Nursing Home Abuse Advocate : Idaho Nursing Home Abuse Lawyers & Attorneys : Kormanik Hallam & Sneed Law Firm : ID Assisted Living Neglect, Nursing Home Injuries : Boise, Nampa, Caldwell

Hey, it's just money...right? A story in today's Bonner County Daily Bee caught my attention and got my hackles up. Apparently, Elise Anne Davidson, of Spirit Lake, Idaho, has received no more than a "slap on the wrist" for her financial exploitation of an elderly man. You see, Ms. Davidson used a financial power of attorney to steal more than $4,000.00 from the victim while he was convalescing in a nursing home. She also apparently attempted to have the victim removed from the nursing home and placed in her care. The victim, who is unidentified in the story, was confined to a wheelchair and incapable of writing or speaking. Rightfully, Ms. Davidson was originally charged with a felony -- exploitation of a vulnerable adult. Unfortunately, through a plea agreement, she pled guilty to misdemeanor theft and was sentenced to 30 days in jail. She was also ordered to pay the nursing home $1,000.00 in funds which the facility was owed.

When you look at it, I suppose it is easy to say that stealing $4,000.00 should not equate with a stiffer sentence than Ms. Davidson received. This is not about the money, however. This is about the exploitation of the vulnerable adult who was the victim in this case. What price can be placed on the betrayal of trust? Recall, I recently wrote about some prosecutors who are using "hate crime" laws to obtain stiffer sentences against those who financially exploit the elderly. Perhaps the prosecutors in Northern Idaho can take a hard look at how they deal with those who take advantage of the elderly and infirm.

It's not "just money." Financial exploitation of vulnerable adults in general, and the elderly in particular, is about much, much more. Only when the perpetrators of such crimes are punished with stiff felony sentences will the message be properly sent. 

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Pressure Sores are a problem in Idaho nursing home facilities. In Fiscal Year 2009, the latest data available, a staggering 33 citations, or 40.5% of skilled nursing facilities, were cited by the Idaho Department of Health and Welfare for failing to properly care for their residents in such a manner as to prevent or heal pressure sores.

What is a "pressure sore" and why is this statistic important, you may ask. According to the website "Bed Sore FAQs," a "pressure sore" also known more commonly as a "bed sore" is a condition where a resident's skin is damaged from sustained pressure which stops the flow of blood. Remarkably, according to this website, this condition can develop from being in a single position for a few hours. One simply way to prevent pressure or bed sores is to simply turn the resident at frequent and regular intervals.

Jonathan Rosenfeld and David Terry, attorneys in the Chicago, Illinois area, are currently involved in an exchange of ideas concerning bed sores and their prevention. Jonathan's blog - Nursing Homes Abuse Blog, and David's blog - Nursing Home Abuse Lawyer Blog contain their thoughts. Their posts have been, and I expect will continue to be, an excellent resource for those interested in this important issue.

The fact remains, however, pressure or bed sores are preventable and are an unnecessary injury sustained by nursing home residents.  If you are a resident who cannot move on your own, make sure the facility is providing you adequate care by turning you on a regular basis. If you have a loved one who is a resident of a nursing home, contact the facility and do the same. It is up to you to make sure nursing home facilities do all that is necessary to keep residents safe. 

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 A recently published study by the University of South Florida, the authors confirmed what many of us probably presumed was true: Quality of care substantially improved following the Florida legislature's enactment of requirements for increased nursing staff levels and other quality care measures. 

According to the study, beginning in 1999, "Florida began developing a national reputation for State policy focused on nursing home quality" by instituting "regular, unannounced quality-of-care monitoring by state officials, release of information about all state licensed nursing homes via a public Internet site, development of a 'Gold Seal Program' to recognize facilities with outstanding care, and funding of a pilot teaching nursing home project to promote statewide development of best practices." Building on that legislation, in 2001, Florida enacted further legislation which mandated staffing levels, increased regulatory oversight and initiated a moratorium on new nursing home beds. According to the authors of the Florida study: "One consistent finding is that higher Registered Nurses (RN) levels are associated with lower number of falls, fewer pressure ulcers, and other patient care outcomes that indicate better quality of care."

Unfortunately, Idaho has not seen fit to follow Florida's lead. In Idaho, there is a requirement for a certain number of "nursing hours per day" depending on the size of the facility. There is, however, no requirement for additional nursing staff based on resident acuity. Instead, Idaho only requires staffing sufficient to "meet the total needs of the patients/residents." 

As shown in Florida, mandatory staffing levels and other mechanisms make a real difference to the health and well being of nursing home residents. Come on, Idaho! Don't some of our most vulnerable citizens, those who can no longer care for themselves and are relying upon nursing homes for their care deserve better?

