis to cognitive impairment and functional disability -- and interventions to prevent or slow these accelerated declines -- is especially important now given the aging of the population," the authors concluded.

Derek C. Angus, MD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, wrote in an accompanying editorial that there are several important implications of this study: "First, the information in this study can help physicians when assessing care options and discussing outcomes with patients and families. Even if clinicians do not know why patients who develop sepsis experience a decline in function, it is clear that many patients do. Second, the development of pre-clinical models could help establish a better understanding of causality, potential mechanisms, and therapeutic targets. Current models of sepsis only crudely mimic sepsis in the modern ICU and rarely afford an assessment of long-term outcomes among survivors. Third, a number of relatively simple strategies used in other areas of medicine to promote physical rehabilitation and minimise the effects of neurocognitive dysfunction might be adaptable to the ICU and post-ICU setting and ought to be evaluated in clinical trials. Fourth, the traditional end point of day 28 all-cause mortality used in the evaluation of any therapy for sepsis should be replaced by longer-term survival data and functional outcomes. Assessing detailed physical and cognitive function is challenging and costly in the multicenter trial environment. However, the larger cost may be from failure to measure these outcomes and miss important benefits or harms of therapies on the lingering consequences of sepsis."


News - Severe Sepsis Associated With Development of Cognitive, Functional Disability in Older Patients

Friday, November 19, 2010

Doctors order mandatory arbitration for patients

The argument against binding arbitration, now common in consumer agreements such as cell phone and credit card contracts, is that it denies access to courts. In health care disputes, the use of mandatory arbitration is not as widespread, but the stakes are much higher, consumer advocates say—in part because patients seeking treatment are likely to sign anything a medical provider puts in front of them.

Some individual doctors, health care facilities, HMOs, and doctors’ insurers routinely ask patients to sign predispute mandatory arbitration agreements. Although some can be revoked later, critics argue that these agreements have no place in medicine.

“Health care isn’t like other goods and services,” said Clark Newhall, a lawyer and physician in Utah, where predispute agreements in health care have been common for years. Consumers usually have access to information on the quality, effectiveness, price, and safety of a good or service they’re choosing, he explained, “but you have less information about your doctor than about a bar of soap.” With predispute mandatory arbitration agreements, Newhall said, “You go forth blindly out of necessity, and you are limited thereafter to one remedy in the event your choice is misguided. There is no appeal.”

Consumer groups fighting to eliminate mandatory arbitration across the board say there is nothing wrong with arbitration itself. But because consumers are asked to sign these agreements before a dispute arises, and the arbitration clause often is buried in a longer document, people don’t understand that they’re signing away their right to a jury trial. Other concerns are that arbitrators are biased and do not have to follow court precedent, some agreements cap damages, and the process lacks transparency and can cost more than a trial.

“In medical malpractice, this is a dangerous road to go down,” said Valkyrie Hanson, campaign organizer for Give Me Back My Rights, a Washington, D.C.-based coalition of public-interest groups fighting against mandatory arbitration.

“They say arbitration is faster, fairer, and cheaper, but it’s not,” said Todd Wahlquist, a Salt Lake City lawyer. Just paying the arbitrator for a simple two-day arbitration can cost $15,000, he said.

“People are handed a stack of papers about insurance, medical history, arbitration—nobody reads them. They trust their doctors,” Wahlquist said. “We assume they’re looking out for our best interests.”

The likelihood that a patient will encounter an arbitration agreement in a medical setting varies widely across the country. A Pennsylvania hospital recently made headlines when it started asking patients to sign these agreements, but patients in California and Utah have been dealing with them for years. Some states have passed laws governing the use of these agreements in health care.

In 1999, the Utah legislature passed a law allowing doctors to use arbitration agreements; it was amended in 2003 to let doctors turn away patients who refused to sign them, although it made an exception for emergency treatment. That law was repealed in 2004; now, health care providers can use these agreements, but they can’t deny treatment because the patient won’t sign. But providers may simply cite other reasons for denying care, Wahlquist said.

Newhall said that some of the people who signed these agreements during the period in which doctors could turn patients away have since filed malpractice suits, and some judges have allowed the arbitration agreements to stand.

Because the two companies that dominate Utah’s health care industry both use mandatory arbitration, patients in the state have a hard time finding doctors who do not use these agreements. When Wahlquist himself refused to sign one at a doctor’s office, he was essentially told that “only people who intend to file frivolous lawsuits don’t sign it,” he said.

In Pennsylvania, such agreements are less common. When attorney David Saba of Kingston discovered that Kindred Hospital, in Wyoming Valley, was asking patients to sign them, it was the first time in 30 years of practice that he had seen them used in health care. “It’s rife with all sorts of problems,” the biggest of which may be the potential for abuse, he said. “We don’t know what patients are being told, if anything.”

Saba noted that once a dispute arises and a client approaches him, he may advise the client to arbitrate, depending on the situation. “Alternative dispute resolution is appropriate if there’s equal status and sophistication” between the parties, but that’s not the case with a hospital and a patient who signs a predispute agreement, he said.

If a pregnant mother signs an arbitration agreement and her child is injured, is the child bound by the agreement? In a wrongful death case, is the heir bound? Can a minor consent to arbitration? Can someone who signs an agreement for a spouse be bound to arbitrate? Courts have gone in different directions on these issues.

The Colorado Supreme Court held in 2003 that although a man’s arbitration agreement with his HMO extended to his surviving spouse and her wrongful death action, the agreement was unenforceable because it did not comply with the Colorado Health Care Availability Act. The court held that the McCarran-Ferguson Act prevented the Federal Arbitration Act from preempting that state law. (Allen v. Pacheco, 71 P.3d 375 (Colo. 2003).) A Texas appeals court relied on that decision in 2005 in denying a nursing home’s motion to compel arbitration. (In re Kepka, 178 S.W.3d 279 (Tex. App. 2005).)

In March, a California appeals court denied a nursing home’s petition to compel arbitration against a woman whose husband had signed an arbitration agreement as part of her admission. (Flores v. Evergreen, 55 Cal. Rptr. 3d 823 (Cal. App. 2007).) The court held, “Although the legislature has specifically conveyed authority over medical decision-making and enforcement of rights to family members, it has not conveyed authority over the arbitration decision to family members.”

Another problem with these agreements, Wahlquist said, is that nonsignatory defendants can sometimes join in the arbitration: “All providers in a dispute can join, even if only one doctor had an arbitration agreement.” Also, a plaintiff can end up in arbitration with one defendant and in court against another—leaving him or her basically “empty-chaired in both places,” with each defendant pointing a finger at the other, Wahlquist explained.

The arbitrators
Arbitrators are ostensibly neutral, but critics say the system is inherently unfair. “Individuals are not repeat users of arbitration—doctors are,” said John Bowman, associate director of legislation for AAJ Public Affairs. “If an arbitrator finds for the plaintiff every time, the doctors won’t hire him or her again,” he said, adding that arbitration providers advertise to health care providers.

In 1998, the American Arbitration Association (AAA), American Bar Association, and American Medical Association (AMA) jointly released a Health Care Due Process Protocol that recommended that “in disputes involving patients, binding forms of dispute resolution should be used only where the parties agree to do so after a dispute arises.”

According to a 2002 press release announcing the AAA’s policy not to arbitrate in cases involving individual patients without a postdispute agreement, the organization’s senior vice president, Robert Meade, said, “Although we support and administer predispute arbitration in other case areas, we thought it appropriate to change our policy in these cases since medical problems can be life-or-death situations and require special consideration.”

Now, the AAA follows those policies but does administer some arbitrations involving predispute agreements, in cases “where a court has ordered a dispute to arbitration, or where medical treatment is not conditioned upon a knowing and voluntary agreement to arbitrate any future disputes and the agreement to arbitrate is revocable by the individual,” according to Wayne Kessler, the association’s vice president of corporate communications. These cases include health care disputes with Duke University, he said.

