California Nursing Home Abuse Lawyer BlogA new stringent system is waiting to be implemented by the Centers for Medicare & Medicaid Services to Nursing Home Compare that will lower the cut-off points regarding the attainment of certain star levels. The system calls for 11 new quality measures that threaten to jeopardize star ratings of as many as 15% of nursing home facilities that could result in their immediate loss of one or two stars. The CMS has not yet disclosed exactly how many facilities will be affected. However, the matter will be discussed at its Skilled Nursing Open Door Forum today, at 2 p.m. ET.
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Vote Yes on Proposition 46
This November, there will be an important proposition on the ballot that all advocates of older adults should be aware of. The Troy and Alana Pack Patient Safety Act, also known as Proposition 46, is a ballot initiative that will protect patients from corporate greed in healthcare services. It is imperative that anyone concerned with elder abuse vote Yes on Proposition 46.
Proposition 46 will accomplish three things: 1) require health care providers to check a uniform database before prescribing medication to prevent drug abuse; 2) require doctors to take a drug and alcohol test; and 3) increase the limits on noneconomic damages for medical malpractice cases.
Older adults take many prescription medications. National Institute on Drug Abuse states that, older adults make up more than a third of all outpatient prescription medication cost even though they are a minority of the general population. California currently has a database that monitors how medication is prescribed and dispensed to prevent various types of drug abuse. This is called the CURES program, or Controlled Substance Utilization Review, and is administered by the Department of Justice. Proposition 46 mandates that physicians and pharmacists check CURES before prescribing or dispensing medication. Doctors would be advised through CURES about existing prescription, especially for strong painkillers (such as Vicodin and OxyContin) that carry a high risk of abuse.
Elder Care Technology can give Independence to Alzheimer’s Patients
According to the Alzheimer’s Association, over 5.3 million people over the age of 65 have been diagnosed with Alzheimer’s disease in the United States. Alzheimer’s is a disease that not only inhibits the patient’s mental capacity, but also can be a severe burden on family and friends close to the Alzheimer’s patient. Having a loved one with Alzheimer’s is both emotionally draining and physically burdensome due to the constant physical care a patient requires. For patients with mild cognitive decline to moderate cognitive decline, a loss of independence may be the most frightening aspect of an Alzheimer’s diagnosis. Presently, there are multiple elder technology companies creating innovative products to delay the patients’ admission to a skilled nursing facility. Continue Reading
Arbitration Agreements Are Not in the Best Interests of Elderly Residents
An increasing number of nursing homes have implemented forced arbitration agreements within their admissions process. This has resulted in elderly residents and their family members signing away their constitutional rights and protections in order to obtain care within these facilities. However, consumers should be aware that nursing home arbitration agreements are inherently unfair and disadvantageous to vulnerable elderly residents and their family members. Therefore, it is important that residents and their family members understand what an arbitration agreement is and realize that they are not required to sign or agree to them.
What is an arbitration agreement?
An arbitration agreement states that the resident agrees that if a dispute arises between the facility and the resident, the resident will agree to bring the dispute before a professional arbitrator, rather than file a lawsuit with the court for resolution in front of a jury. When a case is taken to an arbitrator, the arbitrator will make the final decision and appeals are not allowed as arbitration is conducted in private and is not subject to judicial review. Therefore, arbitration agreements may essentially have the effect of allowing nursing homes to escape accountability for their wrongdoings since these agreements prevent residents and their families from suing the facility if their loved one was to suffer injury, harm, or even death while under their care.
What does California Law require?
It is important to note that in California, under the California Health and Safety Code § 1599.81(a), nursing homes are forbidden from requiring residents or their families from signing arbitration provisions in order to obtain admission into a facility or to continue their stay in such facilities. Additionally, under California Health and Safety Code § 1599.81, California also requires that nursing homes place arbitration agreements on forms separate from the admission agreement documents, and states that a resident may not waive their ability to sue the facility for violations of their Patient’s Bill of Rights. However, even with such laws in place, residents and their family members must remain cautious. They should ensure preservation of their constitutional right to take their case to court if necessary by refusing to sign arbitration agreements.
The Culture of Medical Information Gaps in Skilled Nursing Facilities
Milta O. Little’s article, “Climbing Out of the Black Hole of Subacute Care”, explores the existence of a medical information gap that is aptly comparable to a black hole in outer space: once a patient is moved out of a hospital and into a subacute care facility, their medical profile ceases to exist to the rest of the health care community. Subacute care is implemented for patients who need health care that can be provided on a long-term basis, and can apply to many medical conditions that require the patient to rely on 24-hour nursing care. As a result, many of the patients who disappear into this ‘black hole’ are the frail and elderly who are neither well enough to live independently at home nor ill enough to continue staying at a hospital.
