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An altered mental status is a difficult condition for nursing home residents to manage on their own, especially when symptoms can present slowly and brushed off for age-related memory loss, stress, medication side-effects, lack of sleep, or other conditions like dementia. Delirium, sometimes referred to as “sundowning” or “psychosis”, is one of those conditions that if misdiagnosed or treated with overmedication, can worsen quickly with irreversible outcomes including long-term cognitive impairments.

Delirium has been defined by The American Delirium Society (ADS) as a state of confusion that comes on very suddenly and lasts hours to days. If a nursing home resident becomes delirious, they may have hallucinations, disorganized thinking, difficulty understanding daily tasks, and inability to pay attention and be unaware of their environment or trust of the people in it. Delirium affects nearly 18% of long-term care residents and has a staggering 40% one-year mortality rate.

Nursing homes have been known to manage residents with disruptive behaviors in less productive ways, and many things can make delirium (and other mental conditions) worse, such as:

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Drug Overuse Is Prevalent in Nursing Home Residents with Alzheimer’s

Antipsychotic drugs are sometimes given to patients living in long-term care facilities to calm behaviors associated with Alzheimer’s or memory and behavior illnesses. They are also overly prescribed to residents who may be marked unruly or disruptive. Care staff are known to seek out specific medications to make these patients easier to handle, or quiet them and make them sleepy. Doctors may rely heavily on the recommendation of nurses and other care staff when making these medication decisions.

These drugs can be dangerous when used without a physician or family’s knowledge or consent, a haphazard tactic given that the mismanagement of these drugs has been known to cause sudden death. This practice, also known as chemical restraint, is unfortunately not new although Federal law prohibits the use of antipsychotic drugs or psychoactive drugs solely for the convenience of medical staff, and to sedate a patient. Additionally, consent must be given in order to use chemical restraints.

How to Prepare Your Nursing Home Complaint and Who to Contact

The Illinois Department of Public Health and the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) regulates and inspects Illinois nursing homes and long-term care facilities under the state’s licensing acts, regulations, and federal Medicare Conditions of Participation. The state’s 24-hour a day Nursing Home Hotline receives nearly 19,000 complaint calls each year.

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CMS Says U.S. Nursing Homes Should No Longer Allow ‘Most’ Visitors

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma joined President Trump’s news conference on coronavirus on March 13 in the Rose Garden, where he declared a national emergency. Verma announced that guidance will be coming for U.S. nursing homes about harsher visitor restrictions. She also said the new restrictions now include “all visitors and non-essential personnel, with few exceptions, such as end-of-life situations.”

The U.S. Centers for Disease Control and Prevention (CDC) has said that visitors and healthcare personnel are the most likely sources of introduction of COVID-19, the disease caused by the virus strain, into a long-term care facility. Many facilities in Illinois have already imposed their own harsh visitor rules in hopes of slowing the spread of the fatal virus that is responsible for the death of 22 residents of a nursing home in Kirkland, Washington as of Wednesday, March 11.

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Iowa Nursing Home with Illinois Ties Added To Federal Watch List

An Iowa nursing home in Dallas County has joined other troubled homes on the Centers for Medicare and Medicaid Services’ (CMS) Special Focus Facilities (SFF) list due to its established pattern of numerous, serious violations related to resident care. Rowley Memorial Masonic Home in Perry is responsible for 40 older residents. It is run by Health Dimensions Group, a Minnesota company that also manages nursing homes in Illinois and six other states.

Inspectors recently cited the Iowa home for:

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New Investigation Shows Continual Lax in Oversight of U.S. Nursing Homes

State-licensed elder facilities in Illinois may include assisted living facilities, residential or personal care homes. Each is supposed to be a place for individuals to go when they are no longer able to care for themselves, require help with daily tasks or a managed medical or physical rehabilitation. Unfortunately, dozens of investigations into these facilities across the county have revealed a repetitive cycle in relaxed state-licensed oversight, understaffing, preventable injuries, dangerous abuse and neglect, and tragic deaths.

The most recent investigation making headlines comes from a partnership between Vermont Public Radio and Seven Days. Seven Days is an alt-weekly publication distributed throughout Vermont. The news sources told the story of 78-year-old Marilyn Kelly, a resident placed in a 13-bed care facility by the name of Our House Too to help manage her dementia. According to the report and interviews by the woman’s children, it only took eight months for a flurry of poor care and neglectful events to arise that ultimately ended in her alleged wrongful death.

nursing home medicine stolen
Doctors, nurses, and other nursing home staff are more often being caught and charged with prescription medication theft and obtaining a controlled substance by fraud. The most appealing of all include opioids, powerful medications prescribed by physicians for nursing home residents with moderate to severe pain, and those suffering from life-threatening illnesses. Residents who are taking opioids are also more commonly prescribed pain adjuvants and other addictive or ‘street profitable’ medications that are likely to be stolen by staff. These may include controlled substances such as Benzodiazepines. Many nursing home residents receive Benzodiazepines to treat anxiety, seizures, panic disorders, depression, muscle relaxation, and insomnia. These drugs are also frequently stolen or abused by nursing home staff members.

Some of the most common opioids and Benzodiazepines that are frequently stolen from residents include:

  • Alprazolam (Xanax)

drug abuse

7 Antipsychotic Drugs Used and Abused by Illinois Nursing Homes

Antipsychotic drugs are sometimes given to patients living in nursing homes to calm their behaviors. But some of the most sensitive nursing home patients may be receiving antipsychotic drugs, even though there is no diagnosis of psychosis. For decades, this has been a growing problem for U.S. nursing homes and staff continue to wrongfully use the powerful medications in hopes to make their jobs easier. The misuse of these dangerous drugs is also known as a chemical restraint.

These are seven of the most widely used antipsychotic drugs abused by Illinois nursing homes today.

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New Report Suggests Nursing Home Providers Should Help Reduce Choking Hazards Present with Popular Dietary Supplements 

A new Federal Drug Administration (FDA) report published in the August issue of Annals of Internal Medicine says adults aged 65 years and older are more likely to choke on dietary supplements than are younger adults. The group most impacted by the hazard includes those living in nursing homes or assisted living centers. The research shows multivitamins and calcium tablets, and pills larger than 17 mm in length, can create the highest related adverse choking injuries to elderly residents.

Because there is no oversight for the sizing of dietary supplements, the FDA report continued to suggest that eldercare providers help “residents avoid taking several pills at once, avoid extra-large pills or capsules, and swallow supplements with plenty of water or other fluid.”

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New Rule May Help Justify Antipsychotic Drug Use in Nursing Homes 

For some nursing home residents battling psychosis and severe mental disorders conditions such as schizophrenia, antipsychotic drugs may help when prescribed and administered responsibly. But for decades these narcotics that come with a “black box” warning and dangerous side effects have been overused in dementia residents to hush or lessen their needs on nursing home staff, despite rules against the misuse of these drugs as chemical restraints and drugging patients without their consent.

Earlier this month, the Center for Medicare & Medicaid Services (CMS) proposed a rule that could make the use of antipsychotic drugs such as Clozapine, Abilify, and others easier to come by through simplifying “the survey process and reduce improper deficiency citations, as well as remove potential obstacles for mental health professionals to provide quality care for residents.”

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