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In a recent Los Angeles Times' "Booster Shots" article, Shari Roan writes briefly about a study of nursing home resident's sleep patterns and habits. The study, published in the Journal of American Geriatrics Society, and conducted by UCLA and the VA Greater Los Angeles Healthcare System, looked at 121 "older adults," 65 and older, living in assisted living facilities. According to the Ms. Roan, the study found: "the residents slept about six hours per night and about 1.5 hours during the day. The most common sleep problems included walking in the middle of the night or early morning or the inability to fall asleep within 30 minutes. Not surprisingly, the study also found "declining function status and quality of life and greater depression over 6 months of follow-up." That meant those residents who slept poorly required more help with their "activities of daily living," such as bathing, dressing and grooming. Unfortunately, the study does not get to the cause of the sleeplessness. Obviously, this is an important issue. What can be done?

Two of the causes of sleeplessness in older adults in general and, likely, residents of assisted living facilities in particular, may be chronic pain and medications. Both of these causes can be addressed and, in all likelihood, fixed. The first step is, of course, recognizing the "problem" exists. The next step is to get the "team" -- that is, the doctor, staff and family -- involved in finding the solution. If chronic pain is the culprit, your doctor and, and should, be able to help. In terms of current medications causing sleeplessness, perhaps the dosage of medication can be adjusted or or the medicine changed all together.

No matter what the cause, the problem of sleeplessness of assisted living facility residents must be recognized, properly diagnosed and addressed. If not, the effects are long-lasting and serious.

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I came across an article on CNBC today concerning an unlicensed hospice facility in Twin Falls, Idaho. Apparently, an unlicensed woman is accused of operating an unlicensed healthcare and hospice facility. The charges are misdemeanors and the defendant has moved to dismiss all charges.

Whether the charges are dismissed or not, this news shines a light on a topic which needs to be addressed, that is, verifying the status of any nursing home or assisted living facility's license. This verification can take place while you are searching for an appropriate facility or, even, periodically after you or a loved one has become a resident.

The Idaho Department of Health and Welfare's website contains several links through which you can check on the license status of a nursing home or assisted living facility. For example, the State of Idaho licenses "Residential Care and Assisted Living Facilities." These facilities are facilities or residences, however named, operated either on a profit or nonprofit basis for the purpose of providing necessary supervision, personal assistance, meals and lodging to three or more adults not related to the owner. The IDHW gives you two ways to confirm a nursing home or assisted living facility is licensed: either alphabetically or by region of the state.

Of course, facilities which receive Medicare funding are both licensed by the State of Idaho and certified by the Federal Government. Such facilities include "Long Term Care/Skilled Nursing Facilities, which are designed and function to meet the health needs of two or more elderly or disabled individuals who, at a minimum, require inpatient care, and services, for twenty-four or more consecutive hours. By using the Medicare Compare website, you can ensure any facility which accepts Medicare residents is properly licensed.

Please check the licensing status of the facility you are considering or in which you or a loved one is a resident. Licensing serves to provide nursing home and assisted living facility residents with a modicum of protection. You should not trust your care in a time of need to an unlicensed facility.

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Let's face it: No one wants to think about the end of their life. Because of this, many of us do not have end of life plans to ensure our affairs are in order. Making sure your wishes are followed as your life nears its end is important; after all, they are your wishes!

Melissa Healy, in a recent Los Angeles Times "booster shots" blog, tackled the difficult subject of "getting your affairs in order."  The post links to a Guide Book for those with a serious illness to help get their affairs in order. The guide book was published by the American Bar Association Commission on Law and Aging for the National Hospice and Palliative Care Organization. Although Ms. Healy's entry is based upon receiving bad news from a health care provider, it contains good information for all of us to consider as the new year approaches.

The Guide Book discusses, in fairly good detail, step-by-step instructions on the following areas: 

• Planning how you will pay for the healthcare you need;
• Making a plan for the management of your health and personal decisions during your illness;
• Making a plan for the management of your money and property;
• Planning for the care of dependents;Knowing your rights as a patient;
• Knowing your rights as an employee; and
• Getting your legal documents in order.

Although all of these areas are important, for nursing home residents, perhaps the most important area is that of making a plan for the management of your health and personal decisions. If you cannot make your wishes known, you want to make certain they have been previously documented or someone who knows your wishes is legally able to make them known for you.

In Idaho, there is a specific law governing "living wills and durable powers of attorney for health care." This is just the document to make sure your desires are known and a the appropriate person is able to legally make decisions about your health care when you cannot. Such decisions include, for example, the level of care desired, including whether a "do not resuscitate" or "DNR" is properly carried out.

End of life decisions are difficult things to think about, let alone put on paper. Carefully considering the care you wish to receive, with input from, among others, family, friends, medical care providers and, perhaps, clergy, is critical. If you do not plan, and put your wishes to paper in a legally enforceable document, your wishes may not be followed. That would be a tragedy.

Take the turning of the year to decide what you want concerning your health care. Make a plan and make your wishes known. There is no better time to do so.

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The Idaho Department of Health and Welfare, Bureau of Facility Standards is the state agency that conducts "surveys" of Idaho's nursing homes to make sure they are in compliance with all applicable federal and state regulations. It may surprise you that in the most recent survey available, for the period of January through June 2009, there were seven (7) citations issued for facilities who hired staff "guilty of abuse." Although this may not seem like a large number of citations, remember two things: (1) This survey was for a six month period; and (2) There were only 64 surveys conducted.

