NUDE PHOTOS TAKEN IN VIRGINIA NURSING HOME

This is sad and outrageous. Imagine wrestling with the decision to place mom or dad in a nursing home. You want to take care of them yourself but with your job demands and kids, its impossible. So, you look around for a clean, well-run nursing home that is located close enough to visit on a regular basis.

Next, you wake up one morning to hear the following news report:

Former nursing home employee arrested for taking pornographic pictures of patients.

This is the news family's in the Southwest Virginia community of Galax read about in their morning paper today. According to Galax Police Chief Rick Clark, “an adult protective service worker with the Galax Department of Social Services received an anonymous complaint that employees of Waddell Nursing and Rehabilitation had taken photos of patients without their consent. The photographs were described as pornographic.”

Nothing like having your trust, and the personal dignity of your parents, violated. If these criminal acts are proven, the employee should go to jail....but the inquiry should not end with the firing of an irresponsible and mentally unstable employee.

My question is, " where was the Administrator...where was the Director of Nursing? Is there any supervision of the staff at Waddell Nursing and Rehabilitation?

I think you know the answer.

CHOKING DEATH RESULTS IN NURSING HOME FINE

Elderly nursing home patients often have difficulty swallowing. Technically, its called "dysphagia" and provides the resident with the sensation that food is stuck in the throat or upper chest. The causes are many and include blockages caused by cervical spine disease and tumors, to nerve and muscle problems.

A good nursing home will assess new patients for swallowing problems upon admission to the facility. If the problem develops after admission, the nursing staff should be trained to spot the development of the problem. Either way, medical intervention may be needed and the resident's diet (after review by a nutritionist) may be changed to a soft diet or other options.

What happens when no one is doing their job? Residents choke to death just like this report from California where a nursing home was fined $50,000 for a resident's death due to choking.

My Take: If your loved one has problems swallowing their meals and drinking liquids, demand a visit by the doctor to assess the cause of the problem and discuss with the facility's cafeteria ways to reduce the risk of choking.

GREAT MEDICAL BLOGS

Want to join the conversation about medical issues in the United States? Best way to do that is to stay connected.

I recommend the following sites to stay up to date:

http://www.kevinmd.com/blog/

http://www.codeblog.com/

Enjoy these... and stay tuned.

NURSING HOMES: WHERE DOES ALL THE MONEY GO?

As the readers of this blog know, Lauren and I spend a great deal of time representing nursing home residents, and their families, in civil lawsuits against nursing homes which provide poor, sometimes shocking, care.

Once we get into the lawsuit and get to depose the Director of Nursing and Administrator we "learn" (ha ha ha!) that lack of finances is the reason the facility doesn't have enough nurses to care for all of the residents. We learn that the facility doesn't have enough money in the budget for safer, better beds, wheelchairs, mechanical lifts, etc., etc.

Where does all the money go?

How about to the owners and Administrators. Nursing home Administrators' salaries rose this year at their highest rate in four years.

Administrator salaries jumped by an average of 4.8%, according to the 2009-2010 Nursing Home Salary & Benefits Report from Hospital & Healthcare Compensation Service. This is the largest one-year increase since the 2006-2007 survey found a 4.6% pay rise that put administrators over the $80,000 mark. Last year, the national average salary for facilities of all bed sizes, both for-profit and nonprofit, was $85,464. This year, it is $89,606.

My Take: Maybe nursing homes could provide better care for their residents if they devoted more financial resources to the job.

PREVENTING MALPRACTICE

I tell folks all the time - "the goods sir, is that you don't have a malpractice case because you will get better."

Medical negligence cases aren't fun. You don't file them unless you are so damaged by a mistake, that you cannot recover.

I would like to prevent all medical malpractice if possible. So I often advocate ways that patients can help themselves, and in turn, help the doctor.

Going to a new doctor?
- bring a list of all medications
- bring a list of all other doctors
- tell the doctor every complaint - not just the ones you are there to see them about

Getting a new Medication?
- ask about side effects?
- ask to see literature on the medication?
- tell your other doctors about the new medication?
- have allergies - tell everyone including your pharmacist what you are allergic too..

Getting surgery?
- find out the risks?
- in patient or outpatient? If outpatient - find out who will be at the office in case of an emergency?
- find out what medications you may require after surgery?

