RI legislators want to kick come butt when it comes to keeping nursing home residents healthy. They need to understand more staff are needed in order to prevent skin breakdown. Anyone can write rules and laws and all, but it will take the hearts and hands of good CNA’s to make it all better.

PROVIDENCE — Germine Morsilli was neglected in life at a nursing home that federal prosecutors now call “a fraud from the start.”
In death, she has gotten attention from a special state government task force, the auditor general and now the General Assembly, which announced a package of five bills Thursday designed to increase government oversight of both patient care and fiscal practices at the state’s nursing homes and assisted living facilities.

The death last year of Morsilli, the 87-year-old former resident of Hillside Nursing Home in Providence, helped shine a spotlight on some of the state’s poorly operated nursing homes.

House Majority Leader Gordon Fox, said of Morsilli, “How does someone in this century die of bedsores?” Such a circumstance, he said, “won’t ever be repeated if we have anything to say about it with this package of legislation.”

One of the bills in the package, dubbed the Germaine Morsilli Act, is based on legislation of the same name proposed earlier this year by Lt. Gov. Charles Fogarty and is meant to tighten regulations on the quality of care of nursing home residents.

It defines the responsibilities of nursing home administrators and medical directors as it applies to oversight of the quality of patient care and mandates that nursing homes and assisted living facilities report staffing levels to state regulators annually. It also requires the health department to develop a means to determine and even predict which homes are in need of intervention because of quality care problems.

“It is the role of the health department to protect Rhode Island residents, not to protect failed nursing homes,” said Senate Majority Leader Teresa Paiva Weed.

“One pervasive issue that we found was that the standards are in place, but they’re not being enforced and there aren’t enough inspections or follow-up visits. One of the major focuses of the legislation is making sure the state is actually checking in on nursing homes — both in resident care and in fiscal soundness,” said Providence Rep. Steven M. Costantino, who co-chairs the Permanent Joint Committee on Health Care Oversight that spent the better part of a year studying various issues concerning nursing homes. “We are proposing a more effective use of resources at the Department of Health, focusing on nursing homes in which there is an indication of trouble.”

This article gives a sad voice to a common thing thay happens. Elderly and disabled people often feel they have no options, they don’t want to become a burden to anyone…and they think things could be worse. When they are being abused and/or neglected, they live in a constant state of fear. It is the job of every CNA to keep a keen eye out for this, and to help those we care for speak up. The abuse and neglect often happen in the homes of the victims, and CNA’s may be involved with home care.

DES MOINES (AP) — The elderly are often afraid to report abuse out of fear of being placed in a nursing home, victims’ advocates say.

Advocates say the elderly also may be afraid of their attackers or too proud to admit they can’t defend themselves.

“It’s amazing how those things have such an immense control over these victims,” says John Judisch, a Polk County prosecutor who specializes in adult abuse and neglect cases. “It creates a huge barrier between them and help.”

For Jasper Doroty, 79, of Des Moines, the abuse left him just plain angry.

Jasper said his granddaughter and her husband moved in with him and his wife, low on money and looking for a place to stay.

It wasn’t long, Doroty said, before his grandson-in-law started stealing from them. It started with tools and a coin collection. Then it was a checkbook and money, he said.

“If me and the wife went somewhere, he’d ransack the place. He even cut the copper off the pipes of my furnace. Anything to get a nickel out of me,” says Doroty, who pays the bills with his Social Security check.

Doroty said he couldn’t get the couple to leave, saying the suggestion evoked intimidating confrontations.

“He’d back me into a corner and say he’d make minced meat out of me,” Doroty says. “One day, I just had enough.”

Doroty mustered his resolve and called the Polk County attorney’s office, which sought and received earlier this year a court order forcing his unwanted tenant to leave.

Judisch said cases such as Doroty’s are unusual. Too often, authorities only learn of a problem after there has been violence.

Doroty’s is just one example of abuse. There are others that involve extreme neglect.

In 2000, Blossom Deering, 68, of Des Moines, was left to lay in her own waste for weeks, too weak to move.

