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Nonprofit Nursing Homes Provide Better Care

Don Greiwe — Thu, 01 Oct 2009 08:01:00 GMT

A group of doctors from around the world have came together to take a hard look at the relationship between nursing homes and profiteering, and the results reaffirm what many of us would have guessed: Nonprofit nursing homes provide better care than for-profit nursing homes.

Dr. Gordon Huyatt, the senior author of the study, stated “the reason patients' quality of care is inferior in for-profit nursing homes is that administrators must spend 10 percent to 15 percent of revenues satisfying shareholders and paying taxes,” and as a result, “For-profit providers cut corners to ensure shareholders achieve their expected return on investment.”

Looking at 82 different statistical studies taken into account, 40 significantly favored nonprofit facilities. This means that in 40 of the 82 reports, it was obvious that patients received better care at the nonprofit facilities compared to for-profit facilities. On the flip side, only 3 of those studies favored for-profit facilities. The remaining 39 studies had inconsistent findings and were not counted either way. The study looked at four major factors in determining quality of care:

More or higher quality staffing;
Lower rates of pressure ulcers;
Less use of physical restraints; and
Fewer deficiencies cited by regulatory agencies.

These findings have significant implications for patients across America. Of the roughly 80,000 patients who have bedsores, 7,000 of those can be attributed to for-profit ownership. Additionally, the study went on to predict that if all the current for-profit nursing homes converted to nonprofit, 500,000 hours a DAY would become available to residents without additional cost.

There are many ways to interpret the study data, but the overall conclusion is clear: nonprofit nursing homes offer better care than for-profit ones. These sorts of studies may be very important in the health care reform debate, as many reformers push for an increase in “evidence-based medical treatment.”

Moving forward, if you or a loved one needs the care of a nursing home, look into whether that home is for-profit or not, because it clearly should be a factor to consider.

Originally posted at InjuryBoard by Don Greiwe

Girard Nursing Home Fined for Abuse

Shannon Weidemann — Wed, 29 Aug 2007 13:57:28 GMT

A nursing home in Girard, Illinois had abuse complaints lodged against it. Investigators found that the workers at Pleasant Hill Village Nursing Home was abusing residents. A fine of $25,000 was levied against the home.

A February report by the Illinois Department of Public Health indicated the incidents might have started as early as August 2006.
Aides allegedly poked one resident with a pin to keep her from getting out of her wheelchair; held an alarm next to the ear of another to keep her in bed; intentionally grabbed a resident's injured arm and asked, "Does this hurt?"; restrained one man by holding his arms behind his back and bending his fingers backward; and forced residents to shower against their will.

The nursing home is challenging the fine saying it has taken steps to remedy the situation. The state differs with that account and says the home did nothing until the police came in to investigate.

For more information on this subject matter, please refer to the section on Medical Malpractice and Negligent Care.

Originally posted at InjuryBoard by Shannon Weidemann

Nursing Home Must Pay Damages for Prolonging Life

Shannon Weidemann — Sat, 07 Apr 2007 21:21:55 GMT

A jury in Palm Beach County has decided that a nursing home must pay $150,000 in damages to a woman's family after they did not follow her living will and advance directive. The 92-year-old woman had stated that she did not want to be kept alive by artificial means. Workers at Morse Geriatric called paramedics and had her taken to the hosptial where she died six days later after having many procedures performed on her.

The verdict was lauded by bioethicists, who say the availability of medical technology doesn't always impose a moral duty to use it. And though the impact of the verdict likely won't stretch outside Florida, it's still a precedent that might be taken into account in future cases, according to Dr. Kenneth Goodman, director of the University of Miami's bioethics program and the Florida Bioethics Network.
"We've been watching this case closely," Goodman said. "This is a big deal. It's a reaffirmation that no means no. There are a lot of institutions and a lot of health-care professionals who have acquired the belief that you reduce liability overtreating patients. This case shows that's a bad strategy. The whole point is that advance directives survive your inability to utter them."

The jury did not find the center's former medical director to be at fault though. The patient's granddaughter filed the case in order to make other nursing home's more aware of their patients' living wills.

