Good News: Use of Antipsychotic Medications Wanes?

As we just recently covered, as recently as 2012 the Centers for Medicare and Medicaid Services (CMS) began a nationwide effort to push nursing homes and long-term care facilities to decrease their usage of antipsychotic medications to sedate and restrain patients. The use of antipsychotic medications for this purpose has long been a problem because they are often used in situations when they are not truly needed. Nursing home staff will use these drugs to keep dementia patients calm, when in fact only patients suffering from actual psychosis – such as bipolar disorder or schizophrenia – should even be considered candidates to receive these types of medications.

As recently reported, the Food and Drug Administration (FDA) has mandated “black box” warnings for antipsychotic drugs. This type of warning is exactly as it sounds – it tells the person intending to take it of all the side effects and potentially dire consequences. For example, a black box warning on antipsychotic medications may read “increased mortality in elderly patients with dementia-related psychosis.” Such warnings imply that these drugs should only be used in the most extreme circumstances. In spite of the risks of infection or death, NPR reports that nearly 300,000 nursing home patients are given antipsychotic drugs. The use of such drugs in unnecessary situations is a form of chemical restraint of the patient, and can be grounds for charges or claims of patient abuse and neglect.

Nursing Home Fails to Maintain and Follow Status Codes

In the context of healthcare, hospitals commonly use a code status to indicate a patient’s condition, particularly during an incident or event. A code status also indicates what types of procedures or protocols can be used or followed to treat a patient depending on the type of event they are experiencing, such as a heart attack or a collapsed lung. This could include using electric shock paddles to get a heartbeat going again, possibly chest compressions for the same, injecting a certain drug to stimulate a part of the body, or possibly intubation to provide oxygen to the lungs.

The worst code status phrases that some may be aware of include “Do Not Intubate,” and “Do Not Resuscitate,” which likely means there is nothing more to be done for the patient. Those who have had experiences themselves or with loved ones in hospitals may unfortunately be familiar with these terms, as might fans of medical dramas on television. It is crucial that code status be well understood and carefully communicated, otherwise the wrong procedure could be performed and result in further injury, death, and the inevitable medical malpractice claim. Patients will also typically have the opportunity to convey what they want done in certain situations ahead of time, and unless they are incapacitated or unconscious, can change their minds at any point. For example, they may choose not to be resuscitated in certain scenarios.

Report Shows Problems Across State, Including Champaign County

The News-Gazette recently reported on an investigation conducted by the CU-CitizenAccess group in the Department of Journalism at the University of Illinois. This group researched and investigated 81 nursing homes across Illinois, and found that since early 2011 the Illinois Department of Public Health (IDPH) handed down fines totaling approximately $632,000 to 51 of those 81 nursing homes and facilities. As the article indicates, the homes studied are from different areas of the state (note in recent news and blog posts here that Lee, Whiteside, Ogle and Carroll Counties in particular had incidents with patients that led to substantial sanctions). And prior to this study, another investigation by the same group reported that, from 2006 to 2010, 93 nursing homes paid out over $1 million.

The continued problems to this date are notable because the state enacted reforms through the Illinois Nursing Home Safety Act in 2010. Nursing home owners and industry people cite a faulty rating system that does not accurately reflect the true level of overall care in nursing homes. On the flip side, however, and as we have examined previously, methods of evaluating nursing homes, such as Medicare’s five-star rating scale, have faced criticism largely because they rely on information and data self-reported by nursing home facilities. Naturally there is a conflict of interest here that was touched on in recent months in media reporting, since facilities may inherently be prone to over-report success and underreport failures in order to maintain high ratings. These ratings, which account for “staffing levels, inspection results and resident conditions” among other criteria, are published online on websites such as Medicare.gov. While 51 of the 81 homes in this particular study were fined in some way, 16 of these homes only received one star on the Medicare scale, and 18 facilities had two stars.

