Nursing Home Abuse and Neglect Blog

Nursing home abuse and neglect is not always perpetrated by staff members. New research from Cornell University suggests that aggression and violence between residents may be more prevalent than abuse or mistreatment from nursing home employees.

According to the study, peer-on-peer abuse is nursing home is a problem that has received little attention.

"Given that nursing homes are environments where people live close together, and many residents have lowered inhibitions because of dementia, such incidents are not surprising," said Karl Pillemer of Cornell. "Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem."

The Cornell research examined a large urban nursing home and found 35 different types of verbal and physical abuse between residents. The most commonly found aggressive behavior was screaming, followed by physical violence such as pushing, punching, or fighting. A related study found that 2.4 percent of the residents had personally experienced physically assault from another resident, and more than twice that had experienced verbal aggression.

The authors of the study hope that their findings will assist nursing home staff better manage aggressive behavior among residents.

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Posted In: Elder Abuse , Nursing Home Abuse and Neglect , Peer Abuse

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This comic strip is from the LA Times. We've had this case. The angry caregiver who assaults the nursing home resident, usually over some frustration related to care. Not so funny when it really happens.

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Posted In: Elder Abuse , Nursing Home Abuse and Neglect

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Class AA: The most serious violation, AA citations are issued when a resident death has occurred in such a way that it has been directly and officially attributed to the responsibility of the facility, and carry fines of $25,000 to $100,000.

Class A: Class A citations are issued when violations present imminent danger to patients or the substantial probability of death or serious harm, and carry fines from $2,000 to $20,000.

Class B: Class B citations carry fines from $100 to $1000 and are issued for violations which have a direct or immediate relationship to health, safety, or security, but do not qualify as A or AA citations.

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Posted In: CANHR , Elder Abuse , Nursing Home Abuse and Neglect

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The quality of care provided by California nursing homes has declined by almost every measure since the implementation of a new Medi-Cal rate system that increased funding the nursing facilities according to a new study by the University of California, San Francisco (UCSF). Meanwhile, nursing home complaints and the issuance of deficiencies have grown dramatically since the rate hike.

Critics contend that the nursing home industry crafted the rate hike on the basis that it was necessary to improve care. And while staffing levels improved under the new law, nursing home staff turnovers increased. The study reveals that 144 nursing homes in California failed to meet state minimum staffing requirements (.pdf).

According to the California Advocates for Nursing Home Reform:

The rate system's most controversial provision is a profit component that pays nursing homes 8 percent of their labor costs to spend or pocket as they wish. Estimated to cost Medi-Cal and taxpayers about $150 million per year, it is deceptively labeled as a "labor driven operating allocation." Every freestanding skilled nursing facility certified by Medi-Cal receives profit payments, no matter how poor its care. No other Medi-Cal providers are guaranteed a profit.

The entire UCSF study can be found here (.pdf). If you have any questions about nursing home quality of care, call Walton Barber LLP at (866) 607-1325.

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Posted In: CANHR , Elder Abuse , Nursing Home Abuse and Neglect

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Budget cuts proposed by Governor Schwarzenegger could cripple California's oversight of Residential Care Facilities for the Elderly. Further damage to the already struggling oversight program could put thousands of RCFE residents at risk.

According the California Advocates for Nursing Home Reform (CANHR), the proposed cuts come at a time when assisted living care is growing at a rapid rate. There are more than 7,000 assisted living facilities in the state, an increase of more than 25% over the last decade. Current law requires an inspection of RCFEs only once every five years, a dramatic decline from the 1980s when such facilities were subject to inspections twice a year.

Inspecting RCFEs once every five years or less is a recipe for neglect and abuse," said Patricia McGinnis, CANHR’s executive director. "Care standards and residents’ rights become virtually meaningless when inspections are so rare. Issuing a license under these conditions deceives consumers who assume the state is conducting regular inspections or offering oversight and protection to residents.

In my practice, I have seen more and more RCFEs retaining residents that should be moved to a higher level of care, but are retained in the assisted living facility for questionable reasons. This trend, combined with an unthreatening state oversight program is not good news for California seniors.

