Message received:  Getting older doesn’t mean giving up on health.

An article in today’s News & Observer reports that more senior living communities and facilities are offering state-of-the-art fitness machines to keep up with the demand by residents. Previously ignored, senior fitness is now a burgeoning business.

“Change came slow; however, now it is happening at a frantic pace,” said Colin Milner, CEO of the International Council on Active Aging. Now, he says, communities have their own fitness facilities with the best equipment money can buy.

In North Carolina, the issue is of particular importance due to our status as an ideal retirement destination. Warmer than the north, but without the relentless heat of Florida, North Carolina is the go-to spot for new retirees… and current residents don’t plan on migrating away. By 2020, our senior population is projected to increase by 88%–from about 70,000 now to about 128,000.

The benefits are obvious:  Greater endurance and strength… prevention of muscle deterioration… and improved balance to prevent falls. According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury deaths and trauma hospital admissions, and each year more than one-third of adults 65 and older fall.

In the newspaper article, Janie Clark, a physical therapist and president of the American Senior Fitness Association, offered these exercise tips for seniors (check with your doctor, first):

• Walk or swim. Taking a walk can get your heart pumping and blood flowing.
• Strength train. Lift dumbbells or tug resistance bands.
• Stretch. Sit up straight and try to bring your shoulder blades together.
• Practice your balance. Hold a chair as a support and stand on one foot.

The National Institute on Aging has “The Age Page” on its website with more health and exercise tips for seniors. You can also order the institute’s free book by going to www.nia.nih.gov and searching for “Exercise and Physical Activity: Getting Fit For Life.” The book will be available later this summer.

To find a senior community that offers exercise and wellness options, visit the International Council on Active Aging website at www.icaa.cc. Scroll over “Consumer Section” and click “Facility/services locator.”

To read the full article: http://www.newsobserver.com/2010/06/22/544555/seniors-want-to-take-gym.html#ixzz0raraELya

What is it really like to live in a nursing home? Anna Mae Halgrim Seaver wrote notes while she lived in one. After her death, her son found them and had them published.

“This is my world now. It’s all I have left. You see, I’m old. And, I’m not as healthy as I use to be. I’m not necessarily happy with it but I accept it. Occasionally, a member of my family will stop in to see me. He or she will bring me some flowers or a little present, maybe a set of slippers — I’ve got 8 pair. We’ll visit for awhile and then they will return to the outside world and I’ll be alone again.”

The full note, with attribution to Newsweek, is available on the ElderCare Rights Alliance website: My World Now. It is touching, and makes you want to immediately pick up the phone and call your mother or grandmother. I did.

The North Carolina Board of Nursing has issued a new statements designed to clarify the scope of practice for nurses.

These position paper provide guidelines about what the standards for competent care are for LPNs and RNs. Topics include what to do when assessing a patient, planning for a client’s needs, implementing the plan, evaluating outcomes, recording data, collaborating with others, and counseling the client and/or the client’s family.

Click the links to read the papers:

Position statement for RN practice.

Position statement for LPN practice.

While these papers are intended for nurses, everyone with a loved one being cared for by nurses should review them to make sure that competent care is being delivered. If you wonder how your nurse is following through on the guidelines, ask. Good care starts with good communication.

On the other hand, if it becomes clear that your nurse is not competent, or if you suspect that your loved one is being abused, talk with someone further up the chain of command–the head nurse or facility coordinator. If you believe that your loved one is in immediate danger, it is better to be safe than sorry:  call 911.

And finally, if your loved one has been injured by abuse by a long-term care facility and you want to explore your legal options, call the HensonFuerst Nursing Home Abuse team–we’re here 24 hours a day, 7 days a week. You can reach us at 1-800-4LAW-MED. If you have questions, HensonFuerst has answers.

Today, June 15, is the 5th annual World Elder Abuse Awareness Day.

Sponsored by the International Network for the Prevention of Elder Abuse (INPEA), the first Awareness Day in 2006 involved several hundred organizations and governmental bodies throughout the world, on all seven continents. Their core message is this:  Never ignore elder abuse.

Throughout the world, abuse and neglect of older persons is largely under-recognized. It is an unspoken problem. Unfortunately, no community or country in the world is immune from this costly public health and human rights crisis.

Elder Abuse Facts

According to the World Health Organization, the elderly are especially at risk of abuse in institutions such as hospitals, nursing homes, and other long- term care facilities. In a survey in the United States, for example, 36% of nursing home staff reported having witnessed at least one incident of physical abuse of an elderly patient in the previous year, 10% admitted having committed at least one act of physical abuse themselves, and 40% said that they had psychologically abused patients.

Abusive acts include physically restraining patients, depriving them of dignity and choice over daily affairs, and providing insufficient care (for example, allowing them to develop pressure sores).

Signs and symptoms of abuse include:

• delays between injuries or illness and seeking medical attention;
• implausible or vague explanations for injuries or ill-health, from either patient or caregiver;
• differing injury accounts or case histories from patient and caregiver;
• frequent visits to emergency departments because a chronic condition has worsened, despite a care plan;
• laboratory findings that are inconsistent with reported treatment.

