Year of Elder Abuse Prevention (YEAP)

Every year an estimated 2.1 million older Americans are victims of elder abuse, neglect or exploitation.¹ Combating this requires efforts on state, local, and national levels. Abuse affects all seniors and spans every socio-economic class, culture, and ethnic background.

On May 28, 2013, the Administration on Aging (AoA) paired with the Administration for Community Living (ACL) to sponsor the Year of Elder Abuse Prevention (YEAP). YEAP encourages national, state, and local organizations to protect seniors and raise awareness about elder abuse, neglect, and exploitation.

To act on this mission, the AoA has provided a tool kit for residents, families, and members of the community, that progress YEAP’s mission and stop elder abuse from happening. Among these factsheets includes a list of warning signs of elder abuse, measures anyone can take to raise awareness about neglect and abuse, and how to protect yourself or a loved one from abuse.

If you or a family member notices unexplained bruises, fractures, or other sores, a lack of basic hygiene, dehydration, unexplained withdrawal from daily activities, nursing homes will find any number of reasons to dismiss your concerns. YEAP's goal is to encourage national participation in the movement to prevent the harm from happening altogether. To achieve this goal, it is in the best interest of this national movement to report abuse if you suspect it.

To learn more about how to participate in YEAP's mission, visit http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/YEAP/index.aspx

1. Administration on Aging, “Protect Seniors in the Year of Elder Abuse Prevention"

Special Focus Facility Initiative: A Guide For Potential Nursing Home Residents

National Elder Abuse Awareness month takes place in June, though residents of nursing homes and their families are affected by neglect and abuse year round.  Nursing homes continue to mistreat the vulnerable and frail members of the community, and the safeguards against these instances of abuse seem insufficient. The Special Focus Facility Initiative is a step in the right direction for elder abuse prevention.

On June 20, 2013, the Center for Medicare and Medicaid services updated the Special Focus Facility Initiative, which will give potential and current residents of nursing homes and their families a guideline to follow when they assess the quality of a nursing home.

The CMS conducts annual surveys to ensure the nursing home facilities are abiding by the standards of care it sets out for the facilities in order to qualify for Medicare and Medicaid. Any deficiencies it finds are cited and recorded. After the surveys are completed, the violations are required to be address and corrected within a specified time frame.  Repeated violations and complaints filed by residents will prompt intervention and further inspection of these homes.  If the efforts are not taken by the nursing home administrators and staff to correct substandard quality of care, the CMS may remove these homes from Medicare and Medicaid eligibility.

The SFF takes the results from these surveys and categorizes the nursing homes based on these results.  It lays out three categories in which the nursing homes will fall:

A – Improvement & Graduation

B – Termination from Medicare

C – Extension of Time

Within these categories are five subcategories of the nursing homes:

Table A – New Additions

Table B – Not Improved

Table C – Improving

Table D – Recently Graduated

Table E – No Longer in Medicare and Medicaid

The status of each nursing home within these categories and subcategories may serve as a guideline for current and potential residents and their families.  Special Focus Facility initiative was implemented to address the growing problem of nursing homes continually performing below acceptable standards.  The CMS advises those to interpret the information cautiously and supplement it with information from your local ombudsman’s office, the State survey agency, or other sources.¹

1.  http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/SFFList.pdf

National Alzheimer’s Project Act: Expectations of Care for Residents With Alzheimer’s Disease

            Nearly half (48%) of nursing home residents have Alzheimer’s disease.¹  In more than 90 percent of people with Alzheimer’s disease, symptoms do not appear until after age 60 and the incidence of the disease increases with age.²  Skilled nursing home facilities are expected to provide care for residents who are battling this disease and meet the individualized standards of the families of the residents.

On January 4, 2011, the Department of Health and Human Services established the National Alzheimer’s Project Act.  NAPA is a national plan implemented to overcome Alzheimer’s disease, coordinate research, accelerate treatments that would prevent, halt, or reverse the course of Alzheimer’s disease, improve early diagnosis and treatment, improve outcomes for minority populations that are also at higher risk for the disease, and coordinate with international bodies to fight Alzheimer’s globally.³  The Obama Administration announced on February 7, 2012, a $156 million investment to tackle Alzheimer’s disease, which will be used to sustain research and support individuals and families affected by the disease.

