Jonathan Rosenfeld's Nursing Homes Abuse Blog

Sheesshh!! Move Along, Nursing Homes Trying To Cover Up Incidents Involving Sexual Abuse

Jonathan Rosenfeld — Fri, 30 Jul 2010 05:48:30 -0600

In a world full of crazy people, some have managed to infiltrate the world of nursing homes. While occurrences involving the sexual abuse of nursing home patients are certainly not a common place occurrence, the incidents do occur--- yet too often they are brushed aside by nursing home staff whom may attempt to hide the incident out of embarrassment or perhaps at the request of nursing home management.

Regardless of the underlying reason, failing to report mistreatment of nursing home patients is unacceptable-- and illegal. Laws applicable to nursing homes require facilities to: 1) protect patients from harm and 2) to report allegations of misconduct to appropriate state agencies.

Omissions made with respect to both of the above obligations landed Hazard Nursing Home of Kentucky in a potentially troublesome situation. During the course of litigation on an unrelated wrongful death case, several nursing home employees disclosed at their depositions that they witnessed an 88-year-old woman get sexually assaulted on multiple occasions by other nursing home patients. When the incidents were reported to nursing home supervisors, they instructed the staff not to take any action because there was no 'harm' to the patient (who happened to be disabled).

As a result of the nursing home employees testimony, both a civil lawsuit has been initiated by the woman's family as well as an investigation has been triggered by Kentucky officials.

Hopefully, these recent actions will improve the care provided to all patients at this facility. Traumatic events, such as this, involving mentally and physically handicapped patients can be particularly troublesome to identify and provide treatment for.

In several cases I have worked on regarding sexual assaults of the disabled, we have worked with experts in the fields of psychology and trauma to attempt to more accurately convey the full impact of the event to both defense lawyers as well as potential jurors. In some circumstances, these experts can help explain the trauma when the victim of the assault may not be able to do so.

Knowing the telltale signs of sexual abuse:

For caregivers, knowing the signs of potential sexual abuse is important in order to prevent further mistreatment of the patient as well as others in the facility. Common signs of sexual trauma include:

Fear of certain people
Difficulty walking or standing
Change in behavior, such as crying or withdrawal
Bleeding in the genital area or anus
Bruising in the inner thigh
Sexually transmitted diseases
Pain in the genital area
Depression
Unusual discussion regarding sexual issues

When Bruises Can't Speak For Themselves: The Difficulty Proving Abuse Of Disabled Nursing Home Residents

Nurse Charged With Rape Of Disabled Patient

Nursing Home Fails To Report Suspected Sex Abuse To Authorities

Lawsuit Claims That Nursing Home Failed To Intervene In Case Involving The Sexual Abuse Of A Patient

A failure to protect: Sexual abuse in nursing homes, Kentucky.com July 25, 2010

Forgetful Assisted Living Staff Allows Autistic Patient To Bake In Hot Van

Jonathan Rosenfeld — Thu, 29 Jul 2010 05:12:14 -0600

A shameful story regarding a Pennsylvania assisted living facility / group home recently made headlines after staff left an autistic man in a hot van for five hours following a field trip sponsored by the facility.

Apparently the man was chaperoned to a local amusement park with staff from the Woods Services. When the group returned to the facility, one of the staff members escorted some of the other residents back to the living quarters while the other staff member parked the van. The staff member who parked the van forgot that the autistic man remained in the back seat.

By the time the staff located the autistic man in the van he was dead. According to the medical examiner, the man died from hyperthermia. The staff involved in the event have been suspended pending the results of the investigation in the incident currently underway by multiple investigative agencies.

Hyperthermia Deaths

Sadly, hyperthermia deaths related to people left in vehicles is more common than you think. Even relatively mild temperatures and bright sunlight can allow temperatures in vehicle to reach dangerous levels with short periods of time.

Hyperthermia can occur when the body is exposed to high temperatures and produces more heat than it can dissipate. The increased heat raises the body temperature disrupting normal body functioning. If not treated quickly after the initial onset, hyperthermia can result in disability and death.

Hyperthermia Deaths of Children in Vehicles

Autistic man dies at Langhorne center after five hours in parked van, philly.com July 28, 2010

Second suspension in Woods Services death, phillyburbs.com July 28, 2010

Rather Than Improve Poorly Performing Nursing Homes, Why Not Just Re-Categorize Them?

Jonathan Rosenfeld — Wed, 28 Jul 2010 06:51:29 -0600

Last fall, we discussed the problems state inspectors found at Emeritus at Crossing Pointe, a Florida nursing home, that posed an immediate threat to resident safety. During an inspection at the nursing home, inspectors discovered:

An 82-year-old patient who died after staff failed to provide her heart medication for four days
Inaccurate resident counts by facility managers
Residents with infected bed sores (also called decubitus ulcers, pressure ulcers or pressure sores)
Neglected patients- some Alzheimer's patients had toe nails so long that they curved around their toes
Falsified medical records
Staff administering the wrong medications to patients that resulted in injury

The living conditions were so poor that Florida officials banned the facility from accepting new patients.

Now, it seems Emeritus officials have officially thrown in the towel at this facility. After months of attempting to improve the living conditions at the facility, Emeritus officials have elected not to re-new the facilities nursing home license. Now, the skilled nursing facility will transition to a 'senior housing' facility.

Although the change in facility designation may seem like a minor change, the reality is that the change in designation of the type of facility is significant from a regulatory standpoint. As a senior living facility, the facility will no longer be subject to any of the regulation imposed by the state of Florida on nursing homes such as inspections.

No word yet as to whether the Emeritus Corporation will retain control over the facility as it transitions to a less structured care environment.

As a nursing home lawyer, I continually see poorly performing facilities attempt to re-name, re-organize and re-categorize themselves as problems arise. In some cases, the re-vitalization of the facility provides a fresh start. Unfortunately, most situations involving freshening up sub-par facilities simply means a change in window dressing. Too often, I see these re-newed facilities continue with the pattern of poor care that got them in trouble originally.

Consequently, it is important for families to learn as much as they can about nursing homes and assisted living facilities before placing a loved one there. In addition to researching the corporation itself, it is important to ask direct questions to administrative staff regarding the history of the facility.

Read more about this Florida nursing home here.

