For a website with good information regarding nursing assistants, see www.nursingassistants.net
One of the things I thought was interesting was a listing of state statutes on CNA to resident ratios. There are very few that have such statutes. Here's the site: http://nursingassistants.net/2008/01/26/staffing-ratios-each-state/
As reported by USA Today, the Federal government has published a new nursing home rating guide. The ratings are measured on a 1 to 5 star system.
Out of 112 nursing homes in Maine, 9 (or 8 percent) received the lowest rating of 1 star, while 26 (or 23%) received the highest rating of 5 stars.
| To read more about the rating system or to research individual nursing home ratings, go to: | |
http://www.usatoday.com/news/health/2008-12-18-nursinghomeinside_N.htm
Ben Gideon recently published an article on how to identify and evaluate a nursing home case involving pressure ulcers. Below is an excerpt. To read the full article, click here: http://www.bermansimmons.com/article_detail.php?id=67
Here’s the scenario. Susan is your long-time client. She is a pleasant woman in her fifties. One day she comes to see you and tells you that about eight months ago, she made the difficult decision to admit her mother to a nursing home. Before that, mom had been living independently in her own apartment. Mom was doing alright, but then suffered a minor stroke, fell and broke her leg. After that, she could no longer get around or to the bathroom by herself and needed help rehabilitating her leg. Her heart condition was not life-threatening, but after the stroke, her mental health deteriorated and she was often confused and disoriented. She needed more care and supervision than Susan and her family could provide on their own. Susan located a facility that accepted Medicare and advertised “24-hour” skilled-nursing care, and she made arrangements for her mother’s admission.
Less than eight months later, Susan’s mother died as a result of cardiac shock triggered by a bacterial infection that spread to her bloodstream. After spiking a temperature, the nursing home transferred Susan to the local hospital. For the first time, Susan saw a baseball-sized gaping hole of rotting flesh all the way to the bone on her mother’s buttocks. This was determined to be the site of the infection that led to her mother’s death.
Susan was shocked. She had visited her mother almost every day, and, although her mother’s confusion continued to worsen, there were no signs of deterioration in her mother’s health until the abrupt end.
Susan comes to you now looking for answers. Her anger at the nursing home is exceeded only by her own feeling of guilt for placing her there. She wants to know if she can make a claim against the facility.
To answer Susan’s question requires an understanding of (1) what a pressure ulcer is and why it occurs; (2) the laws and regulations pertaining to pressure ulcers that apply to skilled nursing facilities; and (3) the facts that culminated in her mother’s death.
A recent study shows that elders with dementia are at much greater risk of hospitalization or death if they are prescribed antipsychotic medications. For more information, read the following articles:
http://www.washingtonpost.com/wp-dyn/content/article/2008/05/26/AR2008052601510.html
http://www.bloomberg.com/apps/news?pid=20601082&sid=aTJnSxKPZ0To&refer=canada
The American Association of justice recently released the second in a series of original research reports on the insurance industry, “Tricks of the Trade: How Insurance Companies Deny, Delay, Confuse and Refuse.” Following up on “The Ten Worst Insurance Companies in
You can read the report by visiting www.justice.org/insurance
The following was a 12/5/08 article from McKnight's . . .
December 05 2008
Hospitalization rates as a result of pressure ulcers have risen dramatically over the last 15 years, according to a report from the U.S. Agency for Healthcare Research and Quality.
Hospital admissions for which pressure ulcers were either a primary or secondary diagnosis rose 80% between 1993 and 2006, according to the report. Primary diagnosis hospitalizations reached nearly 45,000 in 2006, compared with 35,800 in 1993, and secondary diagnosis hospitalizations jumped from 245,600 in 1993 to 457,800 in 2006. Those with a secondary diagnosis of bedsores were typically being treated primarily for pneumonia or other infections.
The death rate among secondary diagnosis cases was one in eight. Primary diagnosis patients fared better, with a one in 25 death rate, according to the report. Pressure ulcer hospitalizations also typically lasted more than twice as long and cost between $6,000 and $10,000 more per visit than most other hospitalizations, according to the report.
