Articles Posted in Nursing Home Staff

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PHI National, an organization focused on the direct care workforce, released its annual report on the current landscape of the work place for direct care employees such as nursing assistants. Before providing their most recent findings, PHI National opens with this statement: “The poor quality of nursing assistant jobs makes it difficult for nursing homes to attract and retain enough workers to meet demand.” Why are nursing assistant jobs in nursing homes considered so difficult to fill and why is it so hard to keep good employees? The biggest factors go hand in hand. Nursing assistant wages in nursing homes are notoriously low. PHI National reveals that the national average is $11.87 an hour. The work of taking care of residents with a myriad of complex mental and physical diagnoses is both physically and emotionally demanding, so much so that the average nursing assistant is 3.5 times more likely to be injured on the job than other American workers. When you pile endless responsibilities onto the plate of someone making less than $12 an hour, it should come as no surprise that you have a profession filled with overwhelmed, overworked, and emotionally drained employees. This is when mistakes are made and accidents happen. This is when the elderly are neglected, abused, left alone for hours, left in bathtubs overnight, fall while trying to use the bathroom, wander without being stopped, are giving the wrong medication, and develop pressure sores.

Chronic Understaffing Causing Employee Burnout and Resident Abuse and Neglect

Before we address the findings from PHI National’s recent report, we must address the driving force behind the trend in high patient to nursing assistant ratios. To put it bluntly, the cause is greed. The majority of nursing homes in the U.S. are privately owned, many by equity groups who view them as investments. The tragic heat-related deaths we recently witnessed at the Hollywood, FL nursing home after Hurricane Irma finally showed the world that money and profits are valued more than the health and safety of the elderly. In fact, it was only after the death of 8 residents from the Rehabilitation Center at Hollywood Hills that several other south Florida nursing homes without air conditioning began moving residents.

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Update on Planned Nursing Home Strike

In fairly recent news, and as we had discussed previously in this blog space, about 3,500 nursing home staffers in Connecticut voted to go on strike to protest their wages, which in some places were not too far above the state’s minimum wage level. The workers set to go on strike hoped to push the state to re-think its budgeting when it comes to Medicaid funding. A proposed budget would have kept the level of Medicaid dollars going to nursing home as flat, rather than increasing the funding as tied to increasing costs.

Nursing homes could potentially be exempt from other Medicaid cuts under the governor’s proposal, but the lack of funding increase would still have an impact. Medicaid comprises a substantial revenue stream for nursing homes and thus salaries and wages for nursing home employees, would reduce money available to pay those workers and could possibly force some to accept stagnant wages, reduced hours, or even lose their jobs. The strike was set to go into effect on April 24th, though the workers through their union agreed to delay the work stoppage upon a request from the governor while he and legislators continue to work out a resolution on the budget. A strike would otherwise reportedly affect 27 nursing homes across the state, spanning 20 different neighborhoods, leaving those facilities with even fewer staffers to tend to residents, and having to look into temporary replacements.
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Long-term living locations catered to seniors are often referred to as “skilled nursing facilities” (nursing homes) and “assisted living facilities.” The basic distinction between these types of homes is the level of care provided to residents. Assisted living facilities provide only general aid, perhaps with meals, cleaning, laundry, and other day to day tasks. Conversely, skilled nursing facilities can provide actual medical care. Seniors with more serious health care issues usually need the support that is provided at a traditional nursing home instead of an assisted living facility.

However, the fact that skilled nursing facilities are able to provide some medical care also means that they may commit medical malpractice. One of the most common ways this happens is when nurses and aides make errors with regard to medication. Obviously many seniors in long-term care facilities rely on the various medications to help control different medical issues. When medication is not provided properly, serious harm can result.

A recent Legal Examiner story touched on that very issue. The article points to a study that we have referenced before from the Journal of the American Medical Informatics Association. That research project found a significant number of medication problem in nursing homes. As noted, the most eye-popping statistics from the research effort is that observers identified that about 21.2% of all dispensals of medication involved some error.

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Underreporting of elder abuse is a long-documented problem. Because of the fact that many of the victims are not able to speak up for themselves and have few advocates, many instances of neglect and mistreatment are never made public. Many of those affected die without anyone ever being fully aware of the fact that they suffered in silence.

Those focused on correcting the underreporting problem often suggest that the best approach is to enact safeguards so that those who come into contact with seniors in various ways are trained to identify signs of mistreatment. That may include anyone from at-home therapists and bank tellers to financial advisors and estate planning attorneys.

Also, one of the most common “stop gaps” in that regard are caregivers at hospitals. For example, in many cases a senior will be brought to the hospital for some emergency treatment only for doctors to discover something like serious bedsores on the senior’s body. However, if doctors, nurses, and aides stay silent when they are confronted with signs of elder abuse, the senior may be sent back to a facility only to suffer more abuse.

