Aging isn’t always dignified. That’s especially true for people with dementia. Alzheimer’s disease dismantles a person’s life piece by piece: short-term memory is the first to go, followed by long-term memory, recognition of family members, recognition of self, all cognitive abilities. In addition, a person loses physical capabilities–the ability to walk, to talk, to balance, and even to eat.

Eventually, a person with dementia becomes totally dependent on the care of others. Because the medical needs are intensive, families are generally unable to provide adequate care and a loved one is placed in the hands of a long-term care facility.

We’d like to think that a nursing home that courts families of dementia patients would provide trained and compassionate care. Unfortunately, that’s not always true.

In a letter to the Chicago Tribune, Kim Warchol (of Dementia Care Specialists, Inc.) notes that nursing home residents can’t achieve their best lives unless nursing home staff are properly trained to provide safe, therapeutic care. She states:

“Based on my experience, between 60 to 80 percent of those living in geriatric nursing facilities have dementia, and well over 50 percent of those admitted to assisted living facilities have functional loss due to cognitive impairment. And with a new diagnosis being made every 70 seconds, long-term care facilities must empower their staff for the challenges ahead.” [Kim Warchol, letter to Chicago Tribune]

Her wish is that new laws be enacted to encourage facilities to move from an impairment-based practice to an abilities-based practice, which respects the person behind the disease. What a fantastic idea. Why does it have to even be mentioned as a “revolutionary” concept? It seems basic–dignity for all, but especially for those who lose everything else.

Feeding Dementia Patients with Dignity

A related article in the New York Times this week talks about the “revolutionary” concept of feeding dementia patients with dignity. After a person loses the ability to eat, the family typically is asked whether they would prefer to have a gastric feeding tube inserted so nourishment can be forced, or not…which is the equivalent of withholding nourishment. The decision is always heartbreaking.

But get this…some social workers are suggesting that there is a third option: to feed the patient carefully and slowly by hand, stopping when the person has enough, starts choking, or becomes agitated.

Doctors are calling this new option in palliative care “comfort feeding only.” In a recent paper in The Journal of the American Geriatrics Society, the authors argue that feeding tubes do not necessarily prolong life in patients with advanced dementia, and that surveys indicate that a vast majority of nursing home residents say they would rather die than live with a feeding tube.

“Just imagine someone interacting with the patient, talking to them, cueing them into eating,” Dr. Teno [Joan Teno, professor of community health at Brown University's medical school] said, “as opposed to someone walking to the bedside and pouring a bottle of Ensure down the feeding tube.” [from New York Times article]

Dignity…who knew it could be so revolutionary. At HensonFuerst, every day we fight for the basic dignities of people in nursing homes. We agree that special training should be required of everyone who treats dementia patients, but we would like to take that one step further. Let’s require compassion, caring, and, yes, dignity for our parents and grandparents when they live their days in a nursing home.

HensonFuerst Attorneys provide a voice for people in long-term care, and their families. If you have questions about how your loved one is being treated and suspect neglect or mistreatment, feel free to contact us. 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.

An article on the WRAL webite today reports that an excessive amount of morphine contributed to the death of a patient in the Alzheimer’s unit of Britthaven of Chapel Hill nursing home.

In February, patients were drug tested when managers expressed concern about the way the patients were acting. Of 25 Alzheimer’s patients, nine tested positive for opiates. (Morphine is a type of opiate.)  Three of the patients were removed from the nursing home and hospitalized, and one of those patients–Rachel Holliday–died on February 16, 2010. On autopsy, the medical examiner found extremely high doses of morphine in Ms. Holliday’s system, even though she was not scheduled to receive that medication at all.

The North Carolina State Bureau of Investigation (SBI) is still analyzing evidence in the case; the medical examiner did not rule out homicide.

Everyone at HensonFuerst is outraged and heartsick at these findings, and our prayers go out to the family members affected. Britthaven of Chapel Hill has been providing substandard care for a long while, as evidenced by its Medicare rating: an overall 1 out of 5 stars. It is also a “Special Focus Facility,” which means that they have a history of persistent poor quality of care. Every patient deserves the best possible care, and Britthaven of Chapel Hill has not been keeping up with the implicit promise made by every special care facility: That they will take care of your loved one.

