Quality of Care

Implementing Non-Pharmacological Interventions for Dementia

March 6, 2014 | by Yeroushalmi Law

It is becoming increasingly evident that pharmacological interventions should be a last resort when treating patients with dementia. Due to a lack of resources and staff most skilled nursing home facilities overlook non-pharmacological options. However, studies have shown that non-pharmacological treatments are a safer alternative for patients. While pharmacological interventions are an effortless option for nursing homes and hospitals, they fail to improve the state of the resident. These medications might look like they are improving the condition of the patient however, these drugs sedate them as their condition worsens. In some cases, it could cause sufferers of cognitive disorders to deteriorate rapidly and act out.

The staff at a facility may often focus on the cognitive deterioration of the sufferers of dementia. As such, other symptoms that are linked to dementia may be overlooked. These symptoms generally manifest themselves in the forms of agitation, aggression, eating disorders, loss of appetite, and abnormal vocalization. Many of these symptoms may also grow to be the cause of death. For example, eating disorders and loss of appetite can lead to malnutrition. Furthermore, the use of medications have side-effects including sedation, psychosis, tremors, and may even lead to falls. More recent cases show that the pharmacological treatment of dementia leads to reduced resident well-being and quality of life, and may even accelerate cognitive decline.

Investigation Reveals Rampant Abuse and Neglect at Alzheimer’s Care of Commerce

March 5, 2014 | by Yeroushalmi Law

One may feel that by placing their loved ones under the care of a skilled nursing facility, they would be provided with quality care. Unfortunately, that is not always the case. An investigation began on March 29, 2013 when an employee at an assisted living facility, Alzheimer’s Care of Commerce in Jacksonville County contacted authorities to report cases of abuse. The Alzheimer’s Care of Commerce focuses on elders who are suffering from Alzheimer’s disease.

After some investigation, the facility was raided in July 2013. Authorities arrested twenty employees and the owner of the facility following claims that the staff assaulted, restrained, and over-medicated patients. The facility is currently facing a total of seventy two criminal charges. However, according to Mike Ayers, the special agent in charge of the Georgia Bureau of Investigation Athens regional office, there could be more charges. They will not know until the district attorney looks at the files. The abuses that are being reported are cruel, inhumane; and so severe that the case may be forwarded to a grand jury this May.

Non-Pharmacological Mealtime Interventions for Sufferers of Dementia

March 4, 2014 | by Yeroushalmi Law

Of the symptoms associated with dementia, one of the most common is agitation. It is common for sufferers of dementia to be increasingly agitated at meal times. According to an article in the Journal of American Medical Directors Association, “Effectiveness of Mealtime Interventions on Behavior Symptoms of People with Dementia Living in Care Homes: A Systematic Review,” multiple skilled nursing facilities participated in a study. Four different methods were used to reduce agitation at meals. The goal of this study was to improve behavioral symptoms in elderly people who suffer from dementia in these facilities. These four interventions included playing music during mealtimes, changing the lighting and increasing visual stimulation, providing more options, and promoting conversation. All of these interventions made great alternatives to medicinal interventions, as many studies demonstrate that tranquilizing dementia patients medicinally when they are agitated worsens their condition.

A resident who suffers from dementia could come to cause a scene during a meal which in turn could lead to a loss of appetite and ultimately lead to weight loss and malnutrition. Increased stress and anxiety during meals reduces the sufferer’s ability to meet their nutritional needs, and interrupts other residents from enjoying their meals. This is something that could stress the staff as well. Weight loss and malnutrition are known to be common issues for those who suffer from dementia. Simple and effective non-pharmacological interventions which attempt to improve the mealtime environment could lessen outbursts, increase eating times, and lead to better nutrition, benefitting both the residents and the staff.

