Maryland Nursing Home Lawyer Blog

Federal Grant Program Helps Maryland Improve Care Options for Seniors

July 19, 2012 | Lebowitz & Mzhen

The Patient Protection and Affordable Care Act (ACA), enacted by Congress in 2010 and known colloquially as “Obamacare,” has caused an historic amount of controversy over the past two years. It recently survived a Supreme Court challenge, and some of its provisions have begun to take effect. While Americans may disagree vehemently about all or parts of the law, some provisions have begun to benefit Maryland seniors in significant ways. A grant from the federal government, part of the Balancing Incentive Program (BIP), should allow the Medicaid program to cover more patients and provide seniors with more care options. Seniors who may not require full-time care in a nursing home may now be able to obtain home- or community-based care. This could free up space and resources in overburdened and understaffed full-time care facilities.

President Obama signed the ACA into law on March 23, 2010. The hefty bill mainly addresses the rights and duties of health insurance providers and patients. The most controversial provision, the “individual mandate” to purchase health insurance if it is not available through employment or public assistance, survived review by the Supreme Court in a June 28 ruling. The law includes provisions, most of which have not yet taken effect, preventing insurance companies from denying coverage for a “pre-existing condition,” restricting when and how an insurer may cancel coverage, and much more.

Maryland Nursing Homes Deal with Storms, Power Outages, Heat Waves

July 12, 2012 | Lebowitz & Mzhen

A massive storm struck Maryland on June 29, 2012, causing many parts of the state to struggle to restore power and other utilities. A severe heat wave made matters even worse, with more than a week of temperatures approaching one hundred degrees. Power restoration was completed after nine days, but further storms may still leave people vulnerable to the heat. This is a particular concern for nursing home residents. More than thirty nursing homes lost power after the storm, and at least four went without air conditioning for several days.

The storm began in northern Indiana and swept east, reaching the Atlantic coast in about twelve hours. Wind storms known as “derechos,” which typically accompany thunderstorms, hit parts of the Midwest roughly once a year. They are less common in mid-Atlantic states like Maryland. The intense heat wave seems to have worsened wind conditions in this case, creating what meteorologists are calling a “super derecho.” Wind gusts of up to ninety-one miles per hour hit some areas, equivalent to a category 1 hurricane. By the time the storm passed through Maryland, it had killed thirteen people and knocked out power for millions.

Further storms and one of the region’s longest recorded heat waves added to the death toll. By earlier this week, the heat wave had accounted for eighteen deaths in Maryland. Most of the victims were elderly or had chronic conditions like diabetes. Temperatures reached into the high 90’s and low 100’s for twelve days before finally breaking on July 8.

Study Finds 21% of Short-Stay Patients in Nursing Homes Will Sustain Falls

July 5, 2012 | Lebowitz & Mzhen

A nationwide study, led by a researcher at the University of Southern California, recently reviewed the rates of falls among short-stay nursing home residents. This was the first major study to analyze falls among newly admitted patients. Numerous studies have reviewed fall rates among long-term nursing home residents, and those risks are generally well understood. The study’s findings may help nursing home administrators and staff identify short-term patients who are at greater risk for falls and help take precautions to protect them from injury. Putting staff on notice of important risks faced by residents is an important step in preventing nursing home negligence and keeping residents safe.

The study, which was published in the May 2012 issue of the Journal of the American Geriatrics Society, focused on Medicare or Medicaid patients during their very first nursing home admission. Researchers analyzed clinical assessments prepared by the Centers for Medicare and Medicaid Services, known as Minimum Data Sets (MDS), from 2006 for over 230,000 individuals residing in more than 10,000 nursing homes located around the U.S. The MDS assessments provide a comprehensive overview of a patient’s “functional capabilities” in order to assist nursing homes in determining a patient’s needs. The study also looked at how different nursing homes are organized, with particular attention to the professional composition of the homes’ nursing staffs.

During the first thirty days in a facility, the study found, twenty-one percent of new nursing home residents will sustain at least one fall. This is critically important because falls are associated with greater risks of health complications and death, even among short-stay residents. The study proposes several possible causes for the increased fall risk. Nursing homes with high ratios of certified nursing assistants (CNA’s) to patients appeared to have a lower risk of falls. This suggests that the “hands-on patient care during high-risk activities” offered by CNA’s reduces the risk of falls.

Choking Deaths in Nursing Homes Lead to Calls for More Staff Training

June 27, 2012 | Lebowitz & Mzhen

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.

Lawsuit Claims Abuse and Neglect at School

June 21, 2012 | Lebowitz & Mzhen

A federal lawsuit brought by the parents of several students against a Kansas military school alleges multiple acts of abuse and neglect. Although fellow students committed many of the alleged acts of abuse, the lawsuit claims that adult staff members often knew about the abuse, and that some were even present for some incidents. Faculty, staff, and administrators did not intervene, according to the complaint, thus breaching their duty to protect their students. The claims are similar to claims brought for alleged nursing home abuse and neglect, since both involve a duty to care for vulnerable individuals, and liability for failure to protect people under their care from harm. This could include failures to protect nursing home residents from abuse by staff members or other residents.

A group of parents first filed suit on March 5, 2012 in the U.S. District Court for the District of Kansas. Their children were students at St. John’s Military School, a residential boarding school in Salina. The school teaches grades 6 through 12 and houses all of its students on its premises.

