Articles Posted in nursing home negligence

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Nursing homes have come under fire in recent years for the widespread use of antipsychotic drugs among elderly patients with dementia, as many centers use the drugs to quell outbursts and aggression, while ignoring the many potentially serious health risks to the patient.

Now, there is cause for concern among elderly patients regarding another type of drug: Benzodiazepines. These medications are typically prescribed for insomnia or anxiety. However, new research reveals that while these medications are more widely prescribed than previously thought, they may pose particular danger for older patients. Specifically for those in nursing homes, they may contribute to falls and fractures and reduced cognition.

A recent study by the Journal American Medical Association Psychiatry, nearly 9 percent of Americans between the ages of 65 and 80 are prescribed at least one type of benzodiazepines. These sedative-hypnotic drugs can include Klonopin, Xanax, Valium or Ativan. For older women, the rate of prescription is 11 percent.

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It’s been well-documented that the state of nursing homes in the U.S. warrants improvement. However, a recent, multi-pronged analysis suggests the degree of care received by minorities is markedly below what their white counterparts receive.

The research, published by the Center for Public Integrity, noted some stark differences between nursing homes catering to majority white residents, versus mostly minority residents. For example:

  • Majority-white facilities had, on average, 60 percent higher rates of registered nurse care levels as compared to Latino-majority nursing homes and nearly 35 percent higher than facilities catering to majority black residents.
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Choosing a nursing home for a loved one can be a difficult and painful decision. For many, finding a facility with a good reputation and acceptable government inspection reports is critical.

Regulators tried to make the process easier, starting in December 2008 with its Nursing Home Compare website, which graded nursing homes across the country according to a set of criteria. Centers were rated on a scale of one-to-five stars, with one star being the lowest and five stars being the highest.

However, recent evaluations of the grading criteria showed it was actually far too easy for a center to obtain a top-quality rating, despite evidence of improper care practices. Namely, there is an increasing degree of scrutiny involving the rates at which nursing homes rely on dangerous antipsychotic drugs to subdue patients with dementia – a purpose for which those drugs aren’t approved.

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The majority of nursing homes in Florida receive the bulk of their funding from state and federal coffers. One of the ways regulators can ensure these facilities abide by basic care standards is to reduce or revoke Medicaid and/or Medicare reimbursements to providers who fail those standards.

This has historically proven a very effective tool.

Unfortunately, a recent case out of Florida indicates some troubled facilities may have an easy way out: Bankruptcy. Specifically, Chapter 11 bankruptcy, which allows for business reorganization.

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Recently, a unique case came before the Supreme Court in Connecticut regarding whether a private nursing home, which served both patients in state care and parolees from prison, would be shielded by the protections of sovereign immunity.

The case stemmed from a dispute between the owners of the private facility and the local municipality in which it operated. The city had tried to block the opening of the facility, but was unsuccessful when a superior court judge blocked the town’s request for injunction and further dismissed the lawsuit. The home started admitting patients in the spring of 2013, but the town filed an appeal directly with the state supreme court, bypassing the appellate court.

Nursing home administrators argued that because they were chosen to carry out certain functions mandated by the state (i.e., caring for state wards who are mentally ill as well as state prison parolees), the center should be immune from any local interference.

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There have been many success stories when it comes to use of antipsychotic drugs for those wrestling with serious mental disorders, such as schizophrenia or manic depression.

However, when those same medications are given to older patients diagnosed with Alzheimer’s disease or other various forms of dementia, the outcome can be fatal. In fact, the U.S. Food & Drug Administration has slapped these pharmaceuticals with a black box warning, noting the heightened risk of infections, heart failure and even death. And still, there are hundreds of thousands of nursing homes that continue to use them on elderly dementia patients.

Two years ago, the federal government initiated an effort to push these facilities to slash their use of antispychotic drugs for this purpose. In most places, the campaign has been relatively effective, with use dropping below 20 percent. However, new research indicates that when nursing homes ignore the potential health risks, there are few sanctions or consequence.

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Nursing homes across the country are watching closely the recent lawsuit filed by New Mexico Attorney General Gary King, who alleges inadequate staffing levels made it mathematically impossible to provide an appropriate level of care to elderly patients.

It’s an interesting strategy in that while there are some specific allegations of neglect, the primary source of contention is the failure to provide enough staff. The lawsuit is against for-profit nursing home chain Preferred Care Partners Management Group. The company is based in Texas, but operates dozens of nursing homes in in 10 states – including Florida. It is deemed the 10th-largest nursing home chain in the country. It has collected some $230 million from state and federal government coffers since 2008, and it houses roughly 1 million residents nationally.

Observers say if the New Mexico lawsuit is successful, other states may well follow suit. The lawsuit targets seven facilities operating within that state. The company runs the top four worst-performing nursing homes in that state, according to quality grading provided by the federal website Nursing Home Compare. Those facilities reported more than six times the average number of safety and health care violations as compared to other centers nationwide.

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Far too frequently, nursing home health care providers intentionally force elderly residents with dementia to consume hefty amounts of powerful antipsychotic drugs – most of which contain a black box warning indicating a heightened risk of infection and death.

According to a recent report by NPR, it’s estimated some 300,000 nursing home residents are currently receiving some level of antipsychotic medication, despite the fact these drugs are mainly used to treat serious mental illnesses, such as bipolar disorder and schizophrenia.

Health care providers in nursing home settings use the drugs to suppress anxiety or aggression in patients with dementia or Alzheimer’s disease – even knowing the grave risks associated with the drugs. It’s a form of chemical restraint, and it may be considered a form of negligence or even outright abuse in some cases.

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A number of publications – USA Today, the News-Leader in Virginia and others – have lately been giving great attention to a serious but often hidden problem in many health care settings: Drug addiction.

A USA Today review indicated on a national scale, more than 100,000 doctors, nurses, medical technicians and health care aides are abusing or are dependent on prescription drugs in any given year. Nursing home facilities are not immune to this crisis, and patient safety and well-being is placed at risk as a result.

In some cases, health care workers are stealing drugs. In other cases, their impairment leaves them unable to do the job properly. One nurse anesthetist who is now a recovering drug addict said she used drugs for years, often on-the-job and without detection by colleagues. She is not aware of any mistakes, but said, “I certainly would not say I was immune to that.”

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Additional confirmed cases of Hepatitis C have been linked to a nursing home in North Dakota that is currently the subject of a federal lawsuit alleging negligent care that led to exposure.

The new cases bring the total associated with this single nursing home to 47. This means the possible list of plaintiffs on the pending litigation, filed last year, could grow. The lawsuit started with two residents who say they contracted the disease as a result of poor care from facility staffers.

Hepatitis C is a contagious disease of the liver. Severity can range from mild to life-threatening and can be either acute or chronic. It is primarily spread through blood contact, according to the Centers for Disease Control and Prevention. In nursing home settings, staffers who aren’t careful when placing IVs or sterilizing needles or other equipment could pass the disease from one patient to another.

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