“The AAA agreed not to administer medical cases with predispute agreements because they’re not fair, but they made an exception for Duke because the agreements are voluntary,” said Erin Jennings, a lawyer in Dunn, North Carolina. She added that from the information the AAA has made public, “everyone would think that they don’t administer these cases.”

Jennings represents Bennie Holland, who sued Duke and other defendents after having spinal surgery. He alleges he suffered a severe infection due to a well-publicized incident in which Duke hospital staff mistakenly washed surgical instruments in used hydraulic fluid. (Holland v. Automatic Elevator Co., No. 07CVS00306 (N.C., Durham Co. Super. amended complaint filed Feb. 9, 2007).) Because Holland had signed a predispute arbitration agreement, Duke moved to compel arbitration. In April, the court granted that motion.

“If they can lock patients in arbitration, they’re going to. It’s a growing trend, at least for Duke, because they know they can get away with it,” Jennings said. She added that after the hydraulic fluid incident, Duke started asking all patients to sign predispute arbitration agreements for all past and future claims.

Jennings pointed out that the incident was a case of blatant error; patients could not have anticipated hydraulic fluid contamination as one of the risks of surgery. About 3,800 patients were affected.

The medical community
Hanson of Give Me Back My Rights noted that insurance companies are pushing doctors to use mandatory arbitration. In response to rising malpractice insurance rates, doctors in some specialties have banded together to self-insure in so-called risk retention groups, and some of these groups require patients to sign predispute agreements.

One of them is the Obstetricians & Gynecologists Risk Retention Group of America, Inc. (OGRRGA). According to a letter telling patients that their doctor has joined the group, one of the group’s goals is “to protect you, as a reasonable patient, from the cost, problems, and mistrust caused by patients who want to ‘win the lottery’ off the doctor through a jury trial lawsuit.”

A document titled “The Top Twelve Reasons to Implement OGRRGA Binding Arbitration in Your Ob-Gyn Offices” touts knowledgeable arbitrators: “The list of arbitrators consists only of retired and semiretired ob-gyns. . . . This replaces a jury of driver’s license holders who know nothing about medicine.” Another OGRRGA document notes that “where state provisions could potentially create an issue,” the agreements include waivers “to abnegate state law.”

Eugene Rosov, who is president of OGRRGA, said that “what constitutes the notion of standard of care is quite specific to the [medical practice] area” and that “it’s not fair to expect jurors to really understand the conflicting views of experts.” He pointed to Kaiser Permanente as one company that has succeeded in using mandatory arbitration widely.

The AMA frowns on predispute arbitration agreements. Information on alternative dispute resolution from the AMA’s Office of General Counsel, posted on its Web site, says: “To be used to settle disputes between physicians and patients, arbitration must typically be voluntarily agreed to after a dispute arises, as opposed to being a mandatory prerequisite to treatment (i.e., predispute binding arbitration).”

Although mandatory arbitration agreements are still less pervasive in health care than in other areas, a high-profile judicial decision could trigger a change, Bowman said—or “the AMA could jump on board and encourage the use of mandatory arbitration.”

A bill is expected to be introduced in Congress to prohibit the use of mandatory arbitration agreements in all contracts or agreements involving health care.

“People have an understanding that there may be conflicts with a bank, for example, but when people go to a doctor, they don’t anticipate malpractice,” Wahlquist said. “They don’t consider how they’d resolve that.”

Doctors order mandatory arbitration for patients

Thursday, November 18, 2010

Mass. aims to cut drug overuse for dementia

State regulators and the Massachusetts nursing home industry are launching a campaign today to reduce the inappropriate use of antipsychotic medications for residents with dementia — a practice that endangers lives and is more common here than in most other states.

During the next year, a team of specialists will identify nursing homes with successful methods for avoiding overuse of antipsychotics and determine which homes need help cutting back. Nursing home staff will be taught how to deal with aggressive and difficult behaviors, often displayed by dementia patients, without resorting to antipsychotics to sedate them.

In 2009, 22 percent of Massachusetts nursing home residents who received antipsychotic medications did not have a diagnosis for which the drugs were recommended — the 12th highest rate of inappropriate antipsychotic use in the nation, the Globe re ported earlier this year.

Twice in the past five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, often Alzheimer’s patients.

Specialists say that understaffing sometimes prompts overuse of these medications to help control dementia patients’ behavior, but that inappropriate use can also be traced to lack of training in alternative approaches.

“There is a knowledge gap between the front-line workers — the nurses — and the black-box warnings on these medications,’’ said Laurie Herndon, a geriatric nurse practitioner who is leading the initiative for Massachusetts Senior Care, the trade group representing the state’s 430 nursing homes. A black-box warning is the most serious type of caution used in prescription drug labeling.

“We wanted to avoid talking at them, and instead provide educational material they can use,’’ Herndon said.

Campaign details will be unveiled at the association’s annual meeting today in Worcester, which is expected to draw about 900 people.

Alice Bonner, the state’s top nursing home regulator, said she appointed a task force to study the overuse of antipsychotics in nursing homes and develop alternative approaches after the Globe highlighted the problem in Massachusetts earlier this year. The task force includes nursing home physicians, nurses, social workers, and pharmacists, along with elder advocates, researchers, and state surveyors who monitor the quality of the facilities.

Bonner, director of the Bureau of Health Care Safety and Quality in the Department of Public Health, said the state, given its budget problems, does not have new resources to devote to the campaign, but is working with legislators and the Patrick administration to get new funding in the next state budget. The trade association intends to apply for grants from nonprofit groups to fund the initiative.

“No one is going to plunk a whole lot of money in our laps,’’ Herndon said, “but that shouldn’t stop us.

Bonner said that the task force has already identified low-cost approaches used by some nursing homes. One approach involves more careful screening of patients when they are admitted, which includes gathering more detailed information from families about the patient’s personality before the onset of illness. This, Bonner said, helps staffers tailor care and activities to each patient.

“They get a good sense of who a person was before they began to suffer with dementia, what kinds of things they like to do, and what kinds of things their family can tell us makes them calm or gets them engaged,’’ Bonner said.

“When you see a nursing home with a low rate of antipsychotics, very often you will see these programs,’’ she said.

Bonner also said that nursing homes that give workers consistent schedules that allow them to work with the same patients have also been successful.

“That helps reduce difficult behaviors with patients with dementia because staff knows the patients so well, they pick up on early signs of trouble and prevent a catastrophic event, so they can intervene early,’’ she said. Consistent schedules have the side benefit of helping nursing homes retain their workers longer, Bonner said. “Once this is in place, it turns out it is less expensive because staff turnover is expensive,’’ she said.

The education campaign will draw on the work of Dr. Susan Wehry, a geriatric psychiatrist and associate professor of psychiatry at the University of Vermont College of Medicine. Wehry recently concluded an intensive, nine-month pilot project in four Vermont nursing homes that taught all staffers, from housekeepers to medical directors, alternative approaches, such as using music and massage, to manage difficult patient behaviors.

The program, she said, helped identify which alternatives work, which don’t, and how challenging the mission can be.

Wehry is still analyzing the results but said preliminary findings showed that in one of the homes where the administrator made all of the training sessions mandatory for staff, antipsychotic use was dramatically reduced. A third of the patients with dementia had been prescribed antipsychotics before the program, and not one was on them by the end, she said.

“They were much improved in terms of staff-resident interactions and level of alertness,’’ Wehry said. “And they looked happier.’’

Data from another home that did not make all of the training mandatory showed no change in the number of dementia patients given the medications. Wehry said a more troubling trend also emerged there — one of the physicians switched from giving antipsychotics to prescribing antianxiety medications.

