Friday, July 22, 2011

Black Nursing Home Residents have more Pressure Sores - JAMA

Nursing Home Neglect:
In a study published this month in the prestigeous Journal of American Medicine:
"... Nursing Home pressure ulcer rates in 2.1 million white and 346 808 black residents of 12 473 certified nursing homes in the United States that used the nursing home resident assessment; Nursing homes were categorized according to their proportions of black residents.

The study essentially measured the odds of pressure ulcers in stages 2 through 4 for black and white residents receiving care in different nursing home facilities.

Results ....... black residents of nursing homes showed persistently higher pressure ulcer rates than white residents.

In 2003, the pressure ulcer rate was 16.8% for black nursing home residents compared with 11.4% for white residents; in 2008, the rate was 14.6% compared with 9.6% , respectively. In nursing homes with the highest percentages of black residents (≥35%), both black residents unadjusted rate of 15.5%  in 2008; and white residents unadjusted rate of 12.1% had higher rates of pressure ulcers than nursing homes serving primarily white residents, in which white residents had an unadjusted rate of 8.8%.

Conclusions From 2003 through 2008, the prevalence of pressure ulcers among high-risk nursing home residents was higher among black residents than among white residents. This disparity was in part related to the site of nursing home care."

Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents, July 13, 2011, Li et al. 306 (2): 179 — JAMA

Monday, July 18, 2011

nursing home death ruled homicide

GLENVIEW, Ill.— The Nursing Home wrongful death of an 86-year-old nursing home resident from injuries sustained in an attack by another resident is being investigated as a homicide, suburban Chicago nursing home officials said.

Mercedes Iverson, a resident at Maryhaven Nursing and Rehabilitation Center in Glenview, died last week. The Cook County medical examiner ruled her death a homicide, saying she died from heart disease and brain injuries related to the assault.

"Within the past couple of weeks, an unfortunate incident occurred in a private room" in a part of the nursing home that handles patients with dementia, Brian Crawford, a spokesman for Resurrection Health Care, which runs Maryhaven, told the Chicago Sun-Times for a story posted online Sunday.

Crawford didn't offer further details on the alleged assault.

Glenview police, who are investigating the incident, have declined to comment until Monday.

Iverson was moved to hospice care at St. Francis Hospital in Evanston last week, the newspaper reported. She was pronounced dead Thursday.

Crawford said the incident was reported to the Illinois Department of Public Health as soon as nursing home officials were aware. He said state health officials launched investigations.

Police probe nursing home death ruled homicide -

Sunday, July 17, 2011

State Operations Manual T/C

The State Operations Manual contains sections outlining the Federal Code of Regulations governing Nursing Home Care. The so called "F-Tags" are derived from these sections. The Table of Contents is listed below. All sections are contained in 42 CFR §483

§483.5: Definitions

§483.10 Resident Rights

§483.10(a) Exercise of Rights

§483.10(b) Notice of Rights and Services §483.10(c) Protection of Resident Funds §483.10(d) Free Choice

§483.10(e) Privacy and Confidentiality §483.10(f) Grievances

§483.10(g) Examination of Survey Results §483.10(h) Work

§483.10(i) Mail

§483.10(j) Access and Visitation Rights §483.10(k) Telephone

§483.10(l) Personal Property

§483.10(m) Married Couples

§483.10(n) Self-Administration of Drugs §483.10(o) Refusal of Certain Transfers §483.12 Admission, Transfer, and Discharge Rights

§483.12(a) Transfer, and Discharge

§483.12(b) Notice of Bed-Hold Policy and Readmission

§483.12(c) Equal Access to Quality Care §483.12(d) Admissions Policy

§483.13 Resident Behavior and Facility Practices

§483.13(a) Restraints

§483.13(b) Abuse

§483.13(c) Staff Treatment of Residents (F224* and F226**)