Related Nursing Homes Abuse Blog Entries:

Admissions Suspended At An Emeritus Assisted Living Facility Following The Discovery Of: Medication Errors, Bed Sores & Falsified Medical Records

Another Iowa Assisted Living Facility Chooses To Abandon Its License

Pesky Government Regulations No Problem For Assisted Living Facility In Iowa

Now That We Rate Nursing Homes, Is It Time To Rate Other Adult-Care Facilities?

What causes bed sores?

Use Of Restraints Amongst Nursing Home Patients Has Been Reduced More Than 50% Over The Last Decade. Is It Enough?

Jonathan Rosenfeld — Tue, 27 Jul 2010 06:03:53 -0600

When you consider forms of cruel treatment, maybe you consider beds of nails or solitary confinement? However, another form of cruel treatment-- the use of restraints, is commonly used with innocent nursing home patients. At some facilities, patient restraints are a commonly used tool used by facilities in lieu of providing actual hands-on patient care by facility staff.

In the past, nursing homes used physical restraints such as: bed rails, lap belts, vests, wrist ties and special chairs to assist them in literally controlling their patients. In addition to de-humanizing patients, the use of restraints was attributed to rapid physical deterioration and increased rates of patient injury.

In response the the poor publicity and family outrage, many skilled nursing facilities have made great efforts to reduce use of restraints. The reduction in restraint usage was recently discussed in an article by Megan Brooks on Medscape.

Ms. Brook's article analyzed data from a News and Numbers report from the Agency for Quality Improvement and Patient Safety (AHRQ), which was part of a 2009 National Healthcare Disparities Report. In short the reduction in use of restraints seems promising-- from 1999 to 2007, the number of nursing home patients who were restrained dropped more than 50%.

By most estimates, just 5% of nursing home patients are restrained by facilities. Restraint usage varies significantly based on the following factors such as ethnicity, age and sex.

Certainly this is promising news for nursing home patients in general. However, the data contained in the AHRQ report does not contain enough specifics regarding nursing home patient demographics to assess if restraints are being improperly utilized.

To restrain or not?

This really is a very difficult question to answer and the answer varies significantly amongst experts. I feel restraints may be justified when the patient is at risk for harming themselves or others.

In my experience, I have witnessed facilities slow to utilize restraints--- even after repeated episodes of falls. In one of my cases, the facility refused to restrain a patient despite fourteen reported falls (many with associated injuries) at the facility. Unfortunately, the patient's fifteenth fall resulted in a head injury which ultimately cost the patient her life. In the course of litigation, I asked the director of nursing why the patient was not restrained, she advised that the facility was a 'no restraint facility'.

In this case, I think there certainly is a very strong argument that I can (and will make) that with a no restraint policy, the facility was not properly equipped to care for this patient due to her extensive history of falls.

In another restraint case I worked on, a patient was seriously injured when she was left unattended in her geri-chair with an improperly placed lap belt. Apparently, the belt was too loose and when the woman slipped down in her chair, she became entangled and choked. Again, in the course of litigation, the facility disclosed that lap belts were used on all patients --- regardless of their physical abilities.

Certainly, regardless of a facilities restraint usage policy, it is up to the facility adequately supervise patients to ensure the usage / non-usage of restraints doesn't interfere with the patients well being. Further, this is an important issue for families to discuss and know where the facility caring for their loved ones stands on this issue.

Related Nursing Homes Abuse Blog Entries:

Many Nursing Homes & Assisted Living Facilities Continue To Threaten The Safety Of Their Patients With The Use Of Bed Rails In Their Facilities

Warnings Do Little To Prevent Bed Rail Entrapment

Bedrail Entrapment

Can a nursing home tie my dad to a wheelchair if he has had episodes of wandering around the facility?

Suspect A Problem Nurse? Learn More About The Nurses History Here?

Jonathan Rosenfeld — Mon, 26 Jul 2010 05:51:51 -0600

I received a lot of emails from families who were concerned about the safety of their loved ones following our recent Nursing Homes Abuse Blog entry regarding the lack of national regulation of nurses. Our blog entry was based on an in depth report regarding nursing regulation that appeared in a ProPublica series on poor care provided by nurses with a blemished record of providing quality patient care.

The articles highlight the problems associated without a centralized database regarding nurses backgrounds and whether they have been disciplined in one state-- only to legally find work in another.

Thankfully, ProPublica reporters Charles Ornstein and Tracy Weber did a great service compiling information on nurse regulation on a national level. The duo's compilation contains links to the following information:

License look-up page
Whether the states has a free on-line license look-up
Free disciplinary documents on-line
Contact information regarding obtaining medical records
Lists of disciplines nurses by state

While the information contained in this link can not eradicate poor nursing care, providing transparency on nurses background may help prevent additional situations involving abuse or neglect.

Nonetheless, should you have further concerns regarding the staff at a nursing home or hospital, don't be shy about reporting the individual to the head of the facility or to law enforcement officials. Thankfully, most staffing issues can be resolved in this matter-- before further intervention is necessary.

Below is a map that appeared in the ProPublica series. The purple states allow free retrieval of license look-up on line.

State Steps In After Second Episode Involving Patient Elopmement At Same Facility

Jonathan Rosenfeld — Fri, 23 Jul 2010 05:50:55 -0600

I think its downright scary when facilities fail to learn from their mistakes. Of course, --- any person, --- any facility can make a mistake one time, but when the same errors are repeatedly made I feel there is well deserved cause for concern.

An episode of a patient wandering from Brentwood Assisted Living facility, would normally not be a particularly noteworthy event--- especially since the eloping woman will hopefully recover from her injuries. What deservedly brings more attention to this incident is the fact that this was the second patient to wander from this facility this year!

In the most recent occurrence, the Michigan Department of Human Services is investigating the incident in which a 91-year-old woman wandered from the assisted living facility with her walker. Three days later, the woman was discovered by neighbors in the area at the bottom of a heavily wooded ravine.

As DHS investigates this incident, just months before the agency investigated a similar incident in which a patients eloped from the facility. After the agencies investigation, it was revealed that Brentwood: 1) failed to monitor the patient in accordance with their care plan that identified them as being at high risk for eloping and 2) failed to timely notify the patients family of the occurrence.

