Fall Prevention and accidents FTAG 323

F323
§483.25(h) Accidents.
The facility must ensure that –
(1) The resident environment remains as free from accident hazards as is possible; and
(2) Each resident receives adequate supervision and assistance devices to prevent accidents.

42 CFR 483.25(II) (1) AND (2) ACCIDENTS AND SUPERVISION
The intent of this requirement is to ensure the facility provides an environment that is free from accident hazards over which the facility has control and provides supervision and assistive devices to each resident to prevent avoidable accidents. This includes:
• Identifying hazard(s) and risk(s);
• Evaluating and analyzing hazard(s) and risk(s);

• Implementing interventions to reduce hazard(s) and risk(s); and
• Monitoring for effectiveness and modifying interventions when necessary.

Definitions are provided to clarify terms related to providing supervision and other interventions to prevent accidents.
• “Avoidable Accident” means that an accident occurred because the
facility failed to:
- Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and/or
- Evaluate/analyze the hazards and risks; and/or
- Implement interventions, including adequate supervision, consistent with a resident’s needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and/or
- Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of practice.
“Unavoidable Accident” means that an accident occurred despite
facility efforts to:
- Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and
- Evaluate/analyze the hazards and risks; and
- Implement interventions, including adequate supervision, consistent with the resident’s needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and
- Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of practice.

• “Assistance Device” or “Assistive Device” refers to any item (e.g., fixtures such
as handrails, grab bars, and devices/equipment such as transfer lifts, canes, and wheelchairs, etc.) that is used by, or in the care of a resident to promote, supplement, or enhance the resident’s function and/or safety.
• “Hazards” refer to elements of the resident environment that have the potential to cause injury or illness.
o “Hazards over which the facility has control” are those hazards in the resident environment where reasonable efforts by the facility could influence the risk for resulting injury or illness.
o “Free of accident hazards as is possible” refers to being free of accident hazards over which the facility has control.
• “Resident environment” includes the physical surroundings to which the resident has access (e.g., room, unit, common use areas, and facility grounds, etc.).
• “Risk” refers to any external factor or characteristic of an individual resident that influences the likelihood of an accident.
• “Supervision/Adequate Supervision” refers to an intervention and means of mitigating the risk of an accident. Facilities are obligated to provide adequate supervision to prevent accidents. Adequate supervision is defined by the type and frequency of supervision, based on the individual resident’s assessed needs and identified hazards in the resident environment. Adequate supervision may vary from resident to resident and from time to time for the same resident.

Numerous and varied accident hazards exist in everyday life. The frailty of some residents increases their vulnerability to hazards in the resident environment and can result in life threatening injuries. It is important that all facility staff understand the facility’s responsibility, as well as their own, to ensure the safest environment possible for residents.
The facility is responsible for providing care to residents in a manner that helps promote quality of life. This includes respecting residents’ rights to privacy, dignity and self determination, and their right to make choices about significant aspects of their life in the facility.
For various reasons, residents are exposed to some potential for harm. Although hazards should not be ignored, there are varying degrees of potential for harm. It is reasonable to accept some risks as a trade off for the potential benefits, such as maintaining dignity, self-determination, and control over one’s daily life. The facility’s challenge is to balance protecting the resident’s right to make choices and the facility’s responsibility to comply with all regulations.
The responsibility to respect a resident’s choices is balanced by considering the potential impact of these choices on other individuals and on the facility’s obligation to protect the residents from harm. The facility has a responsibility to educate a resident, family, and staff regarding significant risks related to a resident’s choices. Incorporating a resident’s choices into the plan of care can help the facility balance interventions to reduce the risk of an accident, while honoring the resident’s autonomy.
Consent by resident or responsible party alone does not relieve the provider of its responsibility to assure the health, safety, and welfare of its residents, including protecting them from avoidable accidents. While Federal regulations affirm the resident’s right to participate in care planning and to refuse treatment, the regulations do not create the right for a resident, legal surrogate, or representative to demand the facility
use specific medical interventions or treatments that the facility deems inappropriate. The regulations hold the facility ultimately accountable for the resident’s care and safety. Verbal consent or signed consent forms do not eliminate a facility’s responsibility to protect a resident from an avoidable accident.
An effective way for the facility to avoid accidents is to commit to safety and implement systems that address resident risk and environmental hazards to minimize the likelihood of accidents.2, 3 A facility with a commitment to safety:
• Acknowledges the high-risk nature of its population and setting;
• Develops a reporting system that does not place blame on the staff member for reporting resident risks and environmental hazards;
• Involves all staff in helping identify solutions to ensure a safe resident environment
• Directs resources to address safety concerns; and
• Demonstrates a commitment to safety at all levels of the organization. A SYSTEMS APPROACH
Establishing and utilizing a systematic approach to resident safety helps facilities comply with the regulations at 42 CFR §483.25(h)(1) and (2). Processes in a facility’s system approach may include:
• Identification of hazards, including inadequate supervision, and a resident’s risks of potentially avoidable accidents in the resident environment;
• Evaluation and analysis of hazards and risks;
• Implementation of interventions, including adequate supervision and assistive devices, to reduce individual risks related to hazards in the environment; and
• Monitoring for effectiveness and modification of interventions when necessary.