“If all we do is shift the burden, then all we have done is create a different set of problems,’’ Wehry said. “Our goal is not to just reduce our reliance on antipsychotics, but to change [patient] behaviors.’’

Mass. aims to cut drug overuse for dementia - The Boston Globe

Sunday, November 14, 2010

Albert Lea Nursing Home Abuse Lawsuit Grows

A seventh lawsuit is filed in federal court in South Dakota over alleged abuse of residents at an Albert Lea nursing home. The lawsuit claims the Sioux Falls based Evangelical Good Samaritan Society failed to properly oversee employees at the home in Albert Lea. A 2008 Minnesota Health Department investigation concluded that several nursing assistants mistreated dementia and Alzheimer's patients.

Reportedly, one woman has been sentenced to three months in jail in the case and another is scheduled for sentencing in December. The Good Samaritan Society is asking for the lawsuits to be dismissed.

Albert Lea Nursing Home Abuse Lawsuit Grows

Woman, 94 found in freezer at Calif. nursing home

California investigators are trying to determine how a 94-year-old woman ended up in a freezer at a retirement home.

The Los Angeles Times said Saturday that the California Department of Social Services is investigating the Oct. 28 incident, when the employees of Silverado Senior Living in Calabasas could not find one of their 60 residents.

State records say that after a search of the grounds, the woman was found standing in the home's walk-in freezer.

Senior vice president of Silverado Mark Mostow said the woman was hospitalized but back safe at the home. He would not give further details, citing privacy restrictions.

The home reported the incident to the state as required.

The same home had a former caregiver convicted of torture and elder abuse earlier this year.

Read more:

Woman, 94 found in freezer at Calif. nursing home

Wednesday, November 10, 2010

CMS Proposes to Require LTC Facilities to Have Written Agreements With Hospice

The Centers for Medicare and Medicaid Services plans to require long-term care (LTC) facilities to have written agreements with hospice providers clearly describing which services each entity will provide to nursing home residents.

"We believe there is a lack of clear regulatory direction regarding the responsibilities of providers in caring for LTC facility residents who receive hospice care from a Medicare-certified hospice provider, which could result in duplicative or missing services," CMS said in an Oct. 22 Federal Register notice.

The proposed rule, which mirrors requirements established for hospice providers in June 2008, is intended to ensure that both entities are held equally responsible in the written agreement, CMS said. Delineating responsibility for key services would not only ensure continuity of care but guarantee appropriate care is provided to nursing home residents in a timely manner, the agency added. The rule would apply to both Medicare skilled nursing facilities and Medicaid nursing facilities.

The rule also would require LTC facilities to report to the hospice administrator all alleged violations involving mistreatment, neglect, abuse or misappropriation of resident property by hospice personnel.

CMS Proposes to Require LTC Facilities to Have Written Agreements With Hospice

Is Elder Abuse America's Dirty Secret?

According to Ken Connor of, "The plight of elderly Americans has been a top concern of the Center for a Just Society since our inception in 2005, and as senior citizens comprise an ever increasing percentage of our nation's population, the need is greater than ever to draw attention to a little discussed, little known epidemic in American health care. According to a new study released this month by the American Association for Justice (AAJ), eldercare abuse in America has escalated from a shameful problem to a full-blown humanitarian crisis. As the report illustrates, our nation's looming demographic boom will pose more than a financial challenge for our society – it will pose a moral challenge that is just as important: What kind of care and treatment does our society consider appropriate for its most vulnerable members?

Often, nursing home conditions were so reprehensible and so degrading that – were they unearthed at daycare centers or even federal penitentiaries – members of Congress and the media would be crusading for reform. The AAJ's report is rife with illustrations: A nursing home resident whose leg was amputated after becoming infested with maggots; an Alzheimer's patient who died trapped in a freezer; a Florida nursing home resident who suffered from multiple falls, severe weight loss, multiple pressure sores, infections, dehydration, and eventually death by starvation; patients at a home in Illinois who were given antipsychotic drug injections "assembly-line style" as a means of "chemical restraint;" and an elderly nursing home resident who was sexually assaulted in the middle of the night at the hands of an orderly who was an ex-con.

If something major doesn't change, and change soon, this is the kind of fate that awaits multitudes of Americans expected to join the ranks of the institutionalized elderly in the coming decades."

Elder Abuse: America's Dirty Secret

Parkside House investigation panellist frustrated at lack of available sanctions - Local

A MEMBER of the panel that examined the serious neglect of five elderly people at a Northampton nursing home has expressed “frustration” that action cannot be taken against homes on the basis of Serious Case Reviews.

Joanne Geddes is on the board of Northamptonshire Safeguarding of Vulnerable Adults (SOVA) after being invited to join following a Serious Case Review into the death of her father at a nursing home in Moulton in 2008.

She was also one of a panel of independent members who held a Serious Case Review, released this month, into the cases of five dementia residents who were neglected at Parkside House nursing home in Northampton last summer and later died within two weeks of each other.

Parkside staff identified by the inquiry were waiting to hear if they will be disciplined by their professional bodies but no legal action can be taken based on the in-depth review by health and council officials.

Mrs Geddes said she was frustrated that, in all such cases, no powers existed to bring privately-run care homes to book for serious neglect. She said: “It would be nice if something more could happen when a Serious Case Review makes its findings because it’s a thorough investigation.

“It was clearly, clearly wrong what happened to my dad but there was no case. How can that be right? I can’t believe that situation exists still.

“Residents are not protected in the way they should be and I think that’s a big hole. I said to the home they had failed in their duty of care but there was nothing I could do to take things further. I do find it a bit frustrating that more can’t be done. It’s not just the SOVA board; there’s no legislation to allow you to prosecute the people responsible and make the changes I’d like to see.

“I’d like to see someone accountable for what happened to my dad, either an individual or an organisation.

“People at Parkside and my dad were treated badly. If the same happened to a 15-year-old boy there’d be a consequence but, in these cases, there doesn’t seem to be.”

Parkside House investigation panellist frustrated at lack of available sanctions - Local - Northampton Chronicle & Echo

State lawsuit vs. Bowes owners near end

ELGIN — Another chapter in the story of the now-closed Bowes Retirement Center is nearing an end.

The state expects that an injunction will be granted next week to prevent the former owners of the northeast-side facility from operating another unlicensed nursing home.

“Because the facility is closed and out of business, this will be the last step in the case,” said Maura Possley, spokeswoman for the Illinois Attorney General’s Office.

“We would only pursue further action if they open somewhere else without going through the necessary licensing process,” she said.

Bowes, at 105 N. Gifford St., was shut down and emptied of residents in late September. The closing was the result of an impending mortgage foreclosure in Kane County and a motion for injunction filed by the state. The motion for injunction filed in July 2009 accused Bowes’ owners of running the facility as an unlicensed nursing home and putting the health and safety of its residents at risk.

The closure marked the end of more than two years of efforts to draw attention to and fix nagging problems at the facility, officials said — problems that ranged from unsanitary conditions to reports of neglect and abuse of its elderly residents.

Bowes’ owners — Angel and Bell Corp. of Palos Heights, Ardent Home Health Care Inc. and Benjamin and Angelina Guzman — are accused of operating Bowes under the guise of a retirement center. Although Bowes advertised that it provided living quarters for independent adults, the state’s suit claims that during 2008 and 2009, several residents there needed assistance to bathe, eat, take medications and move — services that can be provided only by a licensed nursing facility.

Last month, a professional liquidation company was named the new caretaker of the now-vacant Bowes Retirement Center property.

Chicago-based Realization Advisors Inc. was appointed by a judge to secure the historical east-side facility from vandals and ready the property for sale.

“We will be doing two things, basically: safety and security first, and secondary, maximizing recovery,” Michael Kayman of Realization Advisors said.

