Articles Posted in Advances in Patient Safety

Nursing homes do not enjoy a good reputation when it comes to patient care, and for good reason. Over the past few years, it seems that there has not been a week that goes by without an incident of nursing home abuse or neglect. With the increase in reports of nursing home abuse and neglect over the past several decades, as well as the corresponding advancement of technology, the question of whether hidden cameras in nursing home facilities should be allowed has recently garnered a significant amount of attention.

Bear with CameraCameras in nursing homes are a good way to monitor the level of care that a nursing home provides to its residents. However, not surprisingly, when a family places a hidden camera in a nursing home, certain legal issues may arise. Importantly, there is no federal legislation giving families or residents the right to install hidden cameras in a nursing home facility. However, some states, such as Oklahoma, Texas, and New Mexico, have passed state legislation giving families the right to place cameras in at least some circumstances.

In most cases, a nursing home will include a clause in the pre-admission contract restricting the resident’s right to use video or audio surveillance. And in most cases, since the resident’s room is technically the property of the nursing home facility, these clauses are upheld. However, if the family of a nursing home resident suspects that their loved one is a victim of abuse or neglect, legal action may be taken through a Maryland nursing home neglect or abuse lawsuit.

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Nursing homes and other long-term care facilities are charged with caring for those who are not able to fully care for themselves. The duty that a nursing home owes to its residents is a broad one, ranging from providing residents with assistance in completing daily tasks to ensuring their physical safety. Included in the duty nursing homes owe to their residents is the obligation to ensure that any medications that are prescribed to the residents are properly administered.

MedicationWhen a nursing home is negligent in administering a resident’s medication, the nursing home employee responsible for the mistake, as well as the nursing home’s management, may be liable for any injuries caused as a result. These nursing home negligence lawsuits can result in significant liability for a nursing home, and the pressure exerted by this potential liability has led some nursing homes to implement additional safety features when it comes to the delivery and administration of patients’ medication.

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Nursing home abuse and neglect have a well-documented history throughout the United States. Sadly, many of the victims of this abuse suffer from serious physical and mental health disorders, such as dementia or Alzheimer’s disease. Since the advent and expansion of social media, this unfortunate trend has accelerated. In fact, the problem has become so common that many state legislatures are looking for ways to curb the rampant nursing home abuse and neglect epidemic.

Security CameraAccording to one local news source servicing the Chicago area, Illinois lawmakers have recently passed a bill that will provide funding to install 100,000 cameras in nursing home facilities across the state. The bill, which would not allow for the installation of cameras without a resident’s consent, allocates a $50,000 budget annually to install and service the cameras. It is hoped that the presence of cameras will act not only to provide evidence of abuse after the fact but also to serve as a deterrent to nursing home employees.

Advocates of the bill call it a “win-win for all stakeholders,” explaining that truly innocent nursing home employees who has been wrongfully accused will be able to rely on the video footage to help prove the allegations were unfounded. However, it is expected that the policy will be met with some resistance from the nursing home industry, which is no doubt aware of the fact that the installation of cameras in facilities may result in exposure to additional liability through increased reporting of abuse and neglect.

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A popular national news source has recently published an article discussing a change of policy by the Centers for Medicare Services that should open up many nursing home contracts to the possibility for the resident to sue nursing home providers accused of abuse or neglect directly in state or federal court, instead of being required to submit their claim to arbitration, a process that generally favors defendants.

Old WomanMedicare Foots Some or All of the Bill in Most Nursing Home Agreements

Health care improvements and the changing dynamics of how Americans approach old age and family relationships mean that most Americans who reach the age of 75 will need long-term, full-time nursing care at a residential facility at some point in their lives. With the increase in the breadth of the nursing care industry and the bill often being paid by the federal government, providers are often incentivized to provide substandard care and cover up or downplay signs or accusations of abuse.

