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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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Palm Beach County officials are considering tightening rules for home health aides in response to a growing industry that is only loosely regulated by the state and federal government.

While such positions are often assumed by relatives, there are also home health agencies whose workers are hired to run errands, oversee medication and prepare meals for those who wish to stay in their homes as opposed to a nursing home facility.

Nurses and nursing assistants who work in licensed nursing home facilities must adhere to certain training requirements, the same standards are not always extended to those who provide in-home care. Many home health agencies do complete background checks, but it’s not a mandated requirement, and, as some officials point out, this can create problems when employees have prior convictions for crimes of theft and violence.

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A number of recent reports indicate a growing number of nursing home staffers are working excessive amounts of overtime, leading to a greater potential for reduced care quality and possibly neglect and abuse.

In one case, a long-time nursing assistance in Pennsylvania clocked an average of 80 hours each week for a full year. Her routine jobs included feeding, dressing and bathing nursing home residents. One registered nurse in the same area worked the equivalent of 90 eight-hour overtime shifts over the course of two years. In a single nursing home, staffers clocked 125,000 hours of overtime over the course of two years.

Another report out of New York detailed how a single, county-run nursing home ran up a $745,300 bill for overtime in 2014, which represented a nearly 22 percent increase from just one year earlier.

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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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A 76-year-old woman who spent months languishing in a South Florida nursing home before being removed in 2003 died just weeks later. A jury later determined her to be the victim of continual neglect, having suffered numerous bed sores, malnutrition and a serious fall that resulted in a head injury.

Her survivors were awarded $110 million against two nursing home companies, ordered to pay $55 million each. Those firms are Trans Healthcare Inc. and Trans Health Management Inc.

However, her family has found it nearly impossible to collect on that verdict. In the last four years, the family has pressed forward through a complex maze of shell corporation transactions involving the firm that appear to have been designed specifically to mitigate such liabilities. Trans Healthcare’s liabilities were all funneled into a company called Fundamental Long Term Care Inc. The problem is, that firm is a shell. It has no assets.

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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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Inadequate staffing for seriously ill patients is alleged to have led to the deaths of at least three patients who received care at several nursing home facilities – one in Winter Haven and two in Lakeland – owned by the same firm, according to lawsuits filed recently.

The Lakeland Ledger reports the cases involve three patients who received care between August 2013 and March 2014. Their deaths, reported days or weeks after discharge, were reportedly connected to their stay at the facilities.

Each complaint alleges the parent company committed neglect by pushing its subsidiary nursing homes to admit more patients who were seriously ill. These individuals would require more care and thus the companies would be more handsomely reimbursed by the federal government. However, the facilities did not increase staffing levels in order to provide the heightened level of care these patients needed, and this led to patients receiving poor care, ultimately resulting in illness and death.

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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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