Nursing Home Abuse and Neglect Blog

New research shows that elderly people suffering from dementia who are given antipsychotic drugs are more likely to end up in a hospital or die, even if the drugs are administered for a very short period of time.

Antipsychotic drugs are frequently used in nursing homes to address the behavioral issues caused by dementia, including aggression, agitation, and delirium. Physicians concede that alternatives to antipsychotics to address this type of behavior are limited.

Many experts feel behavioral interventions should be tried first and antipsychotics used as a last resort, "when the behavior or the psychiatric symptoms are really out of control and causing complete distress not only for the person suffering from Alzheimer's, but for caregivers all around them," said Maria Carrillo, director of medical and scientific affairs at the Alzheimer's Association in Chicago. "It's important to work these things out with the physician and, of course, do follow-up very closely together, so you can make sure these antipsychotics are having the effect you want and, if not, discontinue them immediately."

The study's findings were presented in the most recent edition of the Archives of Internal Medicine.

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Posted In: Antipsychotic Drugs

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Washington D.C.'s most powerful lobbyists are being hired by the nursing home industry to fight congressional efforts to reform the industry. The industry is closely watching bipartisan legislation that would significantly increase oversight and enforcement of nursing homes around the country.

The new legislation, recently introduced by Sens. Grassley (R) and Kohl (D), would require nursing homes to fully disclose their ownership structures, and would increase penalties if a patient is injured or dies due to negligent or neglectful care. The industry is expected to pay millions to fight this legislation.

Why would nursing home owners disapprove so strongly of a law that requires them to disclose who actually owns and runs the facilities that provide them such a great profit? Liability. Many owners have created maze-like ownership structures that makes it nearly impossible to find out who actually owns the facility when something goes wrong. It's not uncommon to have a one corporate entity own the building, who then leases it to a second company (the nursing home), who then contracts with a third company to operate it.

Unbeknown to most, however, is that all three corporate entities are run by the same individuals. And when things go bad, the entity most liable for poor care, usually the operator responsible for the day-to-day care, has nothing to offer the resident that was injured or killed because the it carries no insurance, has no assets, and makes no profit. In effect, the victim gets victimized twice.

This new legislation would make the ownership structure transparent, which some advocates say is not enough.

It is nice to know [who the actual owners are], but then what?” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy. “How do you get these people to be not only identified but accountable?”

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Posted In: Legislation , Nursing Home Abuse and Neglect

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The California Advocates for Nursing Home Reform has issued its 2007 Nursing Home Citation Report. CANHR has prepared a citation summary, including the name of the nursing facility, the date, the level of citation, and a brief summary of the facts that led up to the citation. There is also an instructional key to help readers understand how the individual nursing home citations summaries are displayed. The report, which is broken down by California counties, can be found here. (.pdf)

In summary, a total of 651 citations were issued against nursing homes in California by the Department of Public Health in the year 2007, 22 of which were Class AA citations (violations caused a death), and 122 were Class A (violations present imminent danger and a substantial probability of death).

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Posted In: CANHR , California Department of Public Health , Nursing Home Abuse and Neglect

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Every skilled nursing facility (nursing home) in California is licensed by the California Department of Public Health (DPH). DPH, in turn, is charged with the responsibility of monitoring nursing homes in the state, which includes conducting annual inspections and investigating complaints of abuse or neglect.

Most complaints involve allegations of abuse or neglect of the nursing home resident, but any topic can be the subject of a complaint, including, but not limited to, poor staffing, unsafe conditions, mistreatment, transfer and discharge concerns, generally poor care, or a violation of patient rights. Once a complaint is made - and any person may make a complaint - the DPH will create a file and assign an investigator to the case. In most cases, the investigation is concluded within 90 days. For a list of local DPH offices click here.

If you have a complaint, it is usually a good idea to first address those concerns to the nursing facility itself, whether it is the administrator or the family council. If dissatisfied with the response, it is suggested to call the local ombudsman in your county for further advice. If a complaint involves serious allegations of abuse or neglect that has resulted in some injury, it probably a good idea to get the advice of an attorney with experience in nursing home abuse or neglect cases, such as the attorneys at Walton Barber LLP.

All complaints can be made orally or in writing.

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Posted In: Nursing Home Abuse and Neglect

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A report from the Government Accountability Office states that widespread deficiencies addressing malnutrition, bedsores, medication errors, and abuse of nursing home residents are often understated.