Patterns of poor care

Of course, episodes of poor care should give rise to concern. However patterns of poor care really should give rise to alarm both on the part of families who have loved ones at this facility and on the part of the state.

Even though it appears that neither patient involved in these elopement events was injured seriously, I hope that the state recognizes the severity of these lapses in patient care and reprimands the facility accordingly.

Episodes involving patient elopement and wandering rarely end as well as it did for these patients. Unfortunately, when patients wander from a nursing home or assisted living facility they are ill-equipped to deal with the world around them. In our nursing home abuse practice, we have worked on several cases where patients received severe injuries or were killed after they left the safe confines of their facility.

Read more about this case of elopement from an assisted living facility here.

Elopement

Assisted living and nursing home patients with dementia and Alzheimer's are commonly known to elope from their facilities. On admission, the facility should conduct an assessment of the patient (with family if possible) and determine the persons risk level for eloping from the facility.

Once an assessment has been completed, the implementation of simple preventative measures implemented by a facility to assure the patient remains safely at the facility. Assisted living facilities and nursing homes that care for patients who are at risk for eloping should have the following safeguards in place:

Door alarms
Window locks
Door locks
Bracelets that track each resident's location
Hire adequate staff to look after residents
Have contingent plan to locate patients in the event a resident elopes from the facility

Related Nursing Homes Abuse Blog Entries

Assisted Living Facilities Need To Re-Evaluate If They Are Capable Of Caring For Dementia Patients

Chicago Nursing Home Lawyer, Jonathan Rosenfeld, Interviewed Regarding Preventing Patients From Wandering From Their Facilities

Three Employees At Assisted Living Facility Disciplined For Their Failure To Report Missing Nursing Home Resident

What Can Nursing Homes Learn From Jails?

Nursing Home Negligence Lawsuit Filed After Man Wandered From West Virginia Facility

Wait A While & Bad Nurses May Just Migrate To Your State To Care For Your Loved One

Jonathan Rosenfeld — Thu, 22 Jul 2010 06:06:02 -0600

Loopholes in a reciprocity program amongst 24 states that allows nurses from one state to transfer to another may be putting a tremendous number of nursing home and hospital patients at risk for receiving poor care-- or perhaps more accurately downright dangerous care.

A recent USA Today article "Bad nurses able to keep working in other states" highlights the problems associated with the lack of a national database to keep track of nurses with blemishes on their records. The article chronicles how some nurses legally obtain work in one state when they may have been disciplined for poor care in another.

The 24-state pact was originally intended help under-utilized areas of the county get the nurses when they need them--- without the nurses having to obtain licensing from the state board. However, it seems like the dangers associated with states almost blindly allowing nurses to transfer into their state are alarming.

In particular, there are multiple episodes where nurses have admitted and/or been disciplined in the following circumstances:

Stealing patients medicine
Medication errors
Providing negligent medical care
Neglected patient needs
Physically abusing patients
Failing to register as a convicted sex offender

Certainly, after reading this article, you will likely be left with a similar impression to myself that there needs to be a national tracking system for nurses and all health professionals who may have reciprocity rights that allow them to transfer from one state to another.

However, until such a system is put into place, I firmly believe it is the responsibility of individual facilities (and staffing agencies) to provide qualified staff at their facilities to assure proper care and patient safety. In my opinion, these responsibilities are non-delegable and when a facility fails to uphold their end of the bargain and a patient suffers harm they certainly expose themselves to civil responsibility.

Related Nursing Homes Abuse Blog Entries:

Temp Workers Becoming An Increasing Threat To Nursing Home Patients' Safety

Failure To Conduct Adequate Pre-Employment Criminal Background Search Costs Assisted Living Facility $750,000

'Significant Medication Errors' Discovered In Nursing Home Following Investigation Related To Patient Injury & Death

Why Would Anyone Want To Work In A Nursing Home?

Lawsuit Aginst Nursing Home Alleges Maggot Infestation Contrbiuted To Patient's Death

Jonathan Rosenfeld — Wed, 21 Jul 2010 05:26:41 -0600

If the facts alleged in a recent wrongful death lawsuit against an Oklahoma nursing home prove to be true, perhaps they will serve as a new definition of nursing home neglect.

The recently filed wrongful death lawsuit alleges that The Vian Nursing Home's neglect resulted in a patient developing an infestation of maggots in his nose and mouth during his admission to the facility. It is further alleged that the maggot infestation caused the patient's death because they contributed to a medical condition known as aspiration pneumonia.

The lawsuit filed in Sequoyah County District Court seeks damages for: pain and suffering, medical expenses, funeral expenses, permanent injuries, mental suffering and impairment. Read more about this lawsuit here.

Aspiration Pneumonia

Particularly common in patients with physical disabilities, aspiration pneumonia is caused by breathing food, liquids or vomit into the lungs. Once the lungs fill with fluid or other debris, the lungs tend to swell, breathing becomes difficult and an infection may set in.

Survival rates for patients with aspiration pneumonia are very much dependent upon how quickly staff at the facility make a diagnosis of the condition. Common physical characteristics of aspiration pneumonia include: chest pain, foul smelling sputum, sputum containing pus or blood, fever or wheezing.

Once staff become aware of the physical problems associated with aspiration pneumonia, they should alert the patients physician and conduct further tests to confirm the diagnosis. Common tests to assist in the diagnosis of aspiration pneumonia include: blood culture, x-ray or the chest, arterial blood gas test, CT scan of the chest, and / or sputum culture.

Depending on the severity of the pneumonia and the patients overall physical strength will likely dictate the type of treatment. Usually pneumonia is treated with some type of antibiotics. However, in situations where there is a delay in diagnosis or in situations where a patient may be weak, aspiration pneumonia may cause death.

Related Nursing Homes Abuse Blog entries:

Dysphagia In Nursing Home Patients May Contribute To Medical Complications Such As: Choking, Pneumonia Or Death

Elderly Patients Are At Higher Risk For Developing Aspiration Pneumonia When Facilities Fail To Account For Patient Needs

Nursing Home Staff Must Pay Special Attention To Avoid Complications When Caring For Patients Dependent On Feeding Tubes

Nursing Home Cleared Of Neglect Charges In Case Where Resident Had Maggots In His Eyes

Nursing Home Spotlight: Barry Community Care Center

Jonathan Rosenfeld — Tue, 20 Jul 2010 06:39:54 -0600

Barry Community Care Center is a 75-bed nursing home located in Barry, IL. On January 22, 2010, the Illinois Department of Public Health (IDPH) fined Barry Community Care Center $35,000 for violations in the area of policy and procedure. Even with this significant fine, Medicare rated the facility as a three-star or average nursing home facility, with only one health deficiency between February 2009 and April 2010.

