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

Let me get this straight: The California Department of Public Health performed investigations into the deaths of residents at the following facilities: Fountain View Subacute and Nursing Center in Los Angeles; Motion Picture and Television Hospital in Woodland Hills; and Downey Care Center in Downey. The Department found conditions at the facilities contributed to the deaths of three residents. So what did the Department do? It imposed fines on the facilities. FINES?!

According to an article in the Los Angeles Times, The resident at Fountain View: "The patient, who had a history of falls, was not properly supervised at the nursing home. When he was found on the floor, no one knew how long he had been there, according to the department." For this, the Department levied a fine of $75,000.00.

The Motion Picture and Television Hospital was fined $80,0000.00 when "a 90-year-old Alzheimer's patient who was in a wheelchair died a week after falling down a stairwell, according to a report. She had previously fallen down the same set of stairs."

Downey Care Center received a $75,000.00 fine for for "failing to monitor a patient's blood glucose level after she was released from a hospital in 2010. The woman died from a diabetic coma."

Each and every one of these deaths was preventable. Each and every one of the families of the residents were irreversibly and unnecessarily harmed by the facility's negligence. Each and every one of these families likely has grounds for a lawsuit against the facility.

In this era of personal accountability, I hope the fines imposed by the California Department of Public Health were just the beginning of holding the facility accountable for its negligence. Making sure nursing homes and assisted living facilities are accountable for their negligence in caring for their residents is what I do. I do it because I believe when a loved one's care is entrusted to a Nursing home or assisted living facility, they have a duty to make sure they do every reasonable thing to ensure no harm comes to that resident.

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In a recent New York Times "The New Old Age" post, author Paula Span broached the subject of drinking problems in assisted living facilities. Ms. Span references a study performed by a University of Pittsburgh "team" to determine whether there is, indeed, a problem. The short answer remains: No one really knows.

The "study" referenced by Ms. Span was conducted by interviewing "[m]ore than 800 aides working in assisted living facilities in Pennsylvania." Why weren't the actual residents interviewed? First, funding was insufficient to conduct such a study. Second, there's a little thing called denial! The specter of alcohol abuse in assisted living facilities is certainly raised in article, however. Consider these statistics:

• Nearly 70 percent of assisted living residents drank alcohol.
• More than a third drank daily.
• Twelve percent had abused alcohol (defined as drinking enough to cause “physical or psychosocial harm”) in the past three months.
• Almost 20 percent had experienced an apparent influence on their health from alcohol use in the past three months.

Ms. Span also points out the fact that, because so many assisted living facility residents are on medications, the interaction between alcohol and medicine is a real problem. Finally, the research reveals what we all know...as you age, you can no longer drink as much as you used to be able to drink without adverse affect.

As Ms. Span says: "So might the two or three beers with friends that caused no harm 30 years ago be contributing to your father’s falls now that he is in assisted living? Guess who has been elected to start that conversation." 

It is up to you! Check on your loved one. Just because an assisted living facility allows drinking, does not mean it is the right thing to do! On the other hand, it may not be as bad as you think!

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Although I am a lawyer, I do not typically write on "ins-and-outs" of nursing home or assisted facility law. Frankly, the laws can be complicated and do not typically lend themselves to a relatively "short" (for a lawyer, anyway) post on this site. I'm going to change it up a little today, though, because I think there is something you need to know.

Did you know that, unlike many other matters, in order to bring a lawsuit against a licensed nursing home or assisted living facility in the state of Idaho, you must first jump through a hoop? This hoop is known as a "Prelitigation Screening Panel."

As defined by Idaho law, and in the context of a claim against a license nursing facility, the prelitigation screening process generally can be described as follows:

• Any claim for "alleged negligence or wrongful death" against a "licensed nursing facility," must go through the process;
• A panel serves in the nature of a "special civil grand jury";
• The panel consists of 3 people: 1 person who is a licensed administrator of a nursing facility in the state of Idaho; 1 person who is an attorney, appointed by the commissioners of the Idaho State Bar; and a layperson selected by the two members listed above;
• The process is "informal" and, other than the panel's final decision, there are no records of the proceedings kept;
• The process is nonbinding;
• The process is compulsory, which means you cannot sue a licensed nursing facility for its wrongful acts unless and until you have gone through this process.

