Articles Posted in Nursing Home Abuse and Neglect

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In their ongoing investigation into California nursing, Tracy Weber and Charles Ornstein of ProPublica are out with an article on temporary nursing agencies being a haven for unfit nurses. Temp nursing agencies are used frequently by local hospitals and nursing homes to fill nursing positions that have been vacated for some reason; usually for day or two, but sometimes open-ended.

In its investigation, ProPublica found numerous instances in which the agencies, desperate to find certified nurses, failed to perform background checks or ignored warnings from hospitals about weak nurses in order to fill nursing orders. It is a profitable undertaking; the temporary nursing industry is a $4 billion industry.

Some of the other ProPublica findings were startling:

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The State of California has announced that healthcare providers, namely nurses, that have abused drugs will face more stringent guidelines to maintain their licenses. After treatment, the nurses will be required to pay for regular drug testing. After a negative test, the nurse will be able to return to work, but during the first year, will be required to undergo 104 drug tests. The new guidelines state that a single failure of a drug test will result in an immediate suspension of the nursing license. In addition, the state will be permitted to publically identify nurses who are being subject to this increased supervision.

These new regulations follow an L.A. Times investigation earlier this year (and blogged about here) that found several problems in the licensing, certification, and regulation of California nurses. In that investigation, it was revealed that numerous nurses with documented drug problems were allowed to continue working without consequence, and that nursing complaints were taking years to resolve.

The new regulations can be found here.

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Ninety-two-year-old Robert Doscher was admitted to Valley Gardens Health Care, a for-profit nursing home, on May 18, 2007. He came from a hospital where he was being treated for a mini-stroke, and other heart issues. Upon admission to the nursing home, he needed the use of a walker, and the plan was to stabilize his health, and transfer him to an assisted living facility.

He required the use of a walker when he was admitted, and it was initially planned that he could be discharged to a board-and-care facility when his condition stabilized. The admission assessment at Valley Gardens determined that Doscher was at “high risk” for falling, and the care plan ordered the he be checked “every one to two hours.” He was also instructed not to get up without assistance, and a tab alarm was placed on his clothing to monitor his movements.

On May 21st, only three days after he was admitted to the nursing home, Doscher fell and struck his head on the floor. He was found by staff on the floor. According to the investigation, there was no evidence that Valley Gardens was checking on Doscher every one to two hours, nor did they place him near the nursing station, as had also been recommended upon admission.

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George Washington once said:

Discipline is the soul of an army. It makes small numbers formidable; procures success to the weak, and esteem to all.

Letter of Instructions to the Captains of the Virginia Regiments [July 29, 1759]. The advocates of consumer rights, viewing the resources of defense firms and corporate defendants, can relate to the trepidation felt by the out-numbered and out-gunned Continental Army. Because of that disparity in resources, Consumer Attorneys of California (“CAOC”) consolidates the voices of consumer attorneys throughout the state to (1) preserve and protect the constitutional right to trial by jury for all consumers, (2) champion the cause of those who deserve redress for injury to person or property, (3) encourage and promote changes to California law by legislative, initiative or court action, (4) oppose injustice in existing or contemplated legislation, (5) correct harsh, unjust and oppressive legislation or judicial decisions, (6) advance the common law and promote the public good through the civil justice system and concerted efforts to secure safe products, a safe workplace, a clean environment, and quality health care, (7) uphold the honor, integrity and dignity of the legal profession by encouraging mutual support and cooperation among members, (8) promote the highest standards of professional conduct, and (9) inspire excellence in advocacy. This post is a multi-blog effort to inform consumer attorneys about CAOC’s value and encourage participation in CAOC through membership.

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As America’s elderly population continues to explode (it will double by 2030), an important question that has received little attention in the national healthcare debate is how the U.S. will be able to deal with 78 million aging baby boomers. Those of us who practice elder abuse and neglect law regularly see the costs associated with long term care, and let me tell you, it ain’t cheap.

For many nursing home residents the story goes like this: there is an event that causes them to be hospitalized, whether it’s an injury such as a fractured hip, or an illness. It is determined that after the hospitalization, nursing home rehabilitation is in order. The hospitalization and the first 100 days of nursing home care will generally be covered by Medicare. When the 100 days is up, and the person is determined to be too frail to return home, the financial obligation falls upon the resident, or his or her family. At $5,000 – $10,000 per month, this can quickly be financially devastating. If there is no money, or the resident’s spends it all in the first months of care, they are typically qualified for Medi-Cal, and the taxpayers foot the rest of the bill, even if the patient spends the next five years in the nursing home.

