California Nursing Home Abuse Lawyer Blog

Study Shows that Knowledge of Pressure Sore Prevention in Nursing Homes is Very Low in Nurses

June 20, 2012 | by Law Offices of Ben Yeroushalmi

A recent study, published in the Journal of Clinical Nursing, looks at how the level of education about pressure sore prevention among nursing home staff affects the level of care provided to residents. The article, titled “Pressure ulcers: knowledge and attitude of nurses and nursing assistants in Belgian nursing homes”, relates the results of a survey of registered nurses and assistant. The survey team interviewed 145 nursing staff across 9 different nursing homes and observed the care of 615 residents.

The findings of the study show that knowledge about pressure sore prevention is very low, with registered nurses scoring on average 29.3%. The mean score for certified nursing assistants is even lower at 28.7%. RNs and nursing assistants are in charge of taking steps to prevent the development of pressure sores. And yet this study found that the full measures stipulated by nursing home guidelines were only carried out in 6.9% of residents designated as at risk for pressure sores.

Pressure sores, or Decubitus Ulcers, are areas of dead skin tissue, which can be very painful and lead to infection and the breakdown of skin and muscle. These sores arise from extended periods of unrelieved pressure on a person’s skin. They are commonly found on the joints, back, and head, where the skin contacts or rubs against a bed or chair. Pressure sores are classified in four stages of severity, with stage IV resulting in extreme skin breakdown to the extent that the bone may be exposed. Pressure sores of any stage are very painful and can lead to a lower quality of life.

The development of pressure ulcers is preventable. By moving and changing position periodically, pressure on the skin can be relieved and pressure sores prevented. Other factors such as a healthy diet and good hygiene also help. Nursing staff play a vital role in this process. They are responsible for turning and repositioning at risk residents as well as assisting in activities that help build muscle and maintain skin health. These nurses and nursing assistants should be informed of pressure ulcer prevention measures as well as the proper care procedures if for any reason a resident does develop an ulcer.

One of the main reasons that residents in nursing homes develop pressure sores is understaffing. Many nursing facilities do not have adequate numbers of staff to perform the duties necessary to prevent pressure ulcers in all of the residents. This does not excuse the facilities as the Patients Bill of Rights mandates that all those residing in care facilities have the right to be free from developing any bed sores. It is the responsibility of the nursing home to hire enough staff to properly care for all of the residents. The RNs and nursing assistants should also be fully educated, in subjects such as pressure sore prevention, so that they can provide the care and attention that each and every person in a nursing home deserves.

Department of Health and Human Services Office of Civil Rights Issues Memo to Facilitate Patients’ Access to Their Own Medical Records

June 18, 2012 | by Law Offices of Ben Yeroushalmi

Although it has always been required by law, many patients are unaware that health care facilities are required to provide them with access to their own medical records. The director of the Department of Health and Human Services Office of Civil Rights has recognized this problem and responded by releasing a right to access memorandum. This memorandum is a comprehensive one-page document that you can take to your doctor, hospital, or skilled nursing facility to retrieve your medical records.

Leon Rodriguez, director of the Office of Civil Rights, encourages patients to become more involved with their health care. His concern before issuing the memo was that too often, health care facilities used the Health Insurance Portability and Accountability Act (HIPAA) to prevent patients from having access to their own medical records. Some facilities act under false pretenses of protecting their patients’ privacy, while actually using HIPAA to their advantage to conceal and hold hostage their patients’ medical records.

You may wonder what incentives health care facilities have for concealing their patients’ medical records. Unfortunately, many California skilled nursing facilities today are guilty of nursing home neglect. When patients and their loved ones attempt to escape these abuses by taking legal action, nursing homes and their lawyers often use HIPAA to protect themselves by refusing to provide the patient with his or her medical records. Since the basis of a nursing home neglect case lies in the patients’ medical files, the inability of a patient to access his or her records can significantly hinder any lawsuit brought against the facility. For example, in certain class actions, attorneys will fight for years and are forced to take an excessive amount of steps and bring unnecessary motions just to send letters to other residents of the nursing home who may be potential class members.

