California Nursing Home Abuse Lawyer Blog

World Elder Abuse Awareness Day

June 14, 2013 | by Law Offices of Ben Yeroushalmi

While no one can deny that certain demographics are aggressively protected, as evidenced by campaigns launched to protect children’s rights, women’s rights, or civil rights, it is not often that we hear about protecting our elderly’s rights. This is particularly shocking because the elderly are an especially vulnerable population, and one that is common to all nations. Elderly abuse is not an issue that is particular to any one country; it does not discriminate between developed or underdeveloped nations. For this very reason, it is important that a world-wide effort is made to spread knowledge about the risks of elder abuse and how best to prevent it.

In 2006, the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations designated June 15th as the 1st annual World Elder Abuse Awareness Day (WEAAD) . This day is designated as an international day to focus on ways to prevent elder abuse, in whatever form it may manifest. Very often, the elderly are physically abused by the very people responsible for their well-being. While this abuse may be as evident as acts of violence resulting in bruising or fractures, it may also be more difficult to detect, such as over-medicating to make them easier to handle. It may also be that they are simply being neglected, left unclean and alone for long periods of time resulting in pressure ulcers , infection, and depression. The psychological harm done to these elderly can be just as powerful and destructive as the physical damage. Many nursing homes use physical restraints to calm residents, which offends their sense of dignity and impacts their mental and emotional health. However, abuse is not limited to these categories; our elderly may also be victims of financial abuse. Just in the United States, elders lose upwards of 2.6 billion dollars annually due to financial abuse.

On June 15th, we must all make a collaborative effort to speak about the untold cruelties that many of our elderly are subjected to. We can no longer accept ignorance as an excuse to allow these atrocities to continue, and we must remember that our silence makes us enablers of these cruelties. On this day, people are encouraged to visit an elderly person, volunteer at a nursing home, or submit editorials about elder abuse to their local newspapers. The goal is to spread knowledge about an existing problem, ways to detect it, and steps to prevent or eradicate it.

Reduction in Polypharmacy is Beneficial for Both Nursing Home Residents and Health-Care Providers

June 13, 2013 | by Law Offices of Ben Yeroushalmi

It is not uncommon for the elderly to need the assistance of multiple medications to maintain their health. However, as the number of medications being taken increases, so does the risk involved. A study conducted by the Division of Geriatric Medicine at the Saint Louis University School of Medicine finds that incorporating more inter-professional education in nursing home caretakers’ training can help reduce polypharmacy in their facilities. Such discovery is significant when it is taken into account that up to 28 percent of nursing home residents are hospitalized due to adverse drug reactions (ADR). An ADR’s mortality rate is significantly increased when the patient is taking over six medications.

The need to decrease polypharmacy is not only evident in residents’ high rate of hospitalizations, but it is also reflected in the incredible cost created by it. The study cites a cost analysis which proves that for every dollar spent on medications in nursing homes, another dollar and thirty three cents are spent on treating adverse drug reactions. It is abundantly clear that nursing facilities should have a greater interest in reducing polypharmacy in order to increase the quality of care of their residents, and to decrease the cost of care for themselves.

Enhancing communication amongst nurses, doctors, resident’s families, and staff can help them track the resident’s medications, and detect any deterioration due to polypharmacy. This allows for all those involved in the resident’s care to be more fully informed about how they can best help him or her. The study also suggests that hand counting all medications prescribed to patients from the physician’s order sheet is a more reliable way to avoid any mistakes from using an electronic log. Although this may seem more time consuming for pharmacists, it reduces the time spent on having to solve adverse drug reactions resulting from negative drug interactions later. Additionally, minimizing the number of medications prescribed also reduces medication administration time, which allows staff more time to dedicate to providing proper care and attention to each resident. Furthermore, a resident that is less medicated has a decreased risk for falls, weight-loss, and even death.

This new information-based initiative is simple and can only be made possible through the cooperation of pharmacists and nursing home staff. The Omnibus Budget Reconciliation Act of 1987 (OBRA) included a clause which demands that all certified nursing homes have pharmacy services available on location at their facilities. Therefore, all certified nursing homes already have an infrastructure of professionals which facilitates the spread of knowledge in order to promote a decrease in polypharmacy. There is also an incentive present for nursing homes to decrease medication use in order to save money and time, and increase the quality of care for their residents. This need to increase the quality of care of their residents should outweigh their desire for convenience. Sedating patients so that fewer staff is needed to care for them is a common practice at many nursing homes that value convenience over their residents’ well-being, and it constitutes a form of elder abuse.