According to court documents, Angel & Bell Corp. et al advised their bank — Mutual of Omaha — in September that Bowes would close and be empty of tenants by Oct. 1.

“They are really very good people. They just ran into some financial trouble,” said Lawrence J. Stark, one of the Guzmans’ attorneys.

Stark mentioned after a court appearance this week that he thought a company in Ohio had expressed interest in purchasing the center and converting it into a bed-and-breakfast.

Kayman, however, said Realization Advisors did not know of any interested parties. In addition, Kayman said, the foreclosure proceedings need to be complete before the property could be sold. He did not anticipate that would happen before the end of the year.

Assuming the state’s lawsuit is resolved at the next court date, scheduled for Wednesday , the attorney general’s office will monitor Angel & Bell Corp. to ensure the company does not open any more unlicensed nursing homes in the state, Possley said.

“To do that, we would rely on complaints from the public, residents, family members or the Illinois Department of Public Health,” Possley said. “And, of course, if we receive a complaint, we will aggressively investigate.”
State lawsuit vs. Bowes owners near end

Carers face neglect charges

TWO carers at a Wigan nursing home have, between them, been charged with 18 counts of ill-treatment or wilful neglect of elderly residents.

Sam Rigby and Lynne Parkinson were employed at Alexandra Grange Nursing Home, Wigan, where the alleged neglect is said to have taken place.

Both pleaded not guilty to all charges when they appeared before Wigan Magistrates’ Court.

Rigby, 25, of Dovedale Crescent, Ashton, is charged with seven counts of ill-treatment or the wilful neglect of seven different residents, six between January and July this year and one between April and November last year.

Lynne Parkinson, 54, of Belle Green Lane, Ince, is charged with 11 counts of wilful neglect or 
ill-treatment, between September last year and July this year, although the alleged incidents are 
not thought to be linked.

The women were both given conditional bail.Carers face neglect charges

Nursing home cited after wheelchair fall

A Minnesota nursing home was cited for neglect after a resident with dementia was found lying under her wheelchair at the bottom of a flight of stairs in July, according to a report released Tuesday by the state Office of Health Facility Complaints.
At Westwood Health Care Center in St. Louis Park, certain residents at risk of wandering are fitted with electronic wristbands that lock exits when they approach them. After a resident was found at the top of a stairwell one day, she was given a wristband. Eight hours later, she was in an area of the facility without the automatic locks when she wheeled away from an activity, fell down seven concrete stairs and probably fractured two ribs.
The facility disagreed with the investigatory findings but took corrective measures.

Nursing home cited after wheelchair fall

Judge throws out motion for mistrial in Skilled Healthcare case; court also grants injunction against nursing home company

A Humboldt County, CA judge threw out a motion for a mistrial in the class action lawsuit against Skilled Healthcare on Friday, signaling another wild day for the company's stock.

The motion, filed earlier this month by defense attorneys, alleged misconduct by one member of the jury that returned a $677 million verdict against the company on July 6. Defense attorneys called the amount, which remains the largest jury verdict in the United States this year, “annihilating,” and immediately took action to have it overturned.

In response to the motion, plaintiffs' attorneys filed a handful of declarations from other jury members dismissing the alleged bias and serving as a basis for Judge Bruce Watson to deny the motion. In his ruling, Watson stated that he found no evidence of juror misconduct and no grounds for a mistrial, causing a flurry of events on Wall Street, with shares dropping as low as $2.46, down from $3.25 the day before.

The company -- one of the largest nursing home chains in the country with 78 facilities and some 14,000 employees -- has seen its stock decline since the lawsuit was brought to court last November after documents showed the nursing facilities to be in violation of statewide staffing requirements.

Healthcare industry analyst Sheryl Skolnick said the news should not come as a surprise when the recent declarations filed by other jurors, all of which denied any potential bias, are taken into consideration.
”Proving misconduct is a tough thing to get done in a case like this,” said Skolnick, an analyst with CRT Capital Group in Connecticut, who has been following the case closely. “I'm not surprised at all.”

In addition to the denial of the motion, the court issued a permanent injunction that orders all Skilled Healthcare facilities to comply with the minimum staffing requirements mandated by California statute. Effective immediately, each of the 22 facilities implicated in the suit is to maintain 3.2 nursing hours per-patient, per-day.

A third party will be appointed to monitor that each facility complies with the law, and any costs associated with that will be paid by the defendants, according to court documents.

Plaintiffs' attorneys, based out of Eureka, would not comment on the decision, except to say that it will not effect a scheduled court date next week. Phone calls to the office of defense attorney Kippy Wroten in Southern California were not returned before deadline.

The two teams of lawyers are due back in court on Tuesday, when the court will hear additional arguments on motions filed earlier this month. Skolnick said that despite all the recent filings, which include a motion to have Watson recused from the case and a separate one seeking a new trial, the future for Skilled Healthcare does not appear to look much different than it did one month ago.

Parties in the case agreed to enter into mediation on July 15, and will not say if a settlement has been reached. Many in the investing world have predicted the company will file for bankruptcy under Title 11 of the United States Bankruptcy Code, which would leave the future of Skilled Healthcare nursing homes in California and elsewhere in question.

”At this point, the case looks like it's going forward,” Skolnick said, adding that a final judgment could be looming if a settlement cannot be reached. “Once that happens, there really is no other choice than to file for bankruptcy.”

Judge throws out motion for mistrial in Skilled Healthcare case; court also grants injunction against nursing home company

Antipsychotic drug use for dementia patients is questioned - The Boston Globe

Nearly 2,500 nursing home residents in Massachusetts were given powerful antipsychotic drugs last year that were not intended or recommended for their medical condition, a practice that is more common here than in most other states, according to a Globe analysis of federal data.

Worrisome use of drugs at nursing homes Data collected by the federal Centers for Medicare and Medicaid Services show that 28 percent of Massachusetts nursing home residents were given antipsychotics in 2009. Of that group, 22 percent - or 2,483 - did not have a medical condition that calls for such treatment.

That rate was the 12th highest in the nation, according to the federal data.

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, also known as “‘psychotropics,’’ 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.

Twice in the past five years, federal 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.

Scott Plumb, senior vice president of the Massachusetts Senior Care Association, the trade group representing the state’s 440 nursing homes, said Massachusetts’ consistent ranking as one of the heaviest users of psychotropic drugs indicates much more training is needed in nursing homes.

“We recognize the number is too high,’’ Plumb said, “and we are working to try to bring it down.’’

As the nation ages - up to 14 million baby boomers are expected to develop Alzheimer’s disease or a similar dementia - the drugging of such vulnerable patients takes on increasing urgency. While there has been much focus on the increasing use of antipsychotic drugs among children - highlighted by the recent overdose death of 4-year-old Rebecca Riley - much less attention has been paid to the similar problem among seniors.

“Way too many patients in nursing homes are treated with antipsychotics purely to sedate them or to control behaviors that are difficult for the staff,’’ said Robert A. Stern, an Alzheimer’s specialist and brain researcher at Boston University School of Medicine.

“To the defense of nursing homes and nursing home staff,’’ Stern said, “they are indeed understaffed, they are indeed under-trained, and it takes an awful lot of well-trained people to manage the difficult behaviors that can be exhibited by people with dementia.’’

While there is no barometer for what is considered an appropriate amount of antipsychotic use in nursing homes - and there is no law governing the matter - specialists in caring for the elderly note that the use of antipsychotics is much lower in some homes than others, and in some states than others.

They also point to the federal government’s recent legal action against the largest provider of drugs to nursing homes in the United States. The company, Omnicare, agreed in November to pay $98 million to settle charges that it took kickbacks from Johnson & Johnson to recommend the drug maker’s products, including the antipsychotic Risperdal. The government said Omnicare persuaded physicians to prescribe the medication to dementia patients with behavioral problems. A government suit against J&J is pending.