What drives facilities to make such an egregious and potentially harmful hiring decision? First and foremost, facilities often do not conduct appropriate and thorough background checks on applicants. Second, many facilities do not pay for quality staff and, thus, they "scrape the bottom of the barrel" of the employee pool. Third, some facilities simply need to "fill the void" when existing staff leave and may believe that some staff is better than no staff. Of course, none of these "excuses" for hiring staff "guilty of abuse" are "reasons" for substandard hiring practices.

Before choosing a nursing home, make sure you ask the appropriate administrator what type of background checks are conducted on potential employment candidates. Also ask if the facility has received any citations from the Idaho Department of Health and Welfare's Bureau of Facility Standards. If the facility has received any citations, ask to see them and what the facility did to correct its conduct.

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In a prior post, I wrote about the Ombudsman for the Idaho Commision on Aging and his or her duty concerning the care of nursing home residents. If you are concerned about nursing home care, you can also lodge a complaint with the Idaho Department of Health and Welfare (IDHW). Indeed, the IDHW encourages the filing of appropriate complaints: "The opportunity to lodge a complaint provides the public with a mechanism to notify the Bureau of Facility Standards (i.e. State Survey Agency) of a health care providers failure to provide appropriate care within the framework required by regulations."

If you wish to file a complaint, you should contact the Bureau of Facility Standards at (208) 334-6626, or, in writing at: Bureau of Facility Standards, PO Box 83720, Boise ID 83720-0036. If you file a complaint, you should be prepared to provide the following information:

• Provider/Facility Name and City
• Name of Patient/Resident
• Detailed Statement of Care Provided And Any Negative Outcomes
• Names of Witnesses
• Your Name and Contact Information; unless you wish to remain anonymous.

After a complaint is filed, it will be investigated by Bureau of Facility Standards' staff in a confidential manner. If you would like to know the result of any complaint against a facility, you need to request the results through a public records request to the Idaho Department of Health and Welfare.

Although notification of the staff of a facility is one way to ensure your concerns are heard, you should also file a formal complaint with the Bureau of Facility Standards. Such a complaint will ensure your concerns are taken seriously and investigated appropriately.

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In a recent New York Times blog entitled "Easing Tensions In The Nursing Home," author Paula Span addresses the important issue of tension between family members and nursing home staff. As you can imagine, most, if not all, of the issues contributing to this tension is a family's belief their loved one is not being cared for in an appropriate manner against the staff's belief to the contrary.

According to Ms. Span, the tension between family and staff leaves the family concerned that, if they voice their concerns, their family member will suffer because unhappy staff will, in some way, retaliate against the resident for the complaints of the family. To avoid, or at least lessen, the chance for tension between family and staff, Ms. Span provides the suggestions of Karl Pillemer, a gerontologist at Cornell University, and the sociologist J. Jill Suitor of Purdue University:

• Take complaints and requests to the right place. While aides do most of the hands-on care in nursing homes: “They’re almost never the ones who are making decisions about it. You’ve got to go high enough up the chain to make sure the person you talk to has the ability to influence what goes on.” The staff social worker is a starting point.
• When a problem involves an aide’s duties, practice “clear and respectful communication.” “Avoid blaming the other person. As people get angry, there’s a tendency to insult the other party, and it escalates.” A demand or reproach — “How come nobody’s shaved my father?” — puts overworked staffers on the defensive. Try phrasing it this way: “I noticed my father isn’t shaved. This is very important to him. How can we make sure he’s shaved every day?” After the conversation, summarize to clarify the agreement you have reached: “I understand that you were short-staffed today. But he will be shaved every morning — is that what you’re saying?”
• Keep visiting, and monitoring. “The amount of visiting people receive is directly related to the quality of care. Families do need to advocate for their relatives, but they need to do it in the right way.”
• Give positive feedback as often as possible.

In a previous blog post, entitled "The Ombudsman for the Idaho Commission on Aging is on the Side of Idaho Nursing Home Residents," I addressed the role of the Idaho Ombudsman for long term care in addressing concerns regarding teh care of nursing home and assisted living facility residents. Regardless of the involvement of the Ombudsman, it is important you, as a loving and caring family member, are able to effectively communicate your concerns with the proper individual at the facility so your family member does receive the proper care. As Ms. Span and Mr. Pillemer suggest, perhaps the most important contact at any nursing home or assisted living facility is the social worker or, if none is available, the director of the facility.

I suggest not only approaching the appropriate individual with your comment or concern, but also following up with that person in writing. A written summary of your concerns, the discussion which you had with the appropriate upper-level employee and the outcome or change in care you expect are all good things to write down. This way, if the concern is not addressed, you can again voice it or contact the Ombudsman. If the concern is addressed, you will be able to follow up with a "thank you" to the staff of the facility caring for your family member or loved one.

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