Maryland Nursing Home Lawyer Blog

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.

Family of Man Who Died from Bedsores Receives $3.2 Million Jury Award

May 8, 2012 | Lebowitz & Mzhen

A Colorado jury ruled for the family of a man who died due to complications from bedsores. The family of Henry Frazier sued the nursing home where the man lived, alleging that staff members’ neglect caused Frazier to develop the bed sores, and that the nursing home failed to notify the family of his condition. The jury awarded the family $3.2 million for Frazier’s wrongful death.

Frazier first entered Pioneer Healthcare Center in Rocky Ford, Colorado in May 2009. For a time, he reportedly worked as a janitor at the center, although he suffered from Parkinson’s Disease and had difficulties with mobility. His family, including his wife and adult children, visited him often, with his wife spending two to four hours a day with him. Despite this, the family was not made aware of the injury that would take Frazier’s life until it was too late.

The bedsores began to develop in September 2010, when he was no longer able to move about the facility. Frazier stopped eating or drinking. Confined to his bed, he became “unresponsive.” By early October, Frazier had reportedly developed severe bedsores on his buttocks and scrotum, according to a nurse’s aide who gave this information to Frazier’s son. The nurse’s aide said that he was concerned that he might lose his job for speaking out, but he was also afraid for Frazier’s life. The bedsores had become infected and gave off a foul odor.

Nursing Home Closes After Years of Ongoing Problems

April 27, 2012 | Lebowitz & Mzhen

A Rhode Island nursing home has voluntarily closed after several years of complaints and investigations over non-compliance with both state and federal standards of care. Faced with the revocation of its license, the facility’s management concluded that it would take longer to complete the required improvements to bring the facility into full compliance than was available. The facility has therefore closed, and the state is assisting in moving residents to new facilities.

Complaints against Pawtuxet Village Care and Rehabilitation Center in Warwick, Rhode Island go back at least five years, according to local news station WJAR. Rhode Island’s Secretary of Health and Human Services said that the facility has a “long history of noncompliance” and of not maintaining appropriate standards of care for a nursing home. Neglect topped the list of complaints, which have included allegations of poor maintenance and management of residents’ medications, medication errors, bedsores and other injuries, and other quality of life issues. The state has reportedly cited the nursing home “repeatedly” over the past three years.

State officials cited the facility on February 24, saying the nursing home patients were in “immediate jeopardy.” On March 13, the state notified the nursing home that it would pursue action to revoke the facility’s license. The state also recommended to the Centers for Medicare & Medicaid Services (CMS) that it should cut off the facility’s participation in both the Medicaid and Medicare programs.

The nursing home’s administration reportedly retained a third-party management company to take over operation of the facility and try to turn it around. It was apparently not enough. CMS suspended the facility from its programs, and the state pressed forward on its license revocation action. The nursing home had a right under state law to a hearing on the revocation. On April 10, nursing home administrators announced that they would close the facility, saying that the home’s compliance problems could not be fixed on the state’s timetable.

Owner of Nursing Home Charged with Neglect for Second Time in Eight Years

April 20, 2012 | Lebowitz & Mzhen

Police in North Charleston, South Carolina arrested a nursing home owner on Thursday, April 12, 2012 after an inspection of the facility reportedly found extensive evidence of neglect. Andrea Magwood, age 68, is accused of neglecting vulnerable adults under her care. She went free on April 16 on a $250,000 bond. Her nursing home is currently closed, and authorities have transferred the thirteen residents to other facilities. Magwood faced a similar investigation and charges in 2004 relating to alleged abuse at the same facility.

The Governor’s Office of Ombudsman, the office charged with investigating reports of abuse or neglect in nursing homes, contacted North Charleston police on April 5 with concerns about the health of one of the residents. A 79 year-old resident of Magwood’s nursing home, Fair Havens Manor, had reportedly been admitted to the hospital. Doctors diagnosed him with severe dehydration and malnutrition, and they reportedly found a subdural hematoma on his head that possibly required surgery. Inspectors arrived at the home later on April 5. They reported finding mold clinging to the walls and cockroaches “crawling all over.” Residents allegedly received rotten food, and medications lacked labels or records that would indicate to which resident they belonged.

By April 12, North Charleston authorities had condemned the home’s two buildings and arrested Magwood. EMS personnel assisted police in removing the residents from the facility and taking them to a nearby hospital for medical assessment. From there, the residents would either receive medical care or be transferred to another facility.

Prosecutors charged Magwood with neglect of a vulnerable adult, a felony offense in South Carolina with a maximum penalty of five years in prison. State statutes also allow the attorney general’s office to being a civil action for a penalty of up to $30,000 for a nursing home owner who allegedly fails to protect residents from neglect. A judge set Magwood’s bond at $250,000 on April 13, and she reportedly left jail on Monday, April 16.

Magwood faced similar charges in 2004 when another resident reportedly suffered malnutrition and dehydration. Police raided the home, then known as Genesis Nursing Home, In June 2004 after a bank teller reported several large withdrawals by one of the residents while accompanied by Magwood. The teller also reported that the resident showed signs of physical abuse.

Up to One in Seven Alzheimer’s Sufferers Live Alone, According to Study

April 13, 2012 | Lebowitz & Mzhen

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.

U.S. Senators Call for Reauthorization of Older Americans Act

April 5, 2012 | Lebowitz & Mzhen

At a press conference on March 28, 2012, U.S. Senator Bernie Sanders (I-Vt.) called for reauthorization of the Older Americans Act (OAA), legislation that provides support for American elders. The terms “elder” and “older person” here refer to people aged 65 or older. Fourteen other senators joined Sanders in calling for reauthorization, including Maryland Democratic Senator Barbara Mikulski. Sanders introduced a bill reauthorizing the OAA on January 26, titled the “Older Americans Act Amendments of 2012.” The bill currently has no cosponsors and is pending in the Senate Committee on Health, Education, Labor, and Pensions.

Congress originally enacted the OAA in 1965 as the first federal effort to provide services to older Americans on a wide scale. The law created a National Aging Network consisting of the federal Administration on Aging (AOA) within the Department of Health and Human Services and state- and local-level agencies. The Network funds various community services that that benefit older adults, including nutrition and health support, caregiver support, and legal assistance. Many programs focus on older populations in underserved rural areas and on promoting job skills and community engagement among older people.

Amendments to the OAA in 1992 authorized the creation of an office within the AOA to address issues relating to elder abuse, or “vulnerable elder rights protection.” This led to the establishment of the National Center on Elder Abuse (NCEA) as a permanent office. The NCEA, first formed in 1988, serves as a national resource center for information on elder abuse. It conducts research and compiles statistics, and it provides education on recognizing signs of abuse and preventing abuse. It works with organizations at the state and local level that work on elder rights issues to help people work to prevent elder abuse and neglect by nursing homes, caregivers, and family members.

Senator Sanders’ bill reauthorizing the OAA includes several additions and modifications to the existing law. Perhaps most importantly for nursing home residents, the bill would provide additional support for the AOA’s Long-Term Care Ombudsman Program. The Ombudsman Program supports programs in all fifty states that advocate for the rights and interests of nursing home residents. Ombudsmen review complaints of nursing home residents regarding issues like poor food or care quality, poor administrative services, and conflicts between residents. Serious issues of abuse and neglect may call for the assistance of an elder abuse attorney, but the federal and state ombudsmen offer a valuable support network for nursing home residents.