I know your doctors may not have the time to compare your medications etc if they are in your chart - but if you come in with a list of questions, you will get answers..

ALSO - If you have serious health problems, keep notes. How did that medication make you feel? How did you respond? This way you can communicate exactly what happened when you do have 5 minutes of your doctor's attention.

BED BUGS.... THEY ARE EVERYWHERE

So I have told a few friends and family members that Frith Law Firm has been taking Bed Bug cases for the last 4 months. We represent men and women who were guests in hotels / motels across the South East and were awakened by the sensation of being chewed by these blood sucking insects.

Well, now that I am aware of these insects, and the damage they do, I am acutely aware of their presence.

Last week I was staying in a motel (not the nicest) in Louisiana for a family member's 90th Birthday party. Before I brought my suitcases into the room, I did a bed bug check.

1. curtains
2. behind the heard board
3. drawer in bed side table (yes near the Gideon Bible)
4. Corners of sheets / mattress pads
5. folds of bed spreads.

Thankfully, no bugs or I promise I would not have been staying there.

But then this weekend I was listening to NPR and heard a terrible story of an apartment infestation of bed bugs.

If you want to listen - beware. These bugs can change your life, with long term or short term exposure.

So yes - we are taking Bed Bug cases. My clients are suffering from loss of sleep, emotional distress, property damage, many need medical care because of allergic reactions etc.

If you have the unfortunate experience of spending the night with these creatures, please do the following:

1. Take a photo of the bug or keep a bug or two in a Ziploc bag.
2. Call our office regarding your belongings - you don't want to take them home, but the store bought spray may not kill them.
3. Notify the front desk.
4. Ask the front desk for the Health Department information so you can file a formal complaint and have the room investigated.
5. Keep copies of bills from prescriptions etc.

Call an attorney in the state where the Motel / Hotel is for help.

These are not just in $25 a night motel rooms. I have received calls from very nice hotels that cost over $125 a night.

Want to learn more --- this is a most informative slide show on bed bugs in the United States. I warn you - don't click unless you have a pretty strong stomach.

VIRGINIA ELDER LAW ATTORNEY

Is that a phrase you have heard? "Elder law" attorney? I often get calls from very nice people who have been told they need an elder law attorney.

They ask - "Lauren, do you do Elder law?"

My response is most often - "well, sort of, what do you need? There are many different kinds of attorneys that serve our elderly population.
(1) Wills and Trusts Attorneys.
(2) Medicaid Attorneys.
(3) Abuse and Neglect Attorneys.

EVERYONE - no matter your age, needs a Will and Power of Attorney. If you cannot afford having a private attorney draft one, call your local legal aid. Many places (including Roanoke) have pro bono programs to draft Wills and other important documents for those who cannot afford it.

So lets assume you are now over 70, and you have ignored my advice as stated above, and realize for the first time you may need to get a will, power of attorney etc.

Ask around - who does a good job. Ask for a Virginia Attorney that does WILLS& TRUSTS. They should offer a package for a Will / POA etc.

Will you need long term care treatment? Can you afford a $6,000 a month private payment? If not - you need to find a MEDICAID ATTORNEY to help your family make plans.

Do you have a long term care contract for a facility, and need help understanding it?
Our office reviews contract - many attorneys can do that for you.

Has a physician or long term care facility, provided substandard care and you have been harmed? That is a NURSING HOME ABUSE / NEGLECT ATTORNEY.

Getting older is not the restful experience pictured on the lemonade commercials. It takes planning, including legal planning.

There are many Virginia attorneys that practice elder law - know what type of attorney you need, and then it will be easier to find the right one.

FROM BAD TO WORSE - ASSISTED LIVING TO NO ASSISTANCE

POP QUIZ:

1. Your loved one lives in an assisted living facility in Virginia. That facility is:

(a) a health care provider;
(b) has a duty to provide medical care to your loved one;
(c) none of the above.

2. Your loved one's facility sends you a letter that says they will provide the same services but will no longer be a "licensed" assisted living facility.
This,
(a) changes nothings;
(b) is good, less paper work, more time to help;
(c) is frightening and reason enough to find a new place;
(d) could never happen.