You might ask, if the process is nonbinding, what happens if I "loose" -- get an unfavorable result from the prelitigation screening panel -- to my case? Does that mean I cannot proceed? The answer is an emphatic "no." Because the process is nonbinding, you simply are required to go through it, whatever answer you receive from the panel, you can still choose to proceed with litigation against the licensed nursing facility.

Should you decide you would like to hold a nursing home or assisted living facility accountable for its wrongful acts, there are some steps you should take. First, contact an experienced nursing home abuse lawyer, like the lawyers at Kormanik Hallam & Sneed LLP. Second, remember, you need to go through the prelitigation screening process prior to filing a lawsuit against a licensed nursing facility.

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Imagine walking into a traditional nursing home for the first time. There is a reception area at the front door. Turn right and walk down a hallway - there are resident rooms on both sides. There is typically a nurse's station. in amongst the rooms. There may be medication carts in the hallway. There may even be food carts for those residents who cannot make it to the dining hall. Imagine walking into this traditional nursing for the first time...and being told: "This is your new home." Well, that ain't like any home I've ever lived in...it's a hospital...it's an institutional facility...it is definitely NOT a "home." 

In a article in yesterday's New York Times, Laurie Tarkin explains a relatively new movement in the nursing home industry - Green Houses. These "green houses" are not the kind you grow plants in. They are not even particularly "green" as in environmentally sound. Instead, the Green House theory of nursing home care places residents in real, honest-to-goodness (although slightly modified) homes on the property of the main facility. The article describes the Green Houses as:

• Front door opening into a large living and dining area;
• A hearth surrounded by upholstered chairs;
• A long communal dining table where meals are served;
• Kitchens that open to the dining table so caregivers can chat with residents while preparing meals;
• Private bedrooms and bathrooms;
• Front porch and back deck with tables and chairs.

Perhaps, more importantly, are the items not present in a Green House. There are no: corridors, nursing stations, medicine carts, trays of food delivered to residents in their rooms.

In this environment, staff actually gets to know their residents. They spend more time, on average, with their residents and, according to the article, are more able to build a personal bond with their residents.

There are approximately 117 of these Green Houses across the country. I wonder if there are any here in Idaho? I haven't heard of any such facilities here. If you know of one, I'd like to hear from you.

Imagine walking into a Craftsman-style bungalow. You walk up the porch and notice the rocking chairs. You walk in the front door and notice a hearth ablaze in a warming glow and your new housemate seated in a nice chair in front of it. You see a friendly staff member cooking your first meal in the kitchen. You drop your belongings off in your room and return to the main living room. Your loved one, maybe your son or daughter, reaches over to you and says: "This is your new home." You smile and say: "Yes it is." 

Will the Green House movement accelerate? Will it fall by the wayside as an expensive experiment? Who knows. Is the care received as good or better than that provided in a traditional nursing home? The studies referred to in the article seem to indicate it is.

If you or a loved one is in such a facility, I would love to hear from you about the experience. What are the pluses or minuses? I can't wait to hear from you!

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Did you know: Changing nursing home or assisted living facilities can be hazardous to a resident's health? That would certainly appear to be the case and now there is science to back that fact up.

A recent article in the Science Daily, describes the results of a study by the University of Pennsylvania School of Nursing. The study concerned nursing home residents who required evacuation from their facilities and who were relocated to another facility. Of course, because the residents were relocated, they received care from different people than they were otherwise used to.

"The displaced participants experienced delirium, cognitive changes, hospitalizations, and death." Although the study sample size was small-17 long-term care residents-its results are still worth noting. "The study, published in September 2011 issue, found that more than half the residents were negatively affected by evacuation and showed signs of delirium within the two weeks immediately following -- two participants were hospitalized and one died."