This episode demonstrates that even well-regarded skilled nursing facilities can have very serious problems for patients. Barry Community Care Center’s single deficiency involved its failure to provide each resident the care and services required to achieve or maintain the highest quality of life possible, which resulted in immediate jeopardy to resident health or safety.

This example serves to reinforce how important it is to thoroughly research a potential nursing home because looking at the total number of health deficiencies is not enough. Not all health deficiencies are equal with regard to the level of harm presented to residents. In this case, the facility’s deficiencies and violations were very serious, resulting in the choking death of one resident. (See other Nursing Homes Abuse Blog articles on choking)

A survey conducted by IDPH on November 25, 2009 revealed that Barry Community Care Center failed to provide adequate supervision to a resident during mealtime, which resulted in the resident choking on food. Then, the nursing home did not call 911 for another hour, which led to the resident’s death at the hospital later in the day.

The resident was known to have impaired cognition and limited range of motion for neck, arm, and hand. The facility’s care plan for the resident required one person to physically assist and supervise with meals.

On September 26, 2009 at 1:00 pm, the resident was found in her room with a half-full plate of food from lunch in front of her. The resident was having trouble breathing and her face was ashen. A Licensed Practical Nurse (LPN) was called to the resident’s room. The nurse increased the oxygen and encouraged resident to cough. The resident coughed out some food but became too weak to continue. At that point, the nurse began to suction the resident while another nurse called the physician and power of attorney (POA). When the POA arrived, she requested that the resident be sent to the emergency room (ER).

The ambulance was called at 1:56 pm, almost one hour after the facility found her having trouble breathing and choking on her food. When the ambulance took the resident to the hospital at 2:27, the resident had a rapid pulse and was still having trouble breathing. When the ambulance arrived at the hospital at 2:41 pm, the resident was unresponsive, suffering from major respiratory distress. The resident died at the hospital with a diagnosis of aspiration pneumonia (inflammation of the lungs from breathing foreign matter into your lungs), atrial fibrillation (irregular, rapid heartbeat), hypertension (high blood pressure), Type 2 diabetes, and history of chronic obstructive pulmonary disease (COPD). (See “Elderly Patients Are At Higher Risk for Developing Aspiration Pneumonia When Facilities Fail To Account For Patient Needs”)

The facility never should have left the resident alone with her food tray, especially because the resident’s care plan called for her to have someone assist her with eating and drinking. In addition, the staff knew that the resident had trouble eating her breakfast on the morning of her death. One of the nurses had to physically remove pieces of egg and toast from her mouth before returning the resident to her room. Furthermore, the nurse should have immediately called 911 when she found the resident choking on food and having difficulty breathing.

The choking death of the resident at Barry Community Care Center is a sad reminder of how quickly a nursing home resident can suffer injury, or in this case, death, when they do not receive proper care and supervision. It took only 30 minutes for the resident to choke on food, when she should have had a staff member helping her eat, which would have prevented her death.

Thanks to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog entry

Sources:

Illinois Department of Public Health: Nursing Homes in Illinois Quarterly Report

IDPH: Barry Community Care Center

IDPH: Barry Community Care Center - Quarterly Report

Nursing Homes Abuse Blog: Elderly Patients Are At Higher Risk for Developing Aspiration Pneumonia When Facilities Fail To Account For Patient Needs

Nursing Homes Abuse Blog: Choking

Choking Death Just Latest Problem At California Nursing Home

Teenage Nursing Home Visitor Suspected Of Raping Patient

Jonathan Rosenfeld — Mon, 19 Jul 2010 05:45:39 -0600

Protecting nursing home patients seems like an obvious responsibility of nursing homes, yet too often facilities are lax when it comes to regulating the visitors who come-and-go freely at many facilities. Of course its nice to simply see new faces at the facility-- but there needs to be some method of accounting for who enters and leaves the facility.

On the topic of nursing home visitors, I was sickened by a news report of and 18-year-old man who allegedly raped an elderly female patient at Woods Nursing Home in Tennessee. Apparently, the man was at the facility to visit another patient.

Certainly, stories such as this obviously cause everyone to reconsider the safety of their nursing home patients everywhere. Though the police investigation into this matter is underway, I wonder what-- if anything the facility could have done to prevent this crime from occurring on their property?

When it comes to accepting visitors to their facility, nursing homes should have some type of system to account for who the visitor is, what patient they are there to visit and the times the visitor enters and leaves the facility.

In my practice as a nursing home lawyer, I tend to see a disproportionate number of criminal acts perpetrated by visitors at facilities with an unstructured visitor policy or who seemingly allow anyone to come and go at their leisure. Would we allow such a cavalier security in our homes? Shouldn't we expect more control at skilled nursing facilities and residence homes that house vulnerable people?

Read more about this suspected nursing home rape here.

Related Nursing Homes Abuse Blog Entries:

Nursing Home Fails To Report Suspected Sex Abuse To Authorities

At least 50 Convicted Sex-Offenders Living Freely In Illinois Nursing Homes

Nursing Home Operator And CNA's Named As Defendants In Civil Lawsuit After Sex Abuse Scandal

Sexual Assaults In Nursing Homes, Not Exactly A Pleasant Topic-- But Is An Issue That Needs Attention

Determining The Type Of Fracture A Person Has Sustained Can Reveal If Nursing Home Abuse Is Responsible

Jonathan Rosenfeld — Fri, 16 Jul 2010 06:03:17 -0600

As we age, our bones become weaker and are more susceptible to dangerous bone breaks. This is because older bones form small cracks more easily, which makes bone breaks more likely.

In order to prevent dangerous bone breaks-- and to help determine fractures that may be the result from situations involving nursing home abuse-- it is helpful to understand the types of fractures and what causes them. Common types of bone fractures include:

Stress fracture
Spontaneous fracture
Compression fracture
Traumatic fracture

Stress Fracture

Stress fractures are actually tiny cracks in bones caused by overuse and repetitive motion. They occur mostly commonly in the lower-legs and feet because these are weight-bearing bones. Stress fractures may be barely noticeable at first, but the swelling and pain will intensity as they worsen. Therefore, it is important to receive proper care and treatment to prevent the stress fracture from becoming more serious.