Goal 2 of NAPA, to “Enhance Care Quality and Efficiency”, directly influences the expectations of nursing home facilities.  Action 2.A.4, to “Strengthen the direct care workforce”, was completed this year.  HHS strengthened the ability of nursing home direct care workforce to provide high-quality, person-centered care for people with AD through enhanced training.⁴  A series of videos, “Hand in Hand,” were developed and distributed to every nursing home in the country.⁵  The Center for Medicare & Medicaid Services created the videos to ensure nursing aides and other care staff receive regular training on the care of persons with dementia and to emphasize person-centered care for these residents.⁶

Goal 3 of NAPA is to “Expand Supports for People with Alzheimer’s Disease and Their Families.”⁷ The Department of Health and Services recognizes that AD strains families emotionally and physically. The intensive support required for a person with AD can negatively impact a caregiver’s well-being.  Action 3.B.2, to “Identify and disseminate best practices for caregiver assessment and referral through the long-term services and supports system”, was also completed this past year.⁸  The Administration on Aging partnered with the National Family Caregiver Alliance to create Selected Caregiver Assessment Measures (2nd Edition): A Resource Inventory for Practitioners. http://caregiver.org/caregiver/jsp/content/pdfs/SelCGAssmtMeas_ResInv_FINAL_12.10.12.pdf. The manual identifies caregiver assessments, perceived challenges for caregivers of certain persons, expected skills and knowledge of caregivers of persons with Alzheimer’s Disease, and resources for caregiver’s to use, including nursing home support as well as the stressors of nursing homes.⁹

As the number of people with Alzheimer’s Disease grows over the next two decades, this disease will place a major strain on health care facilities as well as on Medicare and Medicaid, the major funders of this care.  Holding nursing home care facilities to the standards laid out in NAPA is significant.  NAPA provides the guidelines skilled nursing facilities are expected to follow and may inform your decision when choosing a home for your loved one.

1. Magaziner J, German P, Zimmerman SI, Hebel JR, Burton L, Gruber-Baldini AL, May C, Kittner

S. The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older. Gerontol. 2000; 43(4): 514-520.

2. National Plan to Address Alzheimer’s Disease: 2013 Update, page 7

3. Id. at 8

4. Id. at 18

5. http://www.cms-handinhandtoolkit.info/

6. NAPA at 18

7. Id. at 27

8. Id at 28

9. Selected Caregiver Assessment Measures: A resource Inventory for Practitioners: December 2012, Index 

Understanding Rights of Residents in Long Term Care Facilities

Long term care facility residents are, by State and Federal law, guaranteed certain rights, protections and privileges. Title 42 Code of Federal Regulations §483.10 states that residents of long term care facilities are entitled, by law, to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility.  Title 42 Code of Federal Regulations §483.10(a)(2) entitles nursing home residents to be free of interference, coercion, discrimination, and reprisal from nursing home facilities in exercising their own rights.  Unfortunately, these rights are frequently disregarded by staff and facility directors.  Understanding the rights of your loved one is the first step towards protecting these rights and their safety.

Because nursing home care requires constant communication between and among nurses and doctors, abusive behavior often goes unnoticed.  A nurse or CNA who is assigned to bathe 10 residents may only take the time to bathe 5 residents, and, when his or her shift is over, leave the remaining 5 for the next nurse to bathe.  If the next nurse or CNA is not aware of this responsibility, those remaining 5 residents are left without proper hygienic care indefinitely.  This lack of communication happens frequently, without consequences, and at the expense of a resident’s dignity.  Many staff members of nursing home facilities will dismiss a residents’ right to self-determination.  A staff member may decide to place a call light out of reach of a resident, who requires constant supervision, so that the resident does not interrupt a lunch break.  As a result, that resident has been stripped of the right to determine his or her daily activities.  Without access to the call light, the resident cannot ask for water, a pillow, assistance to the restroom, to participate in social activities, etc. A resident's voice is left unheard.