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Posted In: Assisted Living Facilities , CANHR , Elder Abuse , Residential Care Facilities

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In an effort to save some taxpayer money and improve patient care at the same time, the Centers for Medicare and Medicaid Services (CMS) has made a list of health conditions that are preventable and should never occur in the nursing home or hospital setting.

According to the National Quality Forum, “never events” are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.

The list of “never event” endorsed by CMS contains 28 negligent events ranging from a surgery performed on the wrong part of the body, to the discharge of an infant to the wrong person. Those listed events that frequently occur in nursing homes are:

● Stage 3 or 4 pressure ulcers or bedsores acquired after admission to a facility.

● Patient death associated with a fall while being cared for in a healthcare facility.

● Patient death or serious disability associated with patient elopement (disappearance) for more than four hours.

● Patient death or serious disability associated with a medication error.

● Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility.

● Sexual assault on a patient within or on the grounds of a healthcare facility.

So serious are these never events that starting October 1, 2008 CMS will not reimburse healthcare facilities for the occurrence of these conditions, unless the condition was present upon admission to the facility.

While the list contains many events that have no application to nursing facilities, I can say (sadly) that I have been involved in many lawsuits involving all the “never events” listed above, a few of them more than once.

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Posted In: Elder Abuse

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Medicaid spends more money on antipsychotic drugs than any other prescription drug. Physicians are prescribing these powerful drugs in record numbers to nursing home residents in order to control their behavior, not for the treatment of psychotic illness.

It is reported that nearly 30% of the total nursing home population is receiving medication in a practice that is known as "off label use" of prescription drugs. It's no surprise to lawyers who practice this area that studies also reveal that nearly 21% of nursing facility residents being given these drugs do not have a psychosis diagnosis.

"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Here at Walton Barber we frequently get calls from families angry at nursing providers for over-medicating loved ones. It's usually a similar story. The family stops by the facility for a visit, only to find their loved one non-communicative and listless, and sometimes incontinent.

The Centers for Medicare & Medicaid -- the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor -- has "initiated a more rigorous process to oversee appropriate use of medicine," says Chief Medical Officer Barry Straube. He says the number of nursing home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.

Dr. Straube says CMS -- which both funds and oversees nursing homes -- "is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications."

High use of antipsychotics in a nursing home can be an indicator of inadequate staffing, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. "We know the more staffing there is and the higher quality of care, the less the antipsychotic usage," he says.

If you have concerns that someone you know is being over-medicated contact the resident's primary physician immediately.

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Posted In: Antipsychotic Drugs , Elder Abuse , Nursing Home Abuse and Neglect

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Nursing home owners have claimed for years that they are barely getting by, and the lawsuits against them for negligent care are going to drive them out of business, leaving no place to put seniors. We reject this argument as a time-honored trick by tortfeasors to become the victims after causing harm to others. A New York Times article substantiated that the nursing home business is plenty profitable.

According to the Times, private takeover of nursing homes leads to poorer care, and increases the likelihood of nursing home abuse or neglect. A survey of complaints against more than 16,000 U.S. nursing homes found that care often deteriorates significantly after homes are acquired by large private investment firms.

The Times compared the number of complaints received against 1,200 nursing homes acquired by these for-profit firms against those of 14,000 other nursing homes.

The report revealed that, on average, residents of these homes are now much worse off in terms of depression, loss of mobility, and loss of ability to dress and bathe themselves than before the takeover, according to data compiled by the U.S. Centers for Medicare and Medicaid Services. Much of that shortfall in care is linked to drastic cuts in nursing and other staff in the months after an investment firm takes over the home.

“The first thing owners do is lay off nurses and other staff that are essential to keeping patients safe,” said Charlene Harrington, a professor at the University of California in San Francisco who studies nursing homes. In her opinion, she added, “chains have made a lot of money by cutting nurses, but it’s at the cost of human lives.”

Advocates for nursing home reforms say anyone who profits from a facility should be held accountable for its care.

“Private equity is buying up this industry and then hiding the assets,” said Toby S. Edelman, a nursing home expert with the Center for Medicare Advocacy, a nonprofit group that counsels people on Medicare. “And now residents are dying, and there is little the courts or regulators can do.”

There is something you can do. Go after those who cause the harm, plain and simple.

