Articles Posted in Dehydration

Many of us know that the state of California has been under intense scrutiny for the way it has handled nursing home abuse and neglect violations. In addition to concerns about the frequency with which the California Department of Public Health has investigated a number of complaints, victim advocates also contend that facilities across the state aren’t fined enough to prevent future elder abuse violations.

According to a recent news release from the California Advocates for Nursing Home Reform (CANHR), the Department of Public Health has cited a couple of facilities in southern California for serious violations. And, according to the report, each of the facilities received a $75,000 fine—an amount that suggests that the state is heading in the right direction.

empty-bed-in-nursing-homeResident Death at Paramount Meadows

Prime Healthcare Services is a Southern California company well known for turning around troubled hospitals. It also happens to be the subject of a federal investigation for possible overbilling in relation to an outbreak of septicemia. Last week’s release of an investigation by the San Diego Union Tribune and California Watch brought more bad news to the hospital chain.

According to the investigation, eight of the top 10 hospitals for malnutrition rates are owned by Prime Healthcare Services. Why such high rates of malnutrition at these hospitals? It depends who you ask. Prime will tell you it’s because of the patient population they typically serve; very sick patients who generally do not have any health insurance or primary health coverage.

“We agree we’re going to be higher than others because we have a focus on malnutrition and because of our patient mix,” said Mike Sarrao, attorney for Prime. “Because of our business model without managed care contracts, we see more emergency room cases.”

Others suggest the high rates give the hospital a financial benefit. A diagnosis of malnutrition brings with it higher reimbursement rates from Medicare. Remarkably, in 2009, Prime reported that 25 percent of its Medicare patients had some level of malnutrition, while the state average was 7.5 percent.

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The giant nursing home neglect verdicts continue to come in around the country. Last week, a jury in Kentucky awarded the family of a neglected nursing home resident $42.75 million after the resident became lethally dehydrated and malnourished, and arrived at the hospital covered in bed sores. The resident died as a result.

According to news accounts, 92-year-old Joseph Offut had been a resident of Harborside nursing home for only nine days prior to his death. The World War II veteran had been very active up until the age of 90, when he suffered a stroke and was cared for by his wife of 58 years. Like many, after some difficult conversations the family ultimately decided that Mr. Offut needed professional care and placed him in a nursing home.

After his death, Offutt’s family filed a lawsuit for wrongful death against the nursing home’s parent company, Sunbridge Healthcare Corp. The lawsuit alleged that caregivers at the nursing home neglect Offut, causing him to suffer severe dehydration, malnutrition, decubitus ulcers, and ultimately death.

A jury has awarded the family of a 76-year-old nursing home resident $114 million for egregious nursing home abuse and neglect. The family’s lawsuit against the nursing home alleged that the staff knew Juanita Jackson was at a high risk for falls but failed to take preventative measures. She fell within two weeks of admission and suffered a closed head trauma and fractured her upper arm, injuries from which she never fully recovered. The family also alleged that Integrated Health Services, the nursing home where Ms. Jackson lived, failed to provide the elder woman adequate care, including allowing her to become malnourished and dehydrated.

The verdict may not be all that it’s cracked up to be. According to news accounts, the nursing home quit defending itself in the lawsuit several weeks ago after many years of litigation, and the family was able to get a default judgment. The judge then asked the jury to determine the proper amount of damages. After some deliberation, the jury awarded $14 million in compensatory damages, and $100 million in punitive damages. The nursing home, of course, was not there to defend itself.

The family intends to do everything it can to collect on the judgment, and told the TheLedger.com that it was proud of itself for standing up for their mother.

The California Department of Public Health has issued fines to two Orange County nursing homes after concluding that negligent nursing care lead to the deaths of two residents. Alamitos West Health Care Center in Los Alamitos was fined $100,000.00, and Huntington Valley Healthcare in Huntington Beach was fined $80,000.00.

Investigators found that Alamitos West failed to give an 82-year-old female resident adequate fluid, causing her to suffer dehydration and kidney failure. When the woman was finally transferred to a hospital, her dehydration had caused an altered mental status. The woman died a week later, on Christmas Day.

The case against Huntington Valley involved the failure to call 911 as a patient was dying. According to reports, the caregiver thought the resident did not want resuscitation if life saving treatments was needed, but the resident had actually stated in his chart “I Do Want C.P.R.” The resident died in the nursing home.

Studies have suggested that approximately one-third of all nursing home residents suffer from some form of dehydration or malnutrition, a condition that can cause or aggravate more serious medical conditions, and may be caused by elder abuse or neglect.

Much of the problem can be attributed to poor staffing, whether inadequate numbers of staff, poor staff training, and a lack of individualized care. While California law requires 3.2 hours of certified nursing per patient, per day – a minimum number many nursing homes fail to meet – many experts believe the law is inadequate, advocating for an increase to 4.1 hours per resident, per day.

Karen Davis of the Commonwealth Fund, the funder of a report on nursing home care, says, “malnutrition, dehydration, and weight loss in nursing homes constitute one of the largest silent epidemics in this country.”

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.