In keeping with our on-going series, today’s blog is about nursing home tragedy. We collect stories from around the world to remind everyone that the elderly are vulnerable to abusers and unscrupulous care facilities. If there is a lesson to be taken from these stories, it is that friends and family of nursing home residents need to visit often, stay involved, and speak up if anything seems unusual.

Here’s today’s nursing home story round-up:

Whose Meth Lab Was It?

Investigation of a deadly fire at Park Haven Home in Ashtabula, Ohio, revealed that the blaze began in a resident’s room…where someone had created a shake-and-bake meth lab. The man who died, 31-year-old Shaun Warrens, was not a patient or an employee of the facility. As of this writing, it’s not clear what connections he had to the nursing home. Three residents and one non-resident were hospitalized with injuries caused by the fire.

According to an article by the Associated Press:

Police Chief Robert Stell told the Star Beacon of Ashtabula that police believe two visitors and one Park Haven resident knew about the meth lab. Police expect to charge two men who also were burned in the fire.

Methamphetamine, or “meth,” is a highly addictive stimulant. Mobile meth labs, also called one-pot or shake-and-bake labs, usually consist of a 2-liter bottle and the drug’s ingredients. According to Bob Frey, of the health department:

“Basically, you can take all of the components and equipment and put it in a backpack and use it to brew a small quantity of methamphetamine,” he said. “It’s a highly dangerous but very self-contained method of making methamphetamine.”

Shaking the mixture agitates the chemicals and produces the heat needed to cook the drug. But it can also cause a violent reaction that could melt or rupture the container. The explosion or fire usually is confined to the person making the drug and the surrounding area, Frey said.

Meth is a problem nationwide, but it’s highly uncommon in a nursing home setting. I’m not sure whether this speaks more to the expansion of meth’s addictive reach, or to the changing demographics of nursing homes. As addiction spreads, it eventually reaches all segments of society.

To read the full story, click here:  http://www.ajc.com/news/nation-world/nursing-home-with-meth-1374675.html

Jailed for Facebook Photos

According to the Daily Reporter, 26-year-old Oregon nursing assistant Nai Mai Chao served eight days in jail after a jury found her guilty of invasion of personal privacy. Some believe that her crime should have brought a much higher punishment.

“Invasion of personal privacy” sounds so innocuous, doesn’t it?  What Ms. Chao did was awful:  She took disturbing photos of elderly and disabled patients using bedpans, then posted them on Facebook. Ms. Chao surrendered her nursing certificate, and was fired from the Regency Pacific Nursing and Rehab Center where she worked.

To read the full story, click here: http://www.greenfieldreporter.com/view/story/5365bdb7f2544ef9a21be69e5d6f1d4f/US–Nursing-Home-Photos/

British Elderly Denied Basic Care

According to an article in The Telegraph, more than half of nursing home residents are denied even basic health services. Some have to wait up to three months for formal checks of painful conditions, such as bed sores… some face significant delays in getting their medication… and many are not given a choice of male or female staff to help them use the bathroom, raising issues of dignity and respect.

The Geriatrics Society issued results of a study that showed that about half of primary care facilities don’t even provide key services, such as continence assessments, physiotherapy, bed sore checks, and mental health services. According to the president of the society:

“What it shows is that there is a massive disconnect between what the NHS aspires to and what it actually delivers to people in care homes and they are the most vulnerable group of people.

To read the full story, click here:  http://www.telegraph.co.uk/health/elderhealth/9126976/More-than-half-care-home-residents-denied-basic-care-unpublished-data-shows.html

Vulnerable, Inside and Out

When you have to rely on other people for your daily care, you have to trust that you won’t be taken advantage of. Unfortunately, the elderly are often more vulnerable to scammers, cheats, and liars. Case in point:  64-year-old Surjeet Chana, a British “grandmother” who worked in the Land Registry office. She used her position to supply documents to a white-collar gang that stole houses from elderly people who had moved into nursing facilities.

According to an article in The Telegraph:

Using information she gathered, including title deeds and ownership signatures, the group targeted empty homes, pretending to be the owners and selling them on to third parties.

Over the past two years, the gang sold at least nine properties across London, worth a combined value of about $8 million. The judge who sentenced Chana to more than 3 years in prison called her “greedy” and “corrupted.”