Originally posted at InjuryBoard by Shannon Weidemann

Flaws In Florida Emergency Requirements For Nursing Homes

Bob Carroll — Mon, 17 Oct 2005 07:36:02 GMT

After Katrina we were shocked at the disaster in some nursing homes in New Orleans. Florida nursing home residents may not have faired any better. Last month's mandatory evacuation of the Florida Keys lashed by Hurricane Rita revealed critical flaws in the state's elaborate emergency requirements for nursing homes.

In the afternath of Katrina we were shocked at the disaster in some nursing homes in New Orleans. The Palm Beach Post says Florida nursing home residents may not have faired any better. Why? "Last month's mandatory evacuation of the Florida Keys lashed by Hurricane Rita revealed critical flaws in the state's elaborate emergency requirements for nursing homes."

Florida's secretary of Health Care Administration, Alan Levine, confirmed that he personally stepped in to help rescue hundreds of nursing home patients in the Keys when the operator of three nursing homes failed to immediately heed state evacuation orders.
"The owner was going to evacuate his Key West facility to Marathon," Levine said. "And he wanted to move people in his upper Keys facility to Sunrise. . . .
"That would not have gotten people out of harm's way. His position was that it's expensive to even move people to other homes he owned. But when it comes to patient safety, it's nonnegotiable."
Notified of the situation by the Monroe County Emergency Operations Center, Levine, who was working in Florida's state-of-the-art EOC in Tallahassee, arranged for a National Guard plane equipped for medical emergencies to fly to Key West and bring the patients to Broward County.
Those with serious medical conditions, including some in need of kidney dialysis, were transferred to Broward hospitals. Levine personally arranged to have the rest transported by ambulance or bus to Palm Beach County nursing homes. All arrived unharmed.
"Time had run out," Levine said. "We got fantastic cooperation . . . and were able to get the patients to safety."
With the only highway out of the Keys underwater in some areas, and high winds blowing in roofs and windows in parts of the lower Keys, Florida easily could have faced a scenario like the Texas and Louisiana hurricane-driven nursing home tragedies. In one instance, a bus carrying patients and oxygen canisters caught fire on the Houston-to-Dallas highway, killing 24 Texas nursing home residents. Earlier, 34 elderly patients were found dead in a flooded nursing home outside New Orleans whose owners defied evacuation orders. A 35th victim was discovered Monday.

The Post article then itemizes some major problems:

â€¢ No one checks to see whether nursing homes actually have the staff, supplies and transportation contracts to provide what is written in their fairly elaborate and specific emergency plans filed annually. Those reports include provisions for evacuation, staffing, transportation, food, water and medicine. County emergency operations officials review and approve the plans or require revisions, but no government agency keeps a copy or verifies the information.
â€¢ Transportation contracts or "agreements" to move patients in a mandatory evacuation from nursing homes are required, but no one checks to see whether those who have agreed to transport the patients actually have the vehicles and staff to do so or whether they are double- or triple-booked for evacuations.
â€¢ Florida nursing homes are required to have only a 72-hour supply of food, water and medicine to care for evacuated patients. Hurricane Katrina proved that much larger stocks of supplies may be needed in the event of extensive damage.
â€¢ If a nursing home fails to evacuate its patients according to its EOC-approved plan, there is no agency with enforcement authority to penalize it.

State-mandated nursing home emergency plans

Florida state law requires that licensed nursing homeshave emergency plans approved by their respective county Emergency Operations Center to keep patients safe in the event of a hurricane or other disaster. The plans must include:
â€¢ A 72-hour supply of all essentials, including prescription medication, food and water.
â€¢ Written transportation contracts or mutual aid agreements for evacuating patients.
â€¢ Provisions for continuous 24-hour staffing.
â€¢ Arrangements for moving medical records, drugs, food, water and other necessities with the patients.
â€¢ Contracts with predetermined locations to which patients will be evacuated with special consideration for non-ambulatory and the most seriously ill patients.
â€¢ Identification of evacuation routes and alternate evacuation routes.
â€¢ Specific plans for communicating with patients' relatives and guardians before evacuation and throughout the emergency.
â€¢ Accommodations for the families of critical staff members.
â€¢ Identification of the owner and administrator and 24-hour contact information; listing the facility's chain of command in an emergency.
â€¢ Training of all workers in the execution of the disaster plan.
Sources: Emergency Management Planning Criteria for Nursing Homes, American Health Care Association; and Florida statutes

Why should nursing homes bear the expense of emergency evacuations? Many nursing homes argue that it is unfair that they must bear the expense of the evacuations, which can cost tens of thousands of dollars. But, that is part of the responsibilities, legal and fiscal, in operating a nursing home. Protecting the health and life of nursing home patients in an emergency is an obligation of the contract between the patients and the homes.