When her live-in caregiver, who prosecutors say neglected Deering, finally called for help, paramedics had to wear oxygen tanks and masks to breathe through the stench and pry Deering from the floor.

Deering died days later of septic shock.

Her caregiver, Richard Smith Jr., pleaded guilty of dependent adult abuse and neglect, and was sentenced to 15 years in prison.

The National Center on Elder Abuse says it’s difficult to place numbers on the problem. It estimates that as many as 80 percent of cases are hidden.

Prosecutors hardly worried about such abuse a decade ago, but since the Deering case, Polk County has created a prevention task force.

A Polk County prosecutor started specializing in adult abuse cases and police detectives have received special training.

At any one time, Polk County prosecutors have about 20 active criminal cases with charges filed; another 20 to 25 are under investigation.

In all, prosecutors will act on about 200 cases this year, said Polk County Attorney John Sarcone.

“And we’ve only hit the tip of the iceberg,” he said.

Adult abuse isn’t just about seniors. Disabled people who rely on a caregivers also suffer abuse and neglect.

Natalie Davidson, a quadriplegic born with cerebral palsy, uses a wheelchair and can’t feed, bathe or dress herself.

When Davidson, of Johnston, started college two years ago at Drake University, her parents hired a woman to live with her in her dormitory. The arrangement fell apart before the first semester was over.

The caregiver ignored her for days at a time, failed to bathe Davidson for a whole week, didn’t feed or help her to the bathroom for entire days.

Davidson, now 21, said she didn’t complain at first because it’s difficult to find someone to take the job.

“It’s like you take what you can get, and try to be happy with it,” she said. “I’m at their mercy.”

Friends and teachers eventually told Davidson’s parents and Davidson herself started to complain.

“If you don’t have someone who has your best interest at heart, then you don’t have anything, really,” Davidson said.

The caregiver, Kathryn Tolefree, pleaded guilty of wanton neglect of a dependent adult last year.

Davidson and her parents say there is no shame in seeking out help, that there is nothing wrong in protecting your dignity.

“People simply have to step forward and say this can’t happen,” says Brian Davidson, Natalie’s stepfather.

The Pioneer Network is hosting a two day conference on Culture Change in LTC…(link opens a PDF formatted page)

The Pioneer Network is proud to offer the new Pioneer Institute as a means to meet the rapidly growing need for in-depth information and tools related to culture change in long term care and aging. Across the nation, culture change has created a buzz. Many nursing homes and other agencies serving elders have begun initiating changes grounded in the Pioneer Network’s person-directed values that underlie culture change.

There will be five different plenary pathways to chose from:

Participants can choose their area of study and exploration from the following
five pathways:
1| Leading Culture Change: What Does it Take?
2| Becoming a Learning Organization: Transformational Training Techniques
3| Championing the Elders: Creating Communities that Make Life Worth Living
4| The Culture Change Journey: Getting it Started and Keeping it Going
5| Changing the System: A Multi-Stakeholder Approach to Action

Locations/Dates
Choosing a Location
The Pioneer Institute is being offered in four locations across the nation. Participants are encouraged to attend the Institute at whichever location is of most interest to them.Registrations by location will be accepted on a first come, first served basis.The Pioneer Institute will be offered in the following locations:

Portland,Oregon
July 12-13, 2005
(Tuesday/Wednesday) Red Lion Hotel on the River
(formerly Doubletree Jantzen Beach)

Chicago, Illinois (St. Charles)
August 1-2, 2005
(Monday/Tuesday) Pheasant Run Resort

Tarrytown, New York
September 12-13, 2005
(Monday/Tuesday) Westchester Marriott

Denver, Colorado
October 27-28
(Thursday/Friday) Inverness Resort

I may figure out a way to get to the NY event…For more info about the Pioneer Network go here.

Nursing Assistants Week June 9-16, 2005

SOUTH BEND — An awards luncheon on June 10 will celebrate the work of nursing assistants.

Also, a roundtable discussion on June 11 will discuss how to recruit and retain minorities in health care jobs.