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Posted In: Elder Abuse , Nursing Home Abuse and Neglect

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The National Pressure Advisory Panel updated its definition of the four “stages” used to diagnose pressure ulcers or decubitus ulcers (often referred to as bed sores). It also added two new stages on deep-tissue injury and ulcers that cannot be staged. The updated stages of pressure ulcers were released at the conclusion of its 2007 annual conference held in San Antonio, Texas.

A pressure ulcer or bed sore is a localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction. In elderly or disabled patients, sores can begin on the skin of the tailbone, back, buttocks, heels, back of the head, or elbows. Poor nutrition or dehydration can weaken the skin and make it more vulnerable.

The new staging definitions are as follows:

Stage I. Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Stage II. Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Stage III. Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Stage IV. Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Unstageable. Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

There is rarely a legitimate explanation for a pressure ulcer to reach the level of a Stage IV in hospital, nursing home, or assisted living setting. Any skin wound progressing to Stages III or IV should be viewed with a critical eye, and a physician should be involved in the care immediately. The development of pressure ulcers in the custodial care setting is one of the leading causes of lawsuits against nursing homes in the United States, and have been the subject of several lawsuits brought by the attorneys at Walton Barber.

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Posted In: Bed Sores , Decubitus Ulcer , Elder Abuse , Nursing Home Abuse and Neglect

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The Centers for Medicare and Medicaid Services announced last month that, it will no longer reimburse hospitals for treating eight "reasonably preventable" conditions as of October 2008 the Wall Street Journal reports. Pressure ulcers are among the most prevalent, costly and dangerous on the list. In addition to interfering with recovery, lengthening hospital stays and causing extreme pain and discomfort, pressure ulcers can increase the risk of infection, with nearly 60,000 deaths annually from hospital-acquired pressure ulcers.

Nursing homes and long-term-care facilities have made strides of their own in prevention, motivated in part by the costs of lawsuits for failure to prevent bed sores. Prevention methods can include using ultrasound to identify skin breakdown before a pressure sore forms, special pressure reducing mattresses and ensuring that residents are turned at least every two hours.

Despite the availability of these, and other, prevention techniques, nursing homes have long failed to do much to prevent pressure ulcers as they had no real incentive to do so (other than the fear of lawsuits). Most commonly, nursing homes save money by not having enough staff on hand to ensure that residents receive the treatments required. They are then “rewarded” for this behavior by Medicare paying them extra money per patient to treat the decubitus ulcers. As of October of 2008, nursing homes will instead have to “pay” to treat pressure ulcers which they cause. Hopefully this disincentive will result in better care for all nursing home residents.

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Posted In: Bed Sores , Decubitus Ulcer , Elder Abuse , Nursing Home Abuse and Neglect

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The federal Older Americans Act provides funding to states to fulfill the goals of the Act, namely the protection of the vulnerable elderly population. To receive federal funds, states must comply with a variety of statutory requirements, including the formation of an office of the State Long-Term Care Ombudsman.

Under federal law, the designated state ombudsman may designate a local ombudsman office to provide services to protect the health, safety, and welfare of long-term care residents. It is the job of the local ombudsman to “identify, investigate, and resolve complaints made by or on behalf of residents that relate to action, inaction, or decisions, that may adversely affect the health, safety, welfare, or rights of the residents.” (42 U.S.C. §3058g(a)(5)(B)(iii).)

Generally, any concerns about resident rights issues, physical abuse or neglect, transfer and discharge issues, or any other unexpected injury, illness, infection or death should be reported to your local ombudsman office. Reports of elder abuse or neglect are confidential, and will not be revealed in any legal actions that might arise from the complaints.

Remember, residents have rights, including the right to be treated with respect and dignity, the right to be free from chemical and physical restraint, and the right to voice grievances without fear of retaliation.

People with questions about nursing home elder abuse or neglect, or who desire more information about the complaint process, should contact Walton Barber at (760) 607-1325. All consultations are free and confidential.

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Posted In: Elder Abuse , Nursing Home Abuse and Neglect

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The Nursing Home Complaint Investigation Improvement Act (AB 399), authored was approved last week in the Assembly Health Committee by a vote of 10-0. The legislation would fight abuse and neglect by improving the quality and timeliness of nursing home complaint investigations. AB 399 has over 30 registered supporters including the AARP, Congress of California Seniors, Gray Panthers, and Bet Tzedek Legal Services. There is no registered opposition.