For nurses, it’s a constant dash to respond to alarms

For nurses, it’s a constant dash to respond to alarms
By Liz Kowalczyk
Globe Staff / February 13, 2011
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E-mail|Print|Reprints|Comments (2)Text size – + Logan’s cardiac monitor flashed a red crisis alarm and broadcast a fast, high-pitched beeping, a piercing sound that reached his nurse, Tammy Dillon, in the hallway.

Logan was fine. His pumping legs had triggered the crisis alarm again.

The red alarm is the most urgent, meant to alert nurses to a dangerously slow or fast heart rate, abnormal heart rhythm, or low blood oxygen level. But on this morning in the 42-bed cardiac unit at Children’s Hospital Boston, infants and preschoolers activated red alarms by eating, burping, and cutting and pasting paper for an arts and crafts project.

All morning long, nurses heard — and responded to — constant beeping, dinging, and chiming; some kind of alarm sounded at least every minute.

Nurses know that a large percent of patient monitor alarms are false — triggered by movement, a poor connection, or some other factor — but they still must listen carefully to each one and react quickly in case a patient really requires immediate medical attention. Given the almost overwhelming number of alarms going off, nurses, doctors, and health care leaders are concerned about staff in hospitals across the United States becoming desensitized to the noise, a phenomenon called alarm fatigue.

“Children move a lot, and that creates lots of false alarms,’’ said Dillon, a nurse at Children’s since 1996. But “if you have an alarm that is real, a sick child goes down very fast. You never want to be the person responsible for a delay in care.’’

In the case of Logan Narolis of Williamstown, N.Y. — who had surgery at Children’s for a heart defect — the movement of his legs interrupted the oxygen level signal on his monitor.

Children’s is working with engineers at MIT to develop more sophisticated monitors that better identify true crises, with fewer false alerts.

On another morning at nearby Beth Israel Deaconess Medical Center, the 10 nurses caring for 35 patients on Clinical Center 7 responded to all manner of warnings — abnormal heart rate alarms, arrhythmia alarms, bed and chair alarms warning that fragile patients might be getting up, patient call bells, intravenous medication pump alarms, and emergency alarms in patient rooms.

Each has its own unique noise, speed, and pitch — the most urgent are, by design, the most annoying — differences barely discernible to visitors but second nature for nurses. The most serious alarms also scroll across signs in hallways or are sent to nurses’ pagers.

Nurse Sylvia LaRocca was caring for a patient whose cardiac monitor blared a low-heart-rate alarm every few minutes — each time pulling LaRocca away from other patients and into the woman’s room. In every instance, the patient was fine, alert, and breathing well. The hospital’s monitors are programmed to set off an alarm when a patient’s heart rate falls below 40 beats per minute. Doctors had lowered the limit on this patient’s monitor to 34, but her slower-than-normal heart, which dipped down to 31, was still triggering the alarm. Now doctors were debating whether to lower the parameters again.

“You have to respond to the alarm, you have to do it,’’ LaRocca said. “But there are some days when you feel you’re just running from alarm to alarm. It can be exasperating.’’

Dr. Julius Yang, medical director for the unit, said it’s a dilemma. Doctors could risk the patient’s safety if they made her monitor less sensitive, but if they don’t, they run the risk of desensitizing the nurses.

“I worry about alarm fatigue quite a bit,’’ he said. “The problem is, when is real real?’’

For nurses, it’s a constant dash to respond to alarms - The Boston Globe

Patient alarms often unheard, unheeded

Fresh from surgery, the patient was wheeled into the intensive care unit and immediately hooked up to a cardiac monitor that would alert nurses to a crisis. Sometime during the following days, though, the cables running from her chest to the machine slipped loose.