Being educated about the rights of your loved one is one way to prevent opportunities for abuse and neglect.  Illinois' Long Term Care Ombudsman Program gives advice on how to address concerns about the care a nursing home facility provides.  In addition, the Assisted living Federation of America (http://www.alfa.org/ElderAbuse), the Administration on Aging (http://www.aoa.gov/AoA_programs/Elder_Rights/EA_Prevention/weaad.aspx), and the National Committee for Prevention of Elder Abuse (http://www.preventelderabuse.org/elderabuse/) are committed towards preventing elder abuse, raising awareness, and giving voice to our elder community.

Nursing Home Failed to Report the Negligence of It's Employees

A nursing home in Wood River, Illinois was accused of failing to act on the part of its employees, resulting in the death of a patient. The estate of this former resident has filed suit against the nursing home following the former resident’s death.

The suit claims: the nursing home failed to make sure that its residents were safe, failed to report the negligence of its employees, along with a number of other assertions related to the wrongdoing and misconduct of the nursing home and its employees. The defendants include the nursing home owners, a doctor, a nurse practitioner, and three affiliated corporations. The deceased was admitted to the nursing home after receiving treatment for a surgery. Blood results were sent to the nursing home, yet there is no record of the results being received or delivered. A day after the results were sent, the nursing home resident was transferred to a local hospital where doctors diagnosed the patient with increased swelling and shortness of breath. When the patient was transferred back to the nursing home two days later, the patient was immediately remitted to the hospital where doctors diagnosed the patient with generalized edema, respiratory distress, and congestive heart failure. 

An independent doctor hired to review the records noted in a signed statement that he believes there is a case against the defendants. He stated that the practicing doctor made note of patients swelling in the legs, but failed to mention it in an assessment and plan section of a report. In addition, he stated that the doctor and nurse practitioner failed to order a work-up – thorough medical diagnostic study – to investigate the cause of the increasing swelling. The reviewing doctor also noted that the patient was not referred to a specialist, and that no further progress notes were made. An interesting part of the suit is the failure of the nursing home employees to acknowledge blood work results that were sent to the home; these results indicated low serum sodium levels. Low serum sodium levels are associated with what is known as hyponatremia, an electrolyte disturbance in which the sodium ion concentration in the serum is lower than normal.[1] The doctor’s at the hospital diagnosed the patient with generalized edema, respiratory distress, congestive heart failure, and signs of liver failure. Many medical illnesses, such as congestive heart failure and cirrhosis of the liver, are associated with hyponatremia.[2] There may be an underlying correlation between the patient’s medical illnesses, the death, and the nursing home employee’s failure to look into the patient’s blood results. According to the Illinois Department of Public Health, the nursing home in question has had prior nursing home violations. In 2007, the nursing home was sent a notice of Type “A” Violation.[3] Under the Illinois Nursing Home Care Act, a Type “A” violation is a violation thereunder which creates a condition or occurrence relating to the operation and maintenance of a facility that (i) creates a substantial probability that the risk of death or serious mental or physical harm to a resident will result therefrom or (ii) has resulted in actual physical or mental harm to a resident. Then in 2011, the nursing home was sent a notice of Type “Repeat B & B” Violations.[4] A Type “B” violation as defined under the Illinois Nursing Home Care Act means a violation which creates a condition or occurrence relating to the operation and maintenance of a facility that is more likely than not to cause more than minimal physical or mental harm to a resident. [5] These two violations could further add to the credibility of these claims. Nursing home violations are public information that can be accessed through the Illinois Department of Health’s website: http://www.idph.state.il.us/about/nursing_home_violations/quarterlyreports.htm.

The article that this post review came from The Telegraph. The original article was written by Sandford J. Schmidt on Monday, June 10, 2013. It can be found at http://www.thetelegraph.com/news/local/article_7e1e8168-d16e-11e2-b1da-001a4bcf6878.html

If you suspect your loved one is being neglected or abused in a nursing home, call us today at (800) 594-7433 or visit out website. 

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[1] Hyponatremia. MayoClinic.com. Retrieved 2013-06-10.