Originally posted at InjuryBoard by Bob Carroll

Nursing Homes Have Fire Safety Obligations

Bob Carroll — Sat, 21 Oct 2006 03:21:07 GMT

Fire in a nursing home obviously can be a disaster because of the immobility of many of the residents. It would be a guaranteed disaster if the nursing home falsified fire drill reports and appointed an untrained maintenance man to oversee fire safety training at the facility, leaving employees unable to handle the crisis. That is what is alleged to have happened in Nashville.

Judge clears way for two families to pursue damages in nursing home fire case

Two families who lost loved ones in a Nashville nursing home fire can pursue punitive damage claims against the company that owned the facility for its alleged disregard of fire safety training and failures of the facility's employees on the night on the fire, a judge ruled today.
The ruling allows the plaintiffs to pursue their allegations that National Healthcare Corp. falsified fire drill reports and appointed an untrained maintenance man to oversee fire safety training at the facility, leaving employees unable to handle the crisis.
After yesterday's ruling, the plaintiffs said their primarily aim is to make sure all of the information about the fire is known publicly so a similar disaster can be prevented by the government agencies that regulate nursing homes.
"It's very important that all of this information gets out to the public so whatever needs to happen can happen to prevent this from ever happening again," said Amy Cato of Nashville, who was raised by Webb, her aunt, after her mother passed away. "There was a tremendous amount of emotional distress in watching what my aunt went through everyday for five months, and I don't want anyone else to go through that."

Those of us who have loved ones in nursing homes and assisted living facilities in Florida should inquiry about fire safety and the training of personnel. And, it may not be a bad idea to witness a fire drill.

Originally posted at InjuryBoard by Bob Carroll

Blame The Children Of The Nursing Home Residents?

Bob Carroll — Thu, 22 Sep 2005 06:15:26 GMT

Just who is responsible for the timely and safe evacuation of the residents of nursing homes?

The Louisiana Attorney General has got it right. The professions who were entrusted with the lives of their residents had the responsibility to provide a timely and safe evacuation. The relatives of the deceased residents will forever live with their loss and do not need the additional burden of the â€œshameâ€ suggested by the USA Today letter-writer.

Just who is responsible for the timely and safe evacuation of the residents of nursing homes?

An article and a letter in USA Today spotlight the dilemma of many who cannot provide proper care for a loved one and turn to a nursing home.

I have rarely seen a more hurtful sentence in a national publication than the one that will be quoted below from a letter to the editor.

The lead paragraphs of the article: “The Louisiana attorney general launched an investigation Monday into 14 deaths at a New Orleans nursing home that happened after the elderly patients were not evacuated for Hurricane Katrina.”

“Attorney General Charles Foti's office has been besieged with complaints about patients being left at medical facilities during the hurricane or receiving shoddy treatment, said Kris Wartelle, a spokeswoman for Foti. She said state investigators are checking additional reports of patients and residents who died at 20 to 30 other hospitals and nursing homes.”

The letter to the editor in USA Today provides a totally different perspective to the nursing home deaths: “But where were the children of these patients? Did they all flee to higher ground and leave their parents or grandparents to survive on their own?”

Then comes the sentence that twists the knife (and reveals the prejudice of the writer):

“We all know that warehousing parents in nursing homes is a common practice in today’s world – but have the children any shame?”

The use of nursing homes may be common (for plenty of reasons), but “warehousing” is only used in America for products, not people. If the writer or the operators of nursing homes perceive the facilities to be mere “warehouses” it is they who have no shame.

