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Abuse of Antipsychotic Drugs Found in U.S. Nursing Homes

Randy Walton — Tue, 04 Dec 2007 19:35:27 GMT

Studies show that Medicaid spends more money on antipsychotic drugs for Americans than any other prescription drug. Why? Because nursing homes across the country are giving these powerful drugs to elderly residents for the purposes of "quieting" them.

The Wall Street Journal is reporting that nearly 30% of the total nursing home population is receiving antipsychotic drugs in a practice that is known as "off label" use of prescription drugs. It's no surprise to lawyers who practice this area that studies also reveal that nearly 21% of nursing facility residents being given these drugs do not have a psychosis diagnosis.

The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing-home industry.
"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Many Southern California nursing homes are committing the same offense. Here at Walton Barber we frequently get calls from families angry at nursing providers for over-medicating loved ones. It's usually a similar story. The family stops by the facility for a visit, only to find their loved one non-communicative and listless, and sometimes incontinent.

The Centers for Medicare & Medicaid -- the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor -- has "initiated a more rigorous process to oversee appropriate use of medicine," says Chief Medical Officer Barry Straube. He says the number of nursing-home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.
Dr. Straube says CMS -- which both funds and oversees nursing homes -- "is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications."
High use of antipsychotics in a nursing home can be an indicator of inadequate staffing, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. "We know the more staffing there is and the higher quality of care, the less the antipsychotic usage," he says.

If you have concerns that someone you know is being over-medicated contact the resident's primary physician immediately. If the use of the medication has caused harm, you may also want to consult an attorney.

For more information on this subject, please refer to the section on Drugs, Medical Devices and Implants.

Originally posted at InjuryBoard by Randy Walton

Elderly Woman Killed After Wandering From Escondido Nursing Home

Randy Walton — Tue, 27 Nov 2007 15:36:05 GMT

Cases involving nursing home wanderers are not uncommon in the nursing home abuse and neglect arena. I have had them, and I know my colleagues have as well. When an elderly resident of a nursing home wanders away, usually because there is some memory impairment, it rarely ends well.

That was the case in Escondido on Thanksgiving Day when 94-year-old Maria Cobian, a resident of Palomar Heights Care Center in Escondido, wandered away from the Escondido nursing home. Ms. Cobian, who was considered a wandering risk, apparently walked away unnoticed by the nursing home staff as she walked out the door of the nursing facility.

Ms. Cobian was struck by a car while walking in a traffic lane on Grand Avenue and died.

"We're still confused about how this happened," Cobian's grandson, Jesus Cobian, 33, of Oceanside said yesterday. "We're upset and confused."
Jesus Cobian said he and his father, Alberto Cobian, were told by a worker at the nursing home that night that there had been an emergency involving another patient and the staff had been distracted.
"We just don't understand how she could just slip out like that," Jesus Cobian said. Just before the accident, one person had stopped and was about to help Cobian when she was struck by a Crown Victoria driven by a 58-year-old Escondido security guard.

This is not the first time this facility has been under scrutiny.

Last year, the same nursing home was hit with the most severe citation the California Department of Health Services can issue and was fined $100,000 after a 66-year-old patient died after being left alone while smoking a cigarette on a patio while connected to an oxygen machine. A state report said the man became "engulfed" in flames and burned for six minutes, suffering injuries to his face, torso, arms and legs.
The state concluded poor care led to the man's death.

Palomar Heights Care Center is not associated with the Palomar Pomerado Health district.

For more information on this subject, please refer to the section on Nursing Home and Elder Abuse.

Originally posted at InjuryBoard by Randy Walton

Battle Against Bedsores Requires Teamwork

Walton Barber, LLP — Tue, 19 Feb 2008 23:42:24 GMT

New research shows that preventing and treating pressure ulcers in the nursing home setting requires a team approach, involving nurses, laundry workers, cafeteria and maintenance workers, and even the cosmeticians.

Large bedsores are a sight to behold. The larger ones - Stage III and IV - can result in a wound so deep that you can see the bone. Wounds like this can be very painful and can lead to serious and lethal infections, such as the one that killed Christopher Reeves.

It is estimated that a least two million Americans suffer from bedsores every year, most caused by poor nutrition, dehydration, immobility, and/or incontinence. A new study, however, suggests that using a team approach to the battle against pressure ulcers can greatly reduce the numbers.

In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent.
"Preventing pressure ulcers is a 24/7/365 kind of job," said Jeff West, a clinical reviewer at Qualis Health in Seattle, who helped to set up the collaborative in 2003. "It's not as if one person can get it all done. And if it fails just a little bit, just during the weekends, for instance, you're not going to get the results. It takes tremendous consistency."