The monitor repeatedly sounded an alarm — a low-pitched beep. But on that January night two years ago, the nurses at St. Elizabeth’s Medical Center in Brighton didn’t hear the alarm, they later said. They didn’t discover the patient had stopped breathing until it was too late.

At Tobey Hospital in Wareham, nurses failed to heed a different type of warning on a September morning in 2008. An elderly man’s electrocardiogram displayed a “flat line’’ for more than two hours because the battery in his heart monitor had died. While nurses checked on him, no one changed the battery. The man suffered a heart attack and was found unresponsive and without a pulse.

These were just two of more than 200 hospital patients nation wide whose deaths between January 2005 and June 2010 were linked to problems with alarms on patient monitors that track heart function, breathing, and other vital signs, according to an investigation by The Boston Globe. As in these two instances, the problem typically wasn’t a broken device. In many cases it was because medical personnel didn’t react with urgency or didn’t notice the alarm.

They call it “alarm fatigue.’’ Monitors help save lives, by alerting doctors and nurses that a patient is — or soon could be — in trouble. But with the use of monitors rising, their beeps can become so relentless, and false alarms so numerous, that nurses become desensitized — sometimes leaving patients to die without anyone rushing to their bedside. On a 15-bed unit at Johns Hopkins Hospital in Baltimore, staff documented an average of 942 alarms per day — about 1 critical alarm every 90 seconds.

In some cases, busy nurses have not heard or ignored alarms warning of failing batteries or other problems not considered life-threatening. But even the highest-level crisis alarms, which are typically faster and higher-pitched, can go unheeded. At one undisclosed US hospital last year, manufacturer Philips Healthcare, based in Andover, found that one of its cardiac monitors blared at least 19 dangerous-arrhythmia alarms over nearly two hours but that staff, for unexplained reasons, temporarily silenced them at the central nursing station without “providing therapy warranted for this patient.’’ The patient died, according to Philips’s report to federal officials.

In other instances, staff have misprogrammed complicated monitors or forgotten to turn them on.

Patient alarms often unheard, unheeded - The Boston Globe

Swiss care worker sexually abused 114 people: Serial Abuser?

BERN - A 54-year-old Swiss care worker has admitted abusing 114 people, including children and disabled adults, in care homes in Switzerland and Germany over the past 29 years, Swiss police said on Tuesday.

Police arrested the care worker last April after two disabled men, living in a nursing home, told their parents that they had sex with the man, police in the canton (state) of Berne said in a statement.

The man has admitted to 114 cases of abuse and eight cases of attempted abuse, police said. Most of the victims were young men and some had severe mental and physical disabilities, police said.

"Several cases involve children, among them children of nursing home employees," police said. The youngest victim was one year old at the time of the crime, police said.

The man has worked in nine nursing homes in Switzerland and Germany since 1982.

The man had already been investigated in a case of sexual abuse of a severely mentally disabled 13-year-old girl in 2003, but the inquiry was dropped after experts had doubts about the girl's reports. --Reuters


Swiss care worker sexually abused 114 people: police

Brownfield nursing home under investigation following death

Authorities said 71-year-old Willie Joe Byers, who reportedly suffered from dementia, wandered outside the doors of Tumbleweed Care Center around 4:15 a.m. Thursday unsupervised. He was found unresponsive by a nursing home worker four hours later.

Brownfield police said they are conducting a criminal investigation in conjunction with Attorney General Mark White.
"We're talking to employees, checking out stories and making sure everything lines up,” Sgt. Darrel Williams said. “We are looking at possible criminal charges."
Although Brownfield police said this investigation is ongoing, this is not the first incident at the facility.
According to police documents requested by Fox 34, Byers was the third resident to wander off from the facility since November.

A missing persons report filed with the police on January 30 - just three days before Byers was found dead outside the facility - indicated an elderly man wandered out of the center unnoticed before being found in Aspermont, Texas, two hours down the road.

Another occurrence in 2008 left one resident in handcuffs after he jumped the fence at Tumbleweed. The resident was then accused of burglarizing a local dollar store.

Police records indicate multiple accounts of harassment and injury within the fenced gates of the care center.
The Texas Department of Aging and Disability Services cited the facility for 10 deficiencies, alone, in 2010 including repeated offenses for the mistreatment of residents, the hiring of workers with legal history of abuse and neglect, and safe living areas.

Cecelia Fedorov with the D.A.D.S agency said not only is her agency investigating the care center following the death but is staffing the center with regional staff from the agency.
"We did find there was a situation at the facility which was placing the residents in immediate jeopardy,” Fedorov said. “We will have our regional staff on site at the facility to monitor the situation as the facility works to correct the situation until we are satisfied those residents are no longer in immediate jeopardy."

