Archive for November, 2005

Now this is interesting and educational.

Nursing homes cited for defects

Inspections show federal violations at 27 of 33 centers

By Susan Squires
Post-Crescent staff writer November 27, 2005

Human error is responsible for most mistakes at nursing homes. Someone misunderstands instructions. Someone overlooks vital information. Or someone skips a step.

Such mistakes are widespread among skilled nursing centers in the Fox Valley, according to recent state inspection reports. But the vast majority result in no physical harm to patients, they show.

A Post-Crescent review of recent reports documenting federal violations for the 33 nursing homes in Calumet, Outagamie, Waupaca and Winnebago counties shows 117 deficiencies among 27 of the facilities.

Six of the centers were free of violations.

Most deficiencies were considered minor, some including improper filing of paperwork. But others were more serious.

Among deficiencies cited by inspectors at multiple facilities:

Several patients’ blood-sugar counts dropped to dangerous levels.

A patient was left on a toilet for two hours and other patients had incontinence accidents because workers didn’t respond to their call lights promptly.

Workers replaced soiled adult diapers without cleaning patients first.

Surveyors found expired drugs, gunk-caked pill crushers, a grimy stove and a sticky substance oozing through the floor of a cooler.

One of the most serious deficiencies involved a woman whose caregivers failed to detect a broken hip, despite her cries from pain. By the time the woman underwent an X-ray, her hip had been broken, doctors said, for five or six days.

Inspectors cited Crystal River Nursing and Rehabilitation Center, Waupaca, for failing to notify the woman’s doctor that her condition had changed in the August 2004 incident.

Carrie Russert, executive director at Crystal River, defended her facility’s care. Inspectors surveyed Crystal River again this month, and found one, minor federal deficiency.

“Our primary concern is, and has always been, the health and well-being of our residents,” Russert said in a written statement to The Post-Crescent. “We will continue to focus our efforts on providing quality care to the people we serve.”

Care report card

The surveys are the report cards state inspectors compile during approximately annual, unannounced inspections. They are the government’s primary tool for regulating nursing homes that get money from Medicare and Medicaid.

Unlike a report card, however, surveys only document a facility’s faults, not its attributes.

If inspectors find deficiencies, nursing homes are required to file plans for correction. Inspectors verify that deficiencies have been corrected.

There is a lot more to this article…read the rest—>

LANSING, Mich. — Attorney General Mike Cox has called on Michigan’s legislature to pass legislation requiring annual criminal background checks on employees of residential care facilities. The Attorney General’s office has also charged 10 individuals with falsifying criminal histories.

“As the first group of 78 million baby boomers begins to retire in 2010, the safety of loved ones in Michigan’s nursing homes should be on all of our minds. When we place our loved ones in these facilities, we expect that our family members will receive the highest standard of care,” stated Cox. “It is important that nursing homes follow their statutory requirements to properly check prospective employees for criminal backgrounds to ensure a safe environment for vulnerable adults in