Re-hospitalization of Nursing Home Residents Related to Licensed Nurse Retention

June 7, 2013 | by Law Offices of Ben Yeroushalmi

It is no secret that taking care of the elderly in a nursing home is an incredibly important role that carries with it responsibilities of magnanimous proportions. In addition to offering physical aid to avoid falls and encourage mobility through physical exercises, nurses must also build rapport with their residents so that they may offer them emotional support through their caretaking process. However, the daily routine of caring for several residents often becomes exhausting for these nurses, leaving them burned out. Such exhaustion often results in a nurse leaving the facility and the relationships he or she has built with the residents. This common phenomenon among nursing home caretakers causes either a high turnover rate amongst nurses, or leaves the facility constantly understaffed.

A recent study published by The Gerontological Society of America explores the relationship that exists between nurse turnover and nursing home resident re-hospitalization. They find that many hospital readmissions may be prevented if the quality of nursing home care is improved through the hiring of more licensed nurses and licensed practical nurses. As it stands, they estimate that about 28% to a staggering 40% of re-hospitalizations may be avoided. In order to improve the quality of care, nursing homes must hire enough licensed nurses and keep them for long periods of time so that the care may be consistent. The study found that higher licensed nurse staffing correlated with lower licensed nurse turnover rates. More importantly this showed that increasing a nurse retention rate by 10% would reduce hospital readmission rates by 19%. This occurs because a long term stay at a nursing position fosters specialized knowledge which better equips nurses to provide a higher quality of care for residents.

In order to promote higher nurse retention rates in nursing homes, these facilities must invest time in constructing strategies to encourage long-term job retention. A nursing home’s priority must be to provide the highest quality of care to their residents. This includes ensuring that their residents’ needs to be hospitalized are minimized by maximizing the assistance they receive from professional nurses at the facility. In addition to the benefits conceded to residents from increasing nurse retention, there is also an economic incentive derived from it. Many nursing home administrators mistakenly believe that staff turnover is a money-saving strategy. However, nursing homes with higher performance levels on staff turnover, retention, and avoidable hospitalizations receive extra money from the CMS Nursing Home Value-Based Purchasing. Additionally, those that have an increased rate of Medicare hospital readmissions are actually sanctioned by receiving lower Medicare payments.

Nursing Home Dementia Patients: Link Between Pain and Disruptive Behavior

June 5, 2013 | by Law Offices of Ben Yeroushalmi

A 2013 study conducted by BioMed Central Geriatrics found that there is a strong positive correlation between pain and disruptive behaviors displayed by the elderly suffering from dementia. It explains that such behavior is often expressed through aggression or agitation, which increases these patients’ risk for injuries and hospitalizations. In fact, agitation is a common behavioral symptom which occurs in up to 80 percent of nursing home patients suffering from any type of mental deficiencies, not simply dementia. However, because dementia is characterized by a decreased ability to verbalize pain due to memory impairment, it causes the sufferer’s pain to manifest itself through destructive behavior.

This discovery is significant because it emphasizes the need for nursing homes to address troublesome behavior by dealing with the root of its cause, rather than simply attempting to manage the symptoms. Many nursing home caregivers often attempt to deal with these symptoms by using psychoactive restraints which not only lead to falls and decreased mobility, but also offend the personal dignity of the elderly. Such practices are common because a sedated patient does not need to be checked on for long periods of time, allowing a chronically understaffed nursing home to continue running with their limited staff. Therefore, this unethical practice bolsters understaffing, which is an important cause of elder neglect.

The BMC Geriatrics study also found that 30% of the cost of care associated with dementia is attributed to the cost of controlling disruptive behaviors. In other words, learning how to adequately cope with elderly pain would significantly help to reduce the overall cost of caring for dementia patients. This cost reduction should serve as an incentive for understaffed nursing homes to hire and train more qualified caregivers, ensuring a higher quality of care for their residents.

In addition to uncovering the root of a serious issue, this study highlights the extent to which many nursing homes are ill prepared to aid their residents. Without proper and extensive training of their staff, nursing homes will continue their unethical practices of medicating their disruptive patients in order to calm their agitation or aggression. Using psychoactive restraints to sedate patients into a state of compliance is a gross violation of the elderly’s Patient’s Rights. Their cognitive and communicative deficiencies subject them to a torturous silence which must be broken. It is the nursing home’s responsibility to not only care for the patient’s physical well-being, but to ensure their emotional and mental comfort as well.