Brownfield police said there are still many questions to be answered in this case.


When we attempted to reach the facility for a comment, the facility administrator Aaron Jewell released a statement saying: “Tumbleweed administration expresses its deepest sympathy to the family of our recently deceased resident. The matter is currently under investigation.”

A cause of death has not yet been released.
Brownfield nursing home under investigation following death|myFOXlubbock | FOX 34 News KJTV Lubbock, Texas

Nursing home worker pleads guilty to attempted sex abuse

A nursing home employee accused of sexually abusing a female resident pleaded guilty to a lesser charge Friday morning and was sentenced to over 3 years in prison.

Eugene police arrested Robert Price just before the holidays after Valley West Health Care Center called them reporting an alleged case of sex abuse at their facility.

Price pleaded not guilty to first degree sex abuse on Dec. 30.

On Friday, Price pleaded builty to attempted sex abuse.

Judge Maurice Merten sentenced Price to 3 years and nine months in prison.


Nursing home worker pleads guilty to attempted sex abuse | KVAL CBS 13 - News, Weather and Sports - Eugene, OR - Eugene, Oregon | Local & Regional News

Minister promises new checks on elderly care

The ordeal faced by the grandmother of the Independent columnist Johann Hari as she was shunted between residential homes over 10 years was condemned as appalling last night by the Care Services minister.

Paul Burstow urged people with complaints about the treatment of relatives to come forward – and disclosed he was planning tougher protection for the elderly against abuse. Mr Burstow said: "What happened to Johann Hari's grandmother shouldn't happen to anyone's grandmother. Everyone deserves to be treated with dignity and kindness when they need care."

He added: "We all need to be vigilant about abuse. I am currently reviewing arrangements for protecting vulnerable adults to ensure everyone plays their part keeping people safe from those who would exploit and harm them."

Mr Burstow said that anyone worried about low-quality care should report it to the Care Quality Commission (CQC), which had been given extra powers to crack down on poorly-run homes. He also said he was determined to tackle concerns over the use of antipsychotic drugs.

Ministers have said they want to want to give the CQC more teeth. It stipulates that care home staff should have the appropriate qualifications, skills and experience to look after residents. Where staff are judged wanting by the regulator, companies that run care homes can have their licences to operate cancelled and face prosecution.

The Registered Nursing Home Association warned yesterday that care homes – which rely on council funding for around two-thirds of their income – could be forced to cut spending on staffing, food or activities because of the cash squeeze facing the sector. Frank Ursell, its chief executive officer, said: "People talk about quality but then they pay peanuts. What is it exactly that they expect?"

Minister promises new checks on elderly care - Home News, UK - The Independent

'Grannycam' video spurs state to shut Fair Oaks care home in Sacramento

Shortly after his grandmother moved into a residential care home in Fair Oaks, Sean Suh installed a small camera beside her bed to make sure the staff knew someone was watching.

But often when he visited, he said, he would find the "Grannycam" unplugged.

Suh decided to find a new place for Kyong Hui Duncan, a Korean immigrant and beloved matriarch who had become too frail to live on her own. But by the time he found one, Duncan, 73, was dead from a constellation of problems that her grandson said were inflicted upon her at Fair Oaks Residential Elderly Care.

A short video clip captured by Suh's "Grannycam" that shows a staffer violently shaking Duncan in her wheelchair now plays a key role in the state's decision to shut down the care home. The clip, which Suh discovered only after Duncan's death, is also at the center of a civil lawsuit the family filed Thursday that charges abuse, neglect and wrongful death.

"I have nightmares about it," Suh said of the videotaped image. "It's very hard for me to function, knowing she went through that."

Following an investigation spurred by Suh's complaint, the California Department of Social Services on Thursday ordered the care home's operators, Myung S. Kim and Jay J. Kim, to cease operations by the end of the business day. The state is moving to permanently revoke the home's license.

Such emergency actions are rare, said Wendy York, a Sacramento lawyer who represents the family and whose specialty is elder abuse. "In 15 years of prosecuting homes, I have not seen the state suspend a facility," York said.

The Fair Oaks home is licensed to care for 15 residents, and all had managed to find other accommodations by Thursday afternoon, said the facility's lawyer, Jeff Kravitz.

Kravitz said the home's operators reject all the allegations against them.

"We're disputing everything," he said. "All of the residents enjoyed staying there."