Raia helps train nursing home staff in behavior management techniques that can ease agitation and the need for the drugs - skills and training that, specialists say, are often lacking in nursing homes in Massachusetts and across the country. In these homes, he said, as many as 80 percent of the residents are on antipsychotic drugs.

“And then I walk into a good place, one with training, and see 2 or 3 percent on these medications,’’ he said.

A nursing home’s track record for antipsychotic use often is a good predictor for future patients, according to new research from the University of Massachusetts Medical School. The scientists analyzed data from 1,257 nursing homes nationwide and found that patients newly admitted to facilities with some of the highest rates for prescribing antipsychotics are 37 percent more likely to receive the drugs than patients entering homes with the lowest prescribing rates.

Nicki Solomon of Norwood has seen those highs and lows. In 2007, she placed her mother, Corinne, in a nursing home. Although the retired surgical nurse suffered from dementia, she was still able to feed herself and converse clearly, but she had lost her short-term memory, was sometimes agitated and anxious, and would wander off.

Solomon said the nursing home, High Gate Manor in Dedham, asked her permission to prescribe her mother an antipsychotic but didn’t explain the potential side effects. Within weeks, Solomon said, her mother was transformed into someone she didn’t know.

“My mother was out of it all the time. She was asleep and noncommunicative,’’ Solomon said. “She was smothered.’’

She had been given Seroquel, Solomon said, one of the drugs that federal regulators months later would specifically warn against for dementia patients.

High Gate, citing patient confidentiality laws, declined to comment on Solomon’s care.

In June 2008, Solomon transferred her mother to a Needham nursing home that specializes in using alternatives to medication in caring for dementia patients. Her mother rebounded, she said, living another 15 months before her death last November.

Alice Bonner, the state’s top nursing home regulator as director of the Bureau of Health Care Safety and Quality, said “culture change,’’ including a growing consumer movement that focuses on more closely involving families and patients in care decisions, can lower the use of psychotropic drugs.

“We can do better, and use fewer drugs, and do more with behavioral interventions by changing the way we deliver care in nursing homes,’’ she said. Her agency is developing a brochure for nursing homes to give new residents and their families, encouraging them to ask y about the medications prescribed.

For Sharlene Hemp, a North Andover resident who says her father died from side effects of psychotropic drugs just 34 days after entering a nursing home, the answer is legislation. Her father had Alzheimer’s, but she said the family was never told about the medications nor of the potential lethal side effects, until after his death in 2001.

Hemp persuaded her state senator, Steven A. Baddour, to file legislation that would require all Massachusetts nursing homes and their prescribing physicians to obtain written permission from a patient’s health care proxy, which is often a family member, and a court appointed guardian before using antipsychotic medications. A public hearing was held on the bill in January, and it remains in committee.

“When you put a loved one in a nursing home, you are putting your trust in the nursing home and the doctor,’’ Hemp said. “But you don’t know when they go in that they are given all these drugs, and especially dementia patients, because they can’t tell you what they are given.’’

Kay Lazar

Antipsychotic drug use for dementia patients is questioned

Polk County Jury Awards $114 Million against Nursing Home

A Polk County jury has handed down a $114 million verdict in a nursing home abuse case that resulted in an elderly woman's death.

This could be the largest verdict ever in Polk County.

Juanita Jackson, 76, was placed in IHS of Florida, Auburndale, in March 2003 for rehabilitation. The company is now known as Auburndale Oaks Healthcare Center. Trans Healthcare Inc. and Trans Healthcare Management operated the nursing home at that time.

The suit contended that the nursing home staff knew Jackson was at risk for falls but did not put proper preventative measures in place and she fell within two weeks of being admitted. She suffered a closed head trauma and fractured her upper arm, injuries from which she never fully recovered, according to the suit.

When Jackson's family moved her from IHS in May 2003, she had become malnourished and dehydrated and had multiple bedsores. She died July 6, 2003.

The case was filed in the Tenth Judicial Circuit Court in Polk County in 2004
Polk County Jury Awards $114 Million in Nursing Home Lawsuit

Nursing home operator ordered to pay $43.5 million in wrongful death lawsuit

A Georgia jury Friday ordered a Sandy Springs lawyer and nursing home operator to pay $43.5 million in a wrongful death lawsuit.

The payment is to go to the estate of a man whose family said negligent care led to his death at a Rome nursing facility that had been cited for repeated state and federal violations.

Attorneys for the plaintiff said the verdict against George D. Houser is believed to be among the highest in state history against a nursing home operator.

Earlier this week, Houser, 62, filed for bankruptcy protection, listing total assets of between $20 million and $100 million.

The verdict is not the end of his legal troubles.

Houser, who operated Forum Group Corp. and its subsidiary, Forum Group at Moran Lake Nursing Home and Rehabilitation Center in Rome, faces federal charges filed in April in which he is accused of bilking the Medicare and Medicaid programs of more than $30 million.

According to the federal indictment -- in which his wife, Rhonda Washington Houser, 46, also is charged -- those Medicare and Medicaid payments were supposed to go toward care of residents at Houser's three nursing homes.

Instead, federal prosecutors allege the Housers funneled the money to purchase luxury cars and real estate, including a $1.3 million Atlanta home for George Houser's ex-wife.

No trial date has been set for the federal case, said Patrick Crosby, a spokesman for the U.S. Attorney's office in Atlanta. Houser's attorney in that case, Christopher P. Twyman, did not return a telephone call seeking comment.

He represented himself in the three-day wrongful death trial, which was heard in Floyd County Superior Court in Rome. He could not be reached for comment because after the verdict he was immediately taken to the county jail on a contempt of court charge. He was ordered to spend 48 hours in jail.

No one appeared to be home at his Hammond Drive N.E. residence in Sandy Springs.

In the 52-page wrongful death complaint, filed in March of last year, Loretta Terhune, whose 80-year-old father, Morris Ellison, died April 17, 2007, charged the nursing home failed to provide adequate care.

Her father, who was admitted to the facility a year earlier, fell numerous times, breaking his hip in one instance, according to the lawsuit. The nursing home also did not notify Ellison's doctors or family of his injuries.

"Mr. Houser, through his companies, systematically drained the money and resources from his nursing homes [and] caused all sorts of shortages of food, water and medicine and basic supplies," said Stephen G. Lowry, one of Terhune's two attorneys. "He was severely neglected at the time of his death, malnourished and severely dehydrated."

At trial, a nursing home director testified the facility lacked the funds to pay its staff, do laundry and pay bills.

The Georgia Department of Human Resources' Office of Regulatory Services conducted numerous inspections of the facility over several years. The agency closed it and terminated all federal funding after a May 23, 2007, inspection found "Moran Lake’s deficiencies constituted violations of state and federal regulations, nursing home regulations, Georgia state health regulations, and National Fire Protection Association Life Safety Code Standards."

