Nursing Home Abuse Advocate

Nursing Home Abuse Advocate

News and updates on issues concerning nursing homes and assisted living facilities

Pre-Litigation Screening – The First Step In The Legal Process

By John R Kormanik on Posted in Resident and Family Resources

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.

Green Houses – Putting The “Home” Back Into A Nursing Home

By John R Kormanik on Posted in Resident and Family Resources

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!

 

 

 

Relocating From A Nursing Home Facility Can Be Harmful To Nursing Home Residents

By John R Kormanik on Posted in Resident and Family Resources

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.   

Dementia And Antipsychotic Medications In Nursing Homes

By John R Kormanik on Posted in Resident and Family Resources

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.

September 21 – Today Is World Alzheimer’s Day

By John R Kormanik on Posted in Resident and Family Resources

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.

Therapy Dogs – Does Your Nursing Home Have Them?

By John R Kormanik on Posted in Resident and Family Resources

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.

Selecting The Right Nursing Home – Kick The Tires

By John R Kormanik on Posted in Choosing a Nursing Home

At one of my previous employers, we had a saying: "It is important to do some ‘ground-truthing’ before drawing any conclusions." Ground-truthing is, of course, going out into the field and seeing the place with your own eyes because you cannot take as gospel what you are told by others. A recent article from Reuters Money applies this principle to selecting a nursing home.

It is true: According to a GAO study, for-profit nursing homes "more frequent and serious deficiencies than non-profit homes." You need to "peek behind the curtain" and look behind the numbers when selecting an appropriate facility for you or a loved one.

In a previous post, I discussed the Medicare "Nursing Home Compare" website and the excellent information it provides. The NHC, however, should be a starting point for your research, not the "be-all-end-all" of it.

As suggested in my prior posts, and as reiterated by my colleague Jonathan Rosenfeld and others in the Reuters’ article, in-person visitation to a nursing home during the selection process is just as important as the "numbers." Go to various facilities. Go unannounced if you would like. Look around. Is the facility clean no matter what time of day or night you visit? Do the residents look neat and clean or disheveled? Do the residents seem happy or over-medicated? Visit at meal-time; try out the food.

Choosing the right nursing home is a big decision. Do not rely upon "numbers" alone. Do not simply take the recommendation of someone, whether they are a friend or not. You wouldn’t buy a car based on MPG and recommendations, would you? You need to "kick the tires" to make sure the car you are considering is the right one for you. You take it for a test drive. Shouldn’t you do the same when making the decision of which nursing home is right? The answer is undoubtedly: Yes!

Can An Assisted Living Facility Kick You Out Because Of Your End Of Life Wishes?

By John R Kormanik on Posted in Resident and Family Resources

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.

More Evidence Nursing Homes Do Not Pay Staff Enough – Homes Want Exemption From Health Care Law’s Requirements

By John R Kormanik on Posted in Health Care Reform

In an article in today’s New York Times, Robert Pear describes the efforts the nursing home industry is undertaking to escape from the requirements of the new Affordable Care Act. The first sentence in Mr. Pear’s article says it all: "It is an oddity of American health care: Many nursing homes and home care agencies do not provide health insurance to their workers, or they pay wages so low that employees cannot afford the coverage that is offered."

Why is it important that nursing home workers have access to affordable health care? According to Ms. Charlene A. Harrington, a professor at the School of Nursing at the University of California, San Francisco: "If employees have health insurance, they are more likely to be treated for illnesses, less likely to pass on infections to nursing home residents and more likely to get early treatment for occupational injuries.” Unfortunately: "Among workers who provide hands-on care to nursing home residents, one in four has no health insurance."

Shouldn’t the people responsible for caring for nursing home residents be paid a living wage and, thus, be able to afford health insurance? Shouldn’t these same people have access to affordable healthcare? Aren’t nursing home residents safer if staff can afford to see a physician when they are ill or injured? The answer to all of these questions is: "Yes."

If you think nursing homes should have to abide by the new Affordable Health Care Act by offering staff affordable health care beginning in 2014, as the law requires, do not remain silent. Contact your congressperson. Let them know your thoughts. Nursing home residents would be safer if all staff had access to affordable healthcare.

Elderly For Sale: Placement Services Run The Gamut In Quality And Approach To Placing Seniors

By John R Kormanik on Posted in Resident and Family Resources

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.