According to Pamela Cacchione, PhD, APRN, GNP, BC, the lead author of the study: "Older adults often have visual and hearing deficits, making it more difficult to interpret their environments and precipitating increased stress," which can also "exacerbate chronic illnesses, further precipitating delirium."

It would seem to me, no matter the reason for a nursing home resident's relocation--evacuation due to natural disaster or a simple change of facilities--the concerns would be the same. If the decision has been made to change facilities, make certain extra care is taken at the new facility so that your loved one is properly cared for during and following the oftentimes difficult transition.   

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A recent story by Matt Sedensky, addresses the use of antipsychotic medications in treating dementia in nursing home residents. The story begins with the story of Hazel Eng, a resident of the Ecumen home in North Branch, Minn. "Day after day, Hazel Eng sat on her couch, a blank stare on her face. The powerful antipsychotics she was taking often cloaked her in sedation. And when they didn't, the 89-year-old lashed out at her nursing home's aides with such anger and frequency her daughter wondered if her mother would be better off dead." When Ms. Eng was transferred to another section of the facility and was removed from her antipsychotic medications, there was a dramatic change. "She now beams as she ambles the hallways, reads the newspaper, tells stories and constantly laughs."

According to Mr. Sedensky: "Antipsychotics are meant primarily to help control hallucinations, delusions and other abnormal behavior in people suffering from schizophrenia and bipolar disorder, but they're also given to hundreds of thousands of elderly nursing home patients in the U.S. to pacify aggressive and paranoid behavior related to dementia."

The use of antipsychotic medications to treat dementia is an "off-label" use. According to a 2007 government audit, approximately 83% of Medicare claims for antipsychotic drugs were for purposes including the treatment of dementia.

So what, you might ask. Isn't it better to medicate a resident suffering from dementia so they do not harm themselves or others? The answer is an absolute and resounding: NO! Use of antipsychotic medicine to "treat" the symptoms of dementia creates its own set of issues. "The drugs can limit seniors' ability to effectively communicate, socialize or participate in everyday life."

Thankfully, according to the article, the off-label use of antipsychotic medications to treat dementia in the nursing home setting has decreased over the past decade.

If you have a loved one who suffers from dementia and is receiving antipsychotic medicine, you should speak with your physician. Make sure the medications are necessary and are being used correctly. If your loved one seems "out-of-it" during visits, it may very well be the result of the medications he or she is receiving. It is up to you to make sure each and every medication prescribed to a loved one is absolutely necessary.

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According to the Center for Disease Control's website, September 21 is World Alzheimer's Day. Here are some disturbing facts about Alzheimer's disease:

• It is currently estimated that approximately 2.6 million to 5.2 million Americans currently have Alzheimer's disease, depending upon the approach used for identifying individuals with dementia.
• If no cure is developed and present population trends continue, as many as 16 million individuals may have Alzheimer's disease by the year 2050.
• Alzheimer's disease ranks as the 6th leading cause of death among adults aged 18 years and older, and is the 5th leading cause of death for adults aged 65 years and older.
• For people with Alzheimer's disease and other dementias, the total payments for health care, long-term care, and hospice are projected to increase from $183 billion in 2011 to $1.1 trillion in 2050 (in 2011 U.S. dollars).

Indeed, Alzheimer's disease is "the most common form of dementia among older adults.

If you or someone you know has Alzheimer's, take a look at the CDC website. It has more interesting and informative information and links to other sources.

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I am a dog person. I love dogs. I believe they bring joy into our lives like few other things. That is why over the past 20 or so years, I have owned a dog. Pictured here is my dog Maggie May. As you can see, she is very patient with me.

When I first moved to Idaho, I was looking for some public service work I could perform. One of the services I became involved in was a "therapy dog" program at St. Luke's Regional Medical Center in downtown Boise. As a dog owner/lover, it seemed like a perfect fit, and it was. Now, my dog at the time, Sherwood, a yellow lab was not a therapy dog, although she possibly could have been. Instead, I would arrive at the hospital and take the therapy dog and its human around to different parts of the hospital to visit patients, both young and old. The interaction between the therapy dog and patient was something I will never forget.