More on the Problems at Sauk Valley

We recently posted about the disappointing record attributed to nursing home facilities in Sauk Valley by a nursing home watchdog and advocacy group. In Dixon County, for example, a nursing home was cited after failing to properly observe a patient who required CPR, and no CPR was administered because of a disorganized and inaccurate file maintained on the patient that led aides to believe he should not be resuscitated. It was also found that the facility and others did not maintain up-to-date web pages as required by law.

The watchdog group, Families for Better Care, conducted a lengthy and in-depth investigation that yielded even more information than what we briefly touched on in a prior post. The majority of homes in the area were hit with at least one severe deficiency citation in approximately the last two years. Yet in multiple instances the homes’ fines were reduced in spite of the need for sanctions that could actually foment change in how they operate. The overall failures are disturbing in light of the fact that the nursing home industry is heavily regulated in the state of Illinois through both the Nursing Home Care Act as well as federal regulations tied to Medicare, Medicaid and any other federal programs. As reported, last year the state health agency employed 228 surveyors to investigate 4,575 complaints within Illinois.

Sauk Valley Nursing Homes Do Not Meet Standards

Illinois has had a fairly mixed record as a state when it comes to the quality of care at its nursing homes, and unfortunately ranks toward the bottom of the list closer to the likes of Texas and Oklahoma. Case in point, a recent report by an advocacy group has found that in one particular part of the state – Sauk Valley in Dixon County – has had a miserable record of nursing home success, or lack thereof. The specific watchdog group is based out of Florida and is called Families for Better Care.

Families for Better Care evaluates and rates nursing home performance in different states and generally advocates for improved quality of care for facility patients, better oversight of facilities, better laws, rules and regulations, and stiffer enforcement of those rules to ensure nursing homes and their staffs comply. Families for Better Care recently assessed that approximately a quarter of nursing homes in the state of Illinois have been found to have at least one deficiency in the last two years or so, and accordingly assigned Illinois an ‘F’ rating.

State Ombudsman Program In Place to Address Concerns and Problems

There have recently been disturbing reports about the severe deficiencies and failures at various Sauk Valley nursing homes, encompassing facilities in multiple counties (Lee County, Whiteside County, Ogle County, and Carroll County, as well as one facility in Bureau County). Sauk Valley facilities has approximately a 65% rate of severe deficiencies, while the state of Illinois, which is one of the worst in the nation for nursing home care, has about a 25% rate. And on top of the abuse and gross neglect that occur, or at least are alleged to occur at these facilities, those who run the building fail to even adhere to building codes and fire codes, which is even more disturbing.

The state has the Illinois Long-Term Care Ombudsman Program, which was implemented pursuant to both the Federal Older Americans Act as well as the Illinois Act on Aging. The purpose of the program is to “protect[] and promote[] the rights and quality of life for people who reside in long-term care facilities (nursing homes).” Ombudsman duties include “informing residents and their families of their rights; resolving complaints; providing information on residents needs/concerns to their families, facility staff and their community; and advocating for good individualized care.”

Elder-Against-Elder Abuse Draws Attention

Approximately a million and a half elderly Americans reside in nursing homes across the country. Unfortunately they sometimes encounter harsh abuse or unconscionable neglect at the hands of nursing home aides, nurses and other staffers, and this is often covered up or ignored by managers and administrators all in an effort to preserve the facility’s image to outside authorities and prospective customers.

What has been widely overlooked, however, is the threat posed by abuse between elderly residents at nursing homes. According to a Cornell-Weill Cornell Medical College study, as reported in the Cornell Chronicle, in 10 nursing home facilities in the state of New York, over the course of about one month, approximately 20% of the residents experienced at least some type of “aggressive encounter” by not a facility staffer, but another resident in the home. And much as abuse and neglect by nursing home staff can often be underreported and under-investigated, so is the abuse between residents themselves.

Rising Number of Falls and Dangerous Injuries Among the Elderly

For elderly adults who live on their own or in nursing homes and assisted-living facilities, falls can result in serious and life-threatening injuries. While falls are not the result of elder abuse, they can occur when there is a clear issue of nursing home neglect. A recent article in the New York Times emphasized that the number of reported falls among older adults—many of those accidents leading to serious and sometimes fatal injuries—is a number that is “soaring.”