He said the Kims will appeal the suspension and hope to resume operating in the near future.

The state's suspension order accuses the home of violating the personal rights of residents. One of the concerns the state cites stems from the "Grannycam" clip, which shows staff members moving Duncan from the floor to her wheelchair, then dumping the chair backward with Duncan in it and shaking it. Among other allegations: that staff members improperly restrained Duncan and failed to quickly attend to her after she had fallen.

Once, the state alleges, family members arrived to find Duncan, crying and unattended, positioned upside down in her wheelchair. The order also cites instances in which Duncan suffered mysterious bruises and infections that went untreated.

Duncan's autopsy report showed potentially toxic levels of narcotics in her system, at least one of which her doctor had never prescribed, according to the document. The lawsuit charges that she suffered injuries, infection and "lethal doses of drugs," all of which contributed to her death.

The state also accuses the home of fire code violations, failing to dispose of contaminated needles, using prescription medicines that had expired and forging prescriptions.

Suh said he chose the Fair Oaks facility after informing administrators that he intended to install a camera. "I wanted to let them know I would be making sure that my grandmother got the utmost care and had the highest quality of life," he said.

The camera, he said, collected DVD images but was not connected to a computer. He said he looked at all the videotaped material shortly after his grandmother died.

Suh said his grandmother was a strong, determined woman who fled North Korea in the midst of war. A single parent to Suh's mother, she launched a successful restaurant business in Guam, at one point employing 300 people, he said. She later ran a coffee shop and a market in Southern California.

"She came to this country without knowing English, without knowing the culture, and she lived the American dream," even putting her grandson through college, said Suh, a teacher of people with disabilities. Duncan was "full of life, someone who entered a room and everyone knew she was there," he said.

After she retired, Suh moved his grandmother to the Sacramento area, where she lived in her own home until October 2009, he said. Her family began worrying about her welfare when she began falling, but she wanted to maintain her independence. So rather than move in with relatives she agreed to go to the Fair Oaks home, in part because the operators shared her ethnic background, Suh said.

Suh said he started searching for another residential home after she began suffering unexplained gashes and bruises and seemed to be "drugged" when he visited.

"I found a new place, and then I got the call that she had passed away," Suh said. "I guess I was just a couple of days too late."



Read more: http://www.sacbee.com/2011/01/14/3323284/grannycam-video-spurs-state-to.html#ixzz1BWBnBFEo'Grannycam' video spurs state to shut Fair Oaks care home - Sacramento News - Local and Breaking Sacramento News | Sacramento Bee

Ex-nursing home employee charged with abuse, mischief and harassment in

A Decatur woman accused of abusing an Athens nursing home resident and harassing and scratching the car of the employee who reported her has been arrested and charged by Athens Police.

Athens Police on Thursday arrested Larosalyn “Missy” Etherich Freeman, 39, of 1510 Riverview Ave., on charges of neglect or abuse of an aged or disable adult, first-degree criminal mischief and three counts of harassment, Capt. Floyd Johnson said Friday.

Freeman is accused of abusing a resident at Athens Convalescent Center in mid-November, Johnson said. He declined to specify how she allegedly mishandled the resident, but said the victim was not injured and did not require medical treatment.

Freeman was fired because of the incident and is currently barred from holding a caregivers license, Johnson said.

John Wallace, owner and administrator of the nursing home, told The News Courier on Friday there were no signs of harm to the resident.

“We took immediate action, discharged the employee and immediately reported the incident to the proper authorities,” Wallace said.

Records show Freeman was being held in the Limestone County Jail in lieu of posting a $5,000 bail on the two felony charges — neglect and criminal mischief. Bail on the three misdemeanor harassment charges was $1,500, records show.

Sgt. Dustin Lansford arrested Freeman following an investigation.

“In early December, while investigating several harassing communication cases, Lansford was made aware of a case the Alabama Department of Public Health was investigating involving the abuse of a patient reported to them by Athens Convalescent Center,” Johnson said.

The nursing home had already reported the incident to the Public Health Department when it occurred in mid-November, the captain said.

After talking to one of the Public Health investigators and interviewing witnesses, Lansford obtained an arrest warrant for Freeman, and she was arrested Thursday in Decatur by Lansford and Investigator Johnny Campbell, Johnson said.

Freeman was also charged Thursday with first-degree criminal mischief for allegedly scratching an employee’s car in the parking lot of the nursing home and with three counts of harassment relating to an employee, he said.

Johnson credited nursing home employees for their proper handling of the incident.