A recent piece in the Los Angeles Times discussed the use of therapy dogs in "senior communities." According to the piece: "There is a growing body of medical research that shows how interacting with dogs (and other pets) improve seniors' emotional and physical well-being." After reading the piece, it got me thinking...why not have pet therapy in nursing homes in Idaho?

There are resources out there for just such services. One I stumbled upon, called "Idaho Paws for Effect" has a website. According to the website, the organization already apparently already visits several nursing homes in the Treasure Valley area. Another resource, "Heart to Heart: Pets With a Purpose, also apparently provides therapy dogs for long-term care facilities. (I am in no way affiliated with either of these organizations, nor am I stating they are the only resource out there.)

Does your nursing home or assisted living facility provide pet therapy? If not, and you are interested in having having a visit from a therapy dog, you should ask your facility to look into arranging for such a visit.

There are few things in the world that make you feel as good as just petting a dog. But, that view comes from a dog lover.

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I came across an interesting article by Paula Span in the New York Times about a couple's end-of-life decision and a New Mexico assisted living facility's reaction to it. Honestly, the title says it all: "Deciding to Die, Then Shown the Door. The story is about Armond and Dorothy Rudolph and their decision to voluntarily stop eating and drinking in order to legally hasten their death without drugs or violence. According to one source this act results in death in usually about two weeks.

The corporate owner of the facility, Fundamental Long Term Care, apparently upon the advice of legal counsel, called 911 and informed Armond and Dorothy they would be evicted. A physician came and spoke with the Rudolphs and determined they were more than capable of making the decision they did. At the end of the day, the Rudolphs were not evicted; instead, their family removed them from the facility and placed them in a private home where they died less than 2 weeks later, surrounded by family who loved them.

According to the article, what the Rudolphs chose to do is legal in every state under federal law.  The fact that it is legal, however, does not answer the question of whether an Idaho assisted living facility could evict a resident under the same circumstances.

Every resident of an assisted living facility in Idaho has certain rights; they are set forth in Idaho Code § 39-3316. Among these rights is: "The right to refuse medical services based on informed decision making." The Rudolphs presumably had similar rights. That did not stop the facility from trying to evict them.

You have rights as a resident of an assisted living facility. Make certain you exercise them. Remember, though, just because you have the right to make a decision, does not mean the facility will make it easy for you.

If you have questions about your rights, you should contact an attorney who is well versed and knowledgeable in this area of the law.

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In yesterday's Seattle Times, Michael J. Berens wrote an article entitled: "Senior-care Placement Companies Scramble For Cash." In the article, Mr. Berens does an excellent job of pitting two competing business models for elder-care placement against each other: One is a nationwide internet-based service; the other is a locally based provider. Although both providers charge facilities the same amount for their service -- one month's rent -- that is where the similarities end. The differences between the two are both stark and disconcerting.

The nationwide internet-based company, A Place For Mom, is allegedly the nation's largest senior placement firm. The company never meets face-to-face with any senior it is placing; instead all contact is either via telephone or internet. It sends mass facsimile transmissions to its list of approved homes which contain potential residents and urges the facility to call the potential resident. Although they supposedly visit each facility in which they attempt to make a placement, that does not always happen. In fact, according to the article, A Place For Mom placed a resident at a facility which had been cited for hiring caregivers with felony convictions that should have disqualified them from working with vulnerable adults; lying to state investigators and fabricating records; and failing to provide proper care for 32 days to an 88-year-old woman who died from untreated pressure sores. Only after this fact was brought to A Place For Mom's attention by Mr. Berens, did it remove the facility from its list of approved homes.

On the other end of the spectrum is Careful Placement Adult Home Agency, which is a "one-man show" run by Brandon O'Larey. Mr. O'Larey visits each home he places residents in. He visits all potential residents. According to the article, Mr. O'Larey even visits people after he places them to make sure they are doing well and to check up on them. Perhaps this is not the best "business" model; isn't it, however, a more comfortable and caring process?