Much of the information pertaining to a transitioning patient’s current condition is crucial in a nursing home’s ability to truly help the patient through a full recovery while maintaining good health. It is disparaging that vital information needed to fully understand a patient’s needs is often lost or disregarded during a patient’s transition from a hospital to subacute care. As a result, nursing homes often neglect to provide detailed care to patients that need special attention. The loss of that information usually results in the aggravation of a patient’s condition that could have easily been prevented in the first place. Vulnerable patients are also at high risk of reentering a hospital from the facility, thus creating an influx of residents who are constantly being transitioned from the facility to the hospital and back again. This is a situation that is often avoidable if subacute care facilities give the proper amount of attention to their patient’s medical information and employ properly trained nurses. Studies have also shown that constant transitioning between a hospital and a nursing facility is directly harmful to the patient’s health, as patients tend to become despondent. Errors are also more likely to occur as various health providers and care sites become involved in the process.
A large amount of the information loss can be attributed to a lack of communication that is perpetuated and encouraged by the current work environment of nursing facilities. The majority of people who feel that they or their loved ones have suffered from abuse or neglect within the nursing home environment complain that the facility and nurses withhold important information concerning the patient and simply do not communicate any problems or issues that the patient may currently be facing. This lack of communication is an indication of the low quality of care that exists in many nursing homes.
There are many health problems that occur within the nursing home environment that are preventable, given that the nurses and staff are adequately trained and the facility employs the proper amount of staff. When a nursing home is understaffed, a few preventable health issues will start to trend within the facility’s patients. Pressure ulcers, which are sores and bruises that occur on the skin if a patient is not adequately moved around, become a common occurrence, and infections are easily spread from patient to patient through improper handling and poor hygiene on the part of the nurses providing care. Both infections and pressure ulcers are easily preventable and are often signs of elderly neglect.
Non-Pharmacological Alternatives Provide Better Treatment for Neuropsychiatric Symptoms of Dementia
The neuropsychiatric symptoms of dementia (NPS), which are characterized by psychological and behavioral problems, have a rather large presence within nursing homes as about 60% of the elderly individuals living in long term care have been diagnosed with dementia. The majority of the individuals of this group will go on to develop NPS at some point of their illness. Dementia is a chronic brain syndrome that affects a person’s brain function so that their emotional behavior, cognitive skills, memory, and speech are slowly corroded. Most dementia types are degenerative and cannot be reversed. However, even though the effects of dementia cannot be reversed, they can be slowed or treated through two different methods: psychotropic medications or non-pharmacological alternatives. In 2012, JAMDA conducted a study examining the effect of non-pharmacological alternatives as a means of treatment for dementia in comparison with the use of psychotropic medications within long term care facilities.
The guidelines associated for neuropsychiatric symptoms of dementia often strongly recommend the use of non-pharmacological interventions to treat elderly patients, some of which include but are not limited to: mental health consultation and treatment planning, staff training in NPS management strategies, recreational activities, music therapy, exercise, and other forms of sensory stimulation. However, some skilled nursing facilities rely instead on the use of psychotropic medications in order to subdue, or chemically restrain their patients. When psychotropics are combined with other drugs such as benzodiazepines, antipsychotics, or other sedatives, all of which are commonly used to treat NPS, polypharmacy can occur.
Chemical restraints are unjustly used in nursing facilities where understaffing and lack of correctly trained staff is a prevalent problem. The study found that by increasing the number of nursing staff available and ensuring that the staff is properly trained, the facility is able to better process the many demands that long term care staff must fulfill in order to provide sufficient care to their patients. This further opens up the amount of time that staff can engage in non-pharmacological activities that may help reduce NPS in dementia patients. There was evidence that pointed to the idea that NPS was further aggravated by unmet needs, and thus residents would use the symptoms as an expression to relieve needs such as uncomfortable sensations and pain, and a reduced threshold to stress. Chemical restraints do nothing to solve the needs of the elderly; instead, it takes away their ability to even express discomfort or pain.
Misuse of Antibiotics in Long-term Care Facilities Leads to Increasing Amounts of Antibiotic Resistant Bacteria
The Journal of the American Medical Director’s Association has just published a literature survey looking at the overuse of antibiotics and spread of resistant bacteria strains in long-term healthcare institutions. The authors have sifted through 156 scholarly reports on the subject to come up with a synthesized statement on long-term care and antibiotic resistance. They have also focused on prevention measures, both against the creation of new resistant strains and the spread of infections throughout facilities. These observations are particularly relevant to skilled nursing facilities as the elderly are at an increased risk for severe infections due to more compromised immune systems and other care factors.