Local workers will be lauded for the longevity of their service at the luncheon, which will be at 1 p.m. in the Humphreys Multimedia Room at the St. Joseph County Public Library, 304 S. Main St.

The keynote speaker will be Genevieve Gipson, the founder of National Nurse Assistants’ Week, which is June 9 through 16. She is director of the Career Nurse Assistants Programs Inc. in Norton, Ohio.

Other speakers will be Patsy Harris of the National Direct Care Alliance of Washington, D.C., and Chandra J. Johnson, soon to become the associate director of cross-cultural ministry for campus ministry at the University of Notre Dame.

The luncheon is free to all nursing assistants if they make a reservation by Tuesday. After that, they pay $10.

For all others, the lunch costs $25. The fee may be sent to NADCWOC Inc., P.O. Box 3036, South Bend, IN 46619.

Tickets will be sold at the door. To make a reservation, contact John Booker at (574) 289-9326 or j.booker@directcareworkersofcolor.org.

The discussion on June 11 will be from 10 a.m. to 1 p.m. in the Molloy Room at the library. Refreshments will be served. It is free to the public.

The work of nursing assistants ranges from nursing homes to in-home care.

All of the events are hosted by the South Bend-based National Association for Direct Care Workers of Color.

Another LA nursing home news story…I agree with this policy/law. If they allow people to sue for every little and big “abuse” event, nursing homes would close shop and who would take care of our elderly? I don’t think abuse happens enough to warrant extensive government intervention.

The House denied patients who suffer mental or physical abuse in a nursing home the right to sue the facility for damages on Wednesday.

House Bill 388 would have provided stronger legal recourse for violations of 11 out of 23 entitlements listed in the Nursing Home Resident’s Bill of Rights.

These include the right to information about a health condition and the right to appropriate medical care, among others.

Under existing law, residents can only sue to get the homes to stop abuses, but not to receive money.

Read the rest of this article—>

This is really a good program if you’re a patient up at Dartmouth. I have been up there and people love this. Another good thing they have going up there, for parents, is a Family Center. Of course not all the medical people appreciate this effort..they need to get with the times.

LEBANON, N.H. (AP) - For 35 years after he accidentally shot himself in the leg, John Bevacqua managed just fine. But when a long-dormant bone infection reappeared, and three surgeries did nothing to stop it, he agreed to an amputation. The decision wasn’t easy. A unique program at Dartmouth Hitchcock Medical Center, however, helped him realize that getting rid of his leg was the best way to get on with his life.

“I was almost on the verge of going through another operation,” Bevacqua said. “I was in doubt when I went in there, but when I was done, I knew I was going to do it.”

Bevacqua, 58, of Weare, put his hopes on the hospital’s Center for Shared Decision Making, a tiny office with a big mission: helping patients make better, wiser and potentially less costly choices about their treatment by involving them more actively in their health-care decisions.

The center provides free one-on-one counseling along with videos and DVDs that explain the pros and cons of dozens of medical procedures. Though all hospitals routinely give patients information to help them make medical decisions, Dartmouth Hitchcock is believed to have the nation’s only center dedicated to it.

Dr. James Weinstein, the center’s medical director, hopes it will move medicine beyond informed consent to informed choice.

“If you break your hip, you need to have your hip fixed because you can’t walk - you don’t have a choice. But when you have back pain or breast cancer or prostate disease or coronary artery disease, you have lots of choices,” he said. “Patients need to be empowered to make those choices.”

Read more of this article—>

As far as I know, no residents I have worked with in recent years took asprin for pain. They all took either acetaminophen or ibuprofen…and once in a while narcotics, for serious pain. This article puts it all into a new light for me:

FRIDAY, May 20 (HealthDay News) — Daily aches and discomfort may become more common with age, but elderly Americans shouldn’t have to increase their dosage of narcotic pain relievers to keep up with the pain, researchers report.

On the other hand, people under 50 years of age may need to ramp up their dosage of these opioid pain-relieving medicines — drugs like morphine, OxyContin and Percocet — to achieve ongoing relief, reports a study in the June issue of Anesthesia & Analgesia.