Congressional investigators have confirmed in the report something advocates for the elderly have known for sometime. That is, nursing home inspectors routinely miss, overlook, or minimize problems in nursing facilities that can pose a serious risk to patient health.

In California, nursing homes are inspected once a year by the Department of Public Health, which sets the licensing standards. The GAO report found that state employees missed at least one serious deficiency in 15% of the inspections audited by the federal government.

“Poor quality of care — worsening pressure sores or untreated weight loss — in a small but unacceptably high number of nursing homes continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said.

The federal study was done at the request of Senators Charles E. Grassley and Herb Kohl who have introduced a bill to improve nursing home care in the United States, and increase the penalties for violations of federal standards.

The New York Times article can be found here. The GAO report is here (.pdf)

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Posted In: Nursing Home Abuse and Neglect

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A jury in Arizona has awarded $6 million to the family of Sylvia Culpepper after the 81 year old died from an overdose of morphine in a nursing home. Culpepper, who was an active senior, was in the ManorCare nursing home only to recover from a back injury, and was expected to return home after her recovery.

According to reports, the nursing home resident was diagnosed with sciatica in late 2003, and prescribed 15 milligrams of morphine, twice daily. Two days later, while still in the hospital, her morphine dosage was doubled. When she was discharged to Manor Care, both of the prescriptions went with her, and the nursing home staff immediately began giving Culpepper both dosages, twice daily, totally unaware of the mix up.

Attorneys representing the family said the jury blamed the nursing home for failing to recognize morphine intoxication and overdose, and for understaffing.

"ManorCare gave her the morphine and within 24 hours of getting that dosage, she was dead. They weren't watching her," said attorney Brad Astrowsky. "The lesson in all of this is that you shouldn't get transferred to a nursing home on the weekend because the quality and quantity of the nursing staff is very often less than you would find during the week," Astrowsky said.

The jury's verdict won't have to be paid however as the case was settled before the jury reached its verdict.

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Posted In: Medication Errors , Nursing Home Abuse and Neglect

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When entering a nursing home, residents or their family are usually presented with a stack of documents that address everything from the fees to be paid to the type of pillow the resident prefers. More than a dozen signatures can be required to complete the admissions process. Often buried within that stack is an arbitration provision, a binding contract wherein the resident agrees that any disputes over nursing home malpractice, negligence, neglect, or abuse will not be resolved in the courts, but via private arbitration. Private arbitration is simply a process where allegations of neglect or abuse are resolved by a private judge (frequently a lawyer) and not a jury.

Last week, the American Association of Justice, the United State's largest trial bar, announced its support for legislation titled The Fairness in Nursing Home Arbitration Act, which allows the decision to arbitrate to be made after a dispute has arisen, not before in the admissions process.

According to the AAJ, the passage of this act will prevent corporate nursing home owners from manipulating the arbitration system in their favor and at the expense of nursing home residents.

Nursing home residents should not be forced to check their legal rights at the door in deference to large corporate interests", said American Association for Justice President Kathleen Flynn Peterson. "Mandatory arbitration denies nursing home residents access to the civil justice system and stands in the way of the quality long term care they deserve. By forcing people into a costly private system, the corporation sets the rules and hand-picks the players.

I can say with experience that most people learn for the first time that they have waived their rights to a court action in favor of arbitration when they contact our office with claims of nursing home negligence. They are usually not happy about it. And clients get more upset when they learn that they have to pay for a portion of the arbitrator's fee, which usually exceeds $250 per hour. Imagine an elderly victim of neglect or abuse being told that he or she has to pay thousands of dollars simply to seek access to justice. Now you're getting the picture of what arbitration is all about.

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Posted In: Arbitration Agreements , Nursing Home Abuse and Neglect

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In California, approximately 200,000 claims of elder abuse are investigated every year by California social services. Because of proposed cuts to the California state budget, the ability to investigate claims of neglect or abuse could be reduced dramatically at a time when a greater portion of our population will be considered "elderly."

The director of the Center of Excellence in Elder Abuse and Neglect at UC Irvine is watching closely whether 75 social worker positions will be cut in the upcoming state budget. Mary Twomey stated that such a reduction in the investigation work force could translate into 20,000 allegations of elder abuse or neglect that will go uninvestigated.

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Posted In: Nursing Home Abuse and Neglect

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Dehydration in the nursing home can lead to significant complications, including death. If the human body is deprived of necessary fluids, several symptoms may appear, including an increased heart rate, decreased sweating, decreased urination, extreme fatigue, headaches, cramps, and tingling of the limbs.

