August 22, 2014

Keeping a Close Eye - The Need to Monitor Breathing Tubes

by Levin & Perconti

Some elderly and incapacitated resident patients of nursing homes and long-term care facilities have to use breathing tubes in order to aid their breathing and the oxygenation of their bodies and brains. Without the proper level of oxygen going to the brain, a person can suffer brain damage and eventually death. Unfortunately, in some sad instances a patient’s breathing tube can become clogged, and the effect is essentially like choking, where the person’s oxygen is depleted and they can lose consciousness, suffer brain damage, and die. If they are saved in time, brain damage could affect them for the rest of their life.

Breathing tubes are used to aid those who are unable to breathe on their own. These tubes in general are plastic tubes inserted into a patient’s throat or nose. Where a breathing tube is needed for a longer term of time, a more involved setup will be used where the tube extends down the patient’s throat, and makes it impossible for them to eat, drink or speak so that they need nutrition and water either intravenously or through a separate feeding tube.

Continue reading "Keeping a Close Eye - The Need to Monitor Breathing Tubes" »

August 21, 2014

Back to the Basics - Falls in Nursing Homes

by Levin & Perconti

Falls can happen anywhere and anytime to anyone. Yet the common stories we hear most about tend to be when our elderly or otherwise incapacitated loved ones suffer a fall, largely because of any incapacity. Such falls can lead to serious injuries, such as broken or fractured bones, concussions, and even death. There is also an enormous psychological impact, as one fall can leave a person in perpetual fear of falling again, which can in turn lead to self-isolation and even depressive thoughts of helplessness.

In nursing homes, falls are a significant problem, and lead to even bigger problems. According to the Centers for Disease Control (CDC), as of 2012, for every 100 nursing home beds, there are approximately 100 to 200 falls per year, including some who fall more than once. And among the multitude of falls that occur, almost 2,000 people die each year from a fall at a nursing home, and anywhere from 10%-20% of falls at nursing homes can cause serious injuries, while 2%-6% result in bone fractures. Interestingly, 35% of falls occur with nursing home residents who are unable to walk, which may call into question the lack of supervision of those people by nursing home staff. According to the CDC, some of the many causes of falls in nursing homes include:

Continue reading "Back to the Basics - Falls in Nursing Homes" »

August 19, 2014

Psychiatrist Suspended and Sued for Dangerous Use of Medications

by Levin & Perconti

One of the major issues we recently wrote about in the context of nursing homes and elder care has been the use of chemical restraints on residents. A problem has been the misuse and overuse of these medications, as well as the oscillating back and forth between different types of medications, including ones that were never even prescribed.

In a recent case, a psychiatrist’s license has been suspended indefinitely by the Illinois Medical Board for his prescribing a certain antipsychotic medication to his patients. Dr. Michael J. Reinstein used the antipsychotic drug called clozapine on what the Chicago Tribune reports as more than 50% of his patients at nursing homes and mental health facilities. This drug is “known as a risky drug of last resort,” and was associated with the deaths of three patients under Reinstein’s case. The drug has also reportedly been at the center of shady kickback deals between the drug’s maker and doctors, and Dr. Reinstein’s case is no different. Dr. Reinstein has been accused of using the drug in exchange for $350,000 in bribes from the drug’s manufacturer, Teva Pharmaceuticals, over the course of seven years, in spite of the fact that he could employ other medications or treatment methods for his patients, and in spite of the danger the drug poses to the health, well-being, and ultimately lives of patients. Reinstein also allegedly received other gifts from the company, including free travel, a fishing trip, boat cruise, and dinners, as well as sporting event tickets. This indefinite license suspension by the medical board was the culmination of a years-long investigation by the Chicago Tribune and ProPublica.

