Articles Posted in Dementia in Nursing Homes

Nursing homes that care for the elderly have an affirmative duty to provide for the basic needs of the residents for whom the home is charged with caring. This duty goes beyond a moral one, and it is actually legally imposed and enforceable by the courts. In fact, if a nursing home resident suffers any physical injury or psychological torment, the nursing home can be held legally responsible. Injured residents and their families may be entitled to substantial compensation based on the neglectful or abusive tendencies of nursing home staff.

When the term nursing home neglect is thrown around, most imagine a busy nurse failing to attend to every need of their patients. Perhaps the nurse leaves a soiled diaper on a resident for too long, or delivers a meal later than desired. However, the truth about nursing home abuse is much more terrifying.

A Horrific Example of Nursing Home Neglect

Earlier last month, eight employees of an elderly care facility not far from Manchester, England were charged with the neglect of a patient. According to one local news source covering the disturbing story, the eight charged included the owner of the facility as well as the person responsible for keeping the man’s room clean.

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A 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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An unusually high number of cases of nursing home residents choking to death in Connecticut has led to calls for improved training for staff members. The state has fined three nursing homes in three unrelated choking deaths, all occurring within a period of three months. In each incident, nursing home staff left the resident unattended while eating. In two of the cases, the resident had food obtained from outside the nursing home either without the knowledge or permission of the staff. Nursing homes owe a duty to their residents to keep them safe and protect them from unusually dangerous conditions, which includes special needs regarding food.

An elderly resident of the Torrington Health and Rehabilitation Center in Torrington, Connecticut choked to death on a peanut butter and jelly sandwich on February 3, 2012. An investigation determined that nursing home staff left the resident unattended with the sandwich. The resident had strict diet restrictions and required close supervision while eating. The state health department fined the nursing home $510, although the fine could have been as much as $3,000.

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Antipsychotic medications treat serious psychiatric conditions like schizophrenia and bipolar disorder. That was their original intention, anyway. In some nursing homes and hospitals, antipsychotics have found a new use in patients suffering from dementia. In an effort to keep difficult dementia patients calm, some nursing homes use these medications as a “chemical restraint.” For dementia patients who also suffer from schizophrenia or other psychiatric conditions, this can be an effective treatment. For other dementia patients, though, it can worsen the effects of dementia and cause severe side effects, including an increased risk of death. The Centers for Medicare and Medicaid Services (CMS), after months of preparation, last month announced a partnership with state health agencies, nursing homes, and health care advocacy groups to push for the reduction or elimination of antipsychotics as a treatment for dementia sufferers.

We have followed the effort to reduce use of antipsychotics for some time at the Maryland Nursing Home Lawyer Blog. The group of drugs known as “antipsychotics” includes “atypical antipsychotics” like Abilify, Seroquel, and Zyprexa; and older “typical antipsychotics” like Haldol and Thorazine. Concern over the issue goes back at least as far as 2005, when the U.S. Food and Drug Administration (FDA) issued a warning to doctors about risks from antipsychotic medications to dementia patients, including an elevated risk of dying from pneumonia or heart attacks. A report from the Department of Health and Human Services (HHS) released in 2011 found that up to one in seven nursing home residents received an “atypical” antipsychotic in 2007, and that almost ninety percent of the antipsychotic prescriptions issued to nursing homes that year were for dementia patients. CMS first announced its new initiative during a webcast on March 29, 2012, and it followed up with a formal launch on May 30.

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A new study suggests that previous beliefs regarding certain dementia patients’ use of feeding tubes are incorrect. Feeding tubes, the belief went, could rectify nutritional imbalances and therefore aid in the healing of pressure ulcers, also known as bedsores. Research has generally been inconclusive, but this new study appears to disprove the premise entirely.

Patients reviewed in the study who had bedsores when receiving the feeding tube showed no improvement, and patients who previously lacked bedsores before were more likely to develop them with the feeding tube. The study’s conclusions are important to nursing home residents, their families and loved ones, and those who advocate for their safety.

The study looked at hospital records for patients with advanced cognitive impairment, commonly known as dementia, who had a percutaneous endoscopic gastrostomy (PEG) tube inserted, and were then returned to the nursing homes where they live. The purpose of the feeding tube is often to correct nutritional imbalances in the patients, who may suffer from eating disorders brought on by dementia. The study’s lead author has also said that nursing homes and hospitals, looking to cut expenses where possible, may view feeding tubes as a good investment, even if they are not strictly medically necessary. Using feeding tubes in residents suffering from dementia frees up staff members who might otherwise have had to feed those residents by hand.