Signs of Nursing Home Abuse or Neglect

It can be difficult for the families of nursing home abuse victims to know when abuse has occurred. Many of the residents who are the most vulnerable to abuse, whether intentional or the result of neglect, suffer from dementia or other cognitive disorders that may make it difficult for family members to tell if their loved one has been a victim or not. There is also a sense of pride and not “wanting to be a burden” that is often present in older generations, and it may prevent nursing home residents from reporting abuse.

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A new bill in Illinois called the “Put A Registered Nurse in the Nursing Home Act” is being introduced by Representative Jan Schakowsky. The bill, which still needs to be voted on before it would have a chance at becoming law, would require that any nursing home facility receiving either Medicare or Medicaid funds have a Registered Nurse on duty all day, every day.

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According to a report by HealthCare Dive, the current requirement is that any qualifying nursing home must have a nurse on duty for at least eight hours a day. This requirement was passed back in 1987, and there has been little regulation of nursing homes passed since then.

Some states are currently mandating that nursing home facilities have a nurse on staff 24 hours a day, seven days a week. However, the new law would make that requirement extend nationwide. Currently, it is estimated that almost 12% of nursing homes do not have a full-time nurse on staff 24/7. The cost of one full-time nurse is approximately $68,000.

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A recent article by the Chicago Tribune outlines the debate the State of Illinois is having in determining whether nursing homes should be required to allow video cameras to be installed in patient rooms in order to document the type of care the nurses are providing to their patients.

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The article explains that there are two sides to the debate, and even patient advocates are skeptical that cameras are a good idea in all circumstances. Right now, there are about five states that allow a family to install a camera in their loved one’s room. Each state’s law is a little different, but a few things must be considered about the use of cameras in nursing homes, such as:

  • The loss of privacy that nursing home residents would suffer as a result of the cameras always being on;
  • The expense of the equipment and the occasional monitoring of the videos;
  • The effect, both positive and negative, that recording patient interactions may have on the nursing home as a workplace;
  • The admissibility of the tapes in civil or criminal suits against the nursing home and its employees; and
  • The privacy of visitors, guests, and nursing home faculty and how it may be affected by the cameras.

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450px-Department_of_Veteran_Affairs_DCJPG.jpgA recent study adds to the growing body of research regarding overuse of antipsychotic medications in nursing home patients and the associated risks of severe medical complications and death, with a specific focus on residents of nursing homes run by the U.S. Department of Veterans Affairs (VA). The American Public Health Association’s Medical Care Section published the report in the November issue of its official journal, Medical Care. The VA is reportedly making a variety of efforts to reduce antipsychotic use among patients who would be better served by other treatments. This is particularly true of dementia patients in nursing homes.

The researchers, led by Walid Gellad, M.D., M.P.H., reviewed data from the VA’s 133 Community Living Centers around the country from the period January 2004 through June 2005. The data covered 3,692 veterans 65 years of age and older who were admitted to one or more of these facilities for at least ninety days. They found that 948 patients, just over one-quarter of the total number, received an antipsychotic medication, but that only 59.3% of them had an “evidence-based indication for use.” Patients who displayed aggressive behavior, who were receiving nine or more different medications, who were also receiving antidepressants or dementia medications, and/or who were living in an Alzheimer’s or dementia care unit were more likely to receive antipsychotic drugs. The researchers found that patients with dementia but no recorded history of psychosis were just as likely to receive antipsychotic drugs as those with a documented need for such drugs.

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Patient-lift-dorm2.jpgA federal program intended to help transition nursing home residents who receive Medicaid into community- and home-based care has had some success in Maryland, but people in many states have experienced difficulties with relocation. The Money Follows the Person (MFP) program, initiated in early 2008, is intended to help individuals who might benefit from home-based services to get out of long-term care institutions. It could potentially help ease the burden on overcrowded or understaffed long-term care facilities, thereby improving care for all residents.