As with most bone breaks, osteoporosis or weak bones increases your chance of suffering from painful stress fractures. And, to further complicate matters, a study indicated that some post-menopausal women who take biophosphonate drugs such as Actonel, Boniva, Fosomax, and Reclast might actually have a higher risk for hip fractures. (See “Study Links Commonly Prescribed Osteoporosis Drugs To An Increase in Hip Fractures”) It is important to discuss any new medications with your doctor, who will help you weigh the benefits and risks of drug treatment.

In a nursing home setting, staff members should be aware of the signs of stress fractures, so a resident’s care plan can be altered to prevent further damage and alleviate pain. Signs and symptoms are swelling and pain, especially in the lower legs and feet. Nursing home staff or doctors use x-rays to diagnose stress fractures.

Early treatment of stress fractures is important, so the cracks do not worsen. Treatment includes reduced activity until the bone has a chance to heal. However, some stress fractures are harder to heal and are prone to re-injury. Therefore, it is important that nursing home staff monitor the resident’s injury to ensure that proper healing occurs.

Spontaneous Fracture

Spontaneous fractures (also known as compression fractures) are bone breaks that occur without trauma in what seem like normal bones. The spine and hips (bones that directly support your weight) are the bones most likely to be affected by spontaneous fractures. Older bones are more vulnerable to compression fractures because they lack the internal support structures to withstand impacts and pressure. Osteoporosis (weak and brittle bones) is the most common cause of spontaneous fracture.

A 10% bone mass loss in the vertebrae can double the risk of vertebral fractures and a 10% loss of bone mass can increase your risk of hip fracture (2.5 times greater chance of hip fracture). Hip fractures are one of the most common injuries for elderly people. They usually occur because of a fall and can cause serious and even life-threatening medical complications.

While walking exercises are often valuable tools to help maintain health (bone health) and promote strength, strenuous walking exercises can contribute to spontaneous hip fractures. Therefore, it is important to personalize individual walking plans for elderly residents according to their bone health, which can be determined by BMD (bone mineral density) tests.

Hip fractures usually require surgery to realign the bones, often with surgical screws, metal rods, or plates. Then, after surgery the main focus is on controlling pain and preventing infection. The best thing to do after hip surgery is to start moving around as soon as possible. This helps reduce recovery time and prevent dangerous complications such as blood clots, lung congestion, and pressure sores.

Oftentimes, a walking aid (walker, crutches, or cane) is used in the months following surgery. Physical therapy will help the resident regain their strength and independence. However, many elderly nursing home residents are never as independent as they were before their hip fracture. And, if the resident makes no improvements, physical therapy is often cut short.

Elderly persons can also suffer from compression fractures in their spine, which occur when the vertebrae (back bones) become so weak that they compress or collapse. Again, osteoporosis is the main cause of vertebral compression fractures. A compression fracture of the spine can cause severe pain and a stooped posture or even a hunchback (kyphosis). While this type of compression fracture will often heal on its own after 8-12 weeks, previous spinal compression fractures increase your chance of suffering from additional compression fractures of the spine.

Trauma Fracture

Elderly people are susceptible to dangerous falls because of poor balance and coordination, weakness, changes in gait, poor vision, illness, medications that cause sleepiness or dizziness. Over 11 million people over the age of 65 suffer dangerous falls every year. That is an astonishing one out of every three senior citizens.

Your wrists and hips are the bones most likely to break if you suffer from a fall. Your wrists are susceptible to breaks from bracing yourself with your hands as you fall. And, your hips are more susceptible to breaks because as you age your bones (especially your hips) are less able to withstand impacts, and your hips often receive the brunt of the impact when you fall.

After an accident or fall, nursing home staff members will examine the injured area to look for bone breaks, cuts, bruising, or other signs of injury. The staff will ask questions and investigate how the injury occurred. This investigation into the cause of the fall is very important to protect the resident and prevent future falls.

If the resident lost consciousness, this could be a sign of a more serious condition, such as a stroke or heart attack. In the case of a possible bone break, the resident will be treated by a physician who will determine whether x-rays are necessary. The doctor will use a splint or case to immobilize bone breaks that occur on the arms, legs, hands, and feet. However, as discussed above, hip fractures usually require surgery and post-operative physical therapy to help improve mobility.

Understanding the significance of each type of fracture

Understanding the different types of bone fractures can help prevent dangerous bone breaks by avoiding dangerous situations and taking preventative measures. Nursing home facilities are required to keep the facility free from accident hazards and take preventive measures to prevent dangerous falls.

Each resident should have an individual care plan specifically tailored to their strengths and weaknesses in order to provide the best care possible. If you or a loved one suffered a dangerous bone break while a resident at a nursing home facility, you may be entitled to compensation.

Sources:

Nursing Homes Abuse Blog: Study Links Commonly Prescribed Osteoporosis Drugs to an Increase in Hip Fractures

Merck: Fractures

Amherst Bulletin: When Seniors Fall, Perilous but Preventable

e-Medicine: Lumbar Compression Fracture

Mayo Clinic: Stress Fractures

Journal of Orthopedic Surgery: Strenuous walking exercise and spontaneous fracture of the femoral neck in the elderly

Medicine Net: Fracture

WebMD: Understanding Fractures

Pub Med: Spontaneous fracture – multiple causes

New Illinois Court Decision Holds That No Punitive Damages Can Be Awarded In Survival Actions Involving Nursing Home Negligence

Jonathan Rosenfeld — Thu, 15 Jul 2010 06:07:06 -0600

Some of the substantial verdicts we have recently discussed at the Nursing Homes Abuse Blog here and here involve jury verdicts with punitive damage components. While some of these verdicts may seem excessive, most of the time the damages are awarded because the facilities conduct was so extreme that it deserves to be punished. In most jurisdictions, the punitive damages can only be pursued after a judge has approved the punitive damage portion of the lawsuit.

Unlike compensatory damages, that compensate an injured party, punitive damages are intended to punish the wrongdoing facility. While punitive damages may be awarded against one facility, many times the punitive award serves as a wake up call to other facilities to improve their care or risk similar awards.