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Studies show repeatedly that seniors with cognitive injuries–dementia and Alzheimer’s–are far more likely to face neglect and abuse. Our own work as Chicago elder neglect lawyers mirrors that, as we have worked with many local residents and their families following various incidents which were affected in one way or another by a resident’s degenerative brain injury.

As the country ages, more and more seniors continue to face these conditions. In the future years and decades providing better (and safer) care to those with these injuries will become even more imperative. That will likely include better caregiver training and dissemination on alternative ways to provide care beyond excessive medicating and the use of chemical restraints.

Also, it is important for researchers to continue their work understanding how Alzheimer’s develops and possible ways to minimize the consequences. Fortunately, researchers have been working on these issues with more vigor recently and some new information in emerging which may one day help tackle the problem.

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Over the last several years many seniors and their families were affected by problems with metal-on-metal hip implants that they received. From the Depuy hip recall to those affecting Stryker products, tens of thousands of residents faced the anxiety of potentially problematic medical devices installed in their bodies. Many had to undergo complex revisions surgeries and deal with serious medical complications.

In the aftermath of these high-profile problems, many began asking questions about the federal approval process for these products. After all, not just any device can be sold and used in medical procedures, right? Isn’t there a stringent safety process for these tools to ensure these very mass-recalls are prevented?

The truth is quite complicated, and a wake-up call for all consumers who assume that federal regulations protect them from inherently dangerous products. A recent New England Journal of Medicine (NEJM) article provides a comprehensive summary of the complex history behind the metal-on-metal hip implants and the Food and Drug Administration approval process. All those interested in these issues should check out the full article.

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Underlying most instances of nursing home neglect is the drive for profit. Common themes in many neglect lawsuits are cut corners, poor staffing levels, inadequate training and other deficiencies which could be remedied if long-term care facilities committed sufficient resources to keeping residents safe and secure. Sadly, instead of dedicating enough resources to senior well-being, many facilities slowly chip away at budgets. This may increase profits to owner and shareholder, but it can be downright deadly for senior residents.

Financial incentives are also seen in nursing homes in other ways. Not only do some homes try to cut resources from actual caregiving services, but at times they try to collect more resource than they are owed by taxpayers. This takes the form of Medicare and Medicaid fraud, and it is critical that it be rooted out at all times. Public resources are limited, and we must ensure that they are used in the most efficient way possible.

New Federal Fraud Lawsuit

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As part of a Policy Series, the Consumer Voice–one of the nation’s leading senior care advocacy groups–recently created a brief on an important piece of federal legislation. If passed, the new measure, known as Senate Bill S. 3604, would be a helpful step forwars in ensuring proper care is provided to one particularly vulnerable group of nursing home residents–those with cognitive conditions like dementia.

Senate Bill S. 3604

The bill is referred to as the Improving Dementia Care for Older Americans Act. The focus of the measure is simple: eliminate the chemical abuse of residents with antipsychotic medication drugs. As elder care attorneys and other advocates have consistently shown, many long-term care facilities continue to have a hair-trigger response when it comes to prescribing these powerful medications to control seniors, particularly those with dementia. Not only is this over-use severely detrimental to these resident’s quality of life, but it is downright dangerous. Prescription drug experts have explained vociferously that use of these drugs on dementia residents poses serious risks, including death.

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Recently the National Consumer Voice for Quality Long-Term Care created a fact sheet that provides a helpful overview of a very acute problem in senior care: the overuse of antipsychotic medications. The problem is particularly troubling when used to control senior’s with cognitive conditions like dementia. The overuse is an example of nursing homes choosing the easy road without promoting the health and well-being of each individual senior resident in their care.

The Scope

As outlined in the fact sheet, many nursing home residents receive these drugs without a proper diagnosis for one of the specific conditions that the drugs are supposed to treat. This means that they are given out far too leniently. The sheet suggests that a staggering one-quarter of all nursing home residents are on antipsychotic medications. When just residents with dementia are considered the number jumps even higher. Amazingly, almost 40% of nursing home residents with dementia are taking antipschotics. And this all is true even though the U.S. Food and Drug Administration has issed a “Black Box” warning on use of the drug for these residents leads to increase risk of serious complications, including even death.

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In Ruppelt v. Laurel Healthcare, the Court of Appeals of the State of New Mexico determined that the use of an arbitration agreement that a nursing home required patients to sign as a condition of admission was unconscionable under New Mexico law. The attorneys at our firm have long discussed the need for those affected by these agreements to fight hard in court to protect community rights.

The Case

The lawsuit in this case was filed by Celeste Ruppelt against Laurel Healthcare for the wrongful death of Theodore Lendeen, Ms. Ruppelt’s father. The lawsuit arose from the care provided to Ms. Ruppelt’s father while he was a paient of Laurel Healthcare.