Pressure Ulcers Linked to Patient Mortality and Hospital Re-admittance

January 25, 2013 | by Law Offices of Ben Yeroushalmi

A new study published by the Journal of the American Geriatrics Society concluded that there is a direct correlation between pressure ulcers (bedsores) developed during hospitalization, patient mortality and hospital re-admittance. According to the study, not only did seniors that developed pressure ulcers during their hospital stay have a higher chance of returning to the hospital within 30 days, but they also had a higher chance of dying during this subsequent hospital stay.

The lead researcher of this study by the UCLA School of Nursing, Dr. Courtney Lynder, was quoted saying, “It is incumbent upon hospitals to identify individuals at high risk for these ulcers and implement preventive interventions immediately upon admission”. The study found that approximately 4.5 percent of the patients being tracked in the study developed a pressure ulcer during their hospital stay. The majority of these patients developed the bedsores in the pelvic area such as the hip and tailbone. Of the nearly 3,000 patients that were admitted to the hospital with a pressure ulcer, 16.7 percent developed a new pressure ulcer on another part of their body during their hospital stay.

This study uncovers how serious the issue of pressure ulcers really is, especially in patients who are already at high risk of developing these wounds. Whether pressure ulcers are developed within the confines of a hospital or a nursing home, they are extremely painful and detrimental to the health of residents. Skilled nursing facilities must be vigilant to prevent such conditions from occurring by taking the necessary precautions such as alternating the position of immobile bedridden patients at least every hour and properly assessing the level of severity of the pressure ulcer, in order to implement the appropriate treatments. Effective treatment and prevention of pressure sores, however, is only possible with sufficient staff that are well-trained. If your loved one has developed multiple pressure ulcers, this may be a sign that his or her nursing home is understaffed. Unfortunately, maintaining a high quality of care is not always a priority in some nursing homes, especially in those that seek to increase profits by understaffing. This is an affront to the dignity and respect that nursing home residents deserve and a direct violation of their Patients’ Rights.

Polypharmacy is Linked to Increases of Adverse Effects in Nursing Homes

January 14, 2013 | by Law Offices of Ben Yeroushalmi

A recent study in the Journal of American Medical Directors Association has proposed that the use of multiple medications on patients, sometimes for off-label purposes, is a significant practice in nursing homes and may lead to adverse drug effects such as falls and delirium. This practice is referred to as polypharmacy and is reportedly widespread in nursing homes across America, with as much as 40.3 % of residents being given inappropriate prescriptions.

The overuse of these medications is particularly prevalent among psychotropic drugs such as antidepressants and antipsychotics. According to the study, between 50 and 80 percent of nursing home residents are prescribed at least one psychotropic drug. The use of antidepressants has increased among older residents as well, with a reported 49% of US nursing home residents being administered these drugs. Antidepressants are known to cause a multitude of adverse affects such as serotonin syndrome, falls, hypnatremia, delirium, gastrointestinal bleeding, and osteoporosis.

Despite growing evidence of morbidity and mortality, antipsychotic drugs have become the dominant medication in treatments of behavioral and psychological symptoms of dementia. Recent surveys have found that 1 in 3 nursing home residents are treated with antipsychotics, even though the efficiency of antipsychotic drugs is limited, with estimates between only one in three to one in five patients demonstrating significant improvement. Furthermore, the use of antipsychotic medication has been known to trigger numerous side effects such as delirium and unhealthy weight gain. Chronic understaffing in nursing homes coupled with the extensive use of antipsychotic medication for off label purposes can lead to the chemical restraint of patients. This morally reprehensible activity is a violation of the Patients’ Rights.

A study from the US national home survey also reported that 53.8% of all nursing home residents had hyper tension as a primary admission or as a current diagnosis. Of these residents, 84% were receiving at least one prescription for the complication, while 51.5% of those residents diagnosed with the condition were receiving two or more antihypertensive medications. Furthermore, there have been few trials that have included NH residents and even less that have proven a significant benefit to those residents.

The improvement in efficiency and safety of drug utilization in nursing homes has been increasingly seen as an essential element of high quality care in NH’s. This care can improve function and decrease mortality in seniors. Management of the prescription, purchase, storage, distribution, and administration of medications is an important factor in improving the health and lives of NH residents.