“Opioids are very safe if they’re used and dosed appropriately. The elderly should realize that these are very viable options for severe pain and they shouldn’t worry so much about the stigma attached to these drugs,” said researcher Dr. Pamela P. Palmer, professor of anesthesia and director of the pain management center at the University of California, San Francisco.

“Older people won’t have to escalate their dose much,” Palmer added. “However, tolerance is a very real issue in younger patients. Daily chronic use of opioids in young patients may not be getting them anywhere in the long run because our data shows that the average pain score was not improved” with a higher dose.

Go read the rest of this—>

We all know this too…But it’s good to see it in writing just in case some forget.

AKRON, Ohio - A noisy manufacturing plant. The fast-moving traffic of busy city streets. A landfill active with heavy machinery.

A nursing home.

How does the sedate environment of a residential health-care facility end up on this list?

Like the others, it’s one of the most hazardous places to work in the United States.

According to the U.S. Department of Labor Bureau of Labor Statistics, the nursing home industry’s worker-injury rate was third highest among 84 industry groups in 2003, the most recent year for which data are available.

Unlike the other high-risk industries, however, nursing homes are not governed by direct standards set by the Occupational Safety and Health Administration. And while efforts are being made to improve worker safety, the issues are complicated and the solutions are costly.

Meanwhile, the health aides who bear the brunt of those injuries are in one of the fastest growing occupations in the region.

”Ten years ago, we didn’t even pay attention to nursing homes,” said Rob Medlock, director of Occupational Safety and Health Administration’s Cleveland-area office. ”People thought, ‘Nursing homes? They cared for my grandfather, I know they’re good.’ ”

The trouble is, in caring for those who can’t care for themselves, workers sustain their own injuries.

Nursing assistants, in particular, hurt their backs, necks and shoulders while lifting patients.

Also, they face the often-unspoken hazards of working with individuals whose medical conditions make them prone to lash out, kick or even strike their caregivers.

In March, OSHA sent informational letters to about 14,000 employers with higher than average work-related injury and illness rates based on a 2004 nationwide survey of 80,000 employers.

When I read this, I got defensive. Of course falls should not happen, ever. But they do and that is the reality of being older. Whether a fall occurs at a nursing home or at home…makes a difference I guess. More elderly fall at home than do at nursing homes-and no nursing home can prevent every fall. It’s just impossible.

SAGAMORE HILLS — You put your loved one in a nursing home hoping he or she is safe from harm.

Yet, each year, 35,000 residents are injured or killed in a nursing home fall.

Even in the best facilities, falls are common. But in some cases, could they be prevented?

Carl Monday found it’s a problem that’s become a nursing home nightmare for some residents and their families.

“My Aunt Mary was in my life since the day I was born,” said Michelle Starcher.

That’s how Michelle Starcher wants to remember Aunt Mary Kish.

Instead, she’s haunted by photographs of the frail 85-year-old woman shortly after a shower room fall two years ago at the Brentwood Health Care Center in Sagamore Hills.

“She did not deserve this,” Starcher said.

Sam McCoy is the director of elder rights services for the five county area agency on aging. “[This] shouldn’t have happened,” McCoy said when looking at the disturbing pictures.

Two months ago, McCoy sent a staffer into Brentwood to investigate Mary Kish’s fall. The accident happened two years ago. Why the delay? McCoy says until recently, no one reported the fall to his agency and no one reported it to the state.

“The nursing home has a responsibility to report significant injury like this to the department of health,” McCoy said.

But the Ohio Department of Health says it has no record of Mary Kish’s fall. It says nursing homes are not required to report falls unless there’s clear evidence of neglect or abuse.

McCoy says his investigator couldn’t document the cause of the fall. After all, it was two years later. But, he says his agency was still concerned, especially after his investigator observed an employee ignoring a motion alarm set off by an elderly resident.

“It’s a problem,” said McCoy. “It’s a problem for the 100 residents at that facility. The potential is there. The risk is there.”

Read the rest of this article—>