This article at NewAmericanMedia.org addresses this very question.

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A nursing home called Valley Gardens Health Care and Rehabilitation in Stockton, California has received an “AA” citation from the California Department of Public Health due the neglect of one of its residents. The AA citation is the most severe penalty that can be levied by the state, and is issued only when a patient’s death has occurred in a way that can directly attributed to the conduct of the facility. A $90,000.00 fine was also issued.

According to news reports, which are currently scant on facts, the facility failed to ensure a resident was adequately supervised, resulting in a serious fall, which caused the resident to die.

The California Department of Public Health has the statutory authority license and certify all of California’s nursing homes. Part of its authority is to inspect the homes annually, and respond to consumer complaints. If investigations into substandard care are substantiated, the CDPH has the authority to issue citation, and impose fines. Typically, the fine depends on the significance and severity of the substantiated violation.

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In a strongly worded report, the California Senate Office of Oversight and Outcomes recommended major reforms to the California long-term care ombudsman program. The responsibility of the Ombudsman program is to investigate and resolve complaints made by individual residents in nursing homes.

According to the California Advocates for Nursing Home Reform (CANHR), nursing home and assisted living facility residents in California at an increasing risk of elder abuse because ombudsman funding has been severely cut and the state ombudsman office has established unreasonable restrictions on ombudsman reporting of abuse.

The state report, entitled California’s Elder Abuse Investigators: Ombudsman Shackled by Conflicting Laws and Duties, revealed that ombudsman complaint referrals to the nursing home licensing agency dropped by a stunning 44 percent in the last year after the Governor Schwarzenegger slashed funding to the fledgling ombudsman program. Assisted living facilities have been affected as well. During the same period, complaints by ombudsman to California’s Community Care Licensing regarding assisted living and residential care facilities also dropped by more than 40 percent.

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At the end of last week, a Medicare rate adjustment that cuts $16 billion in nursing home funding went into effect. That cut, combined with state cuts, is creating conditions that are likely to put nursing homes in a state of crisis. In fact, the president of the American Health Care Association is predicting the nursing facilities will close their doors.

Already numerous nursing homes have closed their doors because of money problems, and many others have reduced staffing, creating conditions for substandard care. The crisis could not come a worse time, as baby boomers steamroll toward retirement and the need for skilled nursing care. Just last year U.S. nursing homes housed 1.85 million people, about 100,000 more than the previous year.

In Griswold, Conn., the community’s only nursing home shut down earlier this year because of rising costs and an inability to pay for $4.9 million in needed renovations for the 90-bed facility.”A 92-year-old woman was screaming and crying as she was loaded into the ambulance, saying ‘This is my home,'” Griswold First Selectman Philip Anthony said. His 88-year-old mother was a resident of the same home at the time.

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California should take heed. Illinois has been housing mentally ill felons with the elderly in state nursing homes and the results have not been pretty. An elderly woman was raped by an ex-convict, a frail man had his throat slashed, and in one home a wheelchair-bound man died of massive head injuries that a doctor said it looked like he was hit with a baseball bat.

According to one report, mentally ill patients make up over 15% of Illinois’ nursing home patient population, and among them are approximately 3,000 ex-felons with histories of serious crimes. Nursing home owners downplay that numbers of violent attacks, arguing they are miniscule in context to the whole, but there is a growing concern. The states largest nursing home owner’s association has advocated an end to the practice, asking state officials to create separate facilities for those residents who may pose a danger to others.

While the population of U.S. residents is aging, those who can afford to do so are opting from home health or assisted living care over traditional nursing home or convalescent hospitals.

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A report being released today by the Government Accountability Office finds that the federal program designed to identify and scrutinize the country’s worse nursing homes is missing many of the poor performers. The Centers for Medical and Medicaid Services has identified about 136 nursing homes nationwide that are considered “special focus facilities” for their history of problems related to patient care, but many more questionable facilities are not making the list.

Herb Kohl, the chairman of the Senate Aging Committee wants more information about all of the poorest performing facilities on the government website Nursing Home Compare. The current report does not identify the homes.

“If far more than 136 nursing homes boast the bleakest conditions, then perhaps we should consider expanding” the program, said Kohl.

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