Resident Safety

Aide Arrested After Resident Dies in Nursing Home Fight

December 26, 2014 | Lebowitz & Mzhen

Earlier this month in the Bronx, New York, a 77-year-old man died after he was involved in a fight with a nursing aide in a local nursing home. According to a report by one local news source, the two got involved in an intense fight that eventually required witnesses to physically separate the two.

Evidently, the fight broke out when the resident wanted to get out of bed but the aide wasn’t allowing him to do so. At some point during the fracas, the nursing home resident fell on a broken table and was impaled by a piece of metal. He was rushed to a nearby hospital, but he passed away from his injuries just a few hours later.

The nurse—who had been employed with the nursing home for 14 years—told police and reporters that the resident attacked her first. However, that has yet to be verified. For her involvement in the death of the resident, the aide has been charged with criminally negligent homicide, felony assault, and endangering the welfare of an adult. She was released on bail after pleading not guilty to all charges.

Recent Study: One in Five Nursing Home Residents Endure Some Kind of Abuse

November 26, 2014 | Lebowitz & Mzhen

Nursing home abuse is a serious problem across the United States. However, due to the fact that many instances of abuse go unreported, keeping track of the exact number of abused residents is something that is easier said than done.

A recent study released by the Gerontological Society of America suggests that the number of abused nursing home residents may be higher than ever expected, affecting as high as one in five residents. According to the report, the abuse is not only being committed by overworked nursing home employees, but also by fellow residents.

The report suggests that the higher-than-expected rate of abuse is due at least in part to resident-on-resident abuse. This is not to diminish the contribution of employee abuse, since that is still a large part of the problem.

Staffing Shortage May Have Been Responsible for Boy’s Death at Maryland Group Home

July 28, 2014 | Lebowitz & Mzhen

A true tragedy unfolded earlier this month in a group home charged with caring for severely disabled foster children. According to a report by the Baltimore Sun, a 10-year-old boy died at the care facility because there were not enough caretakers to provided the required one-on-one care that the boy needed.

Evidently, as a young baby, the boy suffered a severe case of shaken baby syndrome. So severe, in fact, that his mother was sentenced to a 15-year prison sentence for her involvement. A group home was charged with his care and was provided funding for such care by the State. However, on July 2nd, the boy died when there was only one nurse on staff to care for all the home’s patients.

The staffing shortage came to light when an on-duty nurse came forward, telling all who would listen that she has complained to the staffing company several times without success. Their response, she said, was always, “We know, we know, we’ll fix it.” Now it is too late to fix anything.

New Studies Consider the Effect of Nursing Home Staff Turnover on Resident Care

May 27, 2014 | Lebowitz & Mzhen

Two studies were recently released by the American Medical Directors Association and the Journal of Nursing Administration that looked at the relationship between higher nursing home staff turnover and the quality of care being provided to residents. Not surprisingly, both studies found an adverse relationship, meaning the higher the turnover in the nursing home, the lower the quality of care being provided to residents. A recent article by Nurse.com outlines the findings of both reports.

The first study, entitled ““Are Nursing Home Survey Deficiencies Higher in Facilities with Greater Staff Turnover,” was published by the American Medical Directors Association and found that “turnover for both licensed nurses and certified nursing assistants was associated with quality problems as measured by deficiencies considered to be closely related to nursing care.”

The second study, “Turnover Staffing, Skill Mix, and Resident Outcomes in a National Sample of U.S. Nursing Homes,” published by the Journal of Nursing Administration, looked at adverse patient effects, such as bedsores and pain, and tried to see if there was a tie to a higher staff turnover rate. After controlling for a number of factors, the study did find that, as nursing home staff turnover rates increase, especially in the certified nurse assistant position, adverse patient experiences increase.

Recent Study Finds that 22% of Nursing Home Residents Suffer Preventable Injuries

March 18, 2014 | Lebowitz & Mzhen

Nursing homes are not known for their stellar safety records. In fact, they are usually known by most for the exact opposite; for providing substandard care that can lead to resident injury and even premature death in some cases. A recent study administered by the Health and Human Services Department found that 22% of nursing home residents suffered some kind of preventable injury such as medication errors, falls, and infections.