The Louisiana Attorney General has got it right. The professions who were entrusted with the lives of their residents had the responsibility to provide a timely and safe evacuation. The relatives of the deceased residents will forever live with their loss and do not need the additional burden of the “shame” suggested by the USA Today letter-writer.

Originally posted at InjuryBoard by Bob Carroll

Long Shadow Inn Fails Its Residents

Bob Carroll — Fri, 10 Feb 2006 05:27:17 GMT

My father lived for more than four years at the end of his life at an assisted living facility in Palm Harbor. He received excellent and compassionate services in a setting that was safe and properly supervised. That same facility has now been shut down by state officials because of health and safety violations. What could have caused the changes at the Long Shadow Inn in the years since my father's passing?

The answer probably lies in the ownership. While my father resided at the Inn the owners were a dedicated couple who came to America from a communist country and worked 24-7 to make a difference in the lives of the their residents. They virtually lived at the Inn and put the welfare of the residents ahead of profits. Sadly, for the residents, they sold the facility to persons who appear to have other priorities.

From the St. Pete Times:

A surprise fire drill uncovers numerous health and safety violations at Long Shadow Inn in Palm Harbor.
PALM HARBOR - State officials closed an assisted living facility here Thursday due to numerous health and safety violations, according to the state Attorney General's Office.
Long Shadow Inn, 2275 Nebraska Ave., was closed by Attorney General Charlie Crist's Medicaid Fraud Control Unit as part of its Operation Spot Check Program. Through the program, authorities conduct unannounced checks to determine whether nursing homes and adult living facilities are in compliance.
The surprise drill began at Long Shadow Inn about 9:30 a.m., said Mark Snow, deputy chief for Palm Harbor Fire and Rescue.
About 15 people from the fraud unit, local law enforcement and various state agencies entered the facility and notified the staff that a fire drill was about to take place, said Snow, who was part of the investigation.
The facility staff could not produce a disaster plan that showed how they would evacuate the 33 residents, Snow said.
During the evacuation, four residents were never removed from the premises and several others remained trapped on the second floor, according to reports.
Instead of employing the standard practice of taking residents out the rear of the facility, the staff exited through the front of the building, where firetrucks would normally be staged, Snow said.
"They didn't seem prepared for what to do in a case of evacuation," Snow said.
"That was our concern. That was the deciding factor to taking the residents out. It didn't seem like they were able to care for the people in the event of an emergency."
The facility's administrators were notified by the Agency for Health Care Administration less than five weeks ago that it was out of compliance for poor conditions, according to reports.
The investigation was initiated after the Department of Children and Families and the Patient Abuse, Neglect and Exploitation Project received complaints.
Other safety violations found during the surprise inspection included employees with open wounds on their hands preparing food, a sewage problem and lack of soap for residents, according to reports.
The team also found unlicensed staffers dispensing medication.
Zlata Campara, the facility's owner, could not be reached for comment Thursday.
The 33 elderly residents who lived at Long Shadow Inn are being relocated by the Department of Children and Families.

Originally posted at InjuryBoard by Bob Carroll

Flim-Flam On Nursing Home Residents

Bob Carroll — Sat, 11 Feb 2006 07:25:22 GMT

Nursing Home Residents Storm Tallahassee To Protest Legislature's Dishonesty - that should be the headline in newspapers throughout the State of Florida. The legislative flim-flam that took away their rights in exchange for promised improvements in nursing home care that will likely never occur should be recognized for what it was. It was a fraud, pure and simple. Read the story from the Orlando Sentinel:

Still waiting for nursing-home staff increase
This is the year. This is it -- the year nursing-home residents have been waiting for.
Five years ago, the Legislature made a promise to nursing-home residents. In exchange for limits on their ability to sue homes for abuse or neglect, Florida promised it would meet federally recommended minimum staffing levels. The theory was: Let's reduce the need for lawsuits by providing better care.
Reluctantly, elder advocates agreed.
Lawmakers quickly enacted the new lawsuit limits, making it much harder to hold bad nursing homes accountable. They put limits on damages, eliminated attorneys' fees and changed many of the legal standards used to protect residents' rights. And these changes have had a profound effect. Ever since the law has been in place, lawsuits have dropped dramatically in both size and frequency.
Yet lawmakers still have not kept their promise that, in exchange for lawsuit limits, residents would receive 2.9 hours per day of nursing aide care.
Why is 2.9 hours per day so important? An eight-year federal study found that below 2.9 hours, most residents "needlessly suffer harm." This means residents aren't fed when they are supposed to be; they aren't turned in their beds often enough to prevent bedsores; or they aren't assisted to the bathroom. For those who are too feeble or impaired to feed themselves, the extra time means someone can spend five minutes helping them eat, provide a simple but desperately needed glass of water, or help them to the bathroom so they don't end up in wet or soiled clothing. For many residents, it is the difference between life and death, pain and comfort, dignity or humiliation.
This year, Florida lawmakers find themselves flush with money. They plan to fund a whole host of new initiatives, and give money back to taxpayers. Good. But what about the promise made to nursing-home residents?
While lawmakers enacted the lawsuit limits almost immediately, they enacted only the staffing increases in small steps. The incremental increases have had some positive impact on residents, but the promise to meet the minimum staffing level has been delayed for three years.

Originally posted at InjuryBoard by Bob Carroll

Rocky Times For Nursing Home Resident Leads To Death

Bob Carroll — Fri, 21 Oct 2005 04:10:23 GMT

Rocky Mountain News tells the story of Manuela Beltran who died in a nursing home from starvation and dehydration after she was given almost nothing to drink or eat for nine days, according to a lawsuit filed last week in Denver. The details of this lawsuit show just how rocky life was for the deceased during 10 days in December.

From the Rocky Mountain News comes the story of Manuela Beltran who died in a nursing home from starvation and dehydration after she was given almost nothing to drink or eat for nine days, according to a lawsuit filed last week in Denver.

The details of this lawsuit show just how rocky life was for the deceased during 10 days in December.

The wrongful death suit, filed by Beltran's two sons, Jesse Lujan and Larry Gonzalez, seeks damages for what they allege was gross negligence by Cherry Creek Nursing Center in Aurora.
"Manuela starved to death while simultaneously suffering from severe dehydration," said attorney John Holland in the lawsuit, which was filed in Denver District Court.
Beltran, 77, who suffered from dementia, took a turn for the worse after suffering a fall in a wheelchair Dec. 20, according to the lawsuit. Staff members knew Beltran tended to fall forward when she did not have a walker to prevent it, the lawsuit said.
"Left unsupervised in the TV room and negligently placed in a chair not suitable for her protection, Manuela predictably fell forward, sustaining severe head injuries, which sent her on a fatal, final downward spiral, which the facility staff knew all about but outrageously failed to intervene," the lawsuit alleges.
Beltran's ability to eat and drink immediately began to decline, the lawsuit said, and she didn't eat anything from Dec. 23 to Dec. 30, when she died.
The health department cited the nursing home on Jan. 1 for three violations related to Beltran's care, including failure to provide adequate supervision to prevent an accident, failure to assess and treat a change in a resident's condition, and failure to prevent a severe weight loss.
Weighing only 89 pounds to begin with, Beltran lost nine pounds from Dec. 16 to Dec. 26, the last time she was weighed, the lawsuit said. The staff failed to inform the family or her doctor of Beltran's "drastic" change in status, the lawsuit alleges. A doctor wasn't notified until Dec. 29 when a hospice evaluation was ordered, according to the health department records.

Originally posted at InjuryBoard by Bob Carroll

Resident Suffocated By Clogged Tracheostomy Tube

Bob Carroll — Tue, 22 Aug 2006 06:18:23 GMT

In the category of healthcare screw-up of the week:

An Illinois jury has awarded more than $2.9 million to the family of a Healthcare and Retirement Corp. of America resident who died by suffocation when her tracheostomy tube became clogged (Sheila Albores, as Special Administrator of the Estate of Ana Carrasco, Deceased v. Healthcare And Retirement Corporation of America, d/b/a Manorcare Health Svs Homewood, No. 02 L 7024, Ill. Cir., Cook Co., Law Div.).

My only comment - allowing a tracheostomy tube to become clogged seems particularly incompetent and grossly negligent. The purpose of the tube is to allow oxygen into the lungs of the patient.

Originally posted at InjuryBoard by Bob Carroll