The causes of dehydration are several. The most common is vomiting, diarrhea, malnutrition, or the simple failure to replenish the body with the liquids that are lost from sweating and urinating. Sadly, this is the most common cause of the dehydration in the nursing home.

Nursing homes have a legal duty to provide adequate hydration to their residents, and to provide the proper training to their employees to recognize the signs and symptoms of dehydration. The aging process itself will often cause a decrease in appetite, but this is never an excuse for dehydration in a patient (even though it's an excuse frequently used by nursing homes). For patients at risk, nursing homes are required to monitor the food intake and urine output of its residents, and keep the medical doctor informed of the resident's condition. The failure to do this may be a violation of the standard of care.

If you have any questions about dehydration in the nursing home or residential care setting, call Walton Barber LLP at (866) 607-1325.

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Posted In: Dehydration , Nursing Home Abuse and Neglect , Residential Care Facilities

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Living in a nursing home or assisted living facility continues to get more and more expensive. For a fifth consecutive year, the average annual cost for a private room in a nursing facility rose to $76,460. The costs varied dramatically state by state.

The costs for living in an assisted living facility also rose dramatically. Nationally, the average annual costs of living in an assisted living or residential care facility averaged $36,000, up 25% since 2004.

Experts believe that the costs of living in a nursing or residential facility will continue to rise if a shortage of long-term care workers is not resolved. As baby-boomers approach retirement, most have not adequately addressed the prospect of needing long-term nursing care in old age. The average person spends approximately 2.5 years in a nursing home, at a cost of over $190,000. Just a year or two in a nursing home can wipe out a persons lifetime of savings.

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Posted In: Assisted Living Facilities , Nursing Home Abuse and Neglect , Residential Care Facilities

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Police have arrested an Escondido couple for cheating elderly victims throughout San Diego County in a financial scam that garnered $1.5 million. According to police, Janet and Ronald Reiswig cheated 30 people in the county, most of them senior citizens. The Reiswigs have been charged with 79 criminal counts, including elder abuse and fraud.

According to reports, the couple advertised a certificate of deposit investment product that they claimed would return between 7 and 7.5%. In meetings at their offices, the Reiswigs persuaded their mostly elderly clients to write checks that they promised would be invested. They weren't. Instead the victims were sent phony CDs from the Reiswig's company Global Reserve BT, and the couple then used the money for their personal use.

One East County woman, who is 76, said Friday she lost $63,000 to the alleged investment scam. It was nearly everything she had saved, after a lifetime of setting aside $25, maybe $50, a month. Now, she said, she is reduced to living on her Social Security check, which is less than $1,000 a month, to cover gas, food and rent. Money is so tight, she said, that she quit going to church most days of the week because gas is too expensive.

Financial or fiduciary elder abuse is a growing problem in our society. As fewer people save sufficiently for retirement, those looking for ways to catch up or get ahead may find themselves in the grasp of unscrupulous investment advisers who offer generous investment returns that "look to good to be true." It goes without saying that anyone investing in an investment product that is "new" or "different" than what is conventional or widely accepted should seek a second opinion. The same goes for the advisors that offer returns that far exceed what the current market is offering.

As for the Reiswigs, police are asking those who think they, or someone they know may have been victims to contact investigator Joseph Cargel in the district attorney's office in San Diego at (619) 531-4040.

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Posted In: Financial Elder Abuse

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Since a significant part of my law practice involves cases of abused and neglected seniors in nursing home, I get asked frequently if I can recommend a good nursing home, or at least point out the bad ones. That is, of course, impossible because of the sheer number of nursing homes in California and the simple fact that every nursing facility, even ones with generally good reputations, have the potential for neglectful care.

When I am asked to recommend a home I typically refer people to the Nursing Home Guide. A web resource published by the California Advocates for Nursing Home Reform (CANHR) that provides detailed information about every licensed nursing home in the State of California, including information about prior complaints, citations, ownership, and the services provided. At the site you will also find a nursing home evaluation checklist, which provides a list of things to think about when looking for a nursing facility.

In addition, CANHR also now has a Residential Care Facility Guide which provides information about all licensed residential facilities in the state. The information there is limited, simply because public information about those facilities is not as available.

I encourage you to look at CANHR’s site. It is simply an awesome resource for nursing home, assisted living, and residential care information.

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Posted In: CANHR , Nursing Home Abuse and Neglect , Residential Care Facilities

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