§483.15 Quality of Life

§483.15(a) Dignity

§483.15(b) Self-Determination and Participation

§483.15(c) Participation in Resident and Family Groups

§483.15(d) Participation in Other Activities

§483.15(e) Accommodation of Needs

§483.15(f) Activities

§483.15(g) Social Services §483.15(h) Environment

§483.20 Resident Assessment §483.20(a) Admission Orders §483.20(b) Comprehensive Assessments

§483.20(c) Quality Review Assessment

§483.20(d) Use

§483.20(e) Coordination

§483.20(f) Automated Data Processing Requirement

§483.20(g) Accuracy of Assessment §483.20(h) Coordination

§483.20(i) Certification

§483.20(j) Penalty for Falsification §483.20(k) Comprehensive Care Plans

§483.20(l) Discharge Summary

§483.20(m) Preadmission Screening for Mentally Ill Individuals and Individuals With

Mental Retardation.

§483.25 Quality of Care

§483.25(a) Activities of Daily Living §483.25(b) Vision and hearing

§483.25(c) Pressure Sores
§483.25(d) Urinary Incontinence §483.25(e) Range of motion.

§483.25(f) Mental and Psychosocial Functioning §483.25(g) Naso-Gastric Tubes

§483.25(h) Accidents

§483.25(i) Nutrition

§483.25(j) Hydration

§483.25(k) Special Needs

§483.25(l) Unnecessary Drugs

§483.25(m) Medication Errors

§483.25(n) Influenza and Pneumococcal Immunizations §483.30 Nursing Services

§483.30(a) Sufficient Staff §483.30(b) Registered Nurse §483.30(c) Nursing facilities

§483.30(d) SNFs

§483.30(e) Nurse Staffing Information §483.35 Dietary Services

§483.35(a) Staffing

§483.35 (b) Standard Sufficient Staff

§483.35(c) Standard Menus and Nutritional Adequacy §483.35(d) Food

§483.35(e) Therapeutic Diets §483.35(f) Frequency of Meals §483.35(g) Assistive Devices

§483.35(h) Paid Feeding Assistants §483.35(i) Sanitary Conditions §483.40 Physician Services

§483.40(a) Physician Supervision

§483.40(b) Physician Visits

§483.40(c) Frequency of Physician Visits

§483.40(d) Availability of Physicians for Emergency Care §483.40(e) Physician Delegation of Tasks in SNFs

§483.40(f) Performance of Physician Tasks in NFs

§483.45 Specialized Rehabilitative Services

§483.45(a) Provision of Services §483.45(b) Qualifications

§483.55 Dental Services

§483.55(a) Skilled Nursing Facilities §483.55(b) Nursing Facilities §483.60 Pharmacy Services §483.60(a) Procedures

§483.60(b) Service Consultation §483.60(c) Drug Regimen Review

§483.60(d) Labeling of Drugs and Biologicals

§483.60(e) Storage of Drugs and Biologicals

§483.65 Infection Control

§483.65(a) Infection Control Program §483.65(b) Preventing Spread of Infection

§483.65(c) Linens

§483.70 Physical Environment §483.70(a) Life Safety From Fire §483.70(b) Emergency Power §483.70(c) Space and equipment §483.70(d) Resident Rooms §483.70(e) Toilet Facilities

§483.70(f) Resident Call System §483.70(g) Dining and Resident Activities

§483.70(h) Other Environmental Conditions

§483.75 Administration

§483.75(a) Licensure

§483.75(b) Compliance With Federal, State, and Local Laws and Professional Standards §483.75(c) Relationship to Other HHS Regulations

§483.75(d) Governing Body

§483.75(e) Required Training of Nursing Aides

§483.75(f) Proficiency of Nurse Aides §483.75(g) Staff Qualifications §483.75(h) Use of Outside Resources §483.75(i) Medical Director §483.75(j) Laboratory Services

§483.75(k) Radiology and Other Diagnostic Services

§483.75(l) Clinical Records

§483.75(m) Disaster and Emergency Preparedness

§483.75(n) Transfer Agreement

§483.75(o) Quality Assessment and Assurance

§483.75(p) Disclosure of Ownership