California Nursing Home Abuse Lawyer Blog

Study Shows That Nearly Half of All Medical Homes Fail to Meet National Standards of Quality

December 28, 2011 | by Law Offices of Ben Yeroushalmi

On December 22, 2011, The Seattle Times published an article, titled “Medical; Patients, Doctors Differ on High-Quality Care,” about patient-centered medical homes. Although a survey on the satisfaction of patients showed that they were generally satisfied with their physicians, a recent study conducted by the Health Service Research Journal reported that 46 percent of medical homes fail to meet national standards in quality of care to even qualify them as medical homes.

Patients in medical homes are expected to have a team of nurses, doctors, and technicians to constantly be caring for them. Unfortunately, many skilled nursing facilities are understaffed and instead, this “team” of nurses, in reality, is actually just a few nurses who also has to attend to many other patients. In such environments, it is nearly impossible for residents to receive the one-on-one attention that they need. Quality of care is directly dependent on adequate staffing. If a facility is understaffed, it will not be able to provide high-quality care to your loved one. When searching for a nursing home, it is very important that you place quality of care as a priority and ensure that the facility is adequately staffed.

Understaffing leads to an array of injuries in California nursing homes, especially when the facility in appropriately utilizes restraints. When nurses are unable to meet the needs of all their patients, they often use physical or chemical restraints to subdue their patients, making them easier to handle. In addition to being a direct violation of Patients’ Rights, the use of restraints also leads to pressure sores, incontinence, and chronic depression.

The study also found that a lack of resources and infrastructure also contributed to a decline in quality of care in medical homes. In a ranking of the top hospitals of 2011, Leapfrog Group listed technological resources as one of the most important determining factors of quality of care in medical facilities. Make sure that your loved one’s nursing home has a strong infrastructure and offers the latest in technology and resources to provide your loved one with the care that he or she deserves and to prevent any avoidable suffering.

New Medicare Program to Improve Quality of Care in Los Angeles Nursing Homes

December 21, 2011 | by Law Offices of Ben Yeroushalmi

A new Medicare program is aimed at reducing medical costs, while improving quality of care for the elderly, The Arizona Republic reported on December 20, 2011. Instead of paying doctors after each patient visit, the new health initiative gives health providers a budget within which they must work. The only way to increase this budget is by proving that they provide a high quality of care for their patients. Unfortunately, no such program exists for skilled nursing facilities, so they are often guilty of operating at quality levels much below standard. The quality of care that a nursing home provides is reliant upon its staff’s ability to meet the needs of its patients. Inadequate staffing refers not only to the amount of staff available, but also to the quality of care that they provide.

Understaffing occurs when nursing homes fail to meet the legal standard that requires them to provide patients with an adequate amount of staff to meet all their needs, which California law has quantified as a minimum of 3.2 nursing hours per patient, per day. Inadequate staffing is directly linked to quality of care because when a facility is understaffed, its quality of care declines significantly.

Nurses are often forced to work extended shifts when their skilled nursing facilities are understaffed. These longs shifts increase nurses’ chances of memory lapses, confusion, and slowed judgment, according to a recent study. Consequently, staffing errors occur, putting the lives of the residents in danger, as these mistakes are often fatal. When a care facility is directly responsible for the death of a patient, a Wrongful Death claim can be made by the patient’s successors as compensation for personal loss and suffering.

In other cases, nurses, pressed for time, may shortcut their caretaking procedures and resort to practices that constitute elder abuse. Such practices include, but are not limited to, the use of restraint, which can be either physical or chemical. They are used for the purpose of subduing patients and making them easier to care for. However, regardless of the justification that nurses give in support of restraints, the use of restraints, whether chemical or physical, is a direct violation of Patients’ Rights, which state that patients may only be restrained for medical purposes, but, in any case, are always entitled to refuse treatment.