You have brought great shame on yourself and your family, you have ruined your career and no doubt prejudiced your pension rights.

Judge Grieve added the gang preyed on “highly vulnerable” victims whose family homes which had a “lifetime of memories” were sold from beneath their noses. “It takes little imagination to realise the shattering trauma that this experience would bring,” he said.

Indeed.

To read the full story, click here:  http://www.telegraph.co.uk/news/9126384/Grandmother-jailed-after-plot-to-steal-homes-from-elderly.html

One Final Insult

Even after a resident died, one nursing home went the final, abusive step. In Great Britain, the Highcliffe Nursing Home sent a bill for the equivalent of about $4,740.00 because the dead man didn’t give 4 weeks notice of his death. Got that? The nursing home claims that unless they receive advance notice of a resident’s death, the resident (or his family) can be charged for an extra month’s stay at the facility. They claim that the charge is valid…similar to not giving a month’s notice before moving out of an apartment.

According to an article in the British newspaper The Daily Mail, the resident’s daughter felt that her father had been well cared-for while he lived at the facility, but she questions the crazy charge.

“I wouldn’t mind paying for a week,” she said. “But to pay for a month – which covers his food, laundry and nursing care – is daylight robbery.”

As if this wasn’t bad enough, the billing department was overly efficient. The bereaved daughter received the notice the day after her father’s funeral. The nursing home administrators claim they are reviewing this policy.

To read the full story, click here: http://www.dailymail.co.uk/news/article-2104184/Care-home-bills-grieving-daughter-3k-didnt-notice-fathers-DEATH.html#ixzz1oY2dZafV

As the saying goes, you cannot fully understand what another person’s life is like until you “walk a mile in their shoes.” That’s the point behind an innovative training program designed to help caregivers truly appreciate what life is like for their loved ones with dementia. According to an article on GoErie.com, a division of the Pennsylvania newspaper the Erie Times-News:

“You don’t know what they go through until you do this test yourself,” said [Patty Gregory, a certified nursing assistant at Saint Mary's Home of Erie]. “I took care of my father for 12 years, and now I truly know what he went through.”

In order to give caregivers a taste of what what an elderly person with dementia experiences, this is what they go through:

• Kernels of uncooked popcorn are put in their shoes to make walking more difficult;
• Kernels of popcorn are dropped into rubber gloves before sliding them onto the caregivers’ hands;
• Some fingers of the gloves were taped together to make it more difficult to grab and hold objects;
• They wore goggles with dark circles taped to the middle of each lens to approximate what macular degeneration does to vision;
• A CD played loud static and other distracting sounds through headphones;
• Strobe lights flickered.

The caregivers were then escorted to an empty patient room and told to perform five simple tasks—such as pouring half a glass of water and folding towels—but they had to listen to instructions through the static and noise, or read a list in which the words were scrambled. It was a difficult chore. According to the article:

“Where’s the water, where’s the water, where’s the water?” nursing assistant Alice Flemings said after entering the training room. “Oh my, oh my. Where am I going?”

“Take your time and calm down,” said DeAndra Jackson, a Saint Mary’s Home employee whose job during training was to ensure the nursing assistant did not walk into a door or otherwise hurt themselves.

Some nursing assistants were able to complete most of their tasks, while others struggled to finish even one.

One nursing assistant, who asked not to be identified, was so visibly aggravated when she walked out of the simulation room that Jackson jokingly called her a “noncompliant patient.”

The exercise helped caregivers to understand that it takes more patience to work with people with dementia and physical impairments, and that hurrying them along may only serve to make them agitated.

“My love for people has never changed and never will change,” Gregory said. “But until you walk in that room, you will never know the deep impact a disease like dementia can have.”

Such a fascinating program. It seems that this type of training should be required for anyone who works in a nursing home.

To read the full article, click here:  Erie nursing home shows aides what dementia is like

If your loved one has become bedridden due to illness or infirmity, it is important to take steps to prevent bedsores, also known as “pressure ulcers,” which are areas of broken skin caused by the pressure of lying in one spot too long without moving. Bedsores themselves cause pain, but worse than that, if left untreated bedsores are prone to becoming infected. In severe cases, the infection spreads from the skin to the blood, and even the bone.