According to an article by Modern Healthcare, one of the biggest problems for consumers about the nursing home industry is the lack of awareness of individual nursing home reputations. The article notes that the study suggests that nursing homes are subject to heightened government scrutiny and also create “a list of potential events to help nursing home staff better recognize harm; a review of nursing home practices by state surveyors; and encouraging nursing homes to report adverse events to patient safety organizations, among other measures.”

Others suggest that, in order to make a real difference in the quality of nursing homes, the number and types of safety incidents should be made public for each nursing home.

Peak Flu Season Is About to Hit Maryland Nursing Homes, Be Prepared

January 13, 2014 | Lebowitz & Mzhen

As if the cold temperatures of winter are not bad enough, every January and February “Flu Season” comes around, putting an extra damper on anyone’s season who is unlucky enough to contract the persistent and infectious disease. However, for some the flu is more than a pesky illness that requires we use a few sick days from work. To the elderly, the flu can be a life threatening illness.

One recent article by the Frederick News-Post notes that, while Frederick Memorial Hospital requires all hospital staff to be vaccinated, nursing home employees are not required to get the flu vaccine. Considering that nursing home employees work with an extremely vulnerable population—the same as the hospital employees—a nursing home employee’s failure to get vaccinated may have devastating repercussions, should an outbreak hit a nursing home.

The Effects of the Flu on the Elderly

To most of us, getting the flu means that we will have to take a week off of work, at the worst. However, the elderly are an especially vulnerable population. In fact, according to the government website, flu.gov, 90% of all flu-related deaths occur in people over the age of 65. This is due mostly to the fact that, as we age, our immune systems grow weaker and have a more difficult time fighting off the flu virus.

Finding a Safe Nursing Home for Your Loved One in Maryland

January 6, 2014 | Lebowitz & Mzhen

Rarely does anyone look forward to putting a loved one in a nursing home. Ideally, we would all be able to provide the care that our aging friends and relatives need in their final years. However, the reality of life often prevents us from doing so and many of us will require the services that a nursing home provides at some point in our lives.

However, nursing homes have a bad reputation, and for good reason. The instances of nursing home abuse and neglect seem incredibly high these days. In fact, a recent study conducted by the federal government found that 1 in 3 nursing homes were cited with some kind of violation that could have caused harm (or actually did) to one of their residents. With all the bad nursing homes out there, how can you be sure that you are selecting a good one for your loved one?

How Do Maryland Nursing Homes Stack Up?

Maryland nursing homes rank below average with the quality of care they provide to their residents. According to the 2013 Nursing Home Report Card, Maryland was given a “D.” Below are just a few highlights from the Report:

Approximately 95% of all Maryland nursing homes were deficient in some manner.
Approximately 17% of all Maryland nursing homes were reported to have “severe deficiencies.
Maryland was ranked 34 out of the 50 states when it comes to nursing home care.

Syracuse Nursing Home Faces Federal Sanctions for Substandard Care

April 16, 2013 | Lebowitz & Mzhen

Rosewood Heights, a 242 bed nursing home in Syracuse, New York was recently cited for 26 violations relating to patient care and safety standards. According to the December 2012 inspection report, which was recently published on the New York Health Department’s website, three of the violations were classified as “immediate jeopardy,” which is the most serious type of infraction. Additionally, 12 of the citations were for recurring issues. As a result, the federal Centers for Medicare and Medicaid (CMS) fined the facility $10,000 due to the infractions. (The state Health Department inspects nursing homes on behalf of CMS.)

Because the facility has been repeatedly cited for serious violations and persistent poor quality for more than three years, it was put on the CMS’s Special Focus Facility list in March 2012. Fewer than 1% of the nation’s nursing homes are on this list. Rosewood was informed that it had 18 to 24 months to improve the violations, or else face the potential loss of federal funding. Unfortunately, the latest inspection did not reflect improved conditions.

According to the report, among the most serious problems identified were several safety lapses related to feeding. Although luckily no one was injured or died as a result, there were pervasive lapses of supervision over patients with physiological feeding restrictions.