In other instances, nursing homes have been found guilty of manipulating patient records or carelessly documenting certain conditions, while neglecting to document other important information. Inaccurate documentation can lead to improper assessments, withholding of treatments, and polypharmacy, all of which can lead to death. Because a nursing home staff may not be properly documenting your health condition, it is important that you use your right to access to obtain your own records and review them yourself.

Withholding of this information is especially egregious because patients have a legal right to access their own records. We hope that this article has been informative and will allow you to play a more interactive role in the care that you receive from any skilled nursing facility.

A New Side Effect of Antidepressant Medications of Which You Need to Be Aware

June 10, 2012 | by Law Offices of Ben Yeroushalmi

Depression is a cognitive disorder that plagues one out of every ten Americans. Osteoporosis a bone disease, is also extremely widespread in the American population. Both are especially common in the elderly, and recently, researchers believe they may have found a link between the two. An article published in the June 2012 issue of the Journal of American Medical Directors explores the question “Do SSRIs Play a Role in Decreasing Bone Mineral Density?” The article reports that a certain type of antidepressant drugs may affect bone density. These drugs are classified as selective serotonin receptor inhibitors (SSRIs) and 62% of all antidepressant drugs fall within this category.

This recently discovered side effect of SSRIs highlights the need for extreme caution when administering antidepressant drugs. These types of drugs are very commonly abused in skilled nursing facilities and sometimes even used as chemical restraints. Before your loved one agrees to begin an antidepressant drug regime, make sure that he or she has exhausted all other alternatives. Leisure and social activities are just two examples of non-pharmacological therapies that improve depressive symptoms. The caregiver’s attitude toward his or her patients also has a profound effect on mental health. It is extremely important that your loved one’s caregiver is emotionally supportive and takes the time to personally interact with him or her on a daily basis. This will help prevent patients from feeling socially isolated and delay depressive symptoms.

The link between SSRIs and decreased bone mineral density, however, does not excuse the skilled nursing facility from any liability. In fact, a staff that is continually trained and educated should be aware of these risks and take them into consideration before administering an antidepressant drug regime to their patients. Each and every nursing home patient is entitled to access to an adequate staff. This legal right encompasses both quality and quantity of the staff available. If your loved one’s skilled nursing facility is lacking in either aspect, he or she may be a victim of nursing home neglect.

Furthermore, the nursing home staff is responsible for ensuring effective communication with any other team members that provide care for the patient. By operating under a team environment and maintaining accurate medical records, an efficient nursing home staff is able to prevent adverse drug reactions and polypharmacy, which can occur when a patient is taking an excessive amount of medications at once. By carefully documenting all treatments that the patient is receiving, physicians can be mindful of these other medications before prescribing additional drugs.

Burnout in Los Angeles Nursing Homes and How It Affects Quality of Care

June 7, 2012 | by Law Offices of Ben Yeroushalmi

Caring for the elderly is no easy task. While some elderly adults require acute care in skilled nursing facilities, others remain at home, often living with their children. Regardless of where they live, caregivers often experience burnout due to the high levels of stress encountered when caring for the elderly. A study recently published in the June 2012 issue of the Journal of American Medical Association compares job burnout in different healthcare settings. The article, titled “Professional Caregivers’ Mental Health Problems and Burnout in Small-Scale and Traditional Long Term Care Settings for Elderly People with Dementia in the Netherlands and Belgium” hypothesizes that caregivers in small-scale facilities experience less burnout than their counterparts in larger facilities.

These small-scale facilities refer to a relatively new type of care facility for dementia patients that treat dementia by allowing residents to maintain their own lifestyles and continue carrying out old habits, hobbies, and activities of daily living for as long as possible. Because these facilities are smaller, tasks are more integrated, meaning that a nurse is required not only to care for patients, but also to perform housekeeping and administrative tasks.

The benefits of a small-scale facility include a greater emphasis upon interaction with individual patients and more individualized care. For example, in larger facilities, all residents are forced to comply with daily routines and schedules, whereas in these small-scale facilities, daily schedules are based on each individual’s need. This highlights the inflexibility of care routines that is often a problem in larger facilities since previous studies have recommended that in order to effectively treat dementia, facilities should be open to modifying care routines to fit the needs of individual patients.