Obviously, there has been a serious disconnect somewhere along the way. Is the staff undertrained or incompetent?  Do the corporate heads not care enough improve the facility?

HensonFuerst is also investigating cases involving Britthaven of Chapel Hill nursing home patients receiving opiates. If you are concerned about a loved one who resides in this or any other facility, please give us a call. We want to help.

You can reach our nursing home abuse team by calling 1-800-4-LAW-MED.

New Haven, Connecticut–home to Ivy League Yale University–is also the location of the latest example of how disgusting and neglectful a nursing home can get. According to a story by a Connecticut NBC affiliate, the Department of Public Health held a surprise inspection of The West Rock Health Care Center. Everyone was surprised when inspectors found:

“Linens that were worn thin and brown; boxes of medical records soaked in pooling water; and a nurse who cleaned an open ulcer with the same ‘fecal smeared washcloth’ used to clean the patient.”

In addition, residents were not given medications on time, and slept on beds that were “unmade and with an accumulation of soiled sheets.”  In all, there were 37 pages worth of violations.

The nursing home was shut down.

Reaction of the owner, Anthony Pinto? “This is a travesty,” he said, referring to the closing. He believed everything “was correctable.”

Except you can never correct for the pain and indignity already suffered by the residents, or the extra infections that might have already occurred due to such unclean conditions. HensonFuerst believes that our senior citizens deserve the highest of care, not the lowest. We fight everyday to keep nursing home residents from becoming victims of this type of abuse and neglect.

If you have a loved one in a nursing home, visit often… talk with staff about concerns you might have… and make facilities take responsibility for proper treatment of your relative. If you believe abuse has already taken place and have questions about what additional action you can take, call us. At HensonFuerst, if you have questions, we have answers. (HensonFuerst: www.lawmed.com; 1-800-4-LAW-MED)

The SmartMoney Magazine website published an eye-opening list of “10 Things Nursing Homes Won’t Tell You,” which was adapted from a book by Jonathan Dahl and the editors of SmartMoney.  Everyone related to a nursing home resident should visit the site, read the list, print it, study it, and post it somewhere visible.

So I don’t give everything away, I’ll include 5 items here (with our own commentary).

1. “We’re careless about the drugs we give out.” Some nursing homes have been cited for unnecessary drug use, use of antipsychotic medications among residents who are not psychotic, and overdosing residents so that they are easier to care for. We have seen this locally, when Britthaven of Chapel Hill nursing home was reported to be the subject of investigation when residents were given narcotic medications without a prescription, leading to the death of one patient.
2. “If it’s not in the care plan, we’re not gonna do it.” The federal government requires a care plan for each resident, which outlines how the resident should be cared for. Even if something is on the care plan, nursing homes can neglect the promised duties… but if a particular aspect of care is not on the plan, forget about it. Don’t assume anything.
3. “‘Neglect’ is our middle name.” When nursing home residents are neglected, they can suffer from dehydration, pressure sores, malnutrition, disease, and sometimes death.
4. “We use physical restraints on your loved ones.” Restraints are allowed as a method of last resort to keep a loved one safe or protect others. But that doesn’t mean that use of restraints isn’t abused, and can lead to depression, agitation, bruising, and other physical problems.
5. “Fines? Go ahead–give us your best shot.” When a nursing home doesn’t meet standards, it can be fined… but that doesn’t mean that the money will ever be collected. The facility can appeal the the citation and fine, or find other ways to avoid paying. Plus, corporations that own and operate nursing homes at the highest levels (because there are often shell companies that are the “face” of each facility) are usually so flush with cash that a little fine is barely noticed.

Want to read the rest of the list? Check out the original article here: SmartMoney Magazine.

HensonFuerst is an avid supporter of nursing home residents and their families. Our lawyers have been involved in some groundbreaking litigation that have made residents safer, and we continue to work for the benefit of the “little guy” against corporations who abuse and neglect senior citizens. If you think your loved one is being abused in a nursing home and you don’t know what to do, contact HensonFuerst. If you have questions, we have answers.