[2] Mange K, Matsuura D, Cizman B, et al. (November 1997). “Language Guiding Therapy: The Case of Dehydration Versus Volume Depletion”. Ann. Intern. Med. 127 )9) 848-53. PMID 9382413.

[3] http://www.idph.state.il.us/about/nursing_homes_violations07/quarterly_report_3-07.htm

[4] http://www.idph.state.il.us/about/nursing_homes_violations11/quarterly_report_4-11.htm

[5] http://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1225&ChapterID=21

Nursing Home Staff

Read full Chicago Tribune article here:

Level of Nurse Staffing

At least one adequate measure for evaluating the quality of care provided by nursing homes is the “level of nurse staffing.”  Nurse staffing should be measured both in terms of the quality of the staff as well as the sheer numbers of the staff.  Unfortunately, unlike the home in this article, nursing homes frequently cut corners with the level of nurse staffing—all to maximize profits.

To provide proper care, nursing homes must hire competent staff—from nurse aides to registered nurses to nursing home directors or administrators.  In the course of our nursing home litigation practice, we routinely encounter unqualified staff charged with the duty to provide skilled care to residents:   Nurse aides with little or no experience and training, and registered nurses who repeatedly fail to train, or even communicate with, these nurse aides. 

This is a critical failure for many nursing homes.  Nurse aides are the ones that provide the majority of daily care for residents.  And as such, it is imperative that the charge or floor nurses appropriately train and communicate with these aides.  For instance, consider the all-to-common nursing home resident at risk for pressure sores or ulcers.  It is the nurse aide who has the responsibility to re-position and appropriately turn the residents every one to two hours.  The re-positioning of residents at risk for pressure sores is a key component of care to avoid such sores.  When the aides are inept or not properly trained, or where the charge nurses fail to instruct or otherwise communicate with aides on their re-positioning responsibilities and techniques, nursing home residents inevitably suffer severe and debilitating skin wounds.

The same is true regarding the numbers of staff employed.  Many nursing home companies repeatedly save money by limiting the numbers of nurses and nurse aides to staff their nursing homes.  This is a critical omission of care in exchange for increased corporate profits.  The nursing staff is charged with responsibilities of providing all-encompassing care for residents, including assisting residents with their activities of daily living, such as bathing, feeding, dressing, etc.  This same limited staff, as mentioned above, is responsible to provide care to avoid future injury or harm, such as frequent re-positioning to prevent pressure sores.  Where limited staff are charged with these responsibilities, the unfortunate outcomes are predictable.

For more information about Nursing Home Abuse and Neglect, contact our office today or call 800-594-7433

If you are considering a nursing home for a loved one, you must certainly consider the level of nurse staffing.  One helpful source on this point is Medicare website:  http://www.medicare.gov/NursingHomeCompare/About/Whatis/What-Is-NHC.aspx. 

Read full Chicago Tribune article here:

"Tort Reform” Laws Further Harm Long-Term Care Residents

A Wisconsin tort reform law passed two years ago made state inspection reports of nursing homes and other health care facilities inadmissible as evidence in civil and criminal cases. Proponents of the law say it lets providers discuss problems more openly, but critics argue it puts the elderly and vulnerable at risk. This woman, whose family asked that she not be identified, was a resident at a Sauk City nursing home. / Lukas Keapproth/WCIJ

This is a story that is all too common for long-term care facilities and those individuals who have entrusted their care to such facilities.  As described in the article, Joshua Wahl has spina bifida, is brain-injured and is paralyzed.  He was living at a group residential home in Wisconsin, where he was found to have a half-dollar size bedsore sore.  It developed into a huge crater—to the point that his skin, fat and muscle had rotten away.  And the wound was contaminated with feces.  Due to the severity of the injury, Joshua may be permanently bed-ridden now.  

As part of a formal investigation, the Wisconsin health department determined that Joshua had the bedsore for four (4) months before being hospitalized.  But because of new laws signed by Governor Scott Walker, Joshua Wahl and his attorneys are completely barred from using any part of the State’s investigation in a civil or criminal prosecution against the facility.  The laws were passed as part of “tort reform”—admittedly designed to protect the businesses, at the expense of severely injured long-term care residents like Joshua.