The use of antibiotics in long-term care has a very high prevalence. On average, 47 to 79% of all patients are one some kind of antibiotic, for a wide array of health reasons. While these drugs are a vital tool in healthcare, not all use is warranted or correct. The overuse and misuse of antibiotics can result in bacterial super-strains, that are resistant to all or most of known antibiotics and generally have a higher rate of morbidity and mortality. Perhaps the most well-known of these strains is methicillin-resistant Staphylococcus aureus, or as it is more commonly known: MRSA. Other resistant infections include strains of pneumonia, strep, meningitis, and many cases of sepsis. The numbers of resistant infections have gone up greatly over the last decade. In order to break this trend, training about the misuse of antibiotics has to be stressed, especially in places like nursing homes where prescription rates are very high. The study also identifies the failure to implement infection control procedures as an issue in nursing facilities, putting patients at risk. Only 38.1% of all nursing homes employ an infection control officer.
The misuse of medication can be a problem in skilled nursing facilities. Many institutions do not employ the necessary numbers of nursing staff to see to all of the needs of each resident individually. In such long-term care facilities many patients require assistance in normal function and activities. But instead of devoting the staffing hours necessary to supervise the patients to prevent falls and accidents, some places will instead prescribe antipsychotic drugs and tranquilizers to subdue and restrain them. Off-label prescribing to chemically control patients is frequently employed in conjunction with excessive use of physical restraints. The use of medications as restraints is not only dangerous as many of the drugs can have very harmful side-effects, but it is also a direct violation of patients’ rights.
By law, nursing care facilities are required to provide adequate staff to supervise and assist in daily activities for those patients that need it, and the use of medications instead of direct care contact is abuse. California Health and Safety Code section 1430(b) allows any patient that has been subject to injury and abuse to sue the offending facility for damages. Other abuses that can prompt a 1430(b) case include dehydration, malnutrition, pressure ulcers, and the improper treatment of incontinence issues.
A New Study Looks at the Prevalence of Burnout in Healthcare Employees
A recently published study examines levels of burnout in healthcare workers. Via interview and survey, the researchers looked to discover what percentage of workers suffer, what are the contributing factors that make staff more susceptible, and what types of facilities are most conducive to burnout. The study concluded that burnout is higher in long-term care facilities, especially nursing homes.
On average, 18% of all those involved in healthcare suffer from burnout. Burnout syndrome is characterized by emotional and physical exhaustion, depersonalization with respect to patients, and a low perception of job worth. The study also measured the average levels of each symptom, observing a 33% incident of exhaustion and that 36% of healthcare providers suffer from depersonalization. These values are higher in nurses and assistants, as the amount of time spent in direct contact with patients corresponds with the likeliness of burnout. Because they employ mainly nurses, skilled nursing facilities have an even higher risk than other healthcare center.
Burnout not only has a detrimental effect on employees, but can directly impact the quality of care given to residents. Staff suffering from burnout are much more likely to be irritable, anxious, and moody, resulting in fraught relations with patients and their families. They are also less productive and time efficient. As a result, other staff members are put under more stress to pick up the workload. The quality of care that the patients receive for those with burnout syndrome can also significantly decrease.
Burnout is a very significant issue for nursing homes as it is harmful to both employees and patients. Facilities should take precautions to prevent burnout from happening. Studies indicate that overwork and stress are major factors in burnout, such as would be experienced in an understaffed nursing home. Adequate preparation and job specific training can also help staff avoid burnout. For this reason, and others, it is very important that enough nursing staff are employed to fully take care of all residents. Besides burnout, understaffing can harm patients in other ways, including infection outbreaks, increased fall risks, and even wrongful death.
Perhaps one of the most common injuries brought about by understaffing is the development of pressure ulcers. Pressure sores occur when a bedridden, or largely immobile, patient spends too long in one position and pressure upon tender areas of skin causes the damage and death of issue. Bedsores can become so severe as to destroy the surrounding muscle and even expose bone. Pressure ulcers are preventable, so it is a travesty when nursing home residents are forced to go through long periods of suffering due to them. In some cases, the severity of decubitus ulcers can even lead to death. When there is adequate staff in a nursing home to properly care for their residents, pressure sores can be prevented by periodically repositioning the patient so as to relieve pressure on sensitive areas and keeping up with nutrition, hydration and activities to maintain skin health. These prevention techniques are very effective and relatively easy to do, as long as the nursing home employs enough staff to fully care for their patients, and not violate their right to a good quality of life.
Nursing Home Staff Reports Understaffing as the Main Reason for Failed MRSA Infection Control
Methicillin-resistant Staphylococcus aureus (MRSA) is an infection that is commonly contracted by residents of skilled nursing facilities. It is a type of bacteria that lives on the surface of the skin and does not become a problem until it enters the body, usually via open wounds, such as pressure sores, breathing tubes, and catheters. Once MRSA enters the body, it can become extremely serious because it is often related to other infections including blood infections such as sepsis.
