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Last year, the U.S. Drug Enforcement Administration began investigating allegations that some nursing homes were dispensing powerful narcotics to nursing home residents without a physician order. Because of the new scrutiny, however, nursing home and hospice trade organizations are arguing that many patients are now being left without pain medication as the nursing facilities try to find ways to comply with DEA regulations. Congress has also taken notice, and the subject will be addressed at a Senate hearing today.

The DEA intensified its efforts to battle abuse of prescription drugs in nursing home, after numerous reports of overmedication of patients in nursing facilities, many without prescription, and frequently used as a “chemical restraint,” not to treat a specific illness. In a letter to Congress last December, attorneys for the DEA said that allowing nurses to dispense medications without a doctor’s order, “trivializes the doctor-patient relationship and weakens the quality of care for the frail and infirm.”

Nursing home trade organizations, however, say that long-term care facilities don’t make available enough doctors to issue prescriptions every time. The DEA’s requirement on “hard copy prescriptions,” it says, places burdens on prescribers, pharmacists and nurses, and can lead to extended delays in the administration of pain medication.”

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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 former aide at a home for the disabled has been arrested and charged with molesting two female residents. Curtis Cortez, age 59, is being held on $100,000 bail after his arrest, and is expected to be charged with seven felony counts of lewd and lascivious actions by a caretaker upon a dependent person.

From news accounts, it appears the man has confessed his crimes to police, at least partially. When police confronted Curtis about the allegations, he offered a “Hawaiian defense.” He told authorities that he gave frequent hugs to people because it was part of his Hawaiian culture. He then volunteered that he was having problems with his girlfriend, and that he did touch one of the disabled woman’s breasts and genitals.

From a civil liability standpoint it is an interesting case. Curtis himself would obviously be liable for sexual assault and battery, but probably unable to pay a civil judgment. The question is, would the home be liable? Generally speaking, an employer is not liable for the intentional criminal acts of its employees, unless the acts were engendered by, or arose out, the employee’s duties. This one would be a close call.

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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 New York Times is out with an article about lack of oversight given to the more than 400 long-term acute care hospitals that operate in the United States. These hospitals, most of which operate as for-profit organizations, are supposed to provide care for individuals that are too sick for traditional nursing homes, but too stable to require regular hospitalization. According to the article, long-term care hospitals were much more likely to be cited for serious violations of Medicare rules than regular hospitals, and had a higher incidence of bedsores and infections.

While the care might be questionable, the no one will question the profitability of these health care providers. In 2007, the profit-margins on long-term care hospitals was 6 percent on Medicare patients, which regular acute-care hospitals lost an average of 6 percent on Medicare patients. How does that happen? In a presentation last month by Select Medical, an owner of several long-term care hospitals, to its investors, it revealed that it maintains its profits by monitoring staffing and lowering supply costs.

Those of us who represent victims of neglect in long-term care facilities know that “monitoring staffing” is another way of saying that it keeps staffing levels at the lowest numbers allowable by law. That usually means a lower quality of care. As for Select Medical, this approach is victimizing patients.

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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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A few times a year we hear news stories of Alzheimer’s sufferers wandering away from their homes and becoming lost. Those stories end one of two ways, and unfortunately, too often the ending is not a happy one.

These sad stories have created a cottage industry for nursing home providers. We have all now heard of nursing homes advertising themselves with “special neighborhoods for the memory impaired.” Or providing “safe and secure” housing for the Alzheimer’s patient. But what happens when the victim wanders away from those facilities?

A few years ago, such a thing happened in Escondido. Then a 94-year-old woman walked out of Palomar Heights Care Center in Escondido and into the path of a car, killing her instantly. Caregivers told the media that they didn’t know what happened, but a subsequent lawsuit revealed some serious neglect on the part of the home.

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