First, the bad news: The researchers analyzed data submitted by nursing homes to the U.S. Centers for Medicare and Medicaid Services between 2006 and 2010. According to the analysis, the data showed “rising rates of pneumonia, urinary tract infections, viral hepatitis, septicemia (blood infection), wound infections and multiple drug-resistant bacterial infections such as methicillin-resistant Staphylococcus aureus (MRSA).”

Now, the “good” news: There are simple steps which, if taken, could easily reduce the chance of infection. One example, cut the use of uniary cathaters and, instead, have residents use the bathroom on a regular basis. Sounds simiple, right? Well, nursing home facilities would need to hire sufficient staff to make this happen.

A second, universally recognized, method of reducing infection rates is even more simple: hand washing! The article quotes  the study’s author Carolyn Herzig, of the Columbia University School of Nursing: “When you walk into a nursing home for the first time, you should easily spot hand sanitizer dispensers or hand-washing stations. If you don’t see this, it’s an indication that infection control and prevention may be lacking at the facility.”

At the end of the day, it is up to all of us to prevent infections in nursing home facilities. If you do not see hand sanitizer dispensers or hand-washing stations, say something!

In an article in The Hill: “Nursing homes are promising to reduce their use of antipsychotic medications on dementia patients 25 percent by 2016 and 30 percent by 2017.”  The questions are: (1) Is that “enough” of a reduction; and (2) With the amount of money involved, can we actually trust the nursing home industry to make the cuts?

The Hill article quotes Patrick Conway, chief medical officer with Medicare and Medicaid: “We know that many of the diagnoses in nursing home residents do not merit antipsychotics, but they were being used anyway.” If even one redident suffereing from dementia receives antipsychotic medication in an effort to control their behavior…that is too many. Shouldn’t the goal be “Zero tolerance”?

The amount of money made by Big Pharma in this area is staggering. My original post mentioned the $2.2 billion fine leveled by the federal government against Johnson & Johnson in 2013 for pushing antipsychotics to nursing homes to use on residents suffereing from dementia. Although not mentioned in my original post, this was not the first time Big Pharma had been fined. In fact, the AARP reports: “Back in 2009, Eli Lilly did the same thing with its antipsychotic Zyprexa, marketing to older people in nursing homes and assisted living facilities, federal prosecutors charged. In a settlement, the company agreed to pay $1.4 billion. At the time, Patrick Doyle, special agent in charge of the Office of Inspector General for the U.S. Department of Health and Human Services in Philadelphia, said: ”This case should serve as still another warning to all those who break the law in order to improve their profits.”

I may have a very jaded view, but here it is: There’s simply too much money to be made by Big Pharma for companies to give up this lucrative albeit illegal market. A $1.4 billion fine on a competitor wasn’t enough of a fine to prevent Johnson & Johnson from going down this path. Big Pharma is in the business of making money…the companies will do anything to improve their bottom line.

I do not expect this is the last you will hear from me about this issue.

Families for Better Care

Families “Nursing Home Report Card” uses data compiled by the Kaiser Family Foundation, performance measures utilized in Medicare and Medicaid’s Nursing Home Compare and the Office of State Long-Term Ombudsman complaint data. Basically, Families looks at lots of data and comes up with letter grades for the states. This link will take you to the page describing exactly how Families does its evaluation.

Let’s look at Idaho’s Report Card. In 2013, Idaho received an overall grade of “A” and was in the top ten states in the nation with a rank of 8th. In 2014, Idaho receives an overall grade of “B” and therefore is no longer in the top ten states, instead, Idaho now ranks 15th in the nation.

I think Families’ most disturbing findings are that “Severe deficiencies in Idaho nursing homes swelled 11 percent over the last year, pushing the number of potentially dangerous nursing homes to nearly one in every two” and “Verified ombudsman complaints increased 10 percent over the previous year, indicative of growing problems in nursing homes.”

What does this say about Idaho nursing home facilities? It says they are not as safe as they were. If you or a loved one is injured in an Idaho nursing home or assisted living facility, consider contacting the attorneys of Kormanik Hallam & Sneed LLP to discuss your potential options.