The study obtained its data by questioning workers in five different small-scale facilities and focused on those who care specifically for dementia patients, since the increased level of care required by dementia patients is often correlated with higher rates of job burnout, job dissatisfaction, stress, and mental health problems. “Burnout” was defined as feelings of exhaustion, depersonalization and disconnect from the individual’s job, and a reduced amount of personal accomplishments.

Interestingly enough, the results of the study disproved the hypothesis that caregivers in small-scale facilities experience less burnout than those in larger facilities. Despite the differences in care settings, workers in both types of facilities were observed to experience approximately equal amounts of burnout. However, the study determined that over time, caregivers in all types of care facilities, large or small, experience increased levels of burnout.

In conclusion, the researchers determined that the increased levels of job burnout in care facilities are a result of understaffing.

While these facilities are expected to provide the same quality of care with significantly fewer resources, government agencies are also increasing accountability in nursing homes by conducting inspections and issuing deficiency citations. Some government agencies even offer incentive programs to nursing homes that provide a high quality of care. Others base their funding on quantifiable factors such as number of incidents of preventable fall-related injuries and facility-acquired pressure ulcers. While Medicare’s ‘No-Pay’ rule has proven to effectively improve infection control measures, other programs, unfortunately, have often led nursing homes to withhold care and “downcode” certain injuries in order to avoid liability and continue receiving funds. For this reason, you must be extremely cautious when nursing homes report your loved ones health condition. Even if your loved one is being treated and assessed by nurses and physicians, it is still important for you to personally examine your loved one often since nursing homes often have incentives to conceal certain health conditions.

Many factors such as understaffing and consequently job burnout can prevent a nursing home from providing your loved one with the care that he or she requires. However, regardless of recent budget cuts and sometimes difficult working conditions, skilled nursing facilities continue to carry an obligation to provide your loved one with an adequately staffed facility and a high quality of care. They must learn to adapt and allocate their funding appropriately. For example, despite decreased levels of funding, many nursing homes continue to use their money wastefully by prescribing antipsychotic drugs in order to chemically restrain dementia patients, rather than using this money to increase staffing levels. Your loved one may be a victim of nursing home neglect and elder abuse if his or her nursing home is failing to provide him or her with proper care and an adequately staffed facility.

New Amendment to End the Abuse of Antipsychotic Drugs in California Nursing Homes

May 27, 2012 | by Law Offices of Ben Yeroushalmi

Antipsychotic drugs, intended to treat mental illnesses such as schizophrenia, are the most commonly abused class of drugs in Los Angeles nursing homes. Despite warnings from the Food and Drug Administration (FDA) that using antipsychotic drugs to treat dementia patients can be fatal, one in four California nursing home residents receive these drugs before they are given safer and less expensive treatments.

Often, these drugs are used to chemically restrained patients, especially in understaffed facilities that lack the resources to provide proper dementia care to their patients. Rather than sedating dementia patients with antipsychotic drugs, nursing homes should be taking a non-pharmacological approach to the treatment of dementia. Numerous studies have been conducted to test the effectiveness of various dementia treatments and the results have consistently shown that dementia treatments should be behavioral in nature and involve social and leisure activities. In fact, other studies have shown that antipsychotic drugs actually aggravate certain symptoms of dementia, such as agitation, violent behavior, and delirium.

Because the abuse of antipsychotic drugs directly threatens the mental and physical well-being of patients, it has become a major issue of contention in nursing homes today. This week, U.S. Senators Kohl, Grassley, and Blumenthal took an initiative to end the abuse of antipsychotic drugs in skilled nursing facilities. They have proposed an amendment to the FDA’s Safety and Innovation Act S. 3187 that requires nursing homes to inform patients of the risks associated with using antipsychotic drugs and receive consent from the patients or their legal guardians before administering these drugs.