Because MRSA infections are very serious and can even lead to death, it is important to ensure that your loved one’s nursing home is taking the proper precautions to prevent and control the spread of infection. A recent article published in the Journal of Hospital Infection titled “Infection control and methicillin-resistant Staphylococcus aureus decolonization: the perspective of nursing home staff” studied infection prevention techniques in nursing homes. The study, which focuses specifically on MRSA infection control, interviewed nursing home staff and revealed some of the most common factors preventing caregivers from adhering to infection control procedures.
One of the top recurring factors that nurses cited as a reason for failing to follow infection control guidelines was lack of time. When nurses felt that they were under too much pressure, infection prevention and control were among the first caretaking practices to suffer. One nurse reportedly said that “Anything to do with infection control is more time consuming…you’re always working short staffed…that’s where bad practice comes in.” Usually, when nurses feel pressed for time, it is because the nursing home is understaffed. As this study has confirmed, nursing homes are unable to effectively prevent and control the spread of infection if they are inadequately staffed. Avoid putting your loved on at risk for contracting dangerous infections by ensuring that his or her nursing home is fully staffed.
Additionally, it is also important to ensure that the nursing staff is one dedicated to providing a high standard of care to your loved one. Many nurses reported that even if they adhered to infection prevention guidelines, their efforts were often nullified by other staff members who chose to forgo these infection control procedures. Under these circumstances, the nurses felt that inactive management was responsible for failing to enforce infection control guidelines among their colleagues. It was also found that employees who did not provide direct care to patients were most likely to forgo infection control procedures because they did not feel personally connected with patients. However, the nursing home is responsible for ensuring a cohesive staff that adheres to all rules and regulations regardless of whether or not they provide direct care to patients.
Despite nurses’ pleas to administrators and directors of nursing to enforce or improve infection control regulations, the study revealed that most skilled nursing facilities waited until after massive outbreaks of infection to implement any guidelines at all. It is completely unacceptable and egregious that some nursing homes wait until after many of their residents have suffered infections before taking steps to improve their infection control guidelines. Infection control must be precautionary, not something that happens only after the fact.
Class Action Suit filed against New Hampshire Hospital Responsible for Infecting Over 20 Patients with Hepatitis C Due to Staffing Negligence
You go to a hospital to get better, or at least to receive what medical assistance as may be possible. What you do not expect is for the hospital to make you worse, to give you a new disease. This is exactly what has allegedly happened to patients at Exeter Hospital in New Hampshire. At least 20 people have been confirmed as testing positive for Hepatitis C. During their stay at Exeter they were possibly infected by contaminated needles and equipment. Many people who were hospital residents during the time when the infection was present are currently being tested with their results pending. The government has lent its assistance to the matter and designated two nearby healthcare facilities as alternative testing sites to expedite the process.
The source of the Hep C outbreak has likely been traced to a hospital employee. This person used intravenous drugs while on the job and possibly contaminated syringes that were later used on patients. A class action lawsuit has been filed against Exeter Hospital for their negligence in allegedly allowing this employee to cause the outbreak. It is a hospital’s responsibility to ensure that proper safety procedures are put in place to prevent events like this from occurring. As of now, there are 44 affected people as part of the lawsuit, but this number could easily grow as more than 1,000 were possibly at risk from exposure.
Healthcare facilities, such as Exeter Hospital, are responsible to their patients; they are required to provide a safe environment, free of threats and harm, to those under their care. There must be an adequate number of trained staff, who are properly supervised and monitored, to prevent the type of damage that allegedly occurred at Exeter. Unfortunately, it is very common, especially in skilled nursing facilities, for there not to be enough qualified care givers. Understaffing can be very dangerous and is a contravention of patients’ rights statutes. Studies have shown that understaffed facilities are more likely to have occurrences of harmful, and even fatal, mistakes by care personnel. Patient quality of life is also adversely affected.
Pressure sores are a common side effect of an understaffed and under-educated facility. Bedsores can be avoided by relieving stress on sensitive areas and maintaining skin health through diet and exercise. Unfortunately, many residents in skilled nursing homes are malnourished, which has a marked negative impact on their risk factor for contracting pressure ulcers and other diseases. Nursing home patients who are malnourished or dehydrated are much more susceptible to infections such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, and influenza. When healthcare facilities provide ample nursing staff to maintain and monitor each patient’s health and status, it is much easier to prevent the spread and outbreak of these harmful diseases. Care providers should be educated in the identification and care of common infections and pressure sores.