The study’s findings indicate that not only does the use of feeding tubes not improve a patient’s recovery from bedsores, but that these devices may actually put patients more at risk for having bedsores. Nursing home residents who had no bedsores upon arriving at the hospital were 2.27 times more likely to get a bedsore after getting the feeding tube. Among residents who already had bedsores when they received their feeding tube, researchers found that the bedsores were less likely to heal.

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The Alzheimer’s Association, an organization established to promote both care for Alzheimer’s patients and research into eradicating the disease, recently published a report outlining the prevalence and cost of the disease in Maryland and the rest of the country. In addition to its conclusion that the cost of caring for Alzheimer’s patients will increase greatly over the next twenty to thirty years, the study found that a significant percentage of Alzheimer’s sufferers live alone, with no one to provide care even on a part-time basis. Alzheimer’s already constitutes a very large portion of nursing home and extended care costs. The increased incidence of Alzheimer’s and the lack of support for many sufferers cause concern for us as advocates for nursing home residents suffering abuse and neglect.

Alzheimer’s disease is the most common form of dementia, causing progressive degeneration of brain functions. It most often afflicts people over the age of 60. Little is known about the disease’s precise cause and means of progression, and there is no cure. The disease often manifests first with confusion or irritability, and can progress to forgetfulness and difficulty with language. People with the disease often suffer serious long-term memory loss, and eventually even bodily functions are affected, leading to death.

According to the Alzheimer’s Association, 5.4 million Americans currently suffer from the disease, 5.2 million of them over the age of 65. Almost thirty percent of Alzheimer’s sufferers receive Medicare or Medicaid. Seventy-five percent of people with Alzheimer’s will go to a nursing home by age 80, the Alzheimer’s Association estimates.This is compared to four percent of the general population, meaning that the costs will strain states’ Medicaid budgets.

The report found that about 15.2 million people provide non-professional care to Alzheimer’s sufferers nationwide, including 278,490 in Maryland. This mostly consists of family members and friends providing unpaid care. The report estimates the nationwide economic value of this unpaid care at $210 billion in 2011. Maryland’s share of that amount exceeds $3.8 billion. The caregivers themselves also tend to incur additional health care costs due to the stress of caring for an Alzheimer’s patient. This costs Maryland caregivers around $173 million each year.

Approximately 800,000 Alzheimer’s patients live alone, according to the study, and about half of them have no “identifiable caregiver.” These individuals face serious risks of illness and death due to their progressive inability to care for themselves. This affects not only their health but public health, as state resources must go towards caring for them, which could mean less funds from Medicaid and other programs for nursing homes. It could also mean influxes of residents into nursing homes, putting strain on administrators and staff.

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The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare and Medicaid , has launched an initiative to promote reducing the use of antipsychotic medication in nursing home patients. The goal of the initiative is to spotlight the misuse of these medications in nursing homes, improve their monitoring and regulation, and promote non-drug treatments for certain conditions in nursing home residents. Nursing home staff often use antipsychotics to treat dementia symptoms, which may include agitation and aggressive behavior. Use of antipsychotic medications in dementia patients can have serious side effects, however, increasing their risk of complication and even death. The CMA’s initiative is the latest in a series of government efforts to curb antipsychotic use.

The CMS formally launched its initiative on Thursday, March 29 with a one-hour webcast entitled “Initiative to Improve Behavioral Health and Reduce the Use of Antipsychotic Medications in Nursing Homes [sic] Residents.” It describes the initiative as a “multidimensional approach” that incorporates research, public outreach, regulation, and training.

This Maryland Nursing Home Lawyer Blog has previously reported on the issue of misuse of antipsychotic drugs in dementia patients. The primary purpose of these drugs is the treatment of schizophrenia and bipolar disorder. Nursing home staff sometimes use these drugs with dementia patients, which is fine for the minority of dementia sufferers who also demonstrate symptoms of schizophrenia or psychotic behavior. Antipsychotic medications may only worsen the isolation and communication problems for the remainder of the nursing home residents with dementia.

A report released by the U.S. Department of Health and Human Services (HHS) in 2011, based on an audit conducted in 2007, found that nursing homes often use antipsychotic medications in ways that are neither approved for Medicare coverage nor approved by the Food and Drug Administration (FDA). According to the study, eighty-eight percent of the antipsychotic prescriptions issued that year were for nursing home residents with dementia. Overall, as many as 1 in 7 nursing home residents received an “atypical” antipsychotic drug. The Inspector General for HHS wrote that such uses “violate government standards for unnecessary drug use.”
HHS additionally found that some pharmaceutical companies have specifically marketed certain drugs to nursing homes. In 2009, the nation’s largest pharmacy dealing with nursing homes, Omnicare, agreed to pay $98 billion to the federal government and multiple state governments to settle allegations of receiving illegal kickbacks from drug manufacturers. A lawsuit filed by the U.S. Department of Justice in early 2010 against Pharmaceutical company Johnson & Johnson accused the company of paying kickbacks to pharmacies, including Omnicare, to both purchase and promote its products to nursing homes. This included the antipsychotic drug Risperdal.