“It should be noted the Athens Convalescent Center has met all obligations required in investigating and reporting this case,” he said.



Ex-nursing home employee charged with abuse, mischief and harassment » Local News » The News-Courier in Athens, Alabama

Patient advocates object to nursing home liability limits

Tia Cheney, a 26-year-old diabetic, died in November 2009 purportedly because she was not given enough insulin while at a Port Washington nursing home.

Christine Larson, her mother, is among those opposing a bill that would limit punitive damages as well as extend the current cap of $750,000 on damages for pain and suffering in medical malpractice cases to nursing homes, hospices and assisted living facilities.

"The idea that our lawmakers now want to shield nursing homes from full responsibility for their neglect is the worst kind of public policy at the worst of times," Larson, who lives in West Bend, said before a legislative committee last week.

The caps are among the provisions in sweeping legislation proposed by Gov. Scott Walker to provide businesses with additional protections against lawsuits.

The Senate passed its version of the bill on Tuesday. The Assembly could vote as soon as Thursday.

Larson has not filed a lawsuit against the nursing home but does have an attorney. Citing respect for Cheney's privacy, the nursing home declined to comment.

Plaintiff attorneys have focused many of their arguments against the bill on nursing homes.

AARP, the Coalition of Wisconsin Aging Groups, Disability Rights Wisconsin, Alzheimer's Association of SE Wisconsin, Mental Health of America of Wisconsin, the Wisconsin Alliance for Retired Americans, an affiliate of the AFL-CIO, and other advocacy groups also oppose the bill.

They opposed not only the caps on damages but also provisions that would shield the information in an incident report required by federal and state law whenever a resident is injured, preventing certain state reports from being used in court.

Nursing homes provide care to permanent residents as well as temporary residents who require long-term care but can't be cared for in their homes, such as people who have suffered a stroke or are recovering from hip-replacement surgery.

When a resident has been injured, he or she can sue for economic, noneconomic and punitive damages.

If the injury results in death, adult children can sue for wrongful death. Those awards by state law are capped at $350,000 for adults. They also can sue for economic, noneconomic and punitive damages because the potential claim becomes part of the estate.

The cap on punitive damages, designed to punish a defendant, could be the most significant change, said Pat Sullivan, an attorney with Siesennop & Sullivan.

"Most cases settle, and most get settled because of the risk of punitive damages," said Sullivan, who defends nursing homes and assisted living centers.

Punitive awards are relatively rare. "But they are a very big stick to wield," said Matthew Boller, a Madison plaintiffs' attorney.

The same holds to a lesser extent for awards for pain and suffering, or noneconomic damages.

The proposed cap of $750,000 for pain and suffering would be similar to those for doctors and hospitals. Those caps extend to some - though not all - nursing homes affiliated with nonprofit health systems.

Effects disputed
Economic damages, which are tied to lost earnings and medical expenses, can be relatively limited for residents in nursing home and assisted living centers.

Families can be compensated for funeral and out-of-pocket medical expenses. But awards for medical expenses stemming from the injury, such as hospital costs, typically reimburse Medicare, Medicaid and insurance companies - though plaintiff attorneys get to keep money for expenses and fees. Those typically amount to 30% to 40% of a settlement or award.

The caps on noneconomic and punitive damages would limit plaintiff attorneys' leverage in negotiating settlements because nursing homes and assisted living centers wouldn't have to fear multimillion-dollar awards if the lawsuit went to trial.

Brian Purtell, director of legal services for the Wisconsin Health Care Association, which represents nursing homes, said the cap would help stabilize rates for malpractice insurance.

Malpractice lawsuits against nursing homes are less common in Wisconsin than in other states, Purtell said. But he said the number of lawsuits has increased in the past five years, and national law firms that specialize in suing nursing homes have begun advertising in the state.

"People need to remember this bill is part of a much larger effort on the part of the governor to change the (business) environment," said Purtell, who also is executive director of the Wisconsin Center for Assisted Living, an affiliated trade group.

But John Hendrick, director of governmental affairs for the Coalition of Wisconsin Aging Groups, said the changes would limit people's ability to be compensated for injuries, neglect and abuse.

The advocacy groups opposing the proposed changes contend that if fewer people are harmed, fewer lawsuits will be filed and the cost of insurance will go down.

They also contend that the bill would increase the cost of the Medicaid program, which pays for nursing home care for people who are impoverished.

Medicaid is reimbursed when a resident or his or her estate is awarded damages for negligent care. And the Coalition for Wisconsin Aging Groups estimates that Medicaid pays for 62% of all nursing home residents in Wisconsin.