Inadequate Staffing in Los Angeles Nursing Homes Forces Nurses to Work Long Hours and Increases the Chance of Fatal Errors

December 18, 2011 | by Law Offices of Ben Yeroushalmi

On December 14, 2011, Modern Healthcare reported the dangers of extended hours and long shifts in healthcare facilities. While the correlation between exhaustion and increased error may seem obvious, many nurses have difficulty accepting this truth and determining the point at which their fatigue may lead to fatal consequences. The effects of fatigue include, but are not limited to, confusion, memory lapses, and impaired judgment. Many healthcare facilities fail to comprehend the seriousness of the consequences that can be caused by staffing errors. Often, these careless errors are fatal and lead to the death of a patient.

Nurses are often forced to work long hours because health facilities are understaffed. Even when they are well-rested, nurses who work in inadequately staffed facilities are more likely to make careless errors because they are constantly pressed for time, as they need to attend to more patients than they are able to handle alone. Factoring in exhaustion, in addition to the problem of understaffing significantly increases the chance of error, while decreasing quality of care of patients.

Inadequate staffing has many consequences including an increased risk of falls and incontinence, as well as dehydration and malnutrition. In both cases, patients require one-on-one assistance and individualized care plans. However, when nursing homes are understaffed, nurses simply do not have the time to meet the specific needs of each resident. Not only is understaffing a serious problem because of the health and safety risks it poses, but it is also illegal.

When staffing errors or inadequate staff lead to the death of a patient, a Wrongful Death claim may ensue. If nursing home neglect is directly responsible for a resident’s death, the successors of the patient may demand compensation for the personal losses that they have suffered.

Department of Health and Human Services Now Providing Incentives to Los Angeles Health Agencies in an Attempt to Stop Preventable Injuries

December 17, 2011 | by Law Offices of Ben Yeroushalmi

On December 14, 2011, Modern Healthcare reported that the Department of Health and Human Services is implementing an incentive program to award up to $216 million to health agencies in an attempt to reduce preventable injuries. Despite the honorable intentions of the program, the truth of the matter is that health agencies will now be receiving awards for following procedures that they should have been following all along. A similar problem can be found in nursing homes. Often, skilled nursing facilities are careless in their caretaking processes due to a lack of incentive. Unfortunately, most of the injuries that occur in nursing homes are usually avoidable, but nurses are just too understaffed or unmotivated to take measures to prevent them.

Most injuries in nursing homes occur when patients fall. Common injuries include, but are not limited to, hip fractures and head trauma. Even when elderly adults survive these injuries, they often are unable to make a full recovery. Because one injury has the ability to trigger a gradual decline in the overall health of elderly adults, it is extremely important to take every measure possible to prevent an injury from occurring in the first place. Nursing homes need to create individualized care plans for all their patients, especially those that have conditions that increase their risk of falling. Even more important is that these care plans are carried out by nurses every day.

Unfortunately, it is not rare that these care plans are drafted and then completely disregarded by nurses in their daily caretaking procedures. When nurses are unable to follow care plans, it is usually because they are understaffed and simply do not have the time to provide each patient with the specialized, one-on-one care that they need.

Sometimes, in an attempt to prevent falls, nurses will justify the use of physical restraints. This is, however, a direct violation of Patients’ Rights, which assert that a patient is not to be restrained in any way, except for when medical reasons require it. However, even under these circumstances, patients have the right to refuse treatment. Physical restraints actually incur more harm than they do benefit. In fact, a recent study has confirmed that the use of physical restraints does not decrease the likelihood of falls in nursing homes. However, the use of physical restraints is linked to incontinence, depression, isolation, pressure ulcers, and an overall decline in mobility.

Man Sent to Recover in Care Facility Dies by Suffocation Because of a Staffing Error: Nursing Home Neglect at Its Worst

December 16, 2011 | by Law Offices of Ben Yeroushalmi

On December 11, 2011, the Detroit Free Press published a series of articles investigating nursing home neglect. The first article, titled “Nursing Homes with Good Staff, Stopgaps Can Still Fail”, reports the accidental death of a man as a direct result of nursing home neglect. After having an accident, James Culbert was sent to a care facility to recover. Instead, he died a painful, devastating death by suffocation because the night staff had forgotten to connect his ventilator and check his vital signs. By the time the staff realized their error, it was much too late. Unfortunately, deaths as a result of careless errors are a common occurrence in nursing homes. In the second part of its series, titled “Troubled Nursing Homes Aren’t Closed,” the Detroit Free Press discusses how care facilities are able to remain open, despite major violations of state and federal codes, and incidents, such as James Culbert’s, that often result in death. Finally, the last portion, “Nursing Homes: A Caring Staff Makes All the Difference,” emphasizes the importance of an adequate, highly-qualified staff.