The Long-Term Care Industry has supported these and related tort reform laws all across the country, including Illinois.  In an attempt to justify these laws, proponents contend the laws are required to eliminate frivolous lawsuits against responsible and conscientious businesses.  But there is absolutely no truth to this contention.  These tort reform law are nothing more than a governmental shield and “cover” for the negligence and improper care provided by these facilities. 

Consider Joshua’s circumstances.  Because of the facilities improper care—and worst, the intentional concealment of that improper care—Joshua suffered significant harm and disability.  Can  anyone honestly argue that Joshua’s claim is frivolous?  Or can it be argued that the facility here was acting responsible in concealing his injuries?  This is not a frivolous claim.  In Joshua’s case, as in most cases, these tort reform measures further harm the innocent, while affirmatively protecting the perpetrators.

Indeed, the contention that this particular law will prevent frivolous lawsuits is likewise ludicrous in light of the very nature of such state health investigations.  If a claim is frivolous, then there will be no state health investigation finding that a facility provided neglectful, improper, or sanctionable care.  Accordingly, it is difficult to even imagine how there could be an isolated, damaging investigative report in relation to a frivolous claim.  Simply put, that just does not happen.

Moreover, such investigations routinely provide crucial pieces of evidence for victims of such facilities who cannot, or are unable, to testify to the circumstances of their injuries.  To withhold such evidence from innocent vicitims is plainly unjust.

Bottom line:  Be wary of the tort reform argument.  Such laws are specifically designed to limit your right to fully and fairly prosecute your case.  Nothing more, nothing less.

For more information please call our office toll free at 800-594-7433 or visit our WEBSITE.

Read full article HERE

Lost Nursing Home Resident Found Safe

In Illinois, a “lost” nursing home resident was recently found.  Fortunately, the resident was safe and unharmed.  But that begs the question:  

Why was the resident—a known dementia patient—allowed to wander off?  

The answer likely lies with the lack of care required of such residents.

As our population finds itself increasingly growing older, many of the elderly are forced to turn to nursing homes for long-term care.  In looking to nursing homes, potential nursing home residents present with a variety of physical maladies and cognitive limitations.  And the cognitive limitations of such individuals can be considerable, including conditions such as advanced dementia or Alzheimer’s, obviously requiring specialized and appropriate care.  To provide the needed care for such nursing home residents, nursing homes must be committed to serving these residents—both with qualified staff and a financial commitment.

There are numerous nursing homes within the State of Illinois, but some are more equipped, and some less equipped, to deal with the challenges of caring for the cognitively impaired resident.  And while many nursing homes claim they are capable of caring for such residents, that is simply not the case.  Many of these nursing homes simply do the not have the staff, either in numbers or qualifications, to care for the mentally impaired.  Additionally, providing the appropriate care for such residents is not limited to having the sufficient numbers of qualified staff; appropriate care also requires having in place the physical equipment and security devices to ensure that all such residents will remain safe.

Under Illinois law, nursing homes must provide to each resident the “individualized” care the resident requires for his or her well-being and safety.  And this individualized care certainly includes care specifically designed to care for the cognitively impaired resident.  If a nursing home fails to provide such care, it is in violation of the Illinois Nursing Home Care Act (210 ILCS 45/1 et seq.)

If you have concerns for a famility member that is in a nursing home please call our office today. 800-594-7433 or send us a confidential inquiry. 

Details in Article

Sign of Nursing Home Abuse and Neglect

Since the residents of a nursing home often are unable to fully communicate it is important to know what signs of physical, emotional, and verbal abuse and neglect to look for whenever you visit your loved one.

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• Signs of Neglect

• Dehydration, malnutrition, and bed sores
• Lack of personal hygiene, food, clothing, or shelter
• Unsanitary and unclean conditions
• Infections

Signs of Physical Abuse

• Unreasonable physical restraint
• Over-medication
• Open wounds, cuts, bruises, or welts
• Slapping, pushing, shaking, or beating
• Unexplained injuries

Signs of Verbal and Emotional Abuse

• Emotionally upset or agitated
• Extremely withdrawn and non-communicative
• Unusual behavior (sucking, biting, rocking)
• Humiliating, insulting, frightening, threatening or ignoring behavior towards family and friends
• Wanting to be isolated from other people

For more information about Nursing Home neglect and abuse please go to our website 

or call 800-594-7433

She Took Care of Us . . .