Neglect Results in Death of Nursing Home Resident

March 3, 2014 | by Yeroushalmi Law

More often than not we are forced to do things that we would prefer not to. One example would be placing our loved ones under the care and supervision of a skilled nursing facility. When our loved ones are in a fragile state, we would like to keep them as close to us as possible. Sadly, at times, we are not able to provide our loved ones with the attention and medical care they need. While we would like to think that they are being provided with the highest level of care at a skilled nursing facility, it is regrettably more likely that they are not. An unfortunate example of this would be a recent case at a home in Medford, New York where the neglect of a 72-year-old woman who was under the care of a skilled nursing facility lead to her untimely death.

Evidence shows that the staff ignored all alerts and pages from the patient for more than two hours. The resident stopped breathing and, according to authorities, had likely been dead for some time until a nurses aid finally went to check on her. The level of ignorance and mistreatment in this appalling case is astounding. At a certain point the elderly are unable to breathe on their own, and therefore, are hooked up to a ventilator which regulates their breathing. While it is ludicrous that this resident was ignored for over two hours the resident had orders from her doctor stating that she must be connected to a ventilator machine at night. These orders were blatantly disregarded, which led authorities to believe this was the actual cause of her death.

RCFE Reform Act of 2014 Proposes a Dozen New Bills Aimed At Increasing Care and Regulation

January 22, 2014 | by Yeroushalmi Law

In California, twelve new bills were recently proposed in support of increasing the care, health, and safety of elderly individuals staying at residential care facilities for the elderly (RCFEs). The purpose of these bills was also to enhance state enforcement and regulation, and came in light of numerous reports and occurrences involving elder abuse, injuries, and deaths occurring within such facilities. Many of these bills are sponsored by the advocacy group CANHR and cover a breadth of aspects within RCFEs.

Report Reveals Impact of CMS Initiative Aimed at Reducing Use of Antipsychotic Medications

January 13, 2014 | by Yeroushalmi Law

The Centers for Medicare and Medicaid Services (CMS) launched the initiative Partnership to Improve Dementia Care in Nursing Homes to lower the use of antipsychotic medication in nursing home facilities. The aim of this initiative was to reduce the inappropriate use of antipsychotic drugs by 15%. However, this goal was not met, and as of 2013, the rate of antipsychotic drug use for long-stay residents was reported to be about 21%, which was approximately a 9% reduction. This meant that more than 1-in-5 residents, or about 300,000 individuals, are still being administered antipsychotic medications.

The Center for Medicare Advocacy recently issued a report analyzing antipsychotic medication use in nursing home facilities. One aspect of the report delved into the perspectives of state surveyors and their process of citing facilities for antipsychotic drug deficiencies. Specifically, the report revealed whether or not the surveyors found any changes in the practices of nursing home facilities after CMS launched its antipsychotic medication initiative.

Study Exposes Nursing Home Staff’s Lack of Knowledge Regarding Antipsychotic Medication

January 7, 2014 | by Yeroushalmi Law

A recent study published by the Journal of American Medical Directors Association (JAMDA) provided insight as to the knowledge nursing home staff possessed regarding antipsychotic drugs, along with the beliefs they held regarding the appropriateness and effectiveness of such drugs. Antipsychotic medications are generally administered to dementia patients to address behavioral issues. However, administration of these drugs has raised significant patient safety issues. There has been evidence of increased mortality, morbidity, along with risks of serious side effects such as strokes and death. Furthermore, evidence revealed such drugs have limited efficacy in older adults who suffer from dementia. The Food and Drug Administration (FDA) even issued black box warnings to emphasize these risks. Despite such evidence, the use of antipsychotic medications is still high within such facilities.

The study’s survey revealed gaps in knowledge and awareness across all levels of nursing home staff regarding the negative effects of antipsychotic medication. Many believed these drugs were effective in managing the behaviors of dementia patients, and that managing the challenging behavior of such patients was not possible without these drugs. Specifically, only 37% of direct care staff felt they could handle difficult residents without the use of medications. An even more alarming finding exposed the lack of knowledge amongst prescribers such as medical directors, directors of nursing, and RNs/LPNs concerning the significant adverse effects of such medications. The study revealed that only 24% of nursing home leaders were able to identify at least 1 severe adverse effect of antipsychotics, while only 12% of RNs were able to list at least one adverse effect.