The plaintiffs allege that the school puts incoming students through a series of physical training and other initiation procedures, and that it places significant disciplinary authority in its senior students. This gives the older students powers over the younger students more properly exercised by adults, the complaint says. The school allegedly knows of abuses that occur within this system, including many that result in physical injury to students, but does nothing to address it.

Medicare Formally Announces Partnership to Combat Use of Antipsychotic Medications as “Chemical Restraints” in Nursing Home Residents Suffering from Dementia

June 14, 2012 | Lebowitz & Mzhen

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.

Nurse Convicted of Involuntary Manslaughter for Drugging Patient, Causing Patient’s Death

June 7, 2012 | Lebowitz & Mzhen

A nurse in Durham, North Carolina pleaded guilty to charges of involuntary manslaughter and patient abuse when a nursing home resident under her care died. Prosecutors accused her of drugging patients under her care in order to “keep them quiet.”

Angela Almore worked as a nurse at Britthaven of Chapel Hill, a nursing home located in Chapel Hill, North Carolina. She was reportedly working the 3 p.m. to 11 p.m. shift in the home’s Alzheimer’s unit on February 13, 2010. Seven residents were taken to a nearby hospital in the early morning of February 14 for respiratory issues. All seven of them tested positive for opiates, although it reportedly took doctors several hours to determine what was wrong with the patients. One of the residents, 84 year-old Rachel Holliday, died at the hospital. The cause of death was determined to be pneumonia due to morphine toxicity. The other six residents received treatment for various respiratory ailments and eventually returned to the nursing home.

Fourteen of the approximately twenty-five residents in the Alzheimer’s unit tested positive for morphine. Only one of the residents had a prescription for the powerful opiate. During the subsequent investigation of Holliday’s death and the positive toxicology tests, several employees stated that they had seen Almore giving an orange fluid to patients that did not look like the patients’ regular medication. According to the assistant district attorney who prosecuted the case, employees said that Almore told them she did not want to deal with patients during that shift, and that she had given them something to “relax.” Almore also allegedly stated that “she knocked all their asses out.” One employee who worked in the Alzheimer’s unit told the judge presiding over the case that none of the drugged patients ever caused trouble for the staff.

Nursing Home Fined After Staffers Failed to Help Resident Who Fell Down for Nearly an Hour

May 29, 2012 | Lebowitz & Mzhen

A nursing home in Iowa must pay a $15,000 fine for failing to provide needed treatment to a resident who fell and suffered a head injury. The resident reportedly lay on the floor for almost an hour while staffers attended a holiday party nearby. Nursing home administrators say they plan to appeal the state’s order, and they dispute the state’s interpretation of the video, saying that investigators viewed it “out of context.”
The incident occurred during the afternoon of December 23, 2011 in the dementia unit at All-American Restorative Care in Washington, Iowa. According to state investigators who viewed footage from the facility’s video-monitoring system, a female resident stumbled backwards and fell while walking down a hallway at 2:51 p.m. No one on the staff witnessed the fall, but within seconds, two employees reportedly appeared at a nurse’s station with a view of the fallen woman. Although the woman was “barely moving,” neither staffer appears to have offered her assistance. One of the staffers reportedly told investigators later that she called to the woman to ask if she was alright, and that the woman said “Yes.” The second staffer reported that this particular resident being on the floor was a “recurring situation.”
The resident remained on the floor for another thirty minutes on the video, and then a third staffer appeared. This staffer did not offer any assistance to the resident, according to investigators. A fourth employee appeared on the video at 3:37 p.m., forty-six minutes after the fall. Three staffers enter the video two minutes later and lift the woman up, reportedly without first assessing her neurological condition, and take her to her room. One of these staffers later told investigators that the woman was “pretty out of it” at this point. Nursing home staffers took the woman to the hospital at around 5:00 p.m. for a head wound. She had a cut on the back of her head that required four staples.

Study Finds Link Between Feeding Tubes and Bedsores

May 22, 2012 | Lebowitz & Mzhen

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.

Nursing Home Staffer Charged with Elder Abuse for Allegedly Stealing Medicine

May 15, 2012 | Lebowitz & Mzhen

Prosecutors in Great Falls, Montana have charged former nursing home employee Jennifer Allgrunn with drug possession and elder abuse. The theft of medications allegedly went on for several months, during which time residents might not have had enough medications for their needs. Although the underlying alleged offense is essentially theft and a drug offense, the fact that it directly harmed the nursing home’s elderly residents led to a criminal charge for elder abuse.

Police arrested Allgrunn on Friday, May 4, 2012, after staff at Goldstone Assisted Living Home complained about ongoing and routine drug thefts. Allgrunn had worked at Goldstone since December 2011. Police found nine prescription pills on Allgrunn’s person, including the painkiller hydrocodone, as well as additional medication packaging. Goldstone administered all of the medications in Allgrunn’s possession. She reportedly admitted to police that she had been regularly stealing drugs from the nursing home since December.

Prosecutors charged Allgrunn with elder abuse and criminal possession of dangerous drugs. Court documents filed by prosecutors allege that her thefts harmed the elderly residents of the nursing home by depriving them of medication, and therefore sufficient medical care.