Staffing is the fundamental problem directly linked to all other issues that may occur in nursing homes. While care facilities are legally obligated to meet the minimum of 3.2 nursing hours per patient per day, they are also held accountable for providing high-quality care for their patients. In your search for the best nursing home for your loved one, the Detroit Free Press cautions against automatically correlating quality of care to the physical appearance of the facility because looks can be deceiving. Surprisingly, the Detroit Free Press found that the newest facilities that market luxurious living and provide generous accommodations are sometimes ranked lowest in quality of care. Instead, the article emphasizes the importance of an adequate, qualified staff.

Unfortunately, many nursing homes lack such a staff. The Detroit Free Press investigated various deaths that occurred in nursing homes and found that many of them could have been prevented with a more attentive staff. Falls were among the most common causes of death, simply because a patient would fall down and hours would pass before a staff member even noticed, often much too late. Another common staffing error involves medications. The Detroit Free Press reported one death in which a man was given another patient’s diabetes medication. When patients’ lives are on the line, it is crucial that caregivers avoid making such careless mistakes. In some serious cases, caregivers even forgot to feed patients, who eventually starved to death. This raises the issue of malnutrition and dehydration, which provides clear evidence of nursing home neglect, even when it does not directly lead to death.

Families of Los Angeles Nursing Home Patients Must Be Cautious of Nurse Tampering with Patients’ Drugs

December 15, 2011 | by Law Offices of Ben Yeroushalmi

On December 11, 2011, the Associated Press reported that three nurses were convicted of tampering with their patient’s drugs. All three nurses had been previously convicted of various drug-related crimes and yet were still able to secure jobs at skilled nursing facilities. One nurse, previously convicted for forging prescriptions, was convicted once again, this time for diluting five of her patients’ morphine solutions. Another nurse who stole her patients’ drugs at her previous job was found guilty of adding tap water to one of her patient’s painkillers. The last nurse, fired from her previous job for drug discrepancies, was caught stealing syringes of morphine and replacing them with a dangerous sodium chloride solution. The most disturbing truth about these crimes is that they occur in nursing homes nationwide and are often a cause of pain, suffering, and death in nursing home patients. In this specific situation, blame can be placed on the nursing home for failing to implement background checks on its employees. By simply being a bit more thorough in their hiring processes, nursing home management has the ability to significantly improve quality of care in skilled nursing facilities.

Staffing is the root cause of most problems in nursing homes. While the term ‘inadequate staffing’ is most often associated with quantity, people often overlook that it must also be applied to quality of care as well. A nursing home staff can be inadequate if it fails to provide a high standard of care or if its members are not qualified for the job. Similar to the situation reported above, management of nursing homes often fail to hire nurses who are best qualified to provide the care that your loved one requires. It is important that you emphasize both quantity and quality of care when choosing a skilled nursing facility for your loved one.

Diabetes: An Increasingly Prevalent Issue in Nursing Homes that Requires Immediate Attention

December 12, 2011 | by Law Offices of Ben Yeroushalmi

The prevalence of diabetes is increasing exponentially in the American population. In nursing homes alone, it has been found that 20 percent of adults between the ages of sixty-five and seventy-five suffer from diabetes, and that 40 percent of adults over the age of eighty suffer from this common illness. Because of its widespread nature, the Journal of American Medical Directors Association featured an “Update on Diabetes in the Elderly and in Nursing Homes” in its November 2011 issue.

The article reported that in the elderly, diabetes often manifests itself as weight loss, fatigue, and nocturia. Because these issues are often attributed to old age, 25 to 41 percent of elderly adults remain undiagnosed. Therefore, it is important that your loved one’s nursing home is adequately staffed with trained professionals who recognize that these may in fact be signs of diabetes, rather than automatically blaming old age as the underlying cause.