The advocacy groups also oppose sections of the bill that could make it harder to win lawsuits against nursing homes.

Those sections get technical but could be as important as the proposed caps.

They would protect incident reports - which must be filed by law when a patient has been injured - from being subpoenaed. The reports include interviews with and written statements from employees.

The bill also would prohibit certain state records - such as so-called statements of deficiency and misconduct incident reports - from being used in a deposition or in court.

Lawyers contend the reports can show a pattern, such as chronic understaffing, by a nursing home.

The reports would still be available to the public, but couldn't be used in court.

"I have a hard time understanding the rationale," said Jeff Pitman, an attorney with Pitman, Kyle, Sicula & Dentice S.C.

Nursing homes - as well as hospitals and other health care providers - contend that health care workers are more likely to be candid if their statements will not end up being used in a lawsuit. That is important in quality reviews and other work to improve patient safety.

"You want the opportunity to have that warts-and-all discussion," said Purtell of the Wisconsin Health Care Association.

Patient advocacy groups are unconvinced. But Sullivan, who defends nursing homes, contends the bill's potential effect is overstated.

"There still will be lawsuits against nursing homes," he said. "There will be fewer of them. But as I read the bill, there still will be opportunity for fair compensation for people injured by negligence."



Patient advocates object to nursing home liability limits - JSOnline

Wisconsin Law threatens Seniors

Everyone agrees our economy needs improvement.

But, supposedly in the name of jobs, jobs, jobs, Governor Walker has proposed legislation that would protect the profits of Fortune 500 nursing home corporations at the expense of senior citizens.

His proposed legislation limits the amount of money a jury can award in nursing home abuse and neglect cases and makes it almost impossible for a jury to force a Fortune 500 company to pay money that would punish it for bad conduct that kills or maims local senior citizens.

How will this create jobs?

This legislation would come on the heels of a belt tightening that already severely limits the number of state regulators investigating nursing home abuse cases. Even when the state issues citations to bad facilities that hurt senior citizens, the amount of the fine is almost always laughable. The fines are considered the price of “doing business” for a Fortune 500 company. In fact, many fines are discounted if the facilities agree not to fight the fine and pay within 30 days.

Try striking that bargain with your upcoming property tax bill.

Our tax dollars fund Medicare and Medicaid. The large nursing home claims accept this money to care for our most frail seniors. If and when these same companies abuse and neglect our seniors (their patients), we taxpayers currently can hold them accountable by using our jury system. Only a few of these cases ultimately make their way through the system.

If Walker’s proposals pass, even these cases will fall. So much for concepts like local control, accountability and respect.

We need more accountability. We need to protect seniors. We need to protect the sanctity of human life.

We cannot pull out of an economic downturn by turning a blind eye to bad conduct that hurts and kills our most vulnerable citizens.




The Dunn County News Online - Our Front Page

coroners help in some nursing home deaths

The coroner in Morgan County, Ill., notified nursing home investigators last year when he determined that a nursing home resident had died after choking on a piece of ham.

Coroner Jeff Lair, who asks that nursing homes in his county report all deaths to him, said investigators then cited the facility because the resident was supposed to be on a special diet and be supervised while eating but was not.

The coroner in Effingham County, Ill., also contacts state officials about nursing home deaths.

"We have to speak for these people," said Leigh Hammer, Effingham's coroner. "We have to give them a voice. Just because they are elderly doesn't mean that they were meant to die."

Kentucky does not require nursing homes to report most deaths to coroners, who are rarely called even when abuse or neglect are suspected. However, that might change if a bill proposed by Rep. Tom Burch, D-Louisville, passes.



Read more: http://www.kentucky.com/2011/01/19/1603010/states-say-coroners-help-in-nursing.html#ixzz1BW9b47l6
States say coroners help in nursing home deaths | Voiceless & Vulnerable: Nursing Home Abuse | Kentucky.com

Ex-nursing home workers get 2 years for photos, videos of helpless patients

Two nursing home workers who admitted taking photos and videos of nude, helpless patients were sentenced today to two years in prison.

Mary Ann Burgess, 52, and April Longmire, 37, pleaded guilty last year to four counts of health care abuse each.

Circuit Judge Richard Vance handed down their punishment during the women’s respective hearings at the Sevier County courthouse.

The women, who worked as certified nursing assistants at Pigeon Forge Care and Rehabilitation Center, were indicted in September 2009 after a Tennessee Bureau of Investigation determined they took numerous nude and degrading photos of elderly patients, some dating back to 2007. Some of the photos included shots of patients sitting on the toilet and lying naked on the floor.