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Antipsychotic medications are typically used to treat patients with schizophrenia or bipolar disorder, helping reduce and control delusional thinking and hallucinations. In nursing homes around the United States, staff also use antipsychotics for patients suffering from dementia as a way of controlling paranoia and aggression. These medications can be useful for the small percentage of dementia patients who actually demonstrate psychotic behavior and constitute a risk to other nursing home residents and themselves. For most dementia patients, antipsychotics may only further isolate them and make them even less communicative. This is of particular concern to families and loved ones of dementia patients, who wish to ensure that they are receiving the best possible care.

An FDA warning from 2005 gives notice to doctors of an increased risk of death from pneumonia or heart attacks among dementia patients prescribed atypical antipsychotics. This class of drug includes Abilify, Geodon, Invega, Risperdal, Seroquel, and Zyprexa. The agency added the older class of drugs known as typical antipsychotics to that warning in 2008. Typical antipsychotics include drugs like Thorazine and Haldol. Despite the warnings, off-label use of antipsychotic medications in dementia patients continues.

The Associated Press reports that nursing homes are beginning to take notice of the risks inherent in using antipsychotics for dementia and are gradually decreasing their rate of use. One nursing home in Florida has seen a reduction in the rate from twenty-five percent of all patients to a current rate of fourteen percent. A Brooklyn, New York nursing home went from thirty to fifteen percent without much trouble. Most patients taken off the antipsychotic regimen reportedly displayed significant improvements in both mood and behavior.

Among nursing home staff, the concern is that, without the antipsychotic medications, they will be unable to control aggressive or violent dementia patients. Some patients may truly need such medication, especially since there are no FDA-approved drugs specifically treating behavioral aspects of dementia. Patient advocates cited by the Associated Press argue that the use of such medications has more to do with keeping patients sedated for staff convenience. In situations where use of antipsychotics may be endangering a patient’s life, all other concerns should be secondary to protecting the patient.

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Recently, our Baltimore nursing home abuse blog discussed the financial abuse of elders–a hugely under reported problem affecting around 3.5 million seniors around the country every year.

In recent nursing home abuse lawsuit news, a 68-year-old retired preschool teacher has sued a Seal Beach nursing home for elder abuse, alleging that as a resident, she was chemically restrained with drugs against her will, while the nursing home staff tried to take control of her retirement income.

According to the lawsuit, Marsha Davis lived in her own home until November of 2010, and suffered from many health issues, including diabetes. After collapsing at her home In the fall of 2011, Davis was reportedly hospitalized and then transferred to the Country Villa nursing home, for a three-month stay.

Davis alleges that while residing at the home, she was medicated with psychotropic drugs for chemical restraint against her will—allegations that were reportedly found to be true by state investigators in February. The lawsuit claims that after she was medicated to the point of being entirely disorientated, the nursing home stated that she was suffering from “cognitive impairment” and tried to collect her Social Security payments.

Although Davis has no immediate family members to act as an advocate on her behalf, a friend of hers reportedly intervened, and the medication was stopped. Davis was later transferred to another home where she remains today.

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As our Baltimore, Maryland accident lawyer blog recently reported, the family of an elderly nursing home resident whose wrongful death lead to a nursing home abuse and negligence lawsuit, was awarded $91.5 million earlier this month, after a Charleston, West Virginia jury found Heartland of Charleston nursing home and its corporate owners guilty of negligence—a verdict that the nursing home owners are likely to appeal.

According to the lawsuit, in September of 2009, Tom Douglas placed his mother Dorothy, who suffered from dementia, Parkinson’s and Alzheimer’s disease among other conditions, in Heartland of Charleston nursing home temporarily—until there was room for her in a nearby facility that specialized in Alzheimer’s disease healthcare and treatment.

Before placing Douglas in the home, her son claimed that his mother had lived with he and his family, experiencing improved health conditions that included walking, speaking and even recognizing her own family members.

Three weeks after Tom Douglas placed his 87-year old mother into the nursing home he reportedly found out that she was confined to a wheelchair, and suffered from malnutrition, and dehydration. By the time she was transferred to Heritage Center, the nursing home specializing in Alzheimer’s Disease healthcare, Douglas was reportedly unresponsive, had lost fifteen pounds and suffered such severe dehydration that she died the following day after her nursing home transfer.

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