Nursing home operator ordered to pay $43.5 million in wrongful death lawsuit  |

Wrongful Death Lawsuit Against Nursing Home Results in $43.5M Verdict

Wrongful Death Lawsuit Against Nursing Home Results in $43.5M Verdict

Nursing home in Kentucky issued four citations

The Kentucky Cabinet for Health and Family Services issued four citations to Hilltop Nursing Home reports the Commonwealth Journal. The nursing home in Science Hill was issued Type A citations, the most severe of its kind, issued for incidents of abuse and neglect at care facilities such as Hilltop. The incidents occured n July 2, August 18, September 1 and September 22 and included a resident with mental retardation and chronic obstructive pulmonary disease observed walking away from the facility on the roadway in 93 degree temperatures; knowingly employing an individual on two separate occasions who was listed on the Kentucky Nurse Aide Abuse Registry and failing to provide supervision for a resident with a known history of ingesting potentially harmful household chemicals. home in Science Hill issued four citations

Tuesday, November 02, 2010

Care facility sued after woman jumps out window

Dementia patient Merle Fall died after jumping out the second-floor window of a Ridgeland nursing home.
The state Department of Health cited the Ridgeland Pointe Senior Living Community following Fall's death in March, requiring the facility to move its Memory Care Unit to the first floor.
But when an investigation by the attorney general's office found no criminal violation under the Vulnerable Adults Act, Fall's family filed a lawsuit against Ridgeland Assisted Living LLC and Emeritus Corp. The complaint, filed in Madison County Circuit Court, accuses the companies of neglect and seeks at least $500,000 in damages, plus attorney fees.
The companies deny the allegations and say the family has failed to prove Fall was "harmed due to defendants' negligent or reckless conduct."
Fall's daughter, Diane Phillips, said she had decided to bring her 83-year-old mother, suffering from advanced dementia, to a nursing home after she wandered away one day. "I always said the first time she left home, we'd have to put her in a safe place," Phillips said. "We didn't want her to get hurt."
She admitted her mother Feb. 25. "It was a lockdown unit where they assured us she would be safe," Phillips said.
Several days later, she and her husband visited. According to the lawsuit, she found her mother smelling like urine and dressed in the same clothes she had been wearing when admitted.
Ridgeland Pointe officials deny this claim, saying such allegations are inconsistent with their investigation as well as the attorney general's investigation.
While there, she said a nurse pointed to a chair and mentioned her mother had tried to go out the window. Phillips said her husband checked the window and noticed it was unlocked - something nursing home personnel promised to fix.
The evening before March 6, Fall had been seen wandering the hall, going in and out of various residents' rooms, Kizzy Blount, a resident on duty, told investigators from the attorney general's office. She said Fall was later seen trying to open the locks on her window about 2 a.m.

Care facility sued after woman jumps out window | | The Clarion-Ledger

Nursing Home Closing

A southern Illinois nursing home will surrender its license and close its doors after the state says the home failed to comply with safety regulations.

The Orchard Court Nursing Home in Jonesboro houses 15 residents.
The facility will surrender its license and close within 90 days.
Orchard Court has also agreed to pay a $12,000 fine.
The settlement was reached Monday.

In a document more than 50 pages long, the Department of Public Health gives numerous examples of the facility failing to protect residents from violent attacks.

"When you see a pattern of behavior, when you see these continued abuse or neglect type situations we look at that pattern and if we find they are not able to comply with the statute we then move towards license revocation," says Melaney Arnold with IDPH.

Most of the incidents stem from an 18 year old resident with profound mental retardation.
Numerous times he injured and even hospitalized other residents.
One report describes the beating of a 62 year old blind resident who was treated for lacerations to his head.

Officials say this is abuse.
Each long term care facility is responsible to develop an appropriate care plan for each resident.

"Whether that be means they need to be in a single room, whether that be means they need one-on-one supervision," says Arnold.

IDPH says the facility had been in trouble for some time. Orchard Court was already operating under a type A license, which means during inspection they were found to have some of the most serious violations.

"License revocation is not very common and for this to happen we definitely felt there were issues with continued care and operation with this facility," says Arnold.

In fact, Orchard Court is only one of seven long term care facilities up for license revocation in the state.
The facility could have appealed the citation but surrendered that right. In a statement they said money is the issue.

"Orchard Court is operated by a small not for profit company that cannot afford a protracted legal fight with the government" they say.

The facility also admits no wrongdoing and disagrees with the state's actions.

The residents will soon be moved to other nursing homes.

Orchard Court says they were trying to care for the more severely disabled residents who have been turned away from other state-run facilities.
They say a lack of adequate funding was also an issue.
They claim the state still owes them 6 months worth of pay.

WSIL TV • Nursing Home Closing

Houser being sued again for alleged nursing home neglect

George Houser, who already lost one costly lawsuit over poor care at one of his nursing homes, is now facing another challenge in court.

A Rome woman is claiming her husband was neglected during his five-week stay, and the lack of care led to his eventual death.

Elaine Siegel is being represented by Mike Prieto of Perrotta, Cahn and Prieto, P.C., the same law firm that represented Loretta Terhune, a woman who sued Houser after her father died in one of Houser’s facilities six months after entering it. Houser was ordered to pay the daughter $37 million.

Also named as defendants are Subacute Services Inc., SAS — Mount Berry Inc. and Mount Berry Convalescent Center LLC.

In the lawsuit filed Thursday evening in Floyd County Superior Court, Siegel claims that her husband, Solomon Siegel Jr., entered Summit Health and Rehabilitation Center on Three Mile Road in Rome on Oct. 3, 2008, for rehabilitation for a stroke. He was 79 at the time and had a history of stroke and diabetes, among other medical conditions, the lawsuit stated.

Prieto contends that Houser was still acting as part owner when Solomon Siegel died.

In 2007, the three nursing homes operated under Houser’s Forum Medical Group name closed, including what was then called Mount Berry Nursing and Rehabilitation Center on Three Mile Road.

The closings came after the federal Centers for Medicare and Medicaid Services informed the Forum Medical Group that it would no longer pay for care unless drastic improvements were made.

The Three Mile Road site later reopened as Summit Health and Rehabilitation Center.

The lawsuit contends the patient developed multiple ulcers that went untreated and became infected.

On Nov. 7, 2008, Solomon Siegel was taken to the emergency room with an elevated white blood cell count, according to the lawsuit. Nine days later he died.

Siegel is asking for punitive damages and liability.

Houser and his wife, Rhonda Houser, are both facing federal criminal charges after being accused of defrauding Medicaid and Medicare out of $30 million.

He is scheduled for a pretrial hearing in federal court in Rome on Tuesday.

Siegel contends that the nursing home staff failed “in numerous ways to provide the care, treatment and series that her husband needed in a skilful and non-negligent manner.”

She specifies that the nursing home failed to follow federal and state requirements for a long-term care facility and did not follow standard medical and nursing practices.

Read more: - Houser being sued again for alleged nursing home neglect - Houser being sued again for alleged nursing home neglect

Huge Verdict Shakes Nursing Homes

SAN FRANCISCO -- During Cindy Cool's almost daily visits to the nursing home, she would routinely find her Alzheimer's-suffering father wearing urine-soaked clothes.

The Blue Lake resident said it would take upwards of 20 minutes for the apparently short-handed staff of Eureka Healthcare and Rehabilitation to respond and help Cool clean her father. Other patients fared worse, she said.

"A lot of times I walked out of there crying because of the things I saw," Cool said in an interview.

She provided key testimony before a Humboldt County jury last month slammed the owners of her father's nursing home with a $677 million verdict, sending shock waves through the industry and rekindling calls for tort reform.

The verdict as it stands is already thought to be the largest in the country this year and its ramifications are still being sorted out weeks after the jury surprised even the plaintiffs' lawyers with the size of their verdict. Tort reformers have seized on the verdict as the latest example of litigation abuse.

The company's stock price has plunged on fears it will have to file bankruptcy. Cool, 58, was part of a class-action lawsuit representing 32,000 patients that blamed the nursing home staff shortage for the misery she encountered -- echoing a common complaint across the country that for-profit nursing homes are too concerned with the bottom line.

After Wall Street investment firms went on a nursing home buying spree during the early years of the new century, critics charge that many companies drastically cut payroll expenses to prop up stock prices.

"The major problem for most nursing homes in California and in the nation is staffing," said Pat McGinnis, executive director and founder of the California Advocates for Nursing Home Reform.

Many of the 16,100 homes nationwide are owned by public companies. The home where Cool's father lived and died in 2006 is owned by Skilled Healthcare Group Inc., which is traded on the New York Stock Exchange.