The women’s duties included dressing, changing and feeding severely disabled adults, many of whom suffered from mild dementia to sever Alzheimer’s.

TBI Agent T.J. Battle testified today that the photos were discovered after a lost phone was turned into nursing home employees. Administrators there found the pictures while trying to find out who the phone belonged to.

Battle testified that during interviews both women admitted to taking the photos and said the phone belonged to Longmire.

One victim’s daughter cried on the stand as she pointed to photos both women had taken of her mother.

“She was never the same after those two sickos done what they done to her,” the woman testified.

“She was scared of everyone. There is not a doubt in my mind that those two will do this again. Please keep in mind how helpless my mother was.”

Assistant District Attorney General George Ioannides had asked the judge to sentence both women to two years in prison — the maximum punishment allowed by law.

“Because of the vulnerability of the victims, their age, their various mental capacity and the fact these offenses were committed, we say, for the defendants’ pleasure and excitement ... we ask the court to impose a sentence of significant confinement,” Ioannides said.

“They had rights to privacy. They had rights to decency.”

Both women’s attorneys had asked that their clients receive probation for the offenses because they showed remorse for their actions .

In the end, Vance sentenced both women to prison time.

“The nature of these off were so shocking, reprehensible and offensive,” Vance said.

He ordered her both women to report to the Sevier County jail Feb. 19 to begin serving their sentences.

Both women, fired from the nursing home after the incident, were banned from ever working in a health care facility again.



Ex-nursing home workers get 2 years for photos, videos of helpless patients » Knoxville News Sentinel

Can Music Prevent Bedsores?

Bedsores can be a serious problem for the elderly, but a University of Cincinnati study aims to curb them at Kentucky nursing homes with the help of music.
Every two hours, music plays over a loudspeaker, prompting caregivers to stop what they’re doing and make sure residents are re-positioned to keep bedsores from forming.

Researchers are partnering with Signature HealthCARE to conduct the study at 10 of the company’s Kentucky homes, including two in Louisville.
“We love it,” said Kelly Thompson, administrator of Signature HealthCARE of East Louisville, which is part of the study group. “They let you pick your music … and everybody knows it’s time for moving.”

“Repositioning people is not something new; what’s new is the prompt,” said Pam Larimore-Skinner, director of nursing at Signature HealthCARE of Trimble County in Bedford, Ky., which also is participating. “I think it makes people more conscious of the two hours because time can get away from you.”

Bedsores, also called pressure sores or pressure ulcers, are damaged areas of skin caused by staying in one position too long. People who are bedridden or use wheelchairs are at greater risk for these sores, which can lead to serious infections that can even be life-threatening. The problem is on the rise nationally.
Medical guidelines say patients should be moved at least every two hours. But nationally, “we know that the compliance of staff is frequently not what we want it to be,” said Elaine Miller, a UC nursing professor.

Researchers from the UC College of Nursing got a two-year, $300,000 grant from the Robert Wood Johnson Foundation to look at whether a simple audio reminder can prompt a nurse-led team to make sure patients move or get moved. The Cincinnati team competed with more than 100 other applicants for the funds.

In the study, four nursing homes used the program since the spring, while another four “comparison” homes were observed for months, then began using the program in November. Two others had problems with intercoms and have been used as comparisons throughout.

Every two hours, music plays over a loudspeaker, prompting caregivers to stop what they’re doing and make sure residents are re-positioned to keep bedsores from forming.

“The study involves the ambulatory residents, who can get up themselves, and the bedridden, who need to be turned with the assistance of staff,” said Assistant Professor Tracey Yap, principal investigator on the study. “The musical prompt is a reminder for patients that ‘you need to get up’ and for staff that this is the time to move those who cannot do so themselves.”

Local nursing home officials said their entire staffs are involved in the project, from nurses to administrators to housekeeping workers. Anyone who needs hands-on assistance gets help from the nursing staff, Yap said, while other employees can give verbal reminders to those who don’t need such help.

“It’s a team project,” Yap said. “That’s the innovative part of it.”
Officials said they vary the music so it doesn’t get repetitive or easy to tune out. Larimore-Skinner said her nursing home has played small bursts of everything from classical to country to holiday music.

http://www.courier-journal.com/article/20101231/NEWS01/312310060/10-Kentucky-nursing-homes-using-music-to-help-curb-bedsores

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 - ContraCostaTimes.com