However, the punitive damage aspect of many nursing home lawsuits will now have limited use in some cases involving Illinois nursing homes. Now, if a member of your family dies as a result of injuries caused by the nursing home’s willful and wanton misconduct under the Illinois Nursing Home Care Act, you are no longer entitled to punitive damages in a survival action.

In Vincent v. Alden-Park Strathmoor, Inc., a case decided on April 7, 2010, the Second District Illinois Appellate Court held that an estate representative cannot seek common law punitive damages in a survival action for willful and wanton violations of the Illinois Nursing Home Care Act (NHCA – 210 ILCS 45/1). The court decided that there was no statutory basis for punitive damages.

This case was brought by Thomas Vincent, the legal representative of Marjorie Vincent’s estate. He sued Alden-Park Strathmoor for injuries that Ms. Vincent suffered while in Alden-Park Strathmoor’s care. Alden Park Strathmoor is a one-star Medicare rated nursing home facility in Rockford, IL. This facility had 17 total health deficiencies between February 2009 and April 2010. This is 9 more than the average number of health deficiencies in both Illinois and the United States.

Mr. Thomas Vincent filed a three count complaint against the nursing home:

Count I – defendant’s negligence violated the Nursing Home Care Act
Count II – defendant’s actions violated the Wrongful Death Act
Count III – defendant’s willful and wanton conduct violated the Nursing Home Care Act with the plaintiff reserving the right to seek punitive damages for the alleged willful and wanton conduct

The main interest in this case comes with Count III of the complaint, where the plaintiff reserved the right to seek punitive damages for the defendant’s alleged willful and wanton conduct, under section 2-604.1 of the Code of Civil Procedure (735 ILCS 5/2-604/1), which pertains to the pleading of punitive damages. The Survival Act (755 ILCS 5/1) allows an estate’s representative to maintain any actions that accrued to the decedent prior to death.

The court noted that the Survival Act allows “actions to recover damages for an injury to the person” to survive a decedent’s death. However, the found that the Survival Act did neither provided for punitive damages nor were there strong equitable considerations favoring survival of punitive damages claims.

Therefore, even in cases where a nursing home’s willful and wanton misconduct results in the death of a resident, the administrator of the decedent’s estate may not seek punitive damages in a survival action. Instead, the administrator must rely upon the civil and criminal penalties provided by the Nursing Home Care Act for violations of that Act.

Sources:

Illinois Court Opinions: Vincent v. Alden-Park Strathmoor, Inc.

Illinois State Bar Association: Vincent v. Alden-Park Strathmoor, Inc.

Illinois General Assembly: 735 ILCS 5/2-604.1 – Pleading of Punitive Damages

As Assisted Living Facilities Add Skilled Nursing To Their Repertoire, Is This Really A Move To Improve Patient Care Or Simply An Attempt To Cover More Of The Market?

Jonathan Rosenfeld — Wed, 14 Jul 2010 05:56:11 -0600

One of the emerging trends I've noticed in the senior care industry is how many assisted living facilities have added skilled nursing care to the services offered by the facility. Many facilities promote the additional skilled nursing care as an 'aging in place' alternative to an undesirable re-locating to a different facility when the need for more intensive care arrives.

While the combination of skilled nursing facilities coupled with assisted living facilities may be useful in some circumstances, there are times where facilities seem to shuffle patients around to take advantage of the less structured care standards in assisted living facilities.

In some of our cases, I've seen patients transferred back-and-forth from an assisted living portion of a facility to a skilled nursing section several times within a month. In situations where there may be ongoing negligent care, it can be difficult to ascertain where the inadequate care originated.

While the distinction between skilled nursing vs. assisting living may seem irrelevant, it is very important for purposes of establishing the appropriate standard of care in the course of litigation.

This issue came to mind after reading an article about an Ohio assisted living facility received a donation for the addition of skilled nursing beds at the same facility. Below is a short video of the news story.

How Much Freedom Should Assisted Living Facilities Give The Mentally Disabled?

Admissions Suspended At An Emeritus Assisted Living Facility Following The Discovery Of: Medication Errors, Bed Sores & Falsified Medical Records

Now That We Rate Nursing Homes, Is It Time To Rate Other Adult-Care Facilities?

Assisted Living Facilites Need To Re-Evaluate If They Are Capable Of Caring For Dementia Patients

Take Some Time To Fully Evaluate Your Child Care Options Before Selecting A Facility

Jonathan Rosenfeld — Tue, 13 Jul 2010 05:18:12 -0600

Choosing a high-quality day care facility is very important because you are entrusting that facility with your child’s safety and well-being. It is important that you feel comfortable with your child’s day care facility. Otherwise, you will spend the time that day care frees up worrying about your child. (See “Trust Your Instinct When Placing a Child in Daycare with Potential Hazards”)

There are specific qualities you should look for when choosing a day care facility:

Adult caregivers with training or experience in child development
A warm, nurturing, developmentally appropriate, and intellectually stimulating environment
Small child to staff ratios with consistent, long-term adult caregivers
Good parent-staff communication

Child Care Aware recommends five steps to choosing safe and healthy child care:

1) Start Early – Start looking at child care options early, so you can do research and take your time in choosing an appropriate facility.

2) Make a Call – You can call your local child care resource and referral (CCR&R) agency to learn information about the availability of child care in your area and help you choose a quality child care program that meets regulatory standards as well as your personal needs. You can also contact your State’s child care licensing agency to find out whether a complaint has been filed against a regulated child care program

3) Visit and Ask Questions

Look– You should visit the child care facility, make sure that children are being supervised at all times, ensure that workers follow hygiene guidelines, and make sure that the play are is safe for children to use.
Check – While at the facility, you should make sure that dangerous substances such as medicine and cleaning supplies are out of children’s reach, and make sure the facility has a plan in place if a child is injured, suck, or lost
Count – You need to count the number of adults and the number of children they supervise, and you should make a note of the children’s age. There should be no more than one caregiver per: 3-4 infants, 3-4 young toddlers, 4-6 older toddlers, and 6-9 preschoolers.
Ask – It is important that you ask questions about the caregivers training, CPR and first-aid training, criminal background checks, licensing, accreditation, turnover, and complaints.
Be informed – The best thing you can do is be informed by doing research about the child care facility and doing a thorough check of the facility for yourself.