On July 6, the Humboldt County jury found that Skilled Healthcare on numerous occasions violated state regulations requiring it to keep a minimum number of nurses on duty at its 22 homes in the state.

James Gomez, president and chief executive of the California Association of Health Facilities, called the verdict "outlandish, excessive and extreme" and said a "good provider of skilled nursing care" is likely bound for bankruptcy if the verdict holds up, threatening the livelihoods of 14,000 California workers.

The lawsuit accused Orange County-based Skilled Healthcare of failing to maintain 3.2 nursing hours per patient per day at its 22 nursing homes in California. The company is just the 10th largest, based on beds, in an industry that struggles to keep workers.

"The verdict is a statement that facilities must follow the law and meet minimum standards," McGinnis said.

McGinnis said the 3.2 nursing hours required by California should be an easy standard to meet because it's nearly a full hour less than the federal recommendation of 4.1 nursing hours per patient.

"The fact that this company couldn't maintain these minimum standards makes you wonder why it was in the nursing home business to begin with," McGinnis said.

Skilled Healthcare Chairman and CEO Boyd Hendrickson said in a statement immediately after the verdict that the company is "deeply disappointed" in the verdict and believes its nursing homes are appropriately staffed.

"We strongly disagree with the outcome of this legal matter, and we intend to vigorously challenge it," he said.

The company's options, however, appear to be shrinking.

On Thursday, Humboldt County Superior Court Judge Bruce Watson shot down one of the company's challenges when he denied its demand for a mistrial based on juror misconduct.

Meanwhile, the company's ability to appeal is in question.

Typically, parties challenging a trial court decision are required to post 150% of the verdict as a bond. The company doesn't have the cash or credit to post the $1 billion-plus bond. It also likely faces bankruptcy if the jury's verdict stands up.

Both sides are currently in settlement negotiations, and legal analysts said there's a good chance that the sizable verdict will be reduced.

That is what happened in another high-profile nursing home verdict won in 1998 by Michael Thamer, who is now lead lawyer in the Skilled Healthcare lawsuit.

A Siskiyou County Superior Court jury awarded his client Reba Gregory $95 million after a nursing home attendant dropped her during a bed transfer, fracturing her hip and shoulder. Thamer convinced the jury that two attendants should have attempted the transfer and that Gregory's injuries were the result of staff shortages.

A judge later reduced the $95 million verdict to $3.1 million.

Read more:

Abuse in Texas Nursing Home

MONTGOMERY COUNTY, Texas —The family of a former Texas legislator says he was abused while being treated in a local nursing home.

Donald Brown was a state representative from Galveston County in the 1960s.

As an attorney, Brown sought justice for over 33 years. In the 1980s, he was one of the lawyers who helped clear Clarence Brandley, who was wrongly convicted of rape and murder and spent nine years on death row before he was exonerated.

But Donald Brown’s daughter says what happened to her father at the end of his life was a crime and now he needs justice.

Brown died just days after leaving Willis Nursing and Rehabilitation in Montgomery County. Pictures taken of Brown after he spent two weeks at the facility shows he had horrible bed sores.

His daughter also claims he was over medicated.

"After about the first week there, he was so drugged when I or anyone else visited him, that we couldn’t wake him up," said Celia Brown.

Her father, who was 79 and in poor health, went to the Willis nursing home on August 19 to recover from hip surgery. He was rushed back to a hospital in Conroe on September 3 in respiratory distress and died three days later.

"With proper care he could have been rehabilitated and be alive, either in the nursing home or in a private care setting," said Brown.

Brown, believing her father was abused and neglected at the nursing home, filed a complaint with the Department of Aging and Disability Services, the Texas agency that inspects nursing homes. She also filed a criminal complaint with the Willis Police Department.

Accusations of neglect at nursing homes are not unusual. However, when nursing homes are investigated, the chances of anything happening to the facilities are slim.

In 2009, the Department of Aging and Disability Services investigated 16,000 complaints in the state’s 1,100 nursing homes. Out of all the investigations, the agency revoked one license and handed out 37 administrative penalties. Not one facility was suspended.

11 News also sifted through hundreds of pages of reports, detailing accusations made against Willis Nursing and Rehab. In the past five years, 45 people made more than 100 allegations of everything from neglect and abuse, to lack of care. Of those allegations, 11 News found three instances where the nursing home was cited for a violation.

"It’s actually very rare for us to take that severe an enforcement action," said Cecilia Federov, a spokesperson for the Department of Aging and Disability Services.

Federov said shutting down or closing a facility is rare because, when the agency finds problems, the nursing homes are given a chance to make improvements.

Federov said she would not agree that the nursing homes are given a lot of leeway during investigations.

"We have to keep in mind that moving a resident, forcing a resident to move into a different facility or closing a facility, so that there are fewer facilities in the state, that is very traumatic for the population we are serving," she said.

Federov said rigorous, unannounced inspections of nursing homes, like the one in Willis, are done once a year. She said the agency investigates every complaint.

11 News obtained a copy of the nursing homes skin evaluation sheet on Donald Brown. The evaluations showed he had four bed sores when he was admitted on August 19, all in the early stages. One of the sores was on his hip, two were near his tail bone, and another one was on his right heel.

That day the nurse indicated his heel was a stage-one bed sore, meaning the skin was intact.

But a picture of Brown’s heel the day he left the facility two weeks later showed the skin was gone. The pictures of Brown’s sores near his tail bone were equally as gruesome.

When shown the pictures by 11 News, Federov agreed they were disturbing.

"You know this is horrible, this wound is horrible, we would not say this is not a very tragic condition," she said.

Two weeks after 11 News’ interview with Federov, the state completed its investigation of Donald Brown’s case. The agency found that Willis Rehabilitation and Nursing had not broken any rules. The charge of over medicating was found to be unsubstantiated, as were the charges of neglect and failure to prevent bed sores.

A nurse said in the report that Brown’s right heel, the one that lost all the skin, "went bad very quickly." She also said Brown refused to turn and would rub his heel on the bed.

Brown’s daughter, Celia, was upset with the findings of the investigation.

"Wow, they are really under qualified to investigate, or choose not to see the truth in front of them," she wrote in an email to 11 News.

Valerie Chartier, an administrator of Willing Nursing and Rehabilitation, said she thinks the report spoke for itself.

"We remain committed to providing the finest care for our patients," she said in a written statement.

But when that care falls short, is the state doing enough to protect people’s loved ones? Celia Brown doesn’t think so. Her father once served the state of Texas. In return, she believes the state failed him.


Suit Alleging Neglect Filed

GALVESTON - Clay and Ricky Kilgore have filed a $5.5 million lawsuit against Dr. Firoozeh Saheb Kar, Baywind Village and Enterprise Ambulance for the death of Jeanie Kilgore.

The estate of Jeanie Kilgore argues that Kar knowingly and intentionally violated the doctor-patient trust when the physician discharged the woman without providing alternative medical care. The suit filed Sept. 30 in Galveston County District Court also alleges Baywind Village and Enterprise Ambulance deliberately assisted with the discharge.

Jeanie Kilgore died at Clear Lake Regional Hospital on Oct. 5, 2008.

The Kilgores placed Jeannie Kilgore in Baywind Village on Sept. 16, 2008. At the time, she was suffering from dementia and Parkinson's Disease, which greatly incapacitated her, according to the original complaint.

Court papers state that Kar discharged Jeannie Kilgore two weeks later even though her condition necessitated constant supervision by a qualified person. The suit claims Kar instructed Baywind Village and Enterprise Ambulance to transfer her to a facility in League City without her permission.

Her survivors allege there was no one at the home to care for her, especially when Jeannie Kilgore aspirated vomit on Oct. 2, 2008.

The suit says an employee found her struggling to breathe on the floor. She was rushed to Clear Lake Regional Hospital where she remained in a coma until her death three days later.

