Hospital Delerium a Hazard for the Elderly

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

NY State Elder Abuse Study Finds Abuse

A recent New York Study on Elder Abuse found that:

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

The Elder Justice Act lacking Effectiveness

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

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

Elder Justice Act - full text

The Elder Justice Coalition - Home Page

Elder Justice Act

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

Obama Signs Elder Justice Act

Massachusetts Elder Abuse Lawyer Advises on Nursing Home Safety Culture Factors

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

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

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

Massachusetts Elder Abuse Lawyer Advises on Nursing Home Safety Culture Factors

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

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