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.

RISKS OF BECOMING INFECTED WITH THE FLU VIRUS

According to the Centers for Disease Control and Prevention (CDC), although people 65 years old and older are least likely to become infected with the H1N1 Swine Flu virus, if such a person does get infected, they are at "high risk" to develop serious complications from the virus. Additionally, the CDC believes those 65 years and older are at "increased risk" for serious complications from the seasonal flu as well. As a nursing home or assisted living facility resident, how can you protect yourself? Simple, wash your hands and make sure all those who come in contact with you do the same.

PROPER HANDWASHING IS A SIMPLE AND EFFECTIVE PREVENTATIVE MEASURE

The CDC believes: "Handwashing is a simple thing and it is the best way to prevent infection and illness." Although handwashing seems like a simple process, which all of us have seemingly been doing since we were 2 years old, the CDC provides the following guidelines for effective and proper handwashing:

When washing hands with soap and water:

• Wet your hands with clean running water and apply soap. Use warm water if it is available.
• Rub hands together to make a lather and scrub all surfaces.
• Continue rubbing hands for 15-20 seconds. Need a timer? Imagine singing "Happy Birthday" twice through to a friend.
• Rinse hands well under running water.
• Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet.
• Always use soap and water if your hands are visibly dirty.
• If soap and clean water are not available, use an alcohol-based hand rub to clean your hands. Alcohol-based hand rubs significantly reduce the number of germs on skin and are fast-acting.

When using an alcohol-based hand sanitizer:

• Apply product to the palm of one hand.
• Rub hands together.
• Rub the product over all surfaces of hands and fingers until hands are dry. 

A simple and effective method of ensuring people wash their hands is to purchase a container of alcohol-based hand sanitizer and put it on a table in your room. Do not be shy about asking people to use it! It is up to you to make sure people who come into your room wash their hands.

Protect yourself from infection by making sure those who come in contact with you, whether they be staff caring for you or friends and family visiting you, wash their hands. The alternative, becoming infected with a contagious disease to save a few minutes of time just is not worth the risk. 

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.

The United States Department of Health and Human Services’ Medicare nursing home website is an excellent place to start your quest for knowledge. There, you will find a link called “Nursing Home Compare.” You can use this website to compare nursing home facilities in your area. You can also compare the quality of nursing homes you are considering. A “Nursing Home Checklist” is available if you are going to be visiting a facility.

In Idaho, you have additional choices for researching potential nursing homes. You can contact the Idaho Commission on Aging to help you in this most important decision. There you will find information about the Ombudsman program as well as a link to the Bureau of Facility Standards, where you can review results of surveys of long term care facilities in Idaho. A copy of the most recent survey results lists 84 facilities throughout Idaho. The survey includes complaints, violations discovered during inspections and a facility’s response to these things.

The "Nursing Home Checklist" is an excellent resource for when you go to various facilities to investigate which facility is the right one for you. For example, the beginning of the Checklist focuses you on whether the facility actually has the appropriate level of care you or your loved one requires. Remember, no matter how nice a facility or its staff is or appear to be, if the appropriate level of care (skilled nursing vs. custodial care) that facility is simply not the right one for you or your loved one. Choosing an inappropriate facility can lead to numerous problems, not the least of which is injury to you or your family member.

 In Idaho, if you are a resident of a nursing home or assisted living facility and believe a loved one is being abused or neglected, you have someplace to turn. The Idaho Commission on Aging  has an “Ombudsman” program to help you.

An Ombusman 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.

The Ombudsman is an excellent resource for residents of Idaho’s nursing homes and assisted living facilities. In fact, the Ombudsman’s primary job is to "advocate for resident’s rights and quality care." Because the Ombusdman is familiar with the duties a nursing home or assisted living facility owes to its residents, he or she can answer a variety of questions or accept ensure the investigation of resident complaints. If you have a question about the care you or a family member is receiving in an Idaho nursing home or assisted living facility, the Ombudsman should be your first call.