Continue reading "Psychiatrist Suspended and Sued for Dangerous Use of Medications" »

August 16, 2014

Illinois Statute Aims to Decrease Elder Abuse

by Levin & Perconti

The state of Illinois takes elder abuse very seriously. This is evident from the state legislation that defines the problem and mandates the response of specific agents within the jurisdiction. The Elder Abuse and Neglect Act was implemented in 1988 based on concerns for the safety of older residents. The initiative defines elder abuse as follows:

*Physically striking or battering an elder
*Sexual abuse, including touching, fondling or sexual intercourse with an elderly party who is unable to provide informed consent, or is threatened or forced to consent
*Emotionally abusing an elder through threats of abuse or intimidation
*Confinement of an elderly person through restraint or isolation
*Passive neglect or the failure to provide for an elder's basic needs
*Failure to protect an elder from harm

Continue reading "Illinois Statute Aims to Decrease Elder Abuse" »

August 12, 2014

IL Nursing Home Issue - Chemical Restraints Are Still Pervasive

by Levin & Perconti

"Chemical restraints" are the use of drugs in order to restrain, or subdue, nursing home residents and patients. Drugs can be prescribed by doctors as a means to keep patients subdued or calm where they would otherwise be prone to physical and even violent outbursts in behavior. Patients with dementia or some type of psychosis, for example, can experience these episodes, and pose a safety issue to others around them, and of course themselves. These medications are often referred to as antipsychotic medications. In many instances, however, patients do not truly need these antipsychotic drugs, or do not need nearly the amount that they are given by nursing home staff. Sometimes staff will use antipsychotic medications to subdue patients who were not even prescribed the medication. This is where prescribed or non-prescribed drugs all of the sudden become a form of chemical restraint. Nursing home staff may simply use these chemicals improperly to make their own jobs easier so they keep patients subdued, and pharmaceutical companies certainly must not mind the continuing business.

AARP Study

A recent AARP article has highlighted the use of chemical restraints through antipsychotic drugs. It discusses the example of a woman who, after less than three weeks at a nursing home for treatment and recovery from a broken pelvis, and left “withdrawn, slumped . . . chewing on her hand, her speech garbled.”

Continue reading "IL Nursing Home Issue - Chemical Restraints Are Still Pervasive" »

August 9, 2014

Reminder - The Risk of Bed Rails in a Nursing Home

by Levin & Perconti

So many awful things can happen when patients and residents, be they elderly or otherwise debilitated, are not attended to properly at nursing homes or long-term care facilities. Residents of nursing homes can be vulnerable to wandering, elopement, as well as dangerous falls. Certain accidents can happen even when residents are not even on their feet, though. Many of these are with bed rails, in which the patient can become caught, injured, or even strangled. According to the Food and Drug Administration, these accidents occur in nursing homes as well as hospitals. From 1985 through 2008, 803 patients have reportedly been “caught, trapped, entangled, or strangled in beds with rails” and 480 of these people have died as a result, with over 100 suffering injuries. While bed rails can help keep patients from falling out, they also pose risks.

Bed rails have posed a serious risk to patients at hospitals, nursing homes and anywhere else they are used for decades. In nursing homes in particular, they are particularly risky because the elderly and infirmed are particularly vulnerable to becoming stuck, injured, or even dying as a result of getting their heads caught and suffering asphyxiation. It is not just risky for the physically challenged, but also for those who perhaps suffer from dementia or Alzheimer’s Disease. Earlier this year, for example, an elderly woman became caught in her bed rails, and staff eventually found her dead. While the use of bed rails has reportedly gone down over the years, they are still used enough to cause concern. Of course, and as stated, they may have benefits in terms of securing patients in their beds, but if used bed rails must be inspected and aligned carefully to prevent patients from becoming injured.

Continue reading "Reminder - The Risk of Bed Rails in a Nursing Home" »

August 5, 2014

Back to the Basics - Malnutrition and Dehydration in Nursing Homes

by Levin & Perconti

In thinking about elder abuse or general patient abuse at nursing homes and long-term care facilities, it may be most obvious that affirmative acts, such as physical abuse, chemical abuse in the form of unnecessary overmedication, and sexual abuse. However, sometimes it’s the failure to act that can also jeopardize the health, well-being and lives of patients and residents of these homes. Sadly, among the omissions and failures to act are the serious problems of malnutrition and dehydration that occurs as a result of neglect of the care of the elderly and otherwise disabled members of our population.

The Consequences

Unfortunately, it is more common than one can fathom for residents of homes to lack the proper amount of food and water. In particular with food, malnourishment can occur from eating anything devoid of nutrients, not eating enough, or eating nothing at all if a staffer were to cruelly withhold food or water from a resident. This can all result in serious weight loss, which on its own is dangerous enough, but can also compound other problems where the body needs to be stronger to fight other ailments.