According to the California Chronicle, AB 399 would require the Department of Health Services (DHS) to complete investigations within 40 working days; send complainants a written summary of findings about their complaint; investigate facility-reported complaints of abuse and neglect within the same time frames as public complaints; and extend the number of days a complainant has to seek an informal conference from five business days to 15 days after receipt of the determination.

"Today's vote is an important step toward restoring public confidence in California's nursing home oversight system," said Michael Connors of California Advocates for Nursing Home Reform (CANHR). "Timely DHS investigations will help ensure that nursing home residents are protected from further neglect and abuse once it's been reported."

Supporters of the law are urged to write Governor Schwarzenegger as soon as possible and urge him to sign AB 399 into law.

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Posted In: CANHR , Elder Abuse , Nursing Home Abuse and Neglect

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The California Advocates for Nursing Home Reform (CANHR) in San Francisco has been fighting for the rights of long-term nursing home residents for more than 20 years. Through community education, legislation and litigation, it has been CANHR's goal to remind decision makers of what needs to be done about long-term care; that this "forgotten population" consists of our mothers and fathers, our husbands and wives, our brothers and sisters, and that their suffering is our shame. CANHR has received numerous awards for its work.

Walton Barber is proud to support the work of CANHR, and is now participating in its 2007 Campaign for Justice, an effort to continue the great work of this valuable organization. If you are interested in providing your support to the cause, and helping to give a voice to the voiceless, please visit our contribution site and contribute. Any contribution you can make will be appreciated.

Thank you.

Randy / Scott / Kim

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Posted In: CANHR , Elder Abuse , Nursing Home Abuse and Neglect

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A couple who operated a New Orleans area nursing home was acquitted of 35 negligent homicide charges and 24 counts of cruelty. Jurors believed the couple's mistake of staying in the nursing home during Hurricane Katrina should not be singled out and defense attorneys argued it was the government that did not do their job.

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Posted In: Elder Abuse , Nursing Home Abuse and Neglect

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Providing nutritional support through feeding tubes to patients who are unable to eat enough orally to sustain themselves is an important component of supportive nursing care. Feeding tubes that enter the stomach through the abdominal wall, or percutaneous gastrostomy tubes (PEG tubes), can cause serious injury or death if misplaced or become dislodged. Nursing standards require that caregivers check the proper placement before using the tube for any purpose, whether it is for nutritional support, medication administration, or hydration. Failure to do so can expose the nurse and the nursing facility to legal liability.

Walton Barber currently represents two nursing home residents who were provided tube feedings after the tube was misplaced or became dislodged, causing tube feeding material to spill into the peritoneal space. Both patients became immediately septic, and one, a 73-year-old man, died.

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Posted In: Elder Abuse , Feeding Tube Misplacement , Nursing Home Abuse and Neglect

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Peer abuse in nursing homes is becoming more prevalent as the number of residents suffering from dementia or Alzheimer’s disease increases. Nursing facilities that accept individuals with dementia or Alzheimer's or any other psychological disorders have a duty to properly evaluate each resident and plan for the care of that resident in a manner that protects the resident, the staff, and all other residents of the facility. Failure to do so may expose the nursing home to legal liability. Walton Barber currently represents the family of a San Bernardino man who died shortly after being attacked in a nursing facility by a fellow resident.

Several recent news stories, including an article in Newsweek, highlight the growing problem of peer abuse in nursing homes. (Click link to see MSNBC's article: Nursing-Home Residents at risk For Peer Abuse)

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Posted In: Elder Abuse , Nursing Home Abuse and Neglect , Peer Abuse

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An Alzheimer's patient was strangled by her bedrail while residing at an assisted living facility. She slid off her bed, became trapped between the mattress and the bed rail, and died from positional asphyxia. Bed rails, often used to prevent injuries, can be deadly if not used properly and under the right circumstances. Currently there are many defective bedrails on the market whose dimensions do not meet the current FDA recommendations. Walton Barber represents the family of the 90-year-old woman who is pursuing a claim against the residential care facility for the improper use of bed rails, and against the manufacturer and distributor for producing and supplying defective bedrails.