The HensonFuerst nursing home abuse team has seen first-hand the abuses that can be heaped on the elderly. Just a few months ago, six residents of the Britthaven of Chapel Hill nursing home were given overdoses of morphine, and one resident died. They were all in the Alzheimer’s unit, which means that they were helpless to know what was going on… helpless to fight back.

Stories like that are what keep HensonFuerst fighting against elder abuse every day of the year.

Attorney Carma Henson, partner with North Carolina-based HensonFuerst law firm, told reporters today that the HensonFuerst nursing home abuse team is conducting its own investigation into the the morphine overdose of nine Alzheimer’s patients being treated at Britthaven of Chapel Hill nursing home.

In February, six patients were admitted to the hospital after they tested positive for morphine, even though the pain killer hadn’t been prescribed. One of the patients, 84-year-old Rachel Holliday, died. At the time of her death, she also had high levels of morphine in her blood. On Monday, registered nurse Angela Almore was arrested and indicted on one count of second-degree murder and six counts of felony patient abuse. In a report from WRAL, Orange County District Attorney Jim Woodall said that the state believes Almore acted alone, and that he doesn’t expect any more arrests or charges in the case.

In a news report on WRAL-TV today, Carma Henson said that HensonFuerst is continuing its investigation on behalf of families concerned about how this type of abuse could have happened to their loved ones. The firm is not limiting its research to Almore’s actions; there is also the question of how drugs are administered throughout the facility. According to Carma Henson, a nurse is not supposed to be able to get access to morphine and administer it to patients if it has not been prescribed for those patients.

“This can’t be just a rogue nurse gone bad,” says Ms. Henson. Her hope is that the HensonFuerst investigation gets a look at the bigger picture of how this and other nursing homes are run, so changes can be made to bring about some good. There are still a lot of people in nursing homes who need help… HensonFuerst is determined to make a difference.

(Watch the WRAL video and read their complete story here: HensonFuerst continues investigation.)

People recovering from serious illness used to recuperate in a traditional hospital, no matter how long it took. But in the past 15 years, a new form of hospital–the long-term acute care hospital–has emerged. These hospitals can provide intensive and specialized care for patients who don’t necessarily need all of the services offered by a medical-surgical hospital.

Sounds great, right?  Well, not always.

An article published this week in the Journal of the American Medical Association (JAMA) tracked the admissions and outcomes of Medicare patients transferred to long-term acute care hospitals between 1997 and 2006. Researchers (including Dr. Shannon S. Carson from the University of North Carolina Medical School, Chapel Hill) found that during this time, the number of patients transferred increased, and the one-year mortality rate increased.

The researchers state that there has been no sign that long-term acute care hospitals do a better job at caring for very sick patients than other forms of care, including traditional hospitals. So why are they becoming more prevalent? According to the article:

“In the absence of demonstrated efficacy, long-term acute care hospital expansion may possibly be driven by financial incentives that favor out-of hospital transfer after critical illness. Compared with short-stay hospitals, long-term acute care hospitals operate with relatively high margins and are a profitable sector of the health care market. Additionally, under prospective payment, short-stay hospitals financially benefit by discharging patients with severe acute illness early in their course.”

In other words, it probably all comes down to money. Traditional hospitals often benefit from discharging patients early, and long-term acute care hospitals make more money from doing the same job.

None is this is good for sick people. We know from experience that when money becomes the primary part of the equation, the outcome is never good for patient care–it becomes too easy to cut corners to save a dime. We have seen this happen in nursing homes, where quality care is more and more difficult to find.

The attorneys of HensonFuerst agree with the final analysis of the researchers who wrote the JAMA report: The medical system is capable of innovation, but we should evaluate the effectiveness of all new programs before turning over sick patients to what might turn out to be substandard care. Patients shouldn’t be sacrificed to reduce costs–the standard of care should always be survival over dollars.

(JM Kahn, NM Benson, D Appleby, SS Carson, TJ Iwashyna. Long-term acute care hospital utilization after critical illness. JAMA 2010;303(22):2253-2259.)

WRAL.com reports that registered nurse Angela Almore was indicted on a charge of second-degree murder for the death of an Alzheimer’s patient at Britthaven of Chapel Hill nursing home. Almore is also charged with six counts of felony patient abuse, and is being held in the Orange County jail under a $500,000 bond.

In February, nine Alzheimer’s patients tested positive for powerful opiate medicines, the kind used to control pain. Six of the patients were hospitalized, and one patient–Rachel Holliday–died.  At the time of her death, Ms. Holliday had a blood morphine level of 50,000 ng/ml… even though she had not been prescribed morphine.

HensonFuerst is relieved to know that the investigation into patient abuse at this nursing home will continue, and that an arrest has been made. Our nursing home abuse lawyers are continuing their own investigation of this incident. There are many more questions to be answered….

To read the full WRAL story, click here: Murder Charge at Britthaven of Chapel Hill. And if you have questions about what you can do about suspected cases of nursing home abuse, contact our Nursing Home Abuse team–if you have questions, HensonFuerst has answers.