The most serious lapses included:

A woman who had suffered from dementia, and had also suffered from a stroke, was on a strictly liquid diet. An inspector found the resident being fed two chicken patty sandwiches by friends. Relatives also regularly fed the woman solid foods which were not within her dietary restrictions.
A resident who was posed with the risk of choking if he did not sit upright at meals was witnessed being fed lunch by a nurse while lying flat in bed.
A patient who had doctor’s orders to have meat and other large pieces of food pre-cut by staff was served whole hot dogs in his room, and left to eat without any supervision

The report cited the facility for failure to properly train staff and adequately supervise residents. According to the report, the home provided “substandard” care to a total of eight residents.

Additional violations included:

Failure of staff to wash hands, and in some cases not wearing gloves to feed residents.
Serving residents food that was not the proper temperature
Dirty floors in some resident rooms

Nursing Home Closes Amid Allegations of Abuse, Neglect, and Other Deficiencies

February 12, 2013 | Lebowitz & Mzhen

A Toledo, Ohio nursing home closed in January 2013 after losing its Medicare and Medicaid provider status, receiving notice of federal fines approaching $140,000, and facing loss of its state license. Ongoing concerns regarding the quality of care led to multiple investigations by state and federal officials. The alleged, unreported assault of a resident in mid-2012 led to a push by state officials to shut the facility down.

Two state agencies opened investigations of Liberty Nursing Center of Toledo after the alleged sexual assault of a resident. The facility provides elder care and treats patients with severe mental illness. According to the Toledo Blade, nurses found a male patient on top of a female patient in her room on July 26, 2012, in what appeared to be an act of assault. The male patient had a diagnosis of schizoaffective disorder and a history of sexual aggression. The facility allegedly transferred the male patient to a hospital after notifying his psychiatrist. After determining that the male patient did not make sexual contact with the female patient, however, an administrator allegedly instructed staff to “clean up” the patient. She did not receive any examination after the alleged assault, and no further action was taken, including notification of law enforcement, health officials, or the woman’s guardian.

The Ohio Department of Health (ODOH) notified Liberty on August 9 that it intended to revoke the facility’s license, which would force it to close. It cited the July incident, along with other allegations of abuse, neglect, and deficiencies in quality of care. Several residents have left the facility without permission or supervision in recent years, according to ODOH.

Study by Federal Regulators Finds Higher Rate of Medicare Fraud Among For-Proft Nursing Homes

February 5, 2013 | Lebowitz & Mzhen

A substantial percentage of Medicare claims made by for-profit nursing homes were found to be “improper,” according to a report issued late last year by the U.S. Department of Health and Human Services (HHS). The percentage of improper claims among for-profit facilities was reportedly more than double the rate for non-profit facilities. Bloomberg News profiled several companies that operate for-profit nursing homes, highlighting allegations of unnecessary and even harmful treatments. We have previously explored how for-profit facilities might cut costs in order to boost profits, resulting in neglect of nursing home patients. Similarly, a desire to increase revenue through Medicare billings might lead to unnecessary, abusive treatments. For people selecting a nursing home for themselves or a loved one, this information could be critical to making an informed decision.

For-profit nursing homes vastly outnumber not-for-profit facilities around the country. According to a report by the Medicare Payment Advisory Commission (MedPAC), about seventy percent of skilled nursing facilities (SNFs), which are generally part of a nursing home, are operated on a for-profit basis, while nearly eighty percent of long-term care hospitals (LTCHs) are for-profit. MedPAC, “Report to the Congress: Medicare Payment Policy” at 17 (March 2012). During the period from 2005 through 2009, the number of for-profit LTCHs increased by eighteen percent, while the number of not-for-profit facilities decreased by eight percent. Id.

HHS’s Office of the Inspector General (OIG) released a report in November 2012 entitled “Inappropriate Payments To Skilled Nursing Facilities Cost Medicare More Than A Billion Dollars In 2009.” The report found that SNFs submitted nearly one-fourth of all erroneous Medicare claims in 2009, resulting in $1.5 billion in “inappropriate Medicare payments.” OIG report at 10. The report further found that SNFs misreported basic information about Medicare beneficiaries in almost half of all claims. Id. at 11. It did not expressly draw a connection between for-profit facilities and inappropriate Medicare claims.