In extreme circumstances, bedsores can be deadly. According to an article on the British news site The Daily Mail, bedsores kill almost as many hospital patients as the “super bug” called MRSA (methicillin-resistant Staphylococcus aureus).

According to the Mayo Clinic, bedsores can move through four stages of development very quickly:

• Stage 1:  Closed wound. The skin appears red (on fair skin), or ashen, bluish, or purple in people with darker skin. The site may be painful, and may be either warmer or cooler than the surrounding skin.
• Stage 2: Open wound. The outer layer of skin is damaged, making the ulcer look like a shallow divot, or like a large intact or ruptured blister.
• Stage 3: Deep wound. The ulcer starts looking like a crater, possibly with some yellowish dead tissue.
• Stage 4: Large-scale loss of tissue. The would exposes muscle, bone, and/or tendons. The bottom of the wound may look dark with crusty dead tissue.

Treating bedsores can be difficult, which is why prevention is so important. Whether your loved one is at home, or in a nursing home or hospital, here are some steps you can take to prevent problems before they start, from Dr. Anthony Komaroff (AskDrK.com) and the Lake County News-Sun:

• Relieve pressure on vulnerable areas. Move your loved one every 2 to 4 hours—from lying on the back, to one side, then the other side, then the back again. According to Dr. Komaroff: “When she is on her side, she should be only partly on her side (about a 30-degree tilt); if she is completely on her side, her hip bone will push down hard on her skin.”
• Use pillows to keep vulnerable areas from pressing into the mattress.
• Reduce irritation. You know how a tiny pebble in your shoe can feel like a jagged piece of glass after walking on it for awhile? To the skin of a bedridden person, tiny irritations can cause big pain. Keep sheets smooth and not bunched… don’t allow books or other objects to remain in the bed when not in use… make sure crumbs are caught or cleaned after eating.
• Inspect sore-prone areas at least once a day.
• Get prompt medical care if you see suspicious areas of skin irritation.
• Encourage good nutrition. If you have any doubts or questions, talk with a nutritionist to make sure your loved one gets enough calories, protein, fats, vitamins and minerals.
• Encourage movement or exercise. Even stretches or simple arm or leg lifts can help the blood circulate, which can keep the skin healthy.
• Keep skin clean and dry. Wash with plain water and very gentle soap (when in doubt, ask a nurse for recommendations). If sweating is a problem, use absorbent pads to keep moisture off the skin.
• Communicate with nursing home staff about your bedsore observations. If your loved one lives in a nursing facility, ask what steps they take to prevent bedsores. Let them know if you discover early signs of problems. Ask if they have any recommendations about items you could purchase that might make your loved one more comfortable. If you work as a team, your loved one has a better chance of staying healthy!

To read the full article from the News-Sun, click here: Measures to prevent sores in the bedridden elderly

To read more about bedsores from the Mayo Clinic, click here:  Mayo Clinic Bedsores

The U.S. government’s 5-Star ratings of the nations nursing homes are in!

While these results are not as glamorous as the Oscars or the Grammys… okay, they are not glamorous at all, but they are significantly more meaningful than entertainment awards, and they affect more of us much more directly. Currently, about 7.5% of Americans currently live in nursing homes. With the current trends in costs of care, health concerns, and the number of aging Baby Boomers, it has been estimated that about 11 million people will be likely to require assistance in old age within the next 10 to 20 years. That makes it essential that we understand what makes a “good” nursing home or a “bad” nursing home, and how to find the good ones.

Every year the Centers for Medicare and Medicaid Services (CMS) publish the results of their 5-Star Quality Ratings of nursing homes. The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily, and help identify areas about which you may want to ask questions. Nursing home ratings are taken from three sources of data:

• Health Inspections. Onsite visits by a team of trained inspectors who check on the quality of care, inspect medical records, and talk with residents about their care. Inspectors also make sure that the nursing home meets federal quality processes.
• Staffing. This rating looks at the overall number of staff compared to the number of residents…as well as how many of the staff are trained nurses.
• Quality Measures. This measure rates how well a nursing home performs on 10 important aspects of care, such as how well the nursing home prevents and treats skin ulcers, and how well residents are helped in eating and dressing. While this sounds like a valuable measure, the data for Quality Measures are self-reported by the nursing home staff. This makes it the least objective measure, and the most likely to be inappropriately high.