The moral of the story: Be careful when it comes to placement agencies; they may not always have your best interests in mind. There is no substitute for your own research and site visits to make certain the place you or your loved one is going is all it needs to be. Do not become just another "number" to a placement agency.   

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I found a story in today's Tampa Bay Online (Florida) interesting, disturbing and, unfortunately, unsurprising. According to the article, Brian Lee, Florida's long term care ombudsman resigned after "butting heads" with Florida's new governor, Rick Scott. Mr. Lee indicated the "last straw" which lead to his forced resignation was a letter he sent out to Florida's nursing homes "directing them to submit information on their ownership, as permitted under the new federal health care legislation." This is a contentious issue because, according to critics of the nursing home industry, "facilities are often broken into multiple businesses to make lawsuits against them more difficult."

Florida's ombudsman program is funded, in part, by the federal government. Idaho's Commission's on Aging's ombudsman's program receives similar funding. The federal government is looking into Mr. Lee's situation; a representative of the federal government is quoted as stating: "We expect that Florida will make every effort to avoid even the appearance of a conflict of interest" in the appointment of a new ombudsman.

In Idaho, the Ombudsman is hired by the administrator of the Idaho commission on aging. Currently, Ms. Kim Toryanski is the administrator of the commission. Ms. Toryanski was appointed by the governor, and confirmed by the state senate.

Let's hope the Idaho ombudsman program is not politicized. The Ombudsman serves as a critical advocate for those who need it the most, residents of long-term care facilities and persons 60 years' or older living in the community.

Do you have questions about the Idaho ombudsman? Submit them to me and I will try to find answers and post them in the future on this blog.

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In a story in today's Orange County Register, Courtney Perkes writes about the death of a 93 year-old Donald Bodkin. Mr. Bodkin died of an undetected ruptured intestinal ulcer and infection. Courtney's story reveals the nursing home facility, Victoria Healthcare and Rehabilitation Center, "received the most severe penalty under (California) state law" - $75,000 for violations that led to Mr. Bodkin's death. Victoria Healthcare and Rehabilitation Center is a for-profit facility.

Mr. Bodkin was in the facility for a short time to recover from surgery for a broken hip. A few weeks into  his stay, Mr. Bodkin developed signs and symptoms that should have led staff at the facility to call his doctor:  a distended, painful abdomen, low urine output and loss of appetite. Incredibly, these symptoms were documented by staff. Also, an occupational therapist and Mr. Bodkin's own family told nursing home staff he was lethargic and in pain. Despite all of this information, no one with the facility contacted Mr. Bodkin's doctor. Five days after his first symptoms, Bodkin was found without a pulse. He died soon after at a hospital Sept. 13.

Victoria Healthcare and Rehabilitation Center is contesting the fine. The facility's argument: It does not believe anything it did contributed to Mr. Bodkin's death.

The fact of the matter is the staff at the facility had lots of information which should have been communicated to Mr. Bodkin's doctor. He suffered needlessly for 5 days after his symptoms were first reported. He died from a ruptured ulcer in the small intestine that led to a bloodstream infection.

The moral of the story: Even though nursing home staff have a responsibility to contact a resident's physician, they cannot always be counted on to do so. If you or a loved one is a nursing home resident and believe your physician should be contacted, be sure to hound the staff to do so. If they will not, take it upon yourself to contact the physician. It may very well save a life.

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In a recent post on his law firm's blog, my friend Randy Walton discussed a Washington Post story about younger nursing home residents and their needs. The WP story, by Matt Sedensky, reveals "about one in seven people now living in such facilities in the U.S. is under 65. But the growing phenomenon presents a host of challenges for nursing homes." In fact: :The number of under-65 nursing home residents has risen about 22 percent in the past eight years to about 203,000, according to an analysis of statistics from the Centers for Medicare and Medicaid Services."

