Articles Posted in Nursing Home Abuse and Neglect

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The California legislature has called for an investigation into why only one-third of the fines assessed against nursing homes for negligent care are being collected. The audit that was approved in February is expected to look how the funds are collected and how they’re spent.

Mike Feuer, D-Los Angeles told California Watch, “The whole point of having citation accounts and the penalty system is to deter nursing homes from doing anything but provide the highest quality care to residents. If the fines coming in are less than a third of (those) issued, it leaves one to wonder if the state is being as effective as it could be in protecting nursing home residents.”

Records obtained by California Watch reveal that in 2008 state regulators collected only $1.5 million of the $5 million that had been assessed against California skilled nursing facilities. In comparison, the same regulators have collected nearly 80 percent of the fines levied against hospitals. Kathleen Billingsley, the deputy director of the Department of Public Health Center for Healthcare Quality, said nursing homes who appeal fines do not have to pay until the process is completed.

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California Watch is out with a disturbing report alleging that California nursing homes that received more than $880 million in additional taxpayer funds under a law designed to boost care, took the money did the opposite by cutting staff and wages. [“Nursing homes received millions while cutting staff, wages“] In its investigation, California Watch found 232 California nursing homes that either cut staffing, or paid lower wages to workers after receiving money from the state.

It appears that many of the nursing homes investigated used the state money to improve their financial health, not the health of its residents, and those that cut the most staff had, not surprisingly, more deficiencies issued by state inspectors than those facilities that did not cut staff.

“There was an implicit good faith agreement that things would get better … and that was broken,” state Sen. Elaine Alquist, D-Santa Clara, told California Watch. “It was broken for the people of California and for a very vulnerable population – those that need the greatest care and those that can’t advocate for themselves.”

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It took jurors only five hours to convict 21-year-old Cesar Ulloa of criminal elder abuse for his brutal treatment of residents at the Calabasas nursing home where he worked. According to prosecutors, Ulloa would laugh as he attacked his victims, many of whom were to demented to be able to call for help. He faces life in prison.

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In one of the assaults, a fellow employee witnessed Ulloa jump on the chest of a non-verbal 78-year-old woman’s chest, and throwing her on the bed as she struggled. To another elderly male resident, Ulloa jumped off a dresser and landed with both knees on the man’s abdomen, seriously injuring the man. He apparently would laugh with delight while brutalizing the patients.

Suspicion over Ulloa actions was raised after the wife of a resident received an anonymous phone call the day after her husband’s funeral. The call said that her husband had been abused, and that his death may have been related to the abuse, something the family suspected. The police were notified, and the victim’s body exhumed for an autopsy that revealed more than 24 fractures. The man’s death was determined to be caused by blunt force trauma.

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The healthcare reform bill signed by President Obama this week will have an impact on nursing homes and long-term care. The most dramatic change will come in the form of long-term care insurance, and provision that was long championed by the Senator Edward Kennedy. Under the Community Living Assistance Services and Support Act (CLASS), all Americans will automatically be enrolled in a long-term care insurance program, but will have the option to opt out.

Under the Act, individuals will start paying a premium immediately, and will be able to use the benefit after five years of contribution to the program. The benefit, though, is not much, as it is expected to be about $50 per day to offset other long-term care costs.

The healthcare reform bill will also start to close the “donut hole” in Medicare Part D coverage for prescription drugs. Patients will immediately begin receiving a rebate for drug costs that fall into the gap, and drug manufacturers will be required to provide a discount on brand name drugs. Over time, the gap in coverage will be phased out entirely.

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The Sacramento Business Journal is out with an article accusing the State of California of exposing elderly nursing home residents to dangerous caregivers because state regulators have failed to implement a 2006 law that requires the creation of a centralized database for background checks on all long-term caregivers.

According to the article, an investigation by the state’s Senate Office of Oversight and Outcomes discovered at least 20 incidents where individuals who lost their certification as nursing assistance because of wrongdoing were cleared and hired in a different facility.

“There is no excuse for allowing people with known histories of abuse to work in residential care facilities for the elderly or as caregivers in any other setting,” said Michael Connors, an advocate with California Advocates for Nursing Home Reform, a non-profit that advocates on behalf of nursing home and residential care residents.

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A 76-year-old patient at the Ridgecrest Nursing and Rehabilitation Center in DeLand died after falling to the floor and lying there for 12 hours. Barbara Fasold fell out of her bed at approximately 5:00 a.m. and a fractured both legs and her shoulder, and was not discovered on the floor until a shift change at nearly 5:00 p.m. later that day. When discovered, Ms. Fasold was rushed to a local hospital, but was so badly injured in her fall that she died less than a week later.