Each of these areas is individually rated, and then these three ratings are combined to calculate an Overall Rating.

The lowest overall rating is awarded to homes “much below average” compared with others in their state, according to CMS. Among problems that can drop a rating: consistently dirty equipment and linens, mistreatment and unlicensed caregivers or specialists.

How to Choose a Good Nursing Home

USA TODAY Analyzes Ratings

The CMS Nursing Home Compare data only list the most recent star ratings, but it doesn’t provide a history for consumers. Now, USA TODAY prices an analysis of the ratings for more than 15,000 nursing homes over the past 3 years. Among their findings:

• Quality improved. There was a 5% decrease in the number of nursing homes with 1- or 2-star ratings; and there was a 5% increase in the number of 4- and 5-star rated facilities.
• Some of the worst stay bad. 564 nursing homes received 1-star ratings in each of the rating periods during the past three years.
• Two-thirds of these low-performing facilities are for-profit organizations.

Here’s how to see specific nursing home ratings from the past three years:

• Go to the USA TODAY ratings page here:  USA TODAY Nursing Home Ratings
• On the upper right corner of the chart at the top of the page, enter the state you would like to search.
• On the lower right side of the chart, you can narrow your search by entering a specific term, which can include a city name, part of the name of the nursing home, a street name, etc.
• To see a comparison of all three years’ ratings, click the “+” sign to the left of the nursing home name and address.

ADDITIONAL RESOURCES

USA TODAY article: Fewer seniors live in nursing homes

To see the full reports AND to search for specific nursing homes by name or location, see the Nursing Home Compare page here: Nursing Home Compare

To see the HensonFuerst video about how to choose a good nursing home, click here: How to Choose a Good Nursing Home (and Avoid the Bad Ones)

BINGO is a fun activity for many people, but especially those in nursing homes and assisted living facilities.  Now, researchers have discovered that BINGO has benefits that go way beyond passing the time: Bingo seems to boost thinking and playing skills, especially among people with Alzheimer’s disease and Parkinson’s disease.

According to an article on ScienceDaily, as people age, they begin to lose sensitivity to perceive contrasts…and this problem is worse in people with dementia. The researchers tested different types of specially-made bingo cards, and discovered that improving contrast and increasing the size of the cards improved the players’ skills. In fact, increasing contrast in the environment made living easier for the seniors, too.

For example, putting a black sofa in a white room would improve the contrast of the room and make it easier for individuals to move about. Additionally, they found that individuals with dementia actually eat more if they use a white plate and tableware on a dark tablecloth or are served food that contrasts the color of the plate.

These types of simple interventions could help people with dementia remain independent longer, and give them greater enjoyment of life overall.

To read the full article on ScienceDaily, click here:  BINGO!

Alzheimer’s disease makes just about everyone’s short list of aging fears. The disorder robs individuals of their memories…their sense of self…their connection to friends and family. It’s hard on everyone who has to watch their loved one disappear before their eyes.

Now, scientific research published in The Archives of Neurology offers a small—but statistically significant—ray of hope for anyone hoping to prevent Alzheimer’s disease. The answer:  Walking!

The scientists studied 201 healthy adults (ages 45 to 88). The participants were tested for genetic predisposition to Alzheimer’s disease, and were given a brain scan to look for signs of amyloid plaques, the abnormal protein deposits that are a characteristic of the brains of Alzheimer’s patients. Fifty-six participants tested positive for the APOE-e4 gene, a marker that increases the risk of developing Alzheimer’s disease by a factor of 15. None of the participants had signs of Alzheimer’s disease at the beginning of the study. Finally, everyone completed detailed questionnaires about their exercise habits.

According to an article in The New York Times:

The volunteers who reported walking or jogging often — meeting (or, in rare instances, exceeding) the American Heart Association’s exercise recommendation of 30 minutes of moderate or vigorous activity five times a week — had fewer amyloid plaques than the volunteers who reported almost never exercising….

The carriers of the gene who reported walking or jogging for at least 30 minutes five times a week had plaque accumulation similar to that of volunteers who were e4-negative. In essence, the APOE-e4 gene carriers mitigated their inherited risk for developing Alzheimer’s by working out.