Understaffing also becomes a major issue in the treatment of diabetes. Elderly adults who are diabetic suffer a great burden of disease. They are constantly being transferred in and out of hospitals, and are at higher risk of hypertension, heart failure, kidney disease, visual impairment, and foot problems. Due to the various ailments that often accompany diabetes, adults who suffer from this illness require additional staff assistance for activities of everyday living. Therefore, if your loved one suffers from diabetes, it is crucial for you to ensure that his or her nursing home facility is providing your loved one with the care and assistance that he or she requires as a diabetic.

Caregivers must also be very alert and observant because diabetic residents are also more susceptible to falls. Studies have shown that diabetic residents suffer more fractures than residents who do not have diabetes. This is a significant issue because falls can have serious implications, including death, that can often be avoided with an active and attentive staff.

Regarding the treatment of diabetes, the article emphasizes the importance of individualized care plans, especially in patients with dementia. There is evidence to show that patients with cognitive impairments are less likely to be put on a special diet. Because diabetes is an illness that is directly linked to nutrition, it is essential that every patient’s nutritional needs are met, whether or not they have dementia.

According to the Journal of American Medical Directors Association, the goals of diabetes treatment should be to decrease pain and nocturia, while limiting cognitive impairment. Because diabetic patients are more vulnerable to infections, such as pressure ulcers, the influenza, methicillin-resistant staphylococcus aureus (MRSA), scabies, clostridium difficile (C. difficile), and sepsis, another goal of treatment is to decrease the likeliness of contracting any of the above infections. Additionally, caregivers should strive to improve incontinence and prevent falls in diabetic patients.

Leapfrog Group’s 65 Top Hospitals of 2011 List Sets Standards for Quality of Care in Nursing Home Facilities

December 8, 2011 | by Law Offices of Ben Yeroushalmi

On December 6, <a href="http://www.modernhealthcare.com/article/20111206/NEWS/312069976/leapfrog-recognizes-top-performing-hospitals# reported that Leapfrog Group>Modern Healthcare has recognized the 65 top hospitals of 2011. It is a great honor to receive Leapfrog Group’s “Top Hospital” award, as it is considered to be the most competitive hospital quality award in the country. The survey was based on three main areas: patient well-being, resources used to treat patients, and management practices to foster a safe and high-quality environment. Within each of these categories, staffing levels, hand hygiene, pneumonia care, patient experience, and use of computerized physician-order entry were just a few of the specific matters that were examined.

While the top 65 hospitals excelled in all of the above mentioned areas, the same cannot be said about most California nursing homes. This “Top Hospital” award, however, has definitely set a standard that must be met by all care facilities in the country. Concerning staffing levels, nursing homes often fail to meet the minimum of 3.2 nursing hours per patient per day. Even those that do meet this minimum requirement often do not meet the standard for quality of care, which is much more difficult to quantify. In order to provide high-quality care, nursing home management must train and often re-train their staff in order to keep them updated on the latest improvements in technology and scientific advancements.

Technology is an important variable in almost all industries today, including hospitals and nursing homes. This is made clear by the fact that the “Top Hospital” award was judged, in part, based on the use of computerized physician-order entry. It is important for you to ensure that your loved one’s care facility is updated with the latest technologies so that your loved one may enjoy the best possible quality of life.

While pneumonia care is an important area to observe, there are many other infections that nursing homes encounter on a daily basis, including pressure ulcers, the influenza, methicillin-resistant staphylococcus aureus (MRSA), scabies, clostridium difficile (C. difficile), and sepsis. The nursing home facility is also responsible for taking preventive measures against the spread of infection. Hand hygiene of nurses is an especially important preventive measure, and it was one of the focus areas that Leapfrog Group chose to study in its nationwide survey of hospitals.