The California Advocates for Nursing Home Reform (CANHR) is working diligently to ensure the passage of this amendment. We encourage you to learn more about CANHR’s Campaign to end the Misuse of Psychotropic Drugs in California Nursing Homes. You can also contact California Senators Barbara Boxer and Dianne Feinstein to urge them to vote for this amendment to the Safety and Innovation Act S. 3187.

Even if you feel that the Safety and Innovation Act does not directly affect you or any of your loved ones, it is still important and beneficial for you to support this initiative because skilled nursing facilities are using Medicare funds to pay for these medications. In 2007, $116 million of taxpayers’ money were used to pay for the off-label use of antipsychotic drugs. This money could have been better spent in other areas desperately lacking in funding, or saved by using cheaper and safer non-pharmacological treatments for dementia.

Recent Study Links Osteoporosis Medications to Incidents of Thigh Fractures

May 24, 2012 | by Law Offices of Ben Yeroushalmi

Osteoporosis is an common bone disease, especially in women over the age of fifty. While many medications have proven to be effective in the treatment of osteoporosis, recent studies link a class of drugs called biphosphonates to thigh fractures. Two examples of biphosphonates that are used to treat osteoporosis are Fosamax and Actonel. The University Hospitals of Geneva conducted a study that was published by the American Medical Association to determine the risks of taking biphosphonates.

The Wall Street Journal reported that the study included 477 osteoporosis patients over the age of 50. Of these patients, 39 were inflicted with thigh fractures that are associated with biphosphonate drugs. These thigh fractures are particularly unusual because they occur upon minimal to no impact. For instance, some patients experienced these types of fractures from stepping off a curb. Of these 39 patients, 32 were taking a biphosphonate drug and 11 had fractures in both legs. The study concluded that although biphosphonate drugs are effective in treating osteoporosis, after three to five years, patients should consult their doctors about continuing on this drug regime. At this point, the risks of using biphosphonate drugs may outweigh the benefits.

This new information on medication for osteoporosis highlights the need for skilled nursing facilities to continually train and educate their staff. A nursing home with high quality care must take a broader approach to care of their patients. Although Registered Nurses (RNs) play an extremely important role in the care of nursing home residents, other types of staff are necessary as well. For instance, in this specific case, nursing homes need to employ bone specialists, dieticians, and physical therapists that have the most current information on osteoporosis treatments and can provide osteoporosis patients with the care that they require.

The involvement of multiple parties and disciplines in the care of an individual, however, also requires effective communication. Documentation of medical conditions becomes even more important because doctors, nurses, specialists, and therapists need to have accurate information about a patient’s health condition in order to provide the most effective care. When medications are involved, as is the case with these osteoporosis drugs, it is particularly important to accurately document a patient’s health condition. Often, when caregivers are not aware of other medications already being prescribed to the patient, polypharmacy occurs. Although polypharmacy may seem unrelated to this case with osteoporosis treatments, this new research on biphosphonate drugs definitely highlights the importance of communication and collaboration among the various fields of medicine.

Medicare’s ‘No-pay’ Rule Has Lead to Improvements in Infection-Control in Health Care Facilities

May 20, 2012 | by Law Offices of Ben Yeroushalmi

When it was first adopted, Medicare’s ‘no-pay’ rule was a controversial topic in the world of healthcare. Under the ‘no-pay’ rule, healthcare facilities are not eligible to receive Medicare funding for treatment of conditions acquired within the facility. However, this rule has actually proven to be beneficial to improving quality standards of healthcare facilities, as hospitals and nursing homes now have a greater incentive to prevent infections and other conditions from developing under their watch.

While many different conditions are can be facility-acquired, the three most common were various types of infections related to surgical procedures and the use of catheters. Some other examples of common infections include Methicillin-resistant Staphylococcus aureus (MRSA), scabies, Clostridium difficile (C. difficile), and sepsis. In a recent study by the American Journal of Infection Control, reported by American Medical News, it was found that 70% of professionals now claim that they are spending more time educating their staff on infection prevention techniques as a result of the ‘no-pay’ rule.