Nursing Home Regulations file000289604980Aimed at Preventing Falls

How can nursing homes take steps to prevent dangerous falls? The New York Times article discusses the policies put in place recently by a retirement community which require that, during mealtimes, residents who use walkers to get around must have their walkers “valet parked” after they find a seat at the table. In addition, they are not permitted to use their walkers during the meal—they must stay in their seats while staff members serve them. While many residents of the facility argued that the policy “infringed on [one’s] freedom of movement,” it prevented a number of serious falls at the buffet.

What about at non-mealtimes, when nursing home and assisted-living facility residents might not be under such close monitoring? Many of these facilities are struggling to balance residents’ freedoms with the risk of a serious fall. In particular, most of the rulemakers at these facilities—in California and across the country—know that, when an elderly resident suffers an injury during a preventable fall, that resident may be able to file a claim for nursing home neglect.

Experts indicate that nursing homes throughout the U.S. are beginning the process of creating rules and regulations aimed specifically at preventing falls, given that the number of fall-related injuries have risen dramatically in recent years. For some facilities, this means trying to anticipate hazardous conditions, and hiring architects and designers who can outfit a facility in a way that is safer for elderly residents.

Structural and design changes can take the form of automatic floor lighting that helps to guide seniors from the bed to the restroom, for instance, or energy-absorbing floors that reduce the impact from a fall. For other facilities, changes take the form of rules like the one that prevents residents from using their walkers during mealtime.

Facts and Figures Concerning Elderly Falls

Based on figures from the Centers for Disease Control and Prevention (CDC), a shockingly high number of older adults sustain fatal injuries in fall-related accidents. In 2012, about 24,000 seniors died from injuries they sustained after a fall. That number has doubled over the last decade. And the numbers are even higher for emergency room visits linked to serious falls. In 2012, more than 2.4 million adults over the age of 65 received emergency room treatment for injuries connected to a preventable fall. That number shows a 50 percent increase from 2002.

Over the last ten years, more than 200,000 seniors have sustained fatal injuries in preventable falls. Indeed, falls are “the leading cause of injury-related death in that age group.”

If your parent or elderly loved one suffered a serious fall at a nursing home or assisted-living facility, you should contact an experienced San Diego elder abuse lawyer. You may be able to hold the facility liable.

Image Credit: gracey via morgueFile

See Related Blog Posts:

Higher Penalties for Assisted Living Facilities

The New Financial Side of Hospice Care

Mental Abuse Appears Prevalent Across Mental Health Facilities

Recently, The Chicago Tribune published multiple articles about the abuse of children in state facilities. If you or a loved one has suffered neglect or abuse in an Illinois facility please contact one of our experienced attorneys. Click here for a list of the types of claims Levin & Perconti handles. Our firm has successfully handled thousands of cases and recovered more than $520 million dollars for our clients.

Children with behavioral and mental issues have been sexually and physically abused at various Illinois facilities. One Chicago Tribune article highlights the abuse that occurs in some state facilities. The residential facilities that the article mentions are tasked with housing state-wards. Though these facilities are supposed to help residents, the article shows that many residents were instead hurt. Illinois residential facilities are often funded with Illinois taxpayers’ dollars. The article detailed the following types of abuse:

Physical / Sexual Abuse

According to DCFS records, the state Department of Children and Family Services received 428 reports alleging a ward was sexually assaulted or abused. A reporter from the Chicago Tribune interviewed several former residents of a particular facility. One young lady recounted memories of peers who were involved in prostitution. Many residents ran away and needed a place to stay while they were on the run. She detailed how some residents gave sexual favors to men in exchange for food or a place to stay. Other former residents recalled sexual abuse they experienced from other residents. Almost all of the former-residents spoke about customary beatings and physical abuse they endured while living at the facility. Many interviewees mentioned the poor treatment they received from the facilities’ staff. Employees of the residential facility often teased residents for being involved in prostitution. Some employees made statements such as, “’I heard you prostituting. You dirty.” Most of the interviewees stated they did not feel safe while living in the facility.