For-Profit Nursing Homes Found to Be Overcharging and Underperforming

January 11, 2013 | by Law Offices of Ben Yeroushalmi

According to an article in Bloomberg News, the for-profit private nursing home industry overbills Medicare by 1.5 billion dollars a year by conducting unnecessary procedures and therapy on their patients. This, however, is not the only way that for-profit nursing homes have been using unlawful methods to increase profits. Nursing homes frequently engage in the understaffing of their facilities in an attempt to cut payroll costs and essentially place profits over people. Between the years of 2008 to 2012, federal prosecutors have brought 120 civil and criminal cases against nursing home facilities and other related people that have now been resolved. That is twice the number of cases that were brought in the five years prior to 2008.

One of the most egregious offenders was Skilled Health Care Group Inc., a company that operates 75 nursing homes in the United States. The company was charged with 11 counts of elder abuse at a nursing home in Eureka, California. Prior to the criminal charges being brought forth, Skilled Health Care Group settled six wrongful death civil suits between 2005 and 2012 in California’s Humboldt County. The criminal charges were stemming from incidents occurring at a skilled nursing facility in Eureka, California. This nursing home was one of the 22 company sites that was indentified by the court to be suffering from chronic understaffing and the jury returned a 677 million dollar judgment which was later brought down to 63 million dollars in a settlement. According to documents from the class action suit, patients were left unattended for hours at a time, soiling themselves and not being changed, and being denied meals, which led to suffering and dehydration and malnutrition.

The rise of for-profit institutions in the health care industry, especially with regard to skilled nursing home facilities has led to the cutting of costs that are absolutely necessary to run an efficient and well-maintained nursing facility that provides a high quality of care. At the same time, overbilling and the conducting of unnecessary or even dangerous medical procedures on residents has been on the rise. In the past three years, the U.S. justice department has settled civil fraud complaints against eight hospice companies that enrolled or retained patients that were in improving health and were not dying.

What this means for you and your loved ones is that sometimes, the care and well-being of patients are not being prioritized over low costs and profits. This, in turn, leads to a culture of cutting corners and lack of training, which can result in neglect, elder abuse, and even death. When for-profit nursing homes cut costs by understaffing, they are putting your loved one’s life at risk. Nearly all injuries that occur in skilled nursing facilities can be prevented with proper staff and training. Such injuries include pressure ulcers, malnutrition, dehydration, and those that result from falls.

Proper Nutrition Combined with Physical Exercise Is the Most Effective Treatment for Loss of Muscle Mass in the Elderly

January 8, 2013 | by Law Offices of Ben Yeroushalmi

The term ‘sarcopenia‘ is used to describe the loss of muscle mass as a result of aging. Because sarcopenia progresses with age, it is very common in skilled nursing facilities. Studies that have been conducted on the treatment of sarcopenia generally focus primarily on nutrition. One recent survey titled “Effectiveness of Nutritional Supplementation on Muscle Mass Treatment of Sarcopenia in Old Age” reviews numerous such studies between 1991 and 2012. The review found that nutritional treatment of sarcopenia has been overall effective.

It is extremely important that you monitor your loved one’s nutrition, especially if he or she resides in a nursing home. In understaffed facilities, it is very common for patients to be neglected and become malnourished. For example, some residents may not receive the assistance with feeding that they require and will consequently experience severe weight loss. Proper nutrition can also help maintain skin integrity and prevent pressure ulcers. Patients who are at high risk of developing pressure ulcers should be given nutritional supplements, such as iron and protein.

Unfortunately, many nursing homes do not have your loved one’s best interest in mind and will not work to ensure that he or she does not lose significant muscle mass. This may lead to decreased mobility. Instead, nurses may use physical restraints for purposes of convenience. This, however, is a direct violation of the Patients’ Rights and has been proven to actually accelerate sarcopenia and a decrease in mobility. While caregivers frequently use the argument that physical restraints improve resident safety and helps to prevent falls, specialists assert that the risks and consequences associated with the use of restraints outweighs any benefits. Past studies have shown that the use of physical restraints does not decrease incidences of falls in nursing homes over the long run.

Instead of using restraints, nurses should ensure that residents are engaging in physical exercise. One type of exercise called resistance training, has been shown to effectively improve muscle strength. This therapy involves exercises that are performed against an opposing force. As the patient’s muscle strength improves, the opposing force increases. Resistance training has also been shown to improve overall mental well-being in the elderly. This current review actually concluded that nutritional treatment of sarcopenia is most effective when it is coupled with physical exercise.

Polypharmacy Observed in Over Half of Nursing Home Residents with Cognitive Disorders

January 2, 2013 | by Law Offices of Ben Yeroushalmi

A recent study observed polypharmacy in nursing home residents. While previous studies have confirmed the dangers of polypharmacy in the elderly, this study is unique because it specifically focuses on patients with cognitive disorders. Approximately 60% of nursing home residents suffer from some type of cognitive disorder. Patients with cognitive disorders, who are more likely to experience polypharmacy, are also at a heightened risk for suffering the dangerous side effects associated with polypharmacy. Patients with cognitive disorders such as dementia are often prescribed antipsychotic drugs. This leads to a complex type of polypharmacy because antipsychotic drugs can be particularly dangerous when mixed with other types of pharmaceuticals and lead to adverse drug reactions.

In this specific study, polypharmacy was considered in any residents taking five to nine drugs simultaneously. Patients taking over ten drugs at a time were categorized as experiencing excessive polypharmacy. All the patients included in the study suffered from advanced cognitive impairment. Of the 1,449 residents studied, 50.7% were observed with polypharmacy and 16.9% were observed with excessive polypharmacy. Patients in which polypharmacy or excessive polypharmacy were observed had a higher risk of developing heart disease, Parkinson’s, gastrointestinal disease, pain, and dyspnea.

The study makes it clear that polypharmacy should be avoided whenever possible. The use of pharmaceuticals must be minimized especially in patients who suffer from cognitive disorders. In dementia patients, use of antipsychotic drugs is known to trigger symptoms such as delirium and agitation. It important to note that these drugs are not intended to treat dementia. The Food and Drug Administration (FDA) does not approve of such use and warns of the dangers of using antipsychotics for off-label purposes. The Center for Medicare and Medicaid Services (CMS) has also recognized that antipsychotics are used rather excessively and unnecessarily in nursing homes and has initiated a program to reduce such use.
Understaffed nursing homes may use antipsychotic drugs for purposes of convenience to chemically restrain patients, who would otherwise require additional care and attention. While a non-pharmocological approach to treating dementia is always favorable, facilities that engage in neglect and elder abuse often sedate residents with antipsychotics before even attempting to use therapies that do not utilize pharmaceuticals. In addition to increasing the risks of polypharmacy unnecessarily, the use of antipsychotics as restraints violates your loved one’s Patients’ Rights. Non-profit organizations such as the California Advocates for Nursing Home Reform (CANHR) are working to end the abuse of antipsychotic drugs in skilled nursing facilities.

Implications of Hurricane Sandy for California Nursing Homes

December 18, 2012 | by Law Offices of Ben Yeroushalmi

Although Californians fortunately were not directly affected by Hurricane Sandy, the disaster poses many implications for disaster preparedness in the health care industry. A recent article published by the New England Journal of Medicine titled “Disaster Resilience and People with Functional Needs” discusses strategies that can be used by the health care industry to minimize the adverse effects of natural disasters on medical patients. The article emphasizes the importance of maintaining an established day-to-day system of organization within the facility, even in the absence of a natural disaster. In nursing homes, for example, it is the responsibility of the Administrator and the Director of Nursing to ensure that the facility is operating smoothly, with sufficient staff to meet patient needs.

One strategy recommended by the article is the adoption of an electronic system of maintaining health records. In the midst of a disaster, paper records are often destroyed, leaving health care facilities unorganized and without information on their patients. The Department of Health and Human Services, recognizing the utility of electronic health records, has started to use payment incentives under the Health Information Technology for Economic and Clinical Health (HITECH) Act to encourage health care facilities to make the transition from paper to electronic records. In terms of day-to-day use, electronic health records will serve to improve care provided to patients with functional needs, who are frequently transferred back and forth from hospitals to nursing homes.

Numerous studies in the past have concluded that poor documentation of a patient’s condition can lead to serious injuries, including pressure ulcers. Nurses frequently make inaccurate and contradictory assessments when staging their patients’ pressure ulcers, which is detrimental to the healing of a pressure ulcer since different stages warrant different treatments.

Another study links poor documentation to the improper administration of antidepressant drugs, which can lead to injury, and even death. It is extremely important that skilled nursing facilities carefully document every drug that is administered to its residents, especially since nursing home patients are usually on several drug regimes at once, putting them at a high risk of polypharmacy.

Unfortunately, nurses in understaffed facilities are forced to take shortcuts, and quite often, the provision of accurate and detailed documentation is one of the first duties to be breached. Failure to maintain detailed and organized medical files leads to poor communication among nurses working different shifts, physicians, and future caretakers. Consequently, quality of care and the health of the patient suffers.