Many of the "younger" nursing home residents have suffered some type of traumatic injury which rendered them unable to care for themselves. The injuries, be it a gunshot wound or a car wreck, may have resulted in paralysis or a traumatic brain injury. "For young people who find themselves newly disabled, the psychological and social needs are often even more challenging than their physical demands. That presents a challenge for nursing homes that are used to serving people near the ends of their lives."

Nursing homes and assisted living living facilities need to do a better job at caring for all segments of their populations.

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In a recent article in the Wall Street Journal, Katherine Hobson discusses a Center for Disease Control (CDC) survey of nursing home and hospice residents' files. Specifically, the CDC survey looked to how many residents had an "end of life care plan" or "advanced directive" on file at the time of discharge.

The CDC's numbers were not good:

• Overall, 28% of home health care patients, 65% of nursing home residents, and 88% of discharged hospice care patients had at least one advance directive (AD) on record.
• The most common types of ADs among home health care patients, nursing home residents, and discharged hospice care patients were living wills and do not resuscitate orders.
• Care recipients under age 65 years were less likely to have any AD than those aged 85 and over; black care recipients were less likely than white care recipients to have any AD in all three populations. These age and racial differences were larger in the home health care and nursing home populations than in the hospice care population.

Twenty years ago, Congress passed the Patient Self-Determination Act (PSDA) requiring most health care facilities to inform adult patients about their rights to execute an AD. I have previously written about the importance of "getting your affairs in order," which, in part, means having a living will or advanced directive. Don't be one of the 35% of nursing home residents or 72% of home health care patients without one.

It's important to make your wishes known in writing so that your loved ones will not be left to wonder what those wishes are. It is equally important to make sure your caregivers know what your wishes for end of life care are. Tell them! Make a living will or advanced directive today; don't wait another minute.

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In an article on the Oregonian's website, Julie Sullivan  laments the state of Oregon's Ombudsman's program. According to Ms. Sullivan, Oregon's ombudsman program has only one paid employee for every 6,692 long-term care facility beds. That is not good. Ms. Sullivan's article got me wondering how Idaho fairs in this arena.

One of the very first posts on this blog was about the Idaho Commission on Aging's Ombudsman program. If you recall, an Ombudsman is a person appointed by the Idaho Commission on Aging to investigate complaints concerning your care in either a Nursing Home or an Assisted Living Facility. The Ombudsman will insure your health, safety, welfare and rights are protected. You can contact the Ombudsman free of charge 24 hours a day, seven days a week.

According to the most recent survey available, the 2008 National Ombudsman Report, Idaho has one paid employee for every 1,054 long-term care facility beds. Although this is certainly better than Oregon, some changes apparently loom on the horizon for Idaho's Ombudsman's program. According to Ms. Sullivan, Oregon's Ombudsman's program is slated to loose two-thirds of its federal funding due to a scheduled change in the Medicare law. Idaho's Ombudsman program receives approximately 93.5% of its funding from the federal government. Given the state of the economy, it is highly unlikely any cut in federal funding will be replaced on a dollar-for-dollar basis by the state government. Idaho nursing home and assisted living facility residents may be in a much worse position in the coming year.

At the end of the day, making sure nursing home and assisted facility residents are safe is a full-time job. If you visit a family member, friend or loved-one at a facility, make sure their roommate or neighbor is doing alright. Unfortunately, an Ombudsman may not be around to do so.

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As I look back at the year that was 2010, and review my various postings, one in particular, sticks out today. Almost 1 year ago, on January 11, 2010, I wrote asking Idaho nursing homes to post their Medicare 5-star ratings. This one seemed particularly good given a story in today's Los Angeles Times.

The story, by Molly Hennessy-Fiske, talks about a one-of-a-kind law in California requiring all nursing home facilities to post their Medicare ratings. "The new law is intended to ensure that patients and their families are aware of the evaluations. Nursing home officials also must post information explaining the ratings" and how to obtain state licensing records. Facilities that fail to follow the law "face a range of potential fines." The article goes on to discuss some of the draw backs of the 5-star ratings system, from both a resident-advocate perspective as well as a facility perspective.