A recent article published in Trial magazine entitled “Corporate Neglect in Nursing Homes” catalogues the ways in which increased corporate ownership and focus on corporate profits have contributed to abuse and neglect of nursing home residents and frustrated victims’ ability to hold the nursing homes accountable. For instance:
One way to overcome the attempt by the nursing homes to insulate themselves from responsibility is to pursue claims against both the operating company and the parent or corporate affiliate that shares in the profits or revenues. This may require showing that the parent or affiliate was involved in the budgetary decisions which compromised resident care. The evidence will support this theory in most cases, because the parent or affiliate exercises tight control over the operating company in order to maximize profitability.
With the aging population, retirement of the baby boomers and increasing population of nursing homes, Maine lawyers undoubtedly will face a growing number of questions from clients concerning negligence, abuse and neglect of nursing home residents. Elders who reside in nursing homes are among the most vulnerable members of our population. As lawyers, we have a responsibility to help champion and protect them. To do so, we must understand the duties and obligations of the nursing homes and be willing to fight to ensure that those duties and obligations are met.
Read the rest of the rest of the article. http://www.bermansimmons.com/news/summer-2008.php
There are strict Federal and State regulations prescribing what steps a nursing home and its staff must take to prevent and heal pressure ulcers. The regulations specify that no resident who enters a facility without pressure ulcers should develop pressure ulcers while at the facility unless it is “unavoidable.” It is never unavoidable unless the ulcer develops despite adequate assessment, planning, implementation and monitoring of the resident’s condition. Some residents may be more susceptible to pressure ulcers due to decreased mobility, diabetes or vascular disease, but even in those cases, pressure ulcers are usually avoidable with proper care and treatment. Pressure ulcers range from Stage I ulcers, which are characterized by reddish skin following prolonged pressure, to Stage IV ulcers characterized by open sores which run through the skin and down into the tissue or bone beneath. Pressure ulcers can become infected, leading to sepsis and death. The bottom line is that in most cases, nursing homes should be able to prevent the development or worsening of pressure ulcers, and the regulations require that. Ulcers occur because staff leave residents lying in one position or in urine or fecal matter too long. This happens because some nursing homes are chronically understaffed, and CNAs simply do not have sufficient time to reposition residents frequently enough to prevent bed sores. In addition, residents may be malnourished or dehydrated, thereby lacking the protein, caloric and water intake necessary to heal their skin. Residents and their loved ones must be vigilant to make sure that nursing home staff are taking the necessary steps – the steps mandated by law – to protect against pressure ulcers.
The New York Times recently reported that doctors have found the anti-psychotic medications are overprescribed for dementia and alzheimers patients, particularly those who are residents of nursing homes. http://www.nytimes.com/2008/06/24/health/24deme.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1214618341-mX42KSg/N0jjqNLeiWyVYw
The Times reported that about one-third of all nursing home residents have been prescribed anti-psychotic drugs. The drugs are often prescribed “off label,” because they have not been FDA approved for use by elders.
There have been a number of nursing home residents who have choked and been injured or died as a result of the failure of the nursing home and its staff to follow orders to provide the resident with a soft diet or mechanical soft diet. These diets are intended for residents who are unable for various reasons to consume certain difficult to chew and swallow foods. For a more detailed description of soft diets, please see http://www.gicare.com/pated/edtgs35.htm. Often, the reason that the diet is not followed is that there are insufficient staff or staff who are not adequately trained to meet resident needs.
A recent study found that “elderly dementia patients prescribed antipsychotic drugs are at three times the risk of a serious health problem or dying within a month of treatment, compared to those not given the drug.”
Here is a story about a woman nursing home resident in
A jury in Tuscan,
http://www.tucsoncitizen.com/daily/local/85219.php
This is just another example of the danger faced by nursing home residents from mismanagement and errors in administering prescription medications.
The Government Accountability Office (GAO) issued a report this week showing that a substantial portion of surveys of nursing homes by state regulators failed to identify significant deficiencies. The report indicates that “during fiscal years 2002 through 2007, about 15 percent of federal comparative surveys nationwide identified state surveys that failed to cite at least one deficiency at the most serious levels of non-compliance—actual harm and immediate jeopardy.”
The New York Times described the findings of the GAO report: http://www.nytimes.com/2008/05/15/washington/15health.html?_r=1&sq=nursing%20home&st=nyt&oref=slogin&scp=2&pagewanted=print
For the full text of the GAO report see:
http://www.gao.gov/new.items/d08517.pdf
Despite the findings in the report,