So moderate exercise was protective against Alzheimer’s disease…even for people who have an extremely high genetic risk of developing the disease. The scientists have a lot more work to do to figure out why exercise is protective, but for the average person, the take-home lesson is that exercise should become a part of daily health habits for everyone—but especially for those with a family history of Alzheimer’s disease.

“There are so many benefits to exercise,” [Denise Head, an associate professor of psychology at Washington University who led the study] says, “and one may be that it helps the brain” to defend itself against the slow leaking away of memory.

Now that’s science we can get behind!

Charlene Harrington, RN, PhD, FAAN

Results of a new study suggest that the nation’s largest for-profit nursing homes deliver significantly lower quality of care, compared with smaller and not-for-profit nursing homes. Why? Fewer staff nurses (despite profits).

The study looked at quality in the 10 largest for-profit chains, which control about 13% of all nursing home beds in the country. They were choses because of their influence and expansiveness. The researchers from University of California, San Francisco (UCSF) found that when nursing homes put profits ahead of people, they cut costs by reducing the number of staff… especially trained and experienced (but more expensive) staff.

“Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit chains,” said first author Charlene Harrington, RN, PhD, professor emeritus of sociology and nursing at the UCSF School of Nursing. Harrington also is director of the UCSF National Center for Personal Assistance Services.

“The top 10 chains have a strategy of keeping labor costs low to increase profits,” Harrington said. “They are not making quality a priority.”

The correlation is so strong that many experts believe that the best predictor of nursing home care is the number of nurses working at the facility.

Something to remember if you should find yourself looking for a good nursing home.

True or false: All suspicious deaths are investigated so that justice can be done if foul play is discovered.

Answer: It depends on how old you are.

According to an article on the website ProPublica, a nonprofit investigative newsroom, and PBS’s Frontline, if a senior citizen died under suspicious circumstances, there’s no guarantee that anyone will ever investigate. Although it is impossible to know exactly how many suspicious deaths have been signed off as due to natural causes, the evidence uncovered points to a significant problem. When investigators look closely at deaths of elderly people, they discover many cases of mistreatment, abuse, and even murder.

Case in point: 76-year-old Joseph Shepter was living in a nursing home after a stroke paralyzed much of his body and dementia took away his ability to communicate. When he died, the nursing home’s chief medical officer listed the cause of death as heart failure. No one examined the death any further…until a tip from a staffer at the nursing home prompted the state to re-examine the case.

It was discovered that Shepter died of a combination of ailments related to poor care, including infected ulcer, pneumonia, dehydration, and sepsis. In addition, his death was hastened by antipsychotic drugs—drugs he didn’t need. (We have written about the problem of inappropriate use of dangerous antipsychotic medications. To read that blog, click here:  Antipsychotic Drugs Over-Prescribed in Elderly) According to ProPublica:

Dr. Michael Dobersen, a forensic pathologist and the coroner for Arapahoe County, Colo., said he worries about suspicious deaths in nursing homes. “Sometimes, if I don’t want to sleep at night, I think about all the cases that we miss,” Dobersen said. “I’m afraid we’re not looking very hard.”

How Can This Happen?

The reason so many suspicious deaths are overlooked is because of a number of systemic flaws:

And then there is what is arguably the most common reason of all:  Ageism.  According to geriatrician Kathryn Locatell, who specializes in diagnosing elder abuse, it all boils down to ageism. She said, “We don’t value old people. We don’t want to think about ourselves getting old.”

Catherine Hawes, a Texas A&M health-policy researcher who has studied elder abuse for the U.S. Department of Justice, agrees, calling the issue a “hidden national scandal.” She interviewed 40 coroners and medical examiners about how they handled deaths among senior citizens. They told her that they were reluctant to perform autopsies.

“Many of them made the blanket assumption that when an elderly person dies, it must have been because ‘their time had come,’” she said. “But they don’t make that assumption about any other part of the population.”

A Need to Keep Eyes Open

It’s a sad fact that many legislators work to pass laws that reflect their own experiences, which is why it is so difficult to understand why there are so few safeguards for the elderly. We’ve all had parents, grandparents, great-grandparents, and many of them have ended up in nursing homes. Is it that they were among the lucky ones who had perfect care for their loved ones? Or could it be that no one wants to believe that their loved ones were victims who died painful deaths?