Nursing homes are enlisting every department that can help play a role. The laundry workers look for ill-fitting clothes, the kitchen staff boost nutrition of those at risk, even the hair salon can help by repositioning the resident if sitting for too long.

According to West, the changes need to become hard-wired into the organization. "A lot of places do well when they have a lot of support," he said. "But it's hard to keep that momentum going. That's the real challenge."

Originally posted at InjuryBoard by Walton Barber, LLP

Nursing Home Citations Up 22% Nationwide

Randy Walton — Thu, 20 Dec 2007 23:44:20 GMT

Recent studies show that citations for serious violations issued against nursing homes is up 22% nationwide.

A USA Today analysis, examining records from the Centers for Medicare and Medicaid, shows that from 2000 through 2006, the number of citations for putting patients in "immediate jeopardy" had increased 22%. Those citations are considered the most serious and often follow cases in which patients were physically or sexually abused or left without medications.

Inspectors found nearly 2,000 violations last year that jeopardized patients at nearly 850 of the nation's 16,000 nursing homes, according to the records. They account for about 6% of the total violations uncovered in nursing homes.
New York issued 131 immediate jeopardy citations last year, up from 41 in 2000. This year it cited one home for not stopping two elderly patients from hitting others, and another for not doing enough to check on patients who fell down, a common source of nursing home injuries.
"We have a new mind-set," said Jeffrey Hammond of the New York health department. "It's not that the quality of care has gone down, but we are being more rigorous in our enforcement."

As expected, the industry is nonplussed. The CEO of the American Health Care Association said in a statement that care is improving despite the increase in serious citations. Figure that one out.

Originally posted at InjuryBoard by Randy Walton

Upset about Nursing Home Care? Complain!

Randy Walton — Fri, 14 Sep 2007 22:25:45 GMT

As a lawyer who sues nursing homes and residential care facilities for the abuse or neglect of their residents, I frequently get calls from people who feel that they or their loved one have been a victim abuse or neglect. When I hear genuine stories abuse or neglect, or of highly questionable conduct on the part of nursing home staff, I always ask whether or not anyone complained about it to the CNAs, the nurses, the director of nursing, the administrator, or anyone else, and usually the answer is No.

The first step toward correcting the day-to-day deficiencies in care at a nursing facility is to complain directly to the facility staff. If mom is not getting the right medications, nutrition, therapy, etc., the direct-care staff should be able to address the problem. If corrections to care are not made, then the family should do two things: First, contact the resident's physician and explain the problem, and second contact the California Department of Health Services (DHS), the government body that licenses and regulates all skilled nursing facilities in California.

Any person (not just the resident or family member) can file a complaint with the DHS, and a complaint can be made about abuse, neglect, or any other matter protected by law such as poor care, unsafe conditions, improper charges or general mistreatment. Complaints to the DHS can be made orally or in writing at any DHS office in California, including the San Diego office at (619) 688-6190, and should contain the name and address of the facility, and a concise statement of the facts outlining the problem. Under California law, DHS must begin an onsite investigation of your complaint within 10 working days.

For more information about the complaint process, a sample complaint form, and a list of California DHS offices, visit the website of California Advocates for Nursing Home Reform.

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

Originally posted at InjuryBoard by Randy Walton

Nursing Home Complaint Investigation Improvement Act of 2007 Heads to Governor's Desk

Randy Walton — Thu, 13 Sep 2007 19:11:33 GMT

The Nursing Home Complaint Investigation Improvement Act would require the Department of Health Services (DHS) to complete investigations within 40 working days; send complainants a written summary of findings about their complaint; investigate facility-reported complaints of abuse and neglect within the same timeframes as public complaints; and extend the number of days a complainant has to seek an informal conference from five business days to 15 days after receipt of the determination.

The Nursing Home Complaint Investigation Improvement Act (AB 399), authored was approved last week in the Assembly Health Committee by a vote of 10-0. The legislation would fight abuse and neglect by improving the quality and timeliness of nursing home complaint investigations. AB 399 has over 30 registered supporters including the AARP, Congress of California Seniors, Gray Panthers, and Bet Tzedek Legal Services. There is no registered opposition.

According to the California Chronical, AB 399 would require the Department of Health Services (DHS) to complete investigations within 40 working days; send complainants a written summary of findings about their complaint; investigate facility-reported complaints of abuse and neglect within the same timeframes as public complaints; and extend the number of days a complainant has to seek an informal conference from five business days to 15 days after receipt of the determination.

"Today's vote is an important step toward restoring public confidence in California's nursing home oversight system," said Michael Connors of California Advocates for Nursing Home Reform (CANHR). "Timely DHS investigations will help ensure that nursing home residents are protected from further neglect and abuse once it's been reported."

