Big Pharma - Pushing Antipsychotics On Nursing Home Residents

In a recent article, the American Association of Retired Persons (AARP), described in detail a serious problem in nursing home facilities: pharmaceutical companies "pushing" antipsychotic medications to be used on elderly nursing home residents with dementia. Often times, these types of medications are used as "chemical restraints" on nursing home residents. AARP's article is, quite frankly, startling.

The article cites Charlene Harrington, professor of nursing and sociology at the University of San Francisco, who says "as many as 1-in-5 patients in the nation's 15,500 nursing homes are given antipsychotic drugs that are not only unnecessary, but also extremely dangerous for older patients." 

The article also quotes Toby Edelman, an attorney for the Center for Medicare Advocacy, in Washington D.C., who calls the misuse of antipsychotic drugs "one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents." What does Mr. Edelman believe is the basic problem? Well, it's corporate greed, of course: "When nursing facilities divert funds from care of residents to corporate overhead and profits, the human toll is enormous."

What is perhaps most disturbing is that big pharmaceutical companies are essentially acting like high level drug pushers. For example, in November 2013, the United States Department of Justice settled one of the largest health care fraud cases in history against Johnson *& Johnson. The company paid $2.2 BILLION dollars to resolve criminal and civil charges. Johnson & Johnson's crimes: marketing antipsychotics to nursing homes, when the company knew they were not approved by the FDA as safe and effective for a general elderly population. Johnson & Johnson also allegedly paid kickbacks to doctors and other employees of Omnicare, the nation's largest long-term care pharmacy provider.

Part of my practice is defending those charged with crimes. I can tell you, if a client of mine did the things Johnson & Johnson was accused of doing, a fine would have been the least of the client's worries. My client would be looking at a long prison sentence, courtesy of the United States government!

Do you think you or a loved one in a nursing home is being wrongly given antipsychotic medications? If so, give us a call, maybe we can help.

How To Choose A Nursing Home...Use Your Eyes, Ears and Nose

A few weeks ago I wrote about a New York Times article by Katie Thomas, which addressed the problems with the Medicare 5-star rating system for nursing homes. Because I subscribe to the NYT, I am able to follow the reader's comments on this article, and I have. One "Letter to the Editor" of the NYT is, quite frankly, provides critical information for anyone looking for a nursing home or assisted living facility.

In his letter, Mr. Steven Raichilson, Executive Director fo the Menorah Park Center for Senior Living, located in Beachwood, Ohio, "nails" the factors anyone visiting a nursing home must see to decide if it is an appropriate place for a loved one. In short, you have to use your "eyes, ears and nose." 
Some examples Mr. Raichilson gives are spot-on: 
  • How does the facility smell? Is it free of urine odors?
  • How do the residents look? Are men shaved, is women’s hair brushed, are nails clean and residents dressed appropriately in regular clothes instead of pajamas?
  • How do the meals look? Are there wholesome portions, variety and thoughtful presentation?
  • What is the background noise in the nursing home? Is it TVs blaring and staff speaking loudly to residents, or are there meaningful activities going on with quiet, respectful and professional interaction between residents and staff?
When you're looking for a nursing home or assisted living facility placement, you cannot simply rely of literature and ratings systems. You MUST go to the facility, preferably several times at different times of the day, to help you decide. 
Choosing the right nursing home for you or a loved one is one of the most solemn things anyone can do. The place must not only provide the appropriate care, but must be as much like home as possible. Use ratings systems with a critical eye...but also visit the place. Use your senses...ithe time you take will certainly pay off in the end.

Prescription Drug Theft: Is Your Medicine Really ... Medicine?

A recent story in the Wall Street Journal might be of interest to you. In it, the Journal reports on the theft of nursing home resident's prescription drugs by a technician. The technician, Deborah Cleveland, worked at Heather Heights Assisted Living and Memory Care Facility, in Pittsford, New York. Apparently, she would steal resident's prescription meds and substitute "similar looking pills in their place."

If you or a loved one is in an assisted living or nursing home and takes prescription medication, you have to be on the lookout for this type of activity. If you don't feel like your medication is working like it should, talk to a physician and bring your medication bottle with you. Maybe the reason your medication isn't having the desired effect is because it's not actually your medicine at is something totally different because someone stole your pills and replaced them with something else.  

Elopement - It Just Doesn't Happen At Nursing Homes

My daughter Allie is a 20-year-old junior at Oregon State University. This summer, as she has the past two years, she is working as a counselor at a camp in McCall, Idaho. She shared a story of an occurrence at a recent "woman's camp," which should serve as a reminder to us all.

The camp was for adult women. One afternoon, some of the "campers" approached the staff and told them one of their members had wandered off and couldn't be found. They also told the camp staff the missing camper had mild dementia. Of course, the camp staff immediately acted and began an coordinated search of the camp grounds and road leading from the camp up to the main road. Fortunately, the wandering was quickly found and all was well.

This should serve as a reminder to all of those who are family members or companions of people suffering from dementia. You must always be aware of the potential for someone to wander away. You should always have a plan in place to search for the person if that happens. You should always inform those you are with of the potential for elopement so special precautions can be taken.

The incident at my daughter's camp turned out well. Unfortunately, that is not always the case. 

Medicare 5-Star Rating...Does It Mean Anything??

An excellent article by Katie Thomas in today's New York Times caught my attention. In the past, I've written about Medicare's 5-star rating system and how it can be a tool to help you select a nursing home. "Not so fast" says Ms. Thomas.