Continue reading "Back to the Basics - Malnutrition and Dehydration in Nursing Homes" »

August 1, 2014

Medicaid Backlog Continues to Plague Illinois Residents

by Levin & Perconti

When it comes to health care across the country, the term “back log” has been an unfortunately common part of our lexicon. Backlogs have been famous for years with the U.S. Department of Veterans Affairs, for example, as news throughout this year has revealed serious fraud in the cover-ups of these backlogs by management at VA health care facilities. Other medical facilities and health care providers experience backlogs, and this has unfortunately happened in assessing eligibility of Illinois residents for Medicaid, including those in need of nursing home care.

In the last year or so, the state of Illinois created and has implemented a new system in order to make the process of determining eligibility for state residents who seek state-funded care at nursing homes. The state has hired more employees in order to accomplish this. However, as recently reported in the Chicago Tribune, the NWI Times and multiple other news outlets, an audit report of the situation detailed that as of July 1, 2014, more than 51% of submitted cases for consideration were not resolved within 90 days. Federal regulations mandate a turnaround time of 45 days. Out of 4,226 pending applications, 2,141 languished past the 90 day mark. An additional source of delay has been the federal government’s slow pace of transferring applications to the state.

Continue reading "Medicaid Backlog Continues to Plague Illinois Residents" »

July 30, 2014

Mistrial Declared in Illinois Nursing Home Sexual Assault Case

by Levin & Perconti

The types and severity of nursing home abuse, neglect and exploitation are wide and varied, but the one thing anyone can agree on is that any such type of behavior is unacceptable, improper, inhumane, and illegal. These illegalities and improprieties are governed in part through civil and regulatory laws and enforcement. States and the federal government pass laws, rules and regulations that force nursing homes and long-term care facilities, among other healthcare providers, to operate with certain standards in caring for their patients and residents, who in many cases are elderly. On top of civil enforcement, acts of elder abuse or nursing home abuse and neglect are governed by our criminal laws as well. Nursing home staffers committing such acts can face serious criminal charges for their conduct. This can include heinous acts of physical abuse as well as sexual abuse and exploitation.

Illinois Sexual Assault Case

In a recent case in Illinois, a certified nursing assistant at the Crystal Pines Rehabilitation and Health Care Center was charged criminally with sexually assaulting a 92 year old female resident. We had actually reported on this issue in this blog space back in late 2011 after the accusations came to light. According to the record, the alleged victim suffered from dementia and as the Chicago Tribune reported, “was completely dependent on staff.” Without commenting directly on this case itself, it bears mentioning that while the elderly or those in need of care at a facility are typically more vulnerable, those with mental ailments like dementia are very much a vulnerable group. This affliction also fueled the accused’s defense attorney’s defense theory that the alleged victim was simply psychotic and deluded into thinking people were out to harm her. Doctors were unable to locate signs of trauma in examining her as well. Furthermore, the defense has relied on an argument that the defendant nursing assistant was “coerced” into “signing a false confession after a lengthy interrogation” by police.

Continue reading "Mistrial Declared in Illinois Nursing Home Sexual Assault Case" »

July 28, 2014

Financial Exploitation -- Much More Than Just Stealing

by Levin & Perconti

In discussing nursing home abuse or neglect, or more general abuse and neglect of elders, a sometimes overlooked form of abuse is financial exploitation.
Those close to the elderly and incapacitated, be it loved ones, friends, in-home caretakers, and staff at nursing homes and long-term care facilities. Financial exploitation can be anything. It can be the stealing of credit cards or ATM/debit cards, and it can be stealing identification and routing numbers for bank accounts or investment accounts. It can also simply be swiping cash or taking tangible items, like jewelry, out of a person’s wallet, purse or from their room. Identity theft often accompanies such financial exploitation, whereby someone uses a vulnerably elderly or disabled person’s identity to make financial transactions. In nursing homes specifically, staffers or administrators take advantage of individual patients, but also will take advantage of their position to generally defraud the facility where they work, and by association its patients as well as the government if the facility receives funding through Medicare, Medicaid or other channels.