Supporters of the law are urged to write Governor Schwarzenegger as soon as possible and urge him to sign AB 399 into law.

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

Originally posted at InjuryBoard by Randy Walton

Elder Abuse: Nursing Home Standards to be Enforced

Randy Walton — Mon, 15 Oct 2007 21:25:57 GMT

A new California law took effect on July 1, 2007 requiring the Department of Public Health to determine whether nursing homes are complying with California standards that are stronger than federal law. The new law, SB 1312, was introduced after it was learned that the department was ignoring California nursing home reform laws during inspection and elder abuse complaint investigations.

For more information on this subject, please refer to the section on Nursing Home and Elder Abuse.

Originally posted at InjuryBoard by Randy Walton

Medicare To Stop Paying For The Treatment Of Pressure Ulcers

Scott Barber — Mon, 17 Sep 2007 17:42:17 GMT

Medicare to stop paying nursing homes for treating pressure ulcers which they cause. Pressue ulcers are one of the most common bases for elder aqbuse lawsuits.

The Centers for Medicare and Medicaid Services announced last month that, it will no longer reimburse hospitals for treating eight "reasonably preventable" conditions as of October 2008. Pressure ulcers are among the most prevalent, costly and dangerous on the list: In addition to interfering with recovery, lengthening hospital stays and causing extreme pain and discomfort, pressure ulcers can increase the risk of infection, with nearly 60,000 deaths annually from hospital-acquired pressure ulcers.

Nursing homes and long-term-care facilities have made strides of their own in prevention, motivated in part by the costs of lawsuits for failure to prevent pressure ulcers. Prevention methods can include using ultrasound to identify skin breakdown before a pressure sore forms, special pressure reducing mattresses and ensuring that residents are turned at least every two hours.

Despite the availability of these, and other, prevention techniques, nursing homes have long failed to do much to prevent pressure ulcers as they had no real incentive to do so (other than the fear of lawsuits). Most commonly, nursing homes save money by not having enough staff on hand to ensure that residents receive the treatments required. They are then "rewarded" for this behavior by Medicare paying them extra money per patient to treat the decubitus ulcers. As of October of 2008, nursing homes will instead have to "pay" to treat pressure ulcers which they cause. Hopefully this disincentive will result in better care for all nursing home residents.

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

Originally posted at InjuryBoard by Scott Barber

Abuse of Antipsychotic Drugs Found in U.S. Nursing Homes(2)

Randy Walton — Tue, 04 Dec 2007 19:35:27 GMT

The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing-home industry.
"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

The Centers for Medicare & Medicaid -- the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor -- has "initiated a more rigorous process to oversee appropriate use of medicine," says Chief Medical Officer Barry Straube. He says the number of nursing-home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.
Dr. Straube says CMS -- which both funds and oversees nursing homes -- "is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications."
High use of antipsychotics in a nursing home can be an indicator of inadequate staffing, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. "We know the more staffing there is and the higher quality of care, the less the antipsychotic usage," he says.

Originally posted at InjuryBoard by Randy Walton

After Fires Residents Return to Nursing Homes

Randy Walton — Fri, 26 Oct 2007 19:34:14 GMT

According to most reports, the evacuation of area nursing home residents occurred in an orderly and safe manner, and in accordance with local disaster planning.

Fourteen San Diego nursing homes were evacuated totaling approximately 1,200 patients. In addition, 85 assisted living facilities and two hospitals were also evacuated. While the early news is good, and most of the nursing residents have returned home, officials caution the health risks associated with the fires might not be over.

Stress and hardship can worsen medical conditions and sometimes cause deaths among the elderly and infirm. Seven evacuees in San Diego County -- six older than 60 -- died this week during or after leaving their homes or health facilities. In an evacuation, the residents are vulnerable to dehydration, temperature changes and skin breakdowns.
Experts say the mental health toll of a disaster often doesn't end when it is over. Seniors and others who are frail may require counseling or long-term help to cope with the resulting trauma. Dale Phillip, 55, who is recuperating at Remington Club from a car accident, said she didn't foresee lasting problems from the short evacuation.
"I think tomorrow they won't even remember it, to be quite honest," she said of her fellow residents. "They weren't happy during the interim. Now that they're back here, it's like all is forgotten. I think most of them are just thrilled to be back."

The fires aren't all out yet, but if the smooth performance of local facilities in moving residents to safe locations during the fires holds true, then the experience of San Diego County nursing homes during this disaster could become the model for others to follow.

For more information on this subject, please refer to the section on Nursing Home and Elder Abuse.

Originally posted at InjuryBoard by Randy Walton