Correct answers - (c)... and it does happen - read about a facility doing this exact thing, getting rid of their license, effectively becoming an apartment building.

The article states:

Iowa's largest assisted living center has found a loophole in the law that will enable it to avoid all future government oversight and regulation even though it has been repeatedly penalized for poor quality care.

The Dubuque Retirement Community, which is currently home to 116 seniors, is giving up its state license to operate as an assisted living center. The home's owner, Assisted Living Concepts, plans to operate the building as if it were an apartment complex subject only to landlord-tenant laws.

Residents of the home who are dependent and need medical assistance will be able to stay in the building and pay for 24-hour health care provided by Swan Home Health, a wholly owned subsidiary of Assisted Living Concepts.

By separating the housing from the health care services, the company will be able to provide the same care to the same seniors in the same building, but without a license and all of the regulations that go with it. That means state health inspectors and the long-term-care ombudsman won't be visiting the home and checking on the quality of care that's being delivered.

This is pretty scary folks. No legal duty to help your loved one? That is the other company's job.

If you want to learn about the legal duties and differences between facilities in Virginia (retirement communities, assisted living and nursing home) - read my article on this exact topic found on our website.

Please know what these choices mean

DEEP THROAT TO DIVULGE HEALTH INSURER'S TRICKS

Remember Watergate and the down fall of President Richard Nixon? Well, this might not be quite as good but it is going to be interesting!

For nearly 20 years, Wendell Potter, 57, had a six-figure job inside the health insurance industry, most recently as Vice President of Corporate Communications for the CIGNA Corporation. He left last year and is now a Senior Fellow on Health Care with the Center for Media and Democracy, a nonprofit group dedicated to uncovering the corporate and public relations influences over government, opinion, and public policy.

As insurance industry lobbyists flock to the nation’s capital to keep the lucrative industry alive, Potter is going public. He talks to Bill Moyers on PBS tonight (Friday, July 10).

My Take: Potter tells it like it is...health insurers only priority is making money...and they will do whatever they need to do to make sure they make a lot!

A little preview of his appearance is found in this interview with Jane Akre of InjuryBoard.

WHO IS TAKING CARE OF YOUR LOVED ONE?

Who is taking care of your loved one in a Virginia Nursing Home?

Well - other than the 20 minutes a month a physician will see them for Medicare/ Medicaid certifications, and the few minutes a day an RN will review their chart, they are being primarily cared for by CNAS - Certified Nursing Assistants.

Now let me begin by saying, I know some excellent CNAs... but are they trained to care for someone with complex medical needs? To notice changes in behavior or condition that reflects a more serious problem? To perform wound care or notice changes in wounds, skin condition, etc?

According to the April 2009 issue of The Gerontologist , the median hourly wage for a CNA is $10.04; almost two-thirds of CNAs lived on an annual family income of less than $30,000; 16 percent had no health insurance and more than half were injured on the job at least once during the previous year.

Is it right that these first line care givers are busting their rears to take care of 30 residents, for $10 an hour, with no health insurance, and are struggling financially at home?

Is it right that many have no more training than a GED and a six week CNA course sponsored by the nursing home?

Should we pay them more? YES.
Hire more of them? YES.
Make sure they have health insurance so they don't come to work sick? YES.
Either require more RN or MD direct care? YES.

Just a thought - would happy employees make for better care? What about more employees?

VIRGINIA...ASSISTED LIVING FACILITIES....AND MEDICIAD

The Roanoke Times published an article today (from the Washington Post) titled, "107 Year Old Man Outlives His Savings-Again." The article is about Larry Haubner, a healthy 107 year old living in the Greenfield Assisted Living facility near Washington, DC. Larry's problem is that he has no family and no assets to pay the bills at the assisted living facility. Two years ago supporters raised $56,000 to help pay those bills. That money is now about to run out and another fund raiser is under way. If sufficient funds are not raised, Larry will be moved to a nursing home where his bills will be paid by Medicaid.

Interesting story but here is my problem. Virginia is one of 8 states which does not allow Medicaid to pay for a low-income individual's stay at an assisted living facility. The law basically "forces" low-income individuals to move into a nursing home...whether they need it or not. Nursing homes typically charge $2,000 to $3,000 more per month than assisted living facilities.

My Take: Somebody should wake up our General Assembly members and let them know they are wasting money!