This is not the first incentive program that Medicare has implemented, however.
For example, another recently enacted Medicare program makes the amount of funding provided to a healthcare provider directly contingent upon its quality rating. Meanwhile, the Department of Health and Human Services will award healthcare agencies up to $216 million in funding for reducing preventable injuries.

While they have proven to be beneficial, the necessity of incentive programs highlights the many conditions that can develop as a result of nursing home neglect and understaffing. Some nursing homes will even “downcode” serious conditions in order to relieve themselves of liability and continue to receive funding from government healthcare agencies. This dangerous practice further decreases your loved one’s chances of receiving the care that he or she requires. Because nursing homes and other healthcare facilities have incentives to hide conditions from government health agencies, it is important for you to be extremely attentive of your loved one’s health. Rather than blindly accepting the nursing home’s assessment of your loved one’s health condition, you should often examine your loved one yourself. It is important for you to be aware of all these abuses before choosing a nursing home for your loved one.

Strategies to Maintain Physical Health that You and Your Loved One’s Nursing Home Should Know About

May 18, 2012 | by Law Offices of Ben Yeroushalmi

Recently, the Wall Street Journal published several articles about the maintenance of physical health through old age. One article, published in the “Health Matters” column discusses how to stay healthy even through old age. The article specifies middle age as the critical time to prevent physical decline. Although it may be apparent that exercise is a key factor in staying healthy, specialists emphasize that it is important to modify daily exercise routines in order to minimize injury. Studies have shown that many middle age adults eventually injure themselves from exercise routines, and consequently stop exercising altogether. It is important to address any pain that is experienced with a physician, as this may be a precursor to more serious problems that will eventually lead to physical decline.

The Wall Street Journal’s “Health Blog” featured a related article titled “Preventing Physical Decline in Middle Age Helps Preserve Good Health Later in Life.” This article was inspired by a study that is currently being conducted by the Center for Medicare and Medicaid Services and the Bloomberg School of Public Health at Johns Hopkins University. The study is called the National Health and Aging Trends Study (NHATS) and observes the dependency of elderly adults upon others for assistance in activities of daily living. Such activities include walking, showering, dressing, and getting out of bed. The study hopes that its findings will help to improve quality of life for elderly adults in the future. Statistics today actually show that trends of disability levels among the elderly are declining. These optimistic results can be attributed to the many studies that have focused on improving the physical health of the elderly.

For example, the development of a new exercise regime called resistance training has led to a range of benefits, both mental and physical, for elderly adults. Resistance training involves exercises that are performed against an external, opposing force that increases as muscle strength improves. Various studies have proven that physical therapy can also have many unexpected benefits, including improvements in incontinence and mental well-being.

While skilled nursing facilities should be implementing these physical exercises into their residents’ daily routines, many homes, unfortunately, are so understaffed that they are unable to supervise such activities. Instead, many resort to the use of physical restraints, which has actually been linked to a decline in mobility in elderly adults. Not only is the use of physical restraints harmful to your loved one, however, but it is a direct violation of his or her rights as a patient if not used properly, such as when its done for the convenience of the nursing staff, and not the benefit of the patient.

Los Angeles Nursing Homes Found to Have Chronically Understaffed Levels of Registered Nurses

May 16, 2012 | by Law Offices of Ben Yeroushalmi

A recent article titled “Caring for elders: the role of registered nurses in nursing homes” emphasized the great importance of staffing a sufficient amount of registered nurses (RNs) in nursing homes. The article refers to RNs as the “linchpin” of nursing homes as they are expected to organize innovative activities, exercise clinical judgment, and deal with ethical dilemmas while linking together different departments. The study discussed in the article conducted various interviews with RNs from different nursing homes. The conclusion was that the responsibilities of RNs are absolutely crucial to nursing homes, but many factors such as understaffing and a lack of communication often stand in their way of doing their job properly which in turn leads to a lower quality of care.

While RNs may also do office work and other administrative tasks, these tasks can be delegated to other staff as the skill set of an RN can be better utilized elsewhere. The article stresses that RNs should really be focusing on direct patient care, such as maintaining a good relationship with their residents and exercising clinical judgment. If RNs maintain a good relationship with their residents, they will in a better position to direct other administrative tasks to other staff to ensure that the nursing home is providing the best quality of care.