A heartbreaking article in the New York Times (“Long-Term Care Hospitals Face Little Scrutiny”) reveals a disturbing level of patient neglect…sometimes to the point of leaving the helpless elderly to die in pain and alone. It highlights once again what we have seen ourselves: that for-profit long-term care hospitals provide significantly inferior care to traditional, not-for-profit hospitals.

The long-term care hospitals collect money–a projected $4.8 billion this year–from Medicare, and yet they face little or no oversight. Medicare has never closely examined the care given, and Medicare doesn’t penalize the facilities financially if they don’t provide data on the quality of care. State inspections reveal that these facilities are cited for serious violations of Medicare rules at least twice as often as regular hospitals.

The article describes how hospitals play the Medicare system to gather the most money possible, at the expense of patient care.

“Under Medicare, hospitals receive a payment for a patient based on the patient’s diagnosis, not the cost of care. Patients who recover quickly are profitable, but those who languish are not.” (excerpt from the NYT article)

This article should be required reading–it might help you understand how hospital decisions are made…and what red-flags you should look out for. It’s a powerful–if painful–story.

An unnamed certified nursing assistant at Tennessee’s Pigeon Forge Care and Rehabilitation Center took images of several unclothed residents at the nursing home. The photos and videos were found when a cell phone was left at a local restaurant, a report from the Tennessee Department of Health (TDH) indicates. A restaurant worker turned on the phone in an attempt to identify its owner, recognized one of the photos of a resident at Pigeon Forge Care and Rehabilitation Center and gave the phone to a family member employed at the nursing home, the report states. The TDH conducted an investigation at the nursing home between April 2, when the phone was found, and May 11. In its report, the state determined Pigeon Forge Care and Rehabilitation Center failed to protect the residents from having unauthorized photos and videos taken – compromising their dignity, privacy and safety from abuse – and suspended admissions to the nursing home May 26. The suspension was lifted June 3, after the state said the nursing home showed it had corrected the deficiencies cited in its operations. Twelve residents appeared in 47 pictures and 27 videos, taken between July 2007 and March 2009, found on the phone, the state report states.

Click to read the entire story from knoxnews.com

Nursing home residents suffer many different kinds of injuries due to nursing home negligence—broken bones, pressure sores, skin tears, malnutrition and dehydration.  Perhaps the worst injury they suffer is the injury to their dignity, their self-respect.  Many nursing home residents are completely helpless, and need the nursing home staff to do everything for them, including cleaning them up every two hours, so that they won’t have to lie in their own waste for hours at a time.  But all too often, the nursing home doesn’t realize how terrible it is for these residents to have to endure the discomfort, the smell, the sheer embarrassment and injury to their dignity that results from having to exist in this manner on a regular basis. 

In fact, just last week, Nursing Home Litigation team member Carmaletta Henson was arguing a motion before a judge regarding this same issue.  “I explained to the judge what a horrendous injury to a person’s dignity and sense of self-worth it is for them to have to lie in their own waste for hours at a time, because the nursing home doesn’t have enough staff to change them”. 

The responsive argument from the defense counsel for the nursing home facility was quite telling.  She argued that this resident didn’t develop pressure sores or any other physical injuries as a result of having to lie in her own waste for hours on end, so there was no “injury”,  and a jury should not be asked to value this non-injury. This is a perfect example of the cold and heartless response we oftentimes see from nursing homes and their lawyers, a response that we fight to change.  The injury to these residents is clear, and senseless.  This is an injury that should never happen. 

Nursing home owners MUST provide adequate staff to meet the needs of the residents, including their need to be changed and kept clean.  If they can’t provide that level of care for whatever reason, if they can’t meet the needs of the residents, then they should get out of the business and allow others, who are willing to spend the time and the money to meet the residents’ needs, to step in.   This is the change that we at Henson Fuerst fight for everyday.

The National Center on Elder Abuse (NCEA), directed by the U.S. Administration on Aging, is committed to helping national, state, and local partners in the field be fully prepared to ensure that older Americans will live with dignity, integrity, independence, and without abuse, neglect, and exploitation. The NCEA is a resource for policy makers, social service and health care practitioners, the justice system, researchers, advocates, and families.

Click to view the National Center in Elder Abuse website and learn about resources available.