As I have discussed before, you have access to the Nursing Home Compare feature of Medicare's website. Shouldn't the facility you are looking at make its rating easier for you to find. How much effort would it take for an Idaho nursing home to proudly post its Medicare rating and information concerning how to obtain it state inspection records? Does Idaho really need a law to require this, or is it just good business?

Once again, I invite all Idaho nursing homes to post their Medicare ratings. If a facility does so, be sure to let me know so I can mention you in this forum. If you are visiting a nursing home, be sure to ask what their rating is and why it is not posted. As I recently heard in a commercial for Medicare: "Knowledge is power."

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In an interesting article in today's New York Times, Patrick Egan discusses his experience during a time when his father's assisted living facility decided the father needed an "upgrade" in service. Not surprisingly, the upgrade in service came with a somewhat hefty price tag - $12,000 per year. Mr. Egan sets out some good recommendations for dealing with such a situation:

(1) Be realistic - it is likely your loved one's condition will deteriorate. In fact, Mr. Egan quotes a shocking statistic: assisted living residents average just 28 months in that setting and, almost always, the resident's health deteriorates.

(2) Be proactive - the fact your loved one's health is declining should never come as a surprise. Because the admissions process is very emotional, it is a good idea to have a 3rd party present to ask questions and listen to what the facility's representative says.

(3) Be cautious - according to Ms. Oliensis-Torres, who runs a geriatric care management firm, Geriatric Support/Pathway Care, in Milwaukee, having an attorney review all admission documents and contracts prior to signing them is helpful.

(4) Be aware - you have limitations when it comes to "fighting" against an increase in level of care. If you disagree with the assessment, or just want to be certain it is in your loved one's best interests, you can engage the services of a "geriatric-care manager," who can review the records and make sure the increased level of care is appropriate. If you cannot afford to hire a geriatric-care manager, you can always contact your local ombudsman to discuss the matter with them.

(5) Be involved - you should attend the "care planning meetings" for your loved one. These meetings occur regularly. Go to the meetings; ask questions; be involved in your loved one's care.

(6) Be persistent - Mr. Egan was successful in convincing the facility his father did not require an increased level of care. He organized his thoughts and had a meeting with the administrator of the assisted living facility.

At the end of the day, the facility has a vested interest in offering the highest level of services it can justify. Because it will be paid based on the level of service, it is up to you to make sure the services are needed.

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I have previously written about "getting your affairs in order" in the form of a living will. A story by Jane Friedmann in yesterday's Minneapolis Star Tribune brought to mind an important topic concerning living wills or, as they are sometimes known, "advanced directives for health care." These are formal documents which tell your healthcare providers whether, or to what extent, you would like "heroic measures" such as CPR should your heart stop beating. Idaho Code §§ 39-4501 through -4515 govern these documents in Idaho and, in fact, the law sets forth the specific requirements of such a document.

Instead of boring you with a lot of "law," however, the story brought to light an issue of training and procedures for the Pine Medical Health Care Center. You see, a resident there did, in fact, have a valid living will. The problem was the staff could not locate the document when the resident's heart stopped beating. The nurse, instead of immediately starting CPR, "called her manager who told her where to find the documents and to start CPR." When the nurse who should have performed CPR on the resident was interviewed by the appropriate authorities, she apparently told them she "froze and was unable" to perform CPR even though that was the resident's wishes. Although the article does not state what happened to the resident; it can be safely presumed, however, a needless death occurred. The nurse faces "disqualification by the state and inclusion on an abuse registry."

It goes without saying, if a resident's living will is not placed in an obvious place, the delay in the staff locating it can lead to truly deadly consequences. Additionally, it would seem to me Pine Medical Health Care Center could have, and should have, developed a system to help staff readily identify whether its residents wish to have CPR performed or not. Finally, adequate training of facility staff would have resulted in an ability to properly perform CPR on the resident. Such a system and training could have prevented this needless catastrophe.

Does your facility have such procedures and training in place? You should check! If it does not, it could be your life that is needlessly lost.

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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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