Those committing such acts invite not just losing their jobs, but very serious criminal prosecution on the basis of multiple charges. Financial exploitation of anyone, such as theft of property or money, identity theft, it itself a crime, and in many states statutes that specifically deal with preying on the elderly or disabled will only serve to augment the charges and the possible sentence. Restitution, or paying the victim back, is only the start of the penalties, as there can be jail time as well.

Continue reading "Financial Exploitation -- Much More Than Just Stealing" »

July 26, 2014

Calls to Step Up Funding of the Elder Justice Act

by Levin & Perconti

As we have discussed previously in this space, state and federal governments are active in monitoring nursing homes for neglect and abuse, and promulgate rules and regulations that facilities must abide by in order to keep their doors open, as well as to reap any funding through programs like Medicare and Medicaid, for example. While we focus much on Medicare and Medicaid, as well as Illinois’s own Nursing Home Care Act and efforts of the Illinois Department of Public Health (IDPH) to gather data on nursing homes and hand down penalties for violations where appropriate, the United States Congress also can play a role. A 2010 law called the Elder Justice Act, which was a subpart of the overall Patient Protection and Affordable Care Act (aka “Obamacare” as used commonly), was enacted to help protect the elderly, including those in nursing homes.

Understanding the Law

The Elder Justice Act gives federal funding and resources to deal with the neglect, abuse, and exploitation of elderly people across the country. Its mission is prevention and reform. The law principally required the U.S. Department of Health and Human Services (HHS) to create an Elder Justice Coordinating Council as well as an Advisory Board on Elder Abuse, Neglect, and Exploitation. The purpose of the Council is to make recommendations within Health and Human Services to help coordinate the department’s work along with the Department of Justice and other federal, state, and local agencies in order to gather information on elder abuse and combat this endemic problem.

The Council must also periodically report to Congress on its activities and accomplishments, as well as issues that it must still deal with and try to fix. The Advisory Board similarly advises the Council and makes recommendations as to how it should operate and what its strategic plans should be both in the near and long terms. The Act empowers the agency, Council and Board to work to incentivize elder care training for staff of nursing homes, and to help these facilities in whatever ways it can to improve care and reduce errors, while maintaining a level of reporting on facilities where abuse and criminal acts are committed. The Act also provides federal dollars through grants and other means to state and local adult protective services to investigate and prosecute incidents of elder abuse.

There has recently been a call for the Obama Administration and Congress to step up funding for this law, which to many people has been lackluster in its duties in large part because of lack of funding. Millions of elderly people across the country are abused each year, and billions are spent in medical care (although the money is of course entirely secondary to the actual horrible abuse and trauma suffered). The Administration proposed approximately $25 million of funding for the Elder Justice Act in its budget to go toward the enumerated activities to help improve data collection and to help develop better methods of discovering and preventing abuse of the elderly. A Senate subcommittee that deals with expenditures, however, cut that proposed amount down to about $15 million, making it even more lackluster. In early July the DOJ and HHS released an Elder Justice Roadmap Report to show what initiatives must be taken to help stop elder abuse and neglect.

See Other Blog Posts:

Nine Figure Settlement Goes Through in Omnicare Case

Warning Signs in Nursing Home Selection Process

July 24, 2014

Congress Slow to Combat Elder Abuse and Neglect?

by Levin & Perconti

As federal and state agencies, including those of Illinois, continue to grapple with the issues of elder abuse and neglect, the United States Congress has been slow to act on the pressing need to detect and combat elder abuse, neglect and exploitation. Such abuse can occur in a number of ways that include but are certainly not limited to physical violence, verbal abuse, emotional and mental trauma as a result of such treatment, as well as financial exploitation, and a lack of care that leads to malnutrition, illness, permanent injury, and death. Elder abuse continues to remain a problem, and it has been on Congress to try to fix this. The Elder Justice Act, as a subset of the Patient Protection and Affordable Care Act (i.e. “Obamacare”), was a legislative effort to help guide these efforts on a more national scale. Through creating a Council and Advisory Board, the law sought to empower federal health officials to step up data gathering and the development of strategies and ideas to fix the problem of elder abuse. The law also funds these efforts, although recent calls have come for increased funding. Congress has also sought to tackle this problem in recent years through other legislation, although these bills have either failed miserably or failed to get the traction they have needed to come out of committees and go to the floors of Congress for actual votes.

Continue reading "Congress Slow to Combat Elder Abuse and Neglect?" »