4) Make a Choice

5) Stay Involved

Price is another factor to keep in mind when choosing a day care or child care option because child care can be expensive. It is estimated that 10.6% of a two-parent household’s annual income will be spent on child care. This can be a family’s largest expense after rent or mortgage. The price for child care depends on the type of care, child age, and community.

The Child Care and Development Fund (CCDF) funds some state child care assistance programs, with each State having different guidelines. The CCDF program is a federally funded program that is in place to help low-income families, or families receiving Temporary Assistance for Needy Families (TANF). In addition, you may be eligible for tax benefits such as the Earned Income Tax Credit (EITC), Child Tax Credit, and Child and Dependent Care Credit.

Nurses Failure To Assist Patient To Toilet Costs Nursing Home Dearly

Jonathan Rosenfeld — Mon, 12 Jul 2010 05:01:08 -0600

There's been a lot of talk about a recent jury verdict against Hillcrest Nursing Home, a Kentucky facility, after a patient fell while attempting to transfer herself to the toilet-- and there should be, the jury hit the facility with a $7 million dollar verdict.

The incident involved a patient who was 67-years-young, who was admitted to the nursing home for rehabilitation following a knee surgery. Perhaps due to the woman's youthful appearance, the nurses aide told the woman that she was busy and she could use the toilet herself. It was during the unassisted transfer to the commode, that the nursing home patient fell and severely injured the surgically repaired leg. The leg was so severely injured that it had to be amputated following the fall.

However, as a nursing home lawyer, I am drawn to the common fact pattern that forms the basis of the lawsuit as opposed to the end result. I see many nursing home and hospital patients suffer needless injuries in the bathroom primarily due to two reasons: 1) the staff fails to provide assistance to the patient to get them on to the toilet and 2) the staff leave the patient on the toilet without any supervision.

Of course no one wants to needlessly invade another person's privacy, but when it comes to patients who require assistance, patient safety must trump expectations of privacy.

Even when relatively healthy patients can seemingly navigate their way from their bed to the bathroom and place themselves on the toilet, staff must strictly adhere to the doctors orders when it comes to assistance.

Much more so than in other areas of medical facilities, I tend to see patients suffer injuries in the bathroom due to:

Changes in their blood pressure when getting out of bed or from a wheelchair
Lack of stability devices within the bathroom-- guardrails, hand grips
Staff slow to respond to patients requests to use the toilet
Inadequate staffing levels at facilities to provide the level of patient assistance set forth in a patients care plan
Staff that ignore physician orders with respect to assistance when it comes to bathroom use

I guess the moral of all this is that while patient privacy certainly has a place, when it comes to using the restroom, don't be shy about asking for assistance--- you just may need it.

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

Falls In Nursing Homes Are A Serious Threat To The Safety Of Many Patients

Inadequate Training Of Medi-Car Staff Exposes Seniors To Unnecessary Risk During Non-Emergency Transportation

Avoid Hospitals In July

Jonathan Rosenfeld — Fri, 09 Jul 2010 06:24:12 -0600

We've all heard about how it may be in your best interest to avoid a hospitalization on a holiday or during a weekend, when senior staff tend to be off. However, a new study suggests that you may want to avoid a trip to the hospital completely during the month of July.

As recently reported by Julie Deardorff of the Chicago Tribune, a study from the Journal of Internal Medicine determined that the patient death rate from medication errors was 10% higher in July than in other months.

Perhaps the most reasonable explanation for the spike in medication errors at hospitals was due to the fact that July is when the more than 20,000 fresh medical school graduates begin their residency programs and begin to work on real patients for the first time. Further, in addition to a lack of experience, many residents are encouraged to work excruciating hours without proper oversight from more experienced physicians.

For nursing home patients, this fresh crop of residents can be especially problematic due to the fact that many patients are not capable of communicating effectively or providing a list of the medications they currently take.

Of course, it would be foolish tell anyone to avoid a trip to the hospital simply because a new resident may be present. However, I think this study reinforces the need for families to be advocates for their loved ones and speak up if they have a question or suspect the care provided is inadequate.

Medication Aides In Nursing Homes: A Push To Save Money Or Improve Patient Care?

Half Of Nursing Home Residents Wrongly Drugged

Improper Drug Dosage, Wrong Medication, Interactions With Other Drugs.... May Be The Result Of Pharmaceutical Malpractice

Medication Errors - Nursing Home Injury Laws

Nursing Home Chain Hit With Landmark Verdict In Under-Staffing Class Action Lawsuit

Jonathan Rosenfeld — Thu, 08 Jul 2010 05:39:15 -0600

I guess there's probably a lot a screaming and yelling going on at the Skilled Healthcare Group (SKH) headquarters in California. Perhaps the anger derives from the miserable looking financial chart for the company showing a whopping 75% decline in price per share in one day!

Another portion of the companies anger is probably being misdirected at the lawyers who defended the company in a class action lawsuit brought against Skilled Healthcare based on systematic under-staffing at 22 nursing homes owned by the corporate giant. Really, the only people to blame are the managers in the company who intentionally chose to limit that staffing at their facilities.

After hearing months of evidence regarding staffing levels at the nursing homes operated by Skilled Healthcare, the jury awarded the maximum amount permissible under the California Health and Safety Code--- a whopping $671 million to the members of the class.

The massive jury award is hardly an arbitrary number. Rather, the compensatory damages were awarded based on a statutory violation of $500 per-patient per-day at the 22 subject facilities for not providing that state minimum staffing of 3.2 hours for each patient living at the nursing homes on a daily basis.

In addition to the compensatory damages, the lawsuit also seeks punitive damages against Skilled Healthcare. Unlike compensatory damages, punitive damages are intended to punish the wrongdoer for their acts. The punitive aspect of the lawsuit will move forward in the coming weeks.

I'm sure that it will take some time before any of the plaintiffs involved in this case receive any portion of the recovery, this verdict will likely force nursing home operators to re-evaluate the way they operate and the decisions they make with respect to staffing levels at their facilities.

Sadly, when facilities are short staffed, nursing home patients suffer. Under-staffing in nursing homes continually contributes to incidents of nursing home abuse and neglect.