Nursing Homes Using Medicare Funds to Pay for Wrongly Prescribed Antipsychotics

December 7, 2011 | by Law Offices of Ben Yeroushalmi

On November 30, 2011, the Associated Press and Bloomberg news both reported that Medicare money was being used to improperly prescribe antipsychotics to nursing home patients. These drugs, which include AstraZeneca Plc (AZN) and Eli Lilly & Co. (LLY), are used to treat schizophrenia and bipolar disorder. However, they are also commonly used in nursing homes for patients with dementia. Although specialists recommend that patients with dementia seek non-pharmacological treatments, most nursing homes inappropriately prescribed antipsychotics in order to subdue patients. Of the 14 percent of residents who were prescribed antipsychotics, it was found that 83 percent were for residents with dementia. In 2007, these wrongly prescribed antipsychotics amounted to $116 million of taxpayers’ money. This money could have been used to fund other nursing home projects that are very necessary and would significantly improve quality of life for elderly adults.

The improper use of taxpayers’ money is not the only issue at stake here, however. Patients’ lives are being put at risk by nursing homes who are unnecessarily prescribing antipsychotics. The Food and Drug Administration cautions that the use of antipsychotics increases the risk of death among seniors. Additional side effects include an increase in blood sugar and cholesterol, which may also lead to weight gain, and a higher risk of falls, mortality, and hip fractures.

The use of antipsychotics, known for their sedative effects, to subdue dementia patients is exemplary of the use of drugs to chemically restrain nursing home residents. Not only is this a direct violation of patients’ rights, but it also brings to light issues of understaffing in nursing homes. The inadequate staffing of nursing homes prevents caregivers from providing sufficient care for all their residents and often leads to the use of drugs as chemical restraints. Even if your loved one’s nursing home is adequately staffed, quality of care is another issue that must be addressed. Caregivers must be well-trained, especially in matters such as how to best care for a patient suffering from dementia. Sometimes, dementia patients are prescribed antipsychotics because caregivers are not knowledgeable and are unaware of any other methods of treatment for dementia.

Previous studies have shown that the use of antipsychotics actually triggers aggressive behavior in dementia patients. Because a common cause of agitation is delirium, which is often a consequence of polypharmacy, the excessive use of multiple prescribed drugs simultaneously, it is only logical to conclude that agitation should not be treated by using additional drugs. Specialists confirm that the best treatment for agitation is behavioral, not chemical.

Scientific Discovery: A New Way to Distinguish Alzheimers from Dementia

December 6, 2011 | by Law Offices of Ben Yeroushalmi

On November 30, 2011, the American Academy of Neurology reported in its online journal Neurology an advancement in scientific knowledge that will help elderly adults universally. Prior to this study, doctors used an FDG marker to detect any changes in the brain’s metabolism that could signify either Alzheimer’s or a type of dementia called frontotemporal lobar degeneration. Although both are types of dementia with very similar symptoms, the treatments for each vary vastly and it is therefore important to distinguish the two in order to determine the best and most effective treatment.

Instead of using an FDG marker, this new method employs a PIB marker that detects a type of brain plaque called amyloid that is associated with Alzheimer’s, but not frontotemporal lobar degeneration. The study found that PIB markers had higher sensitivity rates, and better accuracy and precision in measuring qualitative factors that differentiate Alzheimer’s from frontotemporal lobar degeneration. For purposes of comparison, the PIB marker had a sensitivity rate of 89.5 percent, while the FDG marker had a sensitivity rate of only 77.5 percent.

This scientific advancement has many implications. Beyond the most apparent fact that it will improve the quality of life for many elderly adults worldwide, it also proposes the question of whether or not your loved one is receiving the most advanced and effective treatments, especially if he or she resides in a nursing home. Often, since nursing homes are underfunded and understaffed, they do not have the financial backing to provide your loved one with the best treatments. Nursing homes that are privately owned are often more concerned with personal profit than the well-being of your loved one. This is a direct violation of your loved one’s rights, as nursing home residents are entitled to receive the best possible care in response to any and all of their circumstances.

The quality of care provided by a nursing home is directly linked to its staff. Not only must there be an adequate staff, but this staff must also be well-trained and knowledgeable. Furthermore, caregivers must be continually educated and trained and re-trained as science advances and new discoveries are made. It is crucial that caregivers are kept updated with new treatments because nursing home residents may be suffering from preventable conditions that may even lead to death.

There are so many other unfortunate conditions that are prevalent in nursing homes, such as dehydration and malnutrition, pressure sores, incontinence, infections, and more.