Frequently Asked Question

Declining Strength is a Call-To-Action!

Question:
My mother’s physical strength has changed, but it doesn’t seem that the routine of care is keeping up. Can I request more?

Find the answer HERE or read below.

Answer:
Yes…and you should.

Changes to a patient’s overall physical strength, which is often associated with a decrease in activity after entering a skilled nursing facility, can be responsible for a vast array of preventable medical issues and contributing factors in declining health.
Sudden weakness (typically relating to one side of the face and/or body) can suggest a more emergent problem, such as a stroke, and requires immediate intervention and evaluation by a physician.

Progressive weakness however, while not life-threatening, can lead to bed sores, pneumonia, bowel obstructions, urinary infections and other conditions that pose a threat of infection; often severe and indeed, life-threatening. In most cases, these infections can be easily prevented.

A physically-regressive individual will often experience an increased level of depression and loss of appetite, contributing further to an overall decline in physical and mental health.

Family members should begin a “diary” if you will, when a loved one first enters any level of skilled nursing or long-term care environment. They should ask for an opportunity to view and discuss the Minimum Data Set of functional measurements, which must be (by law) evaluated within 14 days after admission. The MDS should also state the level of care and supportive measures to be applied at that time.

Skilled nursing and long-term care facilities are required to review MDS assessments every three months, and completely re-assess patients every 12 months …or, promptly after a significant change in their physical or mental condition. You can, and should request a reassessment now.

Questions that you need to ask include, but are not limited to:

• What type of scheduled daily physical activity does your mother receive?
• Who provides that care?
• What extra steps are taken to ensure her physical safety during exercise?
• What extra steps are taken to ensure her safety during trips to the bathroom, the dining hall (if available), and getting in and out of bed while in a weakened state?
• How often is she assisted with re-positioning while in bed, a chair, a wheelchair …to prevent the risk of pressure sores (bed sores)?
• Has her fluid intake been increased to prevent dehydration, or measured, and if so, ask to view such documentation to record in your diary.
• What changes are being made to her diet to promote muscle strength?
• And most importantly …what medications are being administered; how much and how often? WRITE IT DOWN!

When patients show signs of depression (physical or mental), ongoing research and investigations are revealing that many are being over-medicated, either by design to keep patients quiet and still (requiring less hands-on care for reduced staffing levels), or simply because the administering and documentation policies of the facility are weak, resulting in double (sometimes triple) dosing by different staff members.

Know what medications your mother is taking and request (in writing) to be notified when any changes occur …either to the dose of a current medication, or the addition of a new medication. If you have questions regarding medications, discuss them immediately with the physician in charge of her care. It is also important to request to see verification of the record for written orders; documentation that a physician ordered the change/addition of a new medication. What date was it ordered and why?

Decreased physical strength and changes in mental alertness should never be dismissed as a normal and expected part of the aging process without a complete evaluation of cause.

Residents of facilities that make physical activity (at various levels, even for bed-ridden patients) a priority with support systems and staffing levels in place, experience better overall health, strength, and mental agility with greatly reduced risk factors associated with unnecessary and dangerous infections.

Unfortunately, our system of care today demands that family members stay active, aware and informed with detailed records of their own to support increased levels of care if needed.

A Little Advice...

Is Your Loved One Suffering?

If you suspect your loved one in a nursing home is being neglected or abused, please contact us today!

Tips for Caregivers

Are you caring for an aging or ailing loved one? Here are some preventative tips to protect your health.

5 Tips for Caregivers

1. Don't Neglect Your Own Health
2. Take Some Time To Do Something For Yourself... Every Day!
3. Eat Healthy Foods & Don't Skip Meals
4. Find Caregiver Resources and Support In Your Area
5. Don't Be Afraid To Ask For Help

Contact us today for more questions by calling 800-594-7433 or visit our website.