The primary goal of MFP, according to the Center for Medicare and Medicaid Services, is to help state governments “rebalance their long-term care systems” to favor home- and community-based services (HCBS) over institutional services. HCBS may include small group homes, private homes, or apartments with some degree of living assistance. The program is also intended to expand the use of Medicaid funds to allow patients greater choice in long-term care services, and to provide oversight and quality control over HCBS that receive Medicaid funds. Forty-three states, including Maryland and Virginia, and the District of Columbia have signed on to the program. The Affordable Care Act of 2010 extended the program from its initial five-year period until 2016, appropriated additional funding, and expanded the eligibility criteria for patients.

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825654_88722367.jpgHealthcare-associated infections (HAIs), generally defined as bacterial, viral, or fungal infections contracted by patients while receiving medical treatment, are a potentially major hazard for residents of nursing homes and other long-term care facilities (LTCFs). As many as 2.8 million LTCF patients may contract HAIs, some of them fatal, every year. A group of epidemiologists recently revised the definitions used in the surveillance of HAIs, providing new tools to document and track infections. The Centers for Disease Control and Prevention (CDC) has also issued new guidelines to help LTCF’s monitor HAIs. These new tools will hopefully help reduce the development and spread of infections among nursing home residents.

HAI Surveillance Definitions

In the October 2012 issue of the Society for Healthcare Epidemiology of America’s (SHEA) journal, Infection Control and Hospital Epidemiology, a panel of experts present a new set of definitions for use in monitoring LTCF infections. The existing set of definitions, known as the McGeer criteria, date back to 1991.

A group of experts led by Allison McGeer published a set of definitions in the February 1991 issue of the American Journal of Infection Control. The purpose of the McGeer criteria was to establish a uniform set of guidelines to monitor infections in nursing homes, such as standards for identifying newly-contracted or worsened acute infections that require monitoring.

According to the paper containing the revised definitions, the McGeer criteria work well in nursing homes providing non-acute care to older residents, but they do not necessarily address concerns faced in LCTFs providing acute care and care to younger patients. New types of nonhospital treatment facilities have appeared since 1991, so newer criteria for identifying and tracking HAIs is necessary.

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1097246_52000461_03212012.jpgA recent study found that elderly women residing in nursing homes may face greater rates of mortality if they are not getting enough vitamin D. The study will appear in the Journal of Clinical Endocrinology and Metabolism, a publication of The Endocrine Society. Researchers at the Medical University of Graz, Austria, looked at a sample group of 961 residents. Members of the sample group had an average age of 83.7 years. The study found that, not only does vitamin D deficiency carry a greater risk of death, but that vitamin D deficiency may be common in nursing homes. This could have important implications for the nutritional care that female residents receive in nursing homes.

The researchers examined the 961 residents and followed up twenty-seven months later. They found that 284 individuals, roughly thirty percent of the group, had died during that time. They noted low vitamin D levels in 92.8 percent of the group members. While vitamin D deficiencies have been common knowledge among researchers for some time, the study authors said, no one has developed good strategies for treatment yet. Given the increased risk of bone fractures and other such injuries in patients with low vitamin D, the researchers urge the medical community to work on ways to remedy these deficiencies.

Low levels of vitamin D can have multiple health effects. Scientists have known about an increased rate of mortality due to vitamin D deficiency for some time, but the Graz study has helped tie it to specific populations. Vitamin D is also very important for bone health. Deficiency can cause bone damage, sometimes known as rickets, and it can contribute to an overall loss of bone density that makes fractures and breaks more likely. Some research suggests that vitamin D supplements can help with cardiovascular disease, some cancers, asthma, multiple sclerosis, immune strength, and certain neurodegenerative diseases like Parkinson’s. These claims are all controversial, and no scientific consensus exists on any of them. The U.S. Food and Drug Administration only allows the food industry to claim on its labels that vitamin D “may reduce the risk of osteoporosis.”
Vitamin D may be obtained through certain types of fish, fruits and vegetables, or foods specifically fortified with vitamin D. According to the National Institutes of Health, many people meet much of their vitamin D requirements through exposure to sunlight. Ultraviolet radiation in sunlight interacts with chemicals already present in the skin to produce vitamin D. People who spend most of their time indoors, which could include many nursing homes residents, may face vitamin D deficiencies.

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