Dare I say that this verdict may improve the quality of life-- not just for patients at Skilled Healthcare facilities-- but countless other who suffer from systematic under-staffing at other facilities across the country?

Class Action Lawsuit Against Skilled Healthcare Seeks Damages For Chronic Under-staffing Of Nursing Homes

Under-staffing At Nursing Home Blamed For Pressure Ulcer, Infection & Subsequent Death

Poor Training & Under-Staffing Blamed For The Death Of A Nursing Home Patient Who Died From Injuries Sustained After She Was Dropped By A CNA In A Minnesota Facility

A Recipe For Danger: Nursing Shortage Could Reach 1M By 2020

Minimum Nurse Staffing Ratios

Sometimes Complications With Nursing Home Patients Are Not Disclosed Until They Arrive At A Hospital

Jonathan Rosenfeld — Wed, 07 Jul 2010 05:54:56 -0600

Some of my angriest clients contact me after a loved one was transferred from a nursing home to another nursing home or hospital only to learn of serious medical problems their loved one likely acquired during their original admission.

Of course, breaking disappointing news is difficult for anyone to do. Yet, in the case of nursing homes-- this is something they simply are required to do under the law. Similarly, nursing homes must notify the patients doctor if their condition deteriorates.

I see many cases where there is no doubt an intention on the part of the original facility to cover up change in condition-- but also injuries related to situations involving improper care.

This situation of a dangerous condition being discovered only after the patient was transferred to a hospital was highlighted in a recent lawsuit filed against an Illinois Nursing Home, Alhambra Care Center. Part of the lawsuit alleges that the patient lived that the nursing home with multiple health problems, but the staff at the facility failed to notify the family of the conditions including:

Stage III decubitus ulcer
Multiple stage I and II decubitus ulcers on the patients feet
Dehydration
Urinary tract infection

None of the conditions were disclosed to the family until after the patient was admitted to a local hospital.

In cases such as these-- perhaps more alarming than not notifying the patients family as the various problems their loved one has developed-- is the fact that the facility allowed the conditions to develop in the first place. My guess is that the facility was so ashamed of the condition they allowed their patient to get into that they failed to document the conditions during the patients stay at the facility either.

Some of these situations may give way to a claim against the nursing home where the condition developed. In addition to contacting an attorney to discuss your legal options, you should give serious consideration to locating another facility for your loved one following their discharge from the hospital.

Dehydration & The Development Of Bed Sores In Nursing Home And Hospital Patients

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Why do nursing homes describe pressure sores according to 'stages'?

Are bed sores on the heels common? Bed Sore FAQ

Woman Drowns In Bathtub At Chicago Nursing Home

Jonathan Rosenfeld — Tue, 06 Jul 2010 11:29:17 -0600

WBBM Newsradio is reporting on a tragedy that occurred this past weekend at a Chicago Nursing Home. On Sunday evening, a 51-year-old woman who was a patient at Warren Park Nursing Pavilion was taken to Saint Frances Hospital when she was discovered unresponsive in a bathtub at the facility.

Authorities at Saint Frances pronounced the woman was dead upon her arrival at the hospital. An autopsy performed by the Cook County Medical Examiner determined that the woman died from drowning.

Chicago police detectives are currently investigating this matter to determine more information about the drowning.

While certainly not a common occurrence in nursing homes and assisted living facilities, many patients-- particularly those suffering from mental and physical disabilities-- are at risk for downing during bathing or recreational activities. In order to minimize the risk of drowning, staff should identify those who may be at risk an provide supervision to prevent drownings.

Nursing home injuries, such as this downing, deserve to be investigated by the Illinois Department of Health (IDPH). Many times, investigations completed by IDPH are extremely useful in the prosecution of civil lawsuits against the facilities. The IDPH has investigated other incidents at Warren Park, you can view some of the findings here.

Jean Engstrom, 51, Dies in Tub Drowning Incident at Rogers Park Nursing Home, My Fox Chicago, July 5, 2010

Morphine Intoxication Of Nursing Home Patient Results In Significant Jury Verdict

Jonathan Rosenfeld — Tue, 06 Jul 2010 05:43:28 -0600

Following a three week trial, jurors in Michigan awarded the family of a deceased nursing home patient $4.85 million.

The nursing home negligence lawsuit alleged Mercy Memorial Nursing Center was negligent in administering morphine, a commonly prescribed pain medication, to a man who was admitted to the facility for physical therapy following a non-displaced hip fracture.

A coroner's report concluded that the man died from 'morphine intoxication'-- essentially an overdose of the medicine.

According to the lawyer representing the nursing home patient's family, the facilities poor charting was probably to blame for the man's morphine overdose. "The document stuck out like a sore thumb. It clearly shows morphine was unaccounted for on his chart," the lawyer added.

Like many nursing home negligence cases, this case has a long history. The lawsuit was originally filed in 2005 only to be dismissed and reinstated by the Michigan Appellate Court. Further, the man's wife died during the pendency of the matter-- making the juries decision even more impressive.

Morphine Intoxication

Morphine is an opiate pain medication commonly used for nursing home and hospital patients recovering from trauma or to alleviate chronic pain. Morphine requires a doctors prescription. Due to the strength of the medication, it generally is taken under medical supervision.

Indications of a morphine overdose or morphine intoxication that require medical attention include:

Fixed pupils
Nausea, vomiting
Severe constipation
Low blood pressure
Muted pulse
Discolored fingers and lips
Shallow breathing

Nursing homes that administer morphine and other drugs to patients must do so in a safe manner. This means administering the specific medications according to the dosages and frequency prescribed by a physician. Further, facilities must keep an accurate accounting of every dose given to a patient.

Unfortunately, many medications look very similar and some staff administering the medications are not familiar with the patients. Many times this results in serious injury or death of the patient.

If you believe your loved one was harmed due to a medication error in a nursing home, assisted living facility or hospital, we would be honored to speak with you regarding your legal options. As always, there a never a charge to speak to our lawyers and we only earn a fee if there is a recovery for you. (888) 424-5757

Family wines $4.85 million for nursing home death, Toledoblade.com, June 29, 2010

Medication Errors, Nursinghomeinjurylaws.com

Authorities Investigate North Carolina Nursing Home After Lab Test Determines Patient's Death Related To Morphine Overdose

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement