Articles Posted in Elder Abuse

June 3, 2008

Peer-on-Peer Abuse in Nursing Homes More Common than Believed

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.”

April 9, 2008

Southern California Nursing Home Citation Watch

by Randall Walton

This list contains the issuance of citations to Southern California nursing facilities by the California Department of Public Health over the last six months. All the citations listed are issued for reasons related to patient care. For verification of the citation, please contact the local department office or Walton Law Firm LLP.

<font size='2'Facility	Date	Citation
Los Angeles Nursing Homes
Ayer-Lar Health Care Center	09/21/07	Class B
Bellflower Convalescent	01/29/08	Class B
Brierwood Terrace Convalescent	12/28/07	Class B
Calif. Healthcare and Rehabilitation	11/14/07	Class B
Casitas Care Center	12/19/07	Class B
Chandler Convalescent	10/3/07	Class B
Country Villa Los Feliz	11/29/07	Class B
Country Villa Wilshire	01/4/08	Class A
North Walk Villa Convalescent	12/10/07	Class A

Orange County Nursing Homes
Coastal Community Hospital	10/11/07	Class A

San Bernardino Nursing Homes
Citrus Nursing Center	10/11/07	Class AA
Ontario Health Center	03/19/07	Class A
Sky Harbor Care Center	10/24/07	Class AA

San Diego Nursing Homes
La Mesa Healthcare Center	02/06/08	Class B
Lemon Grove Care and Rehabilitation	01/10/08	Class B
Life Care Center Escondido	01/24/08	Class B
Palomar Continuing Care	11/15/07	Class A
Palomar Heights Care Center	01/31/08	Class AA
Pleasant Care Convalescent	10/19/07	Class B
Villa Las Palmas Healthcare	12/14/07	Class B
Vista Knoll Specialized Care	12/4/07	Class B

Ventura Nursing Homes
Maywood Acres Healthcare	11/5/2007	Class A
Victoria Care Center	11/20/07	Class A

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.

April 8, 2008

Nursing Home Care Fails To Improve Despite Funding Increases

by Randall Walton

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:

April 7, 2008

Residential Care Facility Inspections at Mercy of California Budget Cuts

by Randall Walton

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.

March 31, 2008

Elder Abuse: “Never Events” – Things that Should Never Happen in a San Francisco Nursing Home

by Randall Walton

When families place a loved one in a nursing home or assisted living facility, they do so with the expectation that the facility will provide basic safety, dignity, and competent medical care. Unfortunately, that expectation is not always met. In recognition of this reality, the Centers for Medicare and Medicaid Services, known as CMS, identified a category of catastrophic failures in healthcare that should never occur in a properly run facility.

These incidents are known as “never events.”

According to the National Quality Forum, never events are serious medical errors that are clearly identifiable, largely preventable, and result in significant harm or death. Most importantly, they signal a fundamental breakdown in patient safety systems and oversight. In other words, when a never event occurs, it is not bad luck or an unavoidable outcome. It is evidence of negligence.

December 13, 2007

Many U.S. Nursing Homes Practice “Off-Label Use” of Antipsychotic Drugs

by Randall Walton

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.

September 23, 2007

U.S. Nursing Homes: More Profits, Less Nursing Care

by Randall Walton

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.

September 20, 2007

Pressure Ulcer “Stages” Updated

by Randall Walton

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:

September 19, 2007

Medicare To Stop Paying For Treatment Of Pressure Ulcers

by Randall Walton

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.

September 17, 2007

The Long-Term Care Ombudsman Program

by Randall Walton

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.

"The team at Nursing Home Law Group are a credit to the legal profession, and are warm, compassionate human beings to boot. I cannot recommend the firm highly enough." ★★★★★ - Rebecca L, Los Angeles County -

"We had such a tortuous and discouraging journey with other attorneys before we found our way to you -- from our first call with you truly everything was different. You listened to us so empathetically; you explained the law and the process to us; you communicated with us with such clarity; you generously tolerated our interference; you were completely on top of the specifics of the case." ★★★★★ - Andy L., San Francisco -

"When our father was mistreated in his nursing home we didn't know who to talk to. He had severe dementia and could not defend himself. Luckily, a non-profit organization that helps the elderly recommended Randy from the Nursing Home Law Group. Our family is forever grateful for the guidance he provided, and for fighting for our dad." ★★★★★ - Patricia R., San Diego County -