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It is estimated that a nursing home with an average of 100 beds will experience between 100 and 200 falls every year. More concerning is that nearly 2,000 nursing home residents will every year from injuries related to a fall, and fall victims who survive often suffer debilitating injuries.

Nursing homes are required to prevent falls by providing adequate care-planning. Not all falls can be prevented, but if the nursing facility does an adequate job of assessing the risk of falling on a patient-by-patient basis, and then provide regular reassessments and interventions on an ongoing basis, particularly after a fall, many more falls would be prevented.

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All licensed nursing homes in California are licensed and certified by the California Department of Public Health, which conducts an annual inspection of every licensed skilled nursing facility in the state. In addition, the DPH is charged with the duty to investigate complaints of neglect or abuse, and issue the results of its investigation. Here is some general information about making a complaint against a nursing home.

First, who can make a complaint? Under California law, any person can make a complaint about a nursing home; it does not just have to be the resident, family member, or responsible party. Complaints may be made anonymously.

When is a good time to make a complaint? A complaint should be made whenever one considers the treatment problems to be serious enough to report. It is usually a good idea to express your complaints to the facility first, but if you feel like you’re not being taken seriously, call DPH.

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In their ongoing series on nursing oversight in the State of California, Tracy Weber and Charles Ornstein of ProPublica are out with another story about California’s shortcomings in regulating healthcare professionals. Weber and Ornstein reveal that the national database that tracks dangerous or incompetent caregivers is missing serious disciplinary actions against “what are probably thousands” of health care providers. The revelations apparently surprised federal health officials, who just last month proclaimed that “no data is missing.”

For almost twenty years the federal government has kept a database of disciplinary actions against doctors and dentist, and in 1999 individual state boards were required to include in the database reports on all other healthcare professional, including nurses, whose licenses were restricted or revoked. In California, however, not all penalized caregivers were included in the federal database. For example, California has formally disciplined 84 psychiatric technicians over the last two years, yet the federal database does not contain a single report of discipline against a psychiatric technician in the State of California.

The dangers of an incomplete database are obvious, as Dr. Sidney M. Wolfe of the Public Citizen’s Health Research Group observed, prospective employers of health care professions could be given “a false sense of security that somebody who may be really dangerous isn’t, because their name isn’t there.”

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The nursing home roommate from hell. A former San Diego nursing home resident was sentenced to 19 years in jail yesterday for setting a series of fires at two local nursing homes while she was a resident. According to an investigation, Mary Wilson tried to kill her nursing home roommate by setting her bed on fire while she slept. In another incident, Wilson threatened a resident with a knife.

The first incident occurred in January of 2009, when Wilson was a resident of the San Diego skilled nursing facility El Dorado Care Center in El Cajon. She was placed in a room with two roommates, both of whom were on oxygen and confined to their beds. In the middle of the night, Wilson got out of her bed and set the mattress on fire of one of her roommates. The fire alarm was triggered, and caregivers were able to extinguish the flame before any injuries occurred.

In May, Wilson was transferred to the assisted living center Golden Paradise Senior Living in National City. Shortly after her arrival, she set fire to trash cans and in the library. Luckily, there were no injuries.

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In 2007, Dr. David Graham, a drug safety expert with the FDA, testified before Congress and stated that approximately 15,000 people die each year in U.S. nursing homes from the off-label use of anti-psychotic drugs. Off-label use is the use of the drug for a condition it was not intended. In California, it has been estimated that up to 60% of all nursing home residents are given psychoactive drugs, which is an increase of 30% in only 10 years. It’s no wonder that when we think about nursing homes, we think of isolated elderly people sitting hunched over in wheelchairs, or in bed, segregated from the world. That life is a sad realty for many.

To combat the misuse of psychoactive drugs, the California Advocates for Nursing Home Reform have released a publication called Toxic Medicine – What You Should Know to Fight the Misuse of Psychoactive Drugs in California Nursing Homes. The 20-page booklet provides an overview of what psychoactive drugs are, their purposes, the risks associated with them, and an overview of the resident’s rights.

Primary among those rights is the requirement of consent. Before a psychoactive drug can be used, a physician must inform the resident (or his/her decision-maker) about the drug, why it is being recommended, and the risks associated with it, and then must obtain consent before prescribing it. The guide also provides a list of questions that should be asked of a doctor who is recommending a psychoactive drug, and what to do if it is suspected that the drugs are being used without proper authority.

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