For example, Joe Shepter, the son of Joseph Shepter ”used to think that his father ‘died a somewhat peaceful death’ surrounded by caring professionals. Instead, he now believes, his “father was lying in a hospital bed essentially dying of thirst, unable to express himself….”

It’s a difficult thought to have to live with. There’s no going back from something like that. But it is worth knowing. In fact, some communities are developing new strategies for pinpointing suspicious deaths. For example, some counties formed elder death review teams made up of police, prosecutors, adult protective services, the medical examiner, emergency personnel, and others. They are similar to the kinds of teams used by child-abuse investigators. It’s a way to make sure that more than one set of eyes is responsible for looking for signs of abuse.

It’s also a way to make sure that the elderly get justice…eventually, if belatedly.

To read the full article on ProPublica.org, click here:  Gone Without a Case

Of the hundreds of blogs we write each year, the most heartbreaking are those we write about nursing home abuse and neglect. The stories are tragic, and they happen to people who are vulnerable and defenseless. Here is a round-up of the most important nursing home stories of the year. (To read any of the blogs, click on the title and you’ll be taken directly to the story.)

Nursing Home Horror Stories

I am constantly amazed and disturbed by the level of abuse and neglect happening in nursing homes across the country. I talk to people everyday who say they can’t believe that any care facility could actually put residents at risk of harm or death. To give credence to my pessimism, here are some very frightening stories gathered from news articles across the country.

• Nursing Home Tragedies
• Nursing Home Abuse Caught on Hidden Camera
• More Nursing Home Tragedies
• Riverdale’s Nursing Home “Hell”
• More Tragic Nursing Home Stories
• Even More Nursing Home Tragedies
• More Scary Stories About Nursing Home Care

How to Spot Signs of Elder Abuse

Many older people who are abused are at the mercy of their caregivers, and therefore may be afraid to speak about their pain or fear. If you have a loved one in a nursing home, it’s important to remain alert to the signs that something may be wrong.

• Signs of Nursing Home Abuse or Neglect
• “Granny Cam” Captures Images of Abuse

How to Choose a Good Nursing Home

Want to prevent abuse altogether? Start by choosing a quality nursing home.

• Nursing Home Ratings Available

VIDEOS

Early this month we wrote a blog called “Visiting a Loved One in a Nursing Home,” which talked about the nuts and bolts of holiday visits—what gifts to bring, what to check in advance, and when a visit should be delayed.

Today’s blog deals with the more personal side of visiting a loved one in a nursing home or hospital. This advice, from Carol Abaya of The Sandwich Generation, holds true all the time, not just during the holidays.

Advice for a Successful Visit

• For someone who is confined to a nursing home or hospital, time is the best gift you can give. As Carol Abaya says, “Time is the essence of caring. And the physical presence of a close relative can have positive effects on the emotional health of the person being visited.
• Enter the room quietly and talk softly to the patient. While spreading cheer in the rest of the world might mean loud greetings and shouts, people in a nursing home respond better to quiet energy.
• People who are elderly or sick may have a difficult time following complicated sentences or multiple speakers. Let one person talk at a time, and speak in short sentences.
• Don’t interrupt or rush the patient to finish a thought. This can take practice and patience, but it will make the patient feel like an important part of the conversation.
• Talk about positive events in your life…leave complaints, anger, or fear outside. And don’t talk about anyone else’s illness.
• On the other hand, if the patient wants to talk about important but potentially sad topics, join that conversation at the same emotional level. And don’t try to impose false happiness on a difficult situation. For example, people who are dealing with a terminal illness know that they are very sick and they don’t like for visitors to press false optimism.
• If the patient wants to talk about happier memories, encourage it and chime in with memories of your own.
• Don’t feel the need to fill in every moment with chatter. Sometimes just sitting quietly and watching a TV show together can be more valuable to the patient than hours of talk.
• Don’t overstay your visit. For a very sick person, 15 minutes may be enough time. Unless you know the person well and just want to sit quietly in the room, don’t ever plan to stay longer than about 45 minutes. Any longer than that may tire the person too much for the visit to be enjoyable.

To read more information about caring for elderly loved ones, visit The Sandwich Generation.