Medication Error Dangers in the Nursing Home

November 20, 2013 | by Yeroushalmi Law

A recent investigation in Michigan exposed the number of nursing home facilities in the state that were cited for significant medication errors. The resulting data from the investigation demonstrated that patients within nursing homes either failed to receive enough medication, were administered too much medication, or were administered incorrect medication. The Food and Drug Administration (FDA) reported that medication errors were responsible for injuring approximately 1.3 million people in the United States annually. Given the fact that many elderly individuals commonly take many prescription medications to treat various ailments and conditions, it is imperative that these individuals are provided with correct medication and dosages. The medications that are prescribed to these patients may be critical and vital to their well-being, and may make the difference between life and death.

The investigation noted several examples of medication errors taking place within these facilities. For example, one elderly man entered a nursing home facility for rehabilitation after receiving treatment for his abnormal heartbeat. However, he entered a diabetic coma and passed away after the nursing home failed to treat his diabetes, even though the nursing home knew the elderly resident was a diabetic. Another example involved an elderly woman who died from hypoglycemic brain failure after the nurse accidentally administered her roommate’s medication to her. Furthermore, while one elderly resident was prescribed eleven prescription medications to treat her medical conditions, she failed to receive any of these medications for over a week. The nursing home facility had come to realize their mistake only when the resident’s daughter brought this oversight to their attention. Other tragic cases that have resulted in resident death involved administering residents medication to which they were allergic, or failing to administer prescribed medication.

Lawsuit Seeks to Increase Nursing Home Resident Protections in California

November 4, 2013 | by Yeroushalmi Law

The non-profit nursing home advocacy group, California Advocates for Nursing Home Reform, has filed a lawsuit against the California Department of Public Health, challenging the constitutionality of a 1992 California law, Health and Safety Code § 1418.8. Under this law, if a physician deems a patient to be mentally incapacitated, the resident is found to lack sufficient mental capacity to deny medical treatments and administration of such treatments. As such, in certain instances, these residents were denied life sustaining treatment, subjected to the use of physical restraints, and administered psychotropic medications if they did not have a surrogate such as a relative, conservator, or guardian to deny such medical treatment decisions on their behalf. This is because the Department of Public Health has construed the law to allow facilities to administer intrusive treatments, along with forcing residents to take anti-psychotic medication.

The complaint cited several appalling instances of such elder abuse made against nursing home residents as a result of actions taken under this law. For example, one nursing home resident deemed mentally incompetent was restrained to his bed and fed through a feeding tube, in spite of his medical chart containing a statement that he was not incompetent. When staff later asked him if he wanted to live or die, the resident did not answer, and staff withdrew his feeding tube, revoked a life-sustaining care order, and sent him to a hospice where he died. This occurred because some facilities have interpreted the statute to allow them to end residents’ lives by denying them life-sustaining treatment via ‘do not resuscitate’ orders. Another shocking occurrence involved a nursing home resident who was administered antipsychotic medication without staff informing or checking with her family members who could advise the resident as to the treatment. The woman was later found to be competent.

Home Care Agencies Now Subject to Increased Regulation in California

October 24, 2013 | by Yeroushalmi Law

On October 15, 2013, California Governor Jerry Brown signed the Home Care Services Consumer Protection Act of 2013. The passage of this Act followed after the veto of a similar bill by the governor last year. It has served as a response to critics who have continually argued that the home health care industry has not been subject to enough regulation and oversight. The loose regulation of this industry has created room for caregivers to engage in acts of neglect and abuse towards their elderly clients, as was demonstrated in a study conducted by the California Senate Office of Oversight and Outcomes.

The study was released in April 2011, and demonstrated how California failed to screen employees who cared for the elderly in their homes. Some of these caregivers had criminal records, but had not been screened prior to employment. This documentation of elder abuse and neglect resulted in an increased push for tight industry regulations in California. The Act will impact approximately 120,000 caregivers and 1,400 home care agencies, and is representative of an effort being made to protect consumers receiving services within this industry.