Neglect

The article mentioned various Illinois facilities that improperly handled resident complaints. For example, a worker at a facility in Addison, Illinois caught a 17-year-old boy allegedly sodomizing a 15-year-old boy. However, instead of immediately reporting the incident, the worker waited until the next day. Police reported that a group of residents later chased and beat that same 15-year-old boy outside of the facility. Allegedly, residents beat the boy after a member of the facilities’ staff suggested that residents “handle” the 15-year-old boy.

The Chicago Tribune reported various other accounts of abuse and neglect endured by children in Illinois residential facilities. If you, or someone you know, has been victimized in an Illinois residential facility contact one of our Chicago personal injury attorneys. We at Levin & Perconti have experience in all types of serious injury, medical malpractice, nursing home, and wrongful death litigation. If you would like to discuss a potential case, call us today at 312-332-2872 or toll-free at 877-374-1417 for a free consultation.

See Related Posts:

Part 1 – Protests Continue in the Fight to Shut Down Alden Village North

Part 2 – Protests Continue in the Fight to Shut Down Alden Village North

Mental Abuse Appears Prevalent Across Mental Facilities

Recently, The Chicago Tribune published multiple articles about the abuse of children in state facilities. If you or a loved one has suffered neglect or abuse in an Illinois facility please contact one of our experienced attorneys. Click here for a list of the types of claims Levin & Perconti handles. Our firm has successfully handled thousands of cases and recovered more than $520 million dollars for our clients.

Children with behavioral and mental issues have been sexually and physically abused at various Illinois facilities. One Chicago Tribune article highlights the abuse that occurs in some state facilities. The residential facilities that the article mentions are tasked with housing state-wards. Though these facilities are supposed to help residents, the article shows that many residents were instead hurt. Illinois residential facilities are often funded with Illinois taxpayers’ dollars. The article detailed the following types of abuse:

Physical / Sexual Abuse

According to DCFS records, the state Department of Children and Family Services received 428 reports alleging a ward was sexually assaulted or abused. A reporter from the Chicago Tribune interviewed several former residents of a particular facility. One young lady recounted memories of peers who were involved in prostitution. Many residents ran away and needed a place to stay while they were on the run. She detailed how some residents gave sexual favors to men in exchange for food or a place to stay. Other former residents recalled sexual abuse they experienced from other residents. Almost all of the former-residents spoke about customary beatings and physical abuse they endured while living at the facility. Many interviewees mentioned the poor treatment they received from the facilities’ staff. Employees of the residential facility often teased residents for being involved in prostitution. Some employees made statements such as, “’I heard you prostituting. You dirty.” Most of the interviewees stated they did not feel safe while living in the facility.

Neglect

The article mentioned various Illinois facilities that improperly handled resident complaints. For example, a worker at a facility in Addison, Illinois caught a 17-year-old boy allegedly sodomizing a 15-year-old boy. However, instead of immediately reporting the incident, the worker waited until the next day. Police reported that a group of residents later chased and beat that same 15-year-old boy outside of the facility. Allegedly, residents beat the boy after a member of the facilities’ staff suggested that residents “handle” the 15-year-old boy.

The Chicago Tribune reported various other accounts of abuse and neglect endured by children in Illinois residential facilities. If you, or someone you know, has been victimized in an Illinois residential facility contact one of our Chicago personal injury attorneys. We at Levin & Perconti have experience in all types of serious injury, medical malpractice, nursing home, and wrongful death litigation. If you would like to discuss a potential case, call us today at 312-332-2872 or toll-free at 877-374-1417 for a free consultation.

See Related Posts:

Part 1 – Protests Continue in the Fight to Shut Down Alden Village North

Part 2 – Protests Continue in the Fight to Shut Down Alden Village North