Ms. Thomas writes: "top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about the conditions at the homes." Ms. Thomas goes on to report: "The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify." In fact: "Only one of the three criteria used to determine the star-ratings -- the results of annual health inspections -- relies on assessments from independent reviewers. The other measures -- staff levels and quality statistics -- are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value."

Based on the NYT's analysis of data, Ms. Thomas states: "The Times analysis shows that even nursing homes with a history of poor care rate highly in the areas that rely on self-reported data. Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics. The same homes do not fare as well on the sole criterion that is based on an independent review. More than 95 percent of the homes on the watch list received one or two stars for the health inspection, which is conducted by state workers."

A system weighted so heavily in favor of unverified information provided by the facilities being graded is the textbook definition of "the wolf guarding the hen house." At the end of the day, as a person looking for a proper placement in a nursing home, you have do your research and not blindly rely on the Medicare ratings. Caveat Emptor. 

Where Have I Been?

I apologize for not getting important information about nursing home issues out in quite a while. Truth be told, I was involved in defending a client in a federal criminal case which took up virtually all of my available time. My client was charged with over 80 counts. The trial lasted 44 days and, at the end of it, my client was acquitted of 36 counts of conspiracy and wire fraud. Unfortunately, he was convicted of 44 counts of securities fraud. Last week, he was sentenced to a term of imprisonment of 36 months (3 years), far, far, below the sentence recommended by the United States Sentencing Commission's Sentencing Guidelines, which was 235 to 293 months (19.5 to 24.4 years). My fight on behalf of my client will continue in the appeal from his conviction.

Be that as it may, expect to see more regular postings in this space regarding issues of interest to my readers.

Elopement, Dementia and Winter - A Fatal Combination

A tragic story from Portland, Oregon, underlines the unspeakable consequences when a resident of an adult care home elopes from the facility. The resident, Mr. Koller, age 69, suffered from severe dementia.

According to the report, the care center's staff noticed he was missing and notified the authorities. Heartbreakingly, Mr. Koller was found dead in a backyard near the care facility. He was not dressed for the cold weather. 

From my perspective, there is critical information missing from the report. For example, what was the elapsed time from when staff last saw Mr. Koller and when they noticed he was missing? How long after the facility knew Mr. Koller was missing before someone contacted the authorities for outside assistance. Finally, what precautions did the facility have in place to prevent such a tragedy.

A close eye needs to be kept on people who suffer from severe dementia. Adequate precautions need to be taken to prevent elopement by these folks. A facility should have the staff and resources to ensure all residents, including those who suffer from severe dementia, are kept safe.

If adequate steps are not taken, a fatal tragedy can occur.  

Are You On The Hook For Footing Your Loved One's Nursing Home Bill?

A recent article in Forbes, Howard Glickman, discusses a decision from Pennsylvania where the court determined the son of a nursing home resident was responsible for the $93,000.00 nursing home bill. How can this be you ask? According to Mr. Glickman, Pennsylvania, along with some 29 other states have what are known as "filial responsibility statutes—laws that impose a duty on adult children to care for their indigent parents." Approximately two-thirds of the states having such laws "allow long-term care providers to sue family members to recover unpaid costs."

In Idaho,up until July 1, 2011, there was a law governing "reciprocal duties of support." This law stated it was the duty of a "child or children of any poor person who is unable to maintain himself or herself by work, to maintain such poor person to the extent of his or her ability." This law, however, was repealed. Does that mean a nursing home will not do all it can to recover its bill? Of course not.

Oftentimes, in the flurry of paperwork signed upon admission of a loved-one to a nursing home, the facility will have a financial responsibility document executed by a loved one. This is just one more reason documents provided by a nursing home or assisted living facility must be carefully reviewed prior to signing. You could be putting yourself and your assets on the hook for your parent's nursing home bill.

Memorial Day 2012 - Take A Moment To Remember And Thank A Veteran

Memorial Day was first observed in 1868, when flowers were placed on the graves of Union and Confederate soldiers at Arlington National Cemetery. Today, we continue to honor those who made the ultimate sacrifice for our country by placing flags...row upon row of veterans cemeteries around the country and, indeed, around the world.

Let us not, however, forget those veterans who are still living. There are three veterans homes in Idaho: Boise, Lewiston and Pocatello. This Memorial Day, take time to remember what the day is all about, go to one of these sacred places, and thank a veteran for all he or she has done for you, your children, your country and, indeed, the world.

These wonderful people would never think to ask for our thanks. It is, however, our duty to let them know how much they are appreciated. This Memorial Day, thank a veteran for all you have. Without them, I cannot begin to imagine what a different place the world would be.

Faking Resident Insulin Test Results Gets Nurses Fired in Minnesota

According to a report in the Devils Lake Journal, two nurses from a Duluth, Minnesota, nursing home have been fired for faking residents' blood sugar results. The Minnesota Department of Health and Welfare's investigation of this matter revealed the faked results were utilized to "give or deny insulin" to seven residents. Remarkably, neither nurse was criminally charged.

How did the investigation into this matter begin? A resident mentioned she did not recall having her blood sugar checked or receiving insulin the day before. This just goes to show you: as a nursing home resident or a resident's loved one, it is critical for you to voice your concerns regarding your care...or, lack thereof. Oftentimes, nursing home resident's concerns are "poo-pooed" by staff. Make sure your voice is heard and your concerns noted. If not, at least in Idaho, there are advocates for the resident. As I have previously written, Idaho 's community ombudsman program is there to help.

If you believe you or a loved one is not receiving the medical care prescribed by their doctor, be sure to speak up. If you do not receive the results you believe you are entitled to, you should contact an attorney who is familiar with the requirements of nursing homes and discuss the matter.