ROANOKE, VIRGINIA NURSING HOMES DON'T MAKE THE GRADE

Of 15,000-plus nursing homes ranked by U.S. News in July's update of "America's Best Nursing Homes," only 3 from the state of Virginia made the list. None of the three which made the list are located in Roanoke. All three achieved a perfect five-star rating in each of the federal government's three yardsticks: health inspections, nurse staffing, and quality measures of individual care.

A drum roll please....................the three nursing homes are:

1. Snyder Nursing Home in Salem, Virginia

2. King's Grant Retirement Community in Martinsville, Virginia

3. Central Virginia Training Center in Lynchburg, Virginia

MENTALLY ILL PATIENTS IN NURSING HOMES

We have seen many occasions where a nursing home resident, minding their own business and bothering no one, is physicall attacked and seriously injured or killed by another resident. In every one of those situations, we discover that the attacker has a long history of aggressive and threatening conduct...and often a history of psychaitric or mental illness. I have often wondered how frequently the mentally ill geriatric patient is "housed" in a nursing home which is not designed to care for these patients with additional health care needs. Well, the information has just been released and it is disturbing.



The number of first-time nursing home residents admitted with mental illness has far surpassed the number of first-time residents admitted with Alzheimer's and dementia, according to a recent nursing home population analysis.



Between 1999 and 2005, the number of nursing home residents admitted with a mental illness rose from 168,721 to 187,478. That is more than 50% more than the 118,290 residents admitted with dementia only, according to the study, which considers mental illness schizophrenia, bipolar disorder, depression or anxiety disorder.



The rise in mentally ill residents was fueled by an increase in the number of patients with depression. The joint Harvard and Brown University study, Trends in Mental Health Admissions to Nursing Homes, 1999-2005, employed Minimum Data Set information to track admissions demographics

NURSING HOME RESIDENT DIES FROM DEHYDRATION

Families work through the difficult decision to place a loved one in a nursing home...a decision not undertaken lightly and not without some reservations. But, there comes a point in time when family members can no longer provide the type of skilled around-the-clock care which is sometimes needed. These facts are what make this report so disturbing.

A 61 year old Ohio gentleman suffered an aneurysm, which damaged his hypothalamus. This caused an absence of thirst, which put him at high risk for dehydration and renal failure. He therefore needed to drink a lot of water. Additionally, because of his cognitive deficits, he required assistance in doing so. His wife, who was his primary caretaker, had him admitted to a nursing home (Whetstone Gardens & Care Center) on a short-term basis. At the time of the admission, she told the home’s social worker (1) that her husband required two to three glasses of water at every meal, (2) about the consequences if he did not get enough water, and (3) that he needed to be monitored and assisted while drinking water. The social worker noted these things, put the information in his file, and told his caregivers that he “required lots of water.”

When the gentleman was released from the nursing home about two weeks later, he complained that he was not feeling well. His wife subsequently took him to a hospital emergency room, where he later died of cardiac arrhythmia or pulmonary embolism secondary to dehydration.

The wife, individually and on behalf of his estate, filed suit against the nursing home’s owner and operator, alleging failure to properly hydrate her husband while he was admitted to the home. Among other things, she alleged the home’s social worker failed to communicate her specific instructions about her husband's critical water requirements and his need for help in this regard to the nursing staff, who simply left water by his nightstand.

The jury awarded the family $6.5 million...and I'll defend that award to any proponent of "tort reform."

USE OF RESTRAINTS IN NURSING HOMES HAS DECREASED

This is great news! The percentage of nursing home residents with restraints fell from 10.7% 1999 to 6% in 2006. The report comes from the Agency for Healthcare Research and Quality's 2008 National Healthcare Quality Report.

The report, released last week, provides both a state-by-state and nationwide analysis of quality-of-care performance in nursing homes, hospitals and other healthcare settings. It tracks 14 different measures of nursing home care, including short-stay/long-stay differences, use of restraints and pressure ulcer rates among others.

State snapshots are available on the AHRQ website, along with full copies of the 2008 report.

We have seen multiple tragedies involving residents becoming entrapped in, and falling from, dangerous restraints. These avoidable events can sometimes lead to death such as when a resident becomes entrapped in bed rail resulting it asphyxia.