Friday, October 29, 2010

Nursing Home Abuse filed Against Legacy Health Care

A New York law firm has filed a class action lawsuit against Legacy Health Care on behalf of residents who resided at Legacy facility from at least 2007 to the present, citing neglect and endangerment to the welfare of residents. Legacy Health Care operates numerous elderly care facilities including Ridge View Manor LLC, Williamsville Suburban LLC, Williamsville View Manor Nursing Home, and Sheridan Manor. Richard Zacher, owner and administrator of the named facilities, is also listed as a defendant in the case, as are John Doe 1-200, which includes agents or employees of the above-mentioned facilities.
The class action lawsuit alleges deprivation of rights and benefits to which residents were legally entitled. Among the causes of action brought in this lawsuit, the named defendants are accused of failing to ensure a dignified existence for residents, inadequate staffing, and quality of care issues.

Legacy Health Care Facilities and those named under their umbrella are also accused of fraud, breach of contract and negligence. The complaint states that defendants have violated Section 2801-d of the Public Health Law by failing to staff facilities with adequate and qualified personnel to care for residents, compromising dignity of residents and quality of care. Plaintiffs' complaint also claims breach of contract, as individual plaintiffs entered into contracts with defendants in return for health care services for related residents.

Questions raised by plaintiffs in this complaint relate to fraudulent conduct by defendants, failure to employ sufficient staff to properly care for residents, engagement in unfair or deceptive conduct in regards to administration, management and operation of facilities, and failure of defendants to support and advance environments that provide dignity and proper quality of care to residents.

all plaintiffs in this lawsuit have the right to be compensated for damages and other costs related to breach of contract, fraud, and misrepresentation of care and services provided.

Class Action Lawsuit Filed Against Legacy Health Care Facilities in NY on Behalf of 6 Families

Nursing Home Abuse Suspect Sentenced

Brianna Broitzman, who was accused of physically and sexually abusing nursing home residents in Albert Lea, was sentenced to 180 days in jail Friday afternoon.

Broitzman was given a staggered sentence. She was immediately taken to jail where she will serve 60 days. Under the agreement she'll serve another 60 days in May and another 60 in October.

However, she will be allowed the file an "option to stay" the final 120 days of her sentence. Judge Steven Schwab called it the most complicated sentence he's ever given.

Broitzman will also be required to write letters of apology to the victims and will have to meet with the victim's families. She'll also have to undergo a psychiatric evaluation.

Broitzman was among several nursing aides accused of mistreating residents at the Good Samaritan Society in 2008 by groping, poking and taunting them.

She pleaded guilty to three gross misdeamenors using the Alford Plea, which means she claimed she was innocent, but acknowledged there was enough evidence to convict her.

Her co-defendant, Ashton Larson, is scheduled for court in December.

Monday, October 11, 2010

Standing Up For Seniors

How the Civil Justice System Protects Elderly Americans
Nursing homes are now big business. Corporate chains are anticipating a flood of baby boomers moving into their facilities over the next few years. This increased emphasis on profits has led to a distressing rise in neglected and abused seniors. Between 2000 and 2008, instances of “immediate jeopardy”—violations likely to result in serious harm or even death—rose 22 percent. More than 90 percent of all nursing homes were guilty of at least one violation.

There are many laws and regulations aimed at protecting seniors. Yet government agencies, non-profit watchdogs and media organizations consistently report that serious problems exist in our nation’s nursing homes.

The same is true of insurance companies that mislead and defraud vulnerable seniors. Insurance industry regulators protest that they can do nothing. Even when they do raise their hands, they more often than not strike deals to keep fines to a minimum and settlements secret.

With the regulatory and legislative bodies unable to cope with a groundswell of neglect and abuse, the civil justice system has stepped into the breach. Attorneys who represent our nation’s seniors, and their families, play a critical role in uncovering abuse and neglect, and are the most effective force to compel corporate nursing homes to fix their conduct.

Friday, October 01, 2010

How to Pick a Nursing Home: Talk to CNA's, Staff

While looking at nursing homes for my mother, I always asked the tour guides if I could talk to the nurses’ aides. This seemed to me a logical request. After all, these were the women — and they were all women — who would spend the most time with my mother, who would notice small changes that raised big questions, who would make her feel cared for. Or not.

“They don’t do that,” I was told almost everywhere I visited.

I soon realized why. In casual conversations in hallways and dining rooms at more than a dozen facilities, I found only one nurses’ aide who had been on the job more than six months. I was witnessing in real life one of the most dismal statistics in long-term care: More than 70 percent of nurses’ aides, or certified nursing assistants, change jobs in a given year.

Then came the tour guide who didn’t say no. “No one has ever asked that before, but why not?” the marketing director of a New Jersey nursing home said in response to my request. He said he would ask three aides then on break if they wanted to talk to me. They said yes.

I asked how long they had worked there. One said 12 years; another, 8. The third answered: “I’m the baby. I’ve been here four years.”

I decided this was the place for my mother. These women used the word “we” when talking about the nursing home, making clear that they felt a sense of ownership. And it seemed significant that the marketing director asked their permission before allowing me to impose on their break time. Moreover, he trusted them enough to leave me alone with them in the break room.

That was 10 years ago. I do not know exactly what I would find today, but the overall situation has not changed. The reasons for the high turnover rate among nurses’ aides are the same as they were then: low wages ($10.48 an hour on average), poor benefits, high injury rates and lack of respect on the job.

What has changed is that the industry, the federal government and the states have all identified the turnover rate as a crisis in long-term care, particularly with demand poised to soar as the baby boom generation ages. Researchers have found that high turnover in a facility corresponds with poor quality of care — more bedsores and more use of restraints, catheters and mood-altering drugs. That is, more reliance on medicine and technology, less on relationships.

“Cycling in aides who don’t know you is very disorienting and upsetting, and the resident is the one who suffers on the quality end,” said Peggy Powell, a senior staffer at PHI, formerly known as the Paraprofessional Healthcare Institute, a nonprofit group focused on improving the front-line work force in long-term care.

In nursing homes with high turnover rates, certified nursing assistants tend to leave within three months, often because of inadequate training and support to juggle multiple frail, ailing residents at a time, according to Robyn Stone, senior vice president for research at the American Association of Homes and Services for the Aging. Once aides leave, everyone else must pick up their caseloads, and the stress of the job rises.

Culture change initiatives are under way in nursing homes around the country to make aides’ jobs more fulfilling — not so much through better pay, but by offering better training, more responsibility and more respect from superiors. The aides at my mother’s nursing home had all this, plus health and pension benefits.

Ericka Dickens had been there for nine years when she became my mother’s aide. She had the patience and experience to navigate my mother’s stormy moods as her dementia worsened, to notice immediately when she was feeling weak or sick. Sometimes I would arrive in the early morning to find Ms. Dickens sitting beside my mother, holding her hand and talking to her.

I hadn’t seen Ms. Dickens since shortly after my mother died six years ago. Recently I called to see if she still worked at the nursing home. I discovered that she is now in her 20th year, currently assigned to the physical therapy department. I visited her there and found her assisting a resident who looked up at her at one point and said: “Oh, Ericka, you look so good. You always look so good. You’re a good friend.”

I asked what made her want to stay in the job all these years. She said she always felt respected and supported, but the anchor for her and others is the bond with residents. (There were five other aides from my mother’s era on the afternoon shift that day, including one who had been there for 25 years.)

“We have reminiscences about this person and that person, how we used to love this one and how we used to love that one,” Ms. Dickens said. “They become your family. A few weeks ago, someone passed away, and Winnie and I went to the wake. Her daughter was so happy when she saw us, she started crying. And you feel: ‘Yes, I did something. I’m part of something.’ It’s really fulfilling.”