An RN is becomes tied down with office work usually when the facility is understaffed and do not have enough staff to delegate the proper responsibilities. An RN complained about this understaffing and incorrect delegation of duties saying, “Handling invitations to tender, equipment and resident inventory, billing, and drafting quality control documents could be delegated to others. We actually spend little time building a relationship and communicating (with the resident).” When RNs do not have time to maintain a good relationship with their residents due to understaffing, it becomes nearly impossible to carry out individual care plans for their residents, which is extremely important for ensuring safety of residents and preventing falls.

Previous studies have shown the staffing levels of RNs and the amount of RN direct care time are correlated with avoidable nursing home injuries such as pressure sores, urinary tract infections, and falls. Because of this, it becomes increasingly important that nursing homes both hire enough RNs and allow RNs to carry out their proper responsibilities. Undervaluing the role of an RN could seriously compromise the quality of care. Unfortunately, as this article has shown, many nursing homes do ignore the importance of a proper caregiver-patient relationship, and disregard the importance of staffing nursing homes properly.

When choosing a nursing home, it is important to ensure that the well-being of their residents and the human element of care is one of the most important priorities for the facility. While this may seem obvious, many nursing homes do not have their resident’s health as a first priority. This is both inexcusable and a violation of a patient’s rights.

Protect Your Loved One from the Dangers of Chemical Restraints and Polypharmacy

May 15, 2012 | by Law Offices of Ben Yeroushalmi

Medication is intended to improve the quality of a patient’s life by reducing uncomfortable symptoms or by curing a disease. However, taking more medication does not equal to receiving more benefits. In fact, the consequences of using too many medications at once, or polypharmacy, can be extremely harmful and counterproductive. An article published by Hovstadius and Petersson looks at the different factors that lead to excessive polypharmacy and discusses the alarming finding that polypharmacy is most lethal and occurs most commonly in adults aged over 65 in nursing homes.

The article says that one of the most common risk factors for excessive polypharmacy is age. As the prevalence of disease increases with age, the amount of medication prescribed also increases. The prevalence of polypharmacy has also been increasing as new medications and technology are being discovered. In the entire national population, the prevalence of polypharmacy in the age group 80 to 89 years is 75.1%, and the percentage continues to rise as age increases. Elderly adults also often forget to take certain medications as they already have so many types of medications to keep track of, which is another reason why polypharmacy can be so dangerous.

Another factor associated with polypharmacy other than age is poor self-perceived health, poor life satisfaction, declining ability to function and declining cognitive capacity. Many nursing home residents who suffer from dementia also suffer from depression. This depression can usually be treated by non-pharmacological methods, such as daily social activities, simple exercises, and independence tasks. Unfortunately, many nursing homes do very little to ensure that their residents have a good quality of and good outlook on life as many nursing homes do not have these options of activities available for their residents. Rather than treating patients with non-pharmacological methods, nursing homes often use drug treatments or chemical restraints,which in turn leads to a higher likelihood of polypharmacy occurring.

Perhaps the most common consequence of polypharmacy is harmful drug-drug interactions. The effect of one medication can be influenced by another medication, and result in a harmful side effect. The risk for drug-drug interactions increase greatly as a patient is taking more medications. For example, a patient on 10 different drugs has 45 possible one-to-one drug interactions. Even more harmful is a disease-drug interaction, which occurs when a disease is worsened by a drug prescribed for a reason other than to treat the disease. This is highly common in nursing homes because many nursing home residents have diseases such as Alzheimer’s, but are also given unrelated medications such as nutritional supplements or urinary tract infection antibiotics.

Due to the severe consequences of polypharmacy, it is important to be aware of the risk factors that lead to polypharmacy and ensure that you or your loved one are not being prescribed unnecessary medications. Unfortunately, as many nursing homes are understaffed, instead of providing the proper care and treatment, unnecessary drugs such as chemical restraints are often improperly used.