DO YOU SUSPECT ABUSE OR NEGLECT? Contact Us for a Free Consultation

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The Orange County nursing home Tustin Care Center has received a citation and a fine of $50,000 by the California Department of Public Health after a resident choked to death during lunch. A state investigation concluded that the nursing home’s failure to adequately assess the patient’s growing inability to eat as the cause of death.

According to the state report, the elderly man had been growing weaker over time, but that the nursing facility allowed him to continue to eat regular meals. In March, while eating lunch with his wife, who was also a resident at the Tustin facility, when he had difficulty breathing. As the patient struggled to breath, an attendant was called over, who tried to clear the airway.

The man died at a local hospital later that same day, and an examination found that food was completely blocking his airway.

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As California starts to overhaul the regulation of its 350,000 registered nurses, one of the nursing board’s most promoted and trouble programs is under the microscope. The nursing drug diversion program, which seeks to help nurses maintain their licenses while they kick addiction to drugs, has apparently not been the success the nursing board would like the public to believe.

An investigation by the Los Angeles Times and ProPublica discovered several examples of nurses in the drug diversion program who practiced nursing while intoxicated, stole drugs from bedridden patients, and committed fraud to prevent from being caught.

Most troubling is that since the program was started in 1985, more than half the nurses who entered the program were unable to finish it and numerous nurses who failed the program were deemed to be “public safety threats.” Yet despite the identification of incorrigible nurses, several continued to work after the findings were made.

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The great recession hasn’t impacted everyone negatively. While the salaries and compensation for nurses has remained stagnant, the salaries for nursing home administrators have climbed to its highest rate in four years.

According to a study by the Nursing Home Salary and Benefits Report from Hospital & Healthcare Compensation Service, the average salary of a nursing home administrator rose by an average of 4.8% in 2009. The national average now hovers around $89,000 for administrators of nursing homes of all sizes, including not-for-profit facilities.

The study took samples from more than 10,000 nursing homes across the United States.

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The California State Assembly voted overwhelmingly to approve Assembly Bill 392, which would immediately restore $1.6 million to Long-Term Care Ombudsman programs throughout the state. Much of the funding to the programs was cut last year when Gov. Schwarzenegger vetoed the Ombudsman funding request.

In June 2009, a nursing home owner was arrested on allegations of criminal abuse and neglect, when a resident of his facility was so severely neglect that pressure sores went untreated and led to a fatal infection. Numerous nursing homes throughout the state have received citations for failing to provide adequate care of residents. Without an Ombudsman program, it is difficult to monitor the care the residents of these facilities.

“We need to take every step we can to protect seniors who may be at serious risk of abuse or exploitation,” said Assembly member Mike Feuer (D-Los Angeles), who authored the bill. “The funds provided to Ombudsman programs in AB 392 fill this important need during the next year. Isolated and vulnerable residents of nursing homes and assisted living facilities have nowhere else to turn, and their lives depend upon these programs being restored immediately.”

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Elder abuse cases are rarely reported, and even more rarely prosecuted. “Elder abuse cases, for whatever inappropriate reason, are not considered as severe,” said Riverside County District Attorney Rod Pacheco.

The reasons for the low reporting and prosecuting are varied. There is the embarrassment of being a victim, and in many cases – up to two-thirds – the elderly victim knows the abuser. But there is also the problem of ageism; the failure to take the matter seriously because the victim is elderly.

And it’s not just the public that needs educating about elder abuse and neglect, but law enforcement as well. Riverside County has a special team dedicated to elder abuse cases, and it sees the ageism first hand. “They’re old. They didn’t have to live anyway,” are the types of excuses heard by Tristan Svare, a San Bernardino deputy district attorney.

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After a L.A.Times and ProPublica investigtion found that violent or negligent nurses were allowed to stay on the job for years because of slow responses from the California Board of Nursing, Gov. Arnold Schwarzenegger fired three of the seven appointees to the board. The Governor also named six new members to the nine-member panel, which oversees the work of approximately 350,000 registered nurses in California.

Schwarzenegger was forceful in his response to the report: “It is absolutely unacceptable that it takes years to investigate such outrageous allegations of misconduct against licensed health professionals whom the public rely on for their health and well-being.”

The report from the LA Times (which was blogged about here) discovered nurses who continued to work years despite documented histories of incompetence, violence, criminal convictions and drug theft or abuse.

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It’s been almost six months since Nursing Home Compare was launched, and all of the nations 15,600 nursing homes were listed and rated by the U.S. government. The reviews are in, and it’s no blockbuster, but it isn’t a flop.

For consumers, it’s been mostly a good thing. It is the most complete nursing home rating website, which provides information about nursing staffing, state inspections, allegations of neglect. But some consumer groups want more details included about inspection results, and how staffing hours is calculated. Just counting workers, they say, is no indicator of the quality of care.

The nursing home industry, which tried to delay the website’s rollout, says the grading system used by the site is misleading. Just because an allegation of neglect or abuse is made, it doesn’t mean it has been substantiated.

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One nurse twisted a patient’s jaw until he screamed. Another grabbed an elderly man by the shoulders and slammed him against a mattress. Our 70-year-old client was punched in the face by an angry nurse while giving our client a bath.

Charles Ornstein of the LA Times is out with an article today about problem nurses. He highlights a very troubling fact: It sometimes takes years for a formal complaint against a nurse to be addressed by the California Board of Registered Nursing. As Ornstein writes:

It’s a high-stakes gamble that no one will be hurt as nurses with histories of drug abuse, negligence, violence and incompetence continue to provide care across the state. While the inquiries drag on, many nurses maintain spotless records. New employers and patients have no way of knowing the risks.

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The U.S. Court of Appeals, 3rd Circuit has ruled that the Federal Nursing Home Reform Amendments grants residents of county-operated nursing homes the right to bring civil rights claims for allegations of abuse, neglect, or other care-related complaints.

The ruling arose in a case involving the 80-year-old Melvinteen Daniels, who died in a county-run nursing home as a result of neglect, malnourishment, and pressure ulcers. The family brought a lawsuit against the nursing home alleging, among other things, civil rights claims under Section 1983. Challenges to the claims wound their way through the courts and leading to yesterday’s ruling.

In a 23-page opinion, U.S. Circuit Judge Richard L. Nygaard held that, “the language used throughout the FNHRA is explicitly and unambiguously rights-creating. These provisions make clear that nursing homes must provide a basic level of service and care for residents and Medicaid patients.”

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Every year, nursing homes throughout the state of California are fined for deficiencies found in state investigations, frequently related to nursing home care. The fines range anywhere from a Class B fine of $1,000 to an AA citation of $100,000, as was recently issued against the Encinitas nursing home Aviara Healthcare.

But California officials concede that collecting these fines can take years, if they are collected at all. Nursing homes have a right to appeal fines that are issued, and most do. In the year 2007, the state issued more than $2 million in fines and to date has collected less than 10 percent.

The California Department of Public Health is charged with the oversight of skilled nursing facilities, and is the state department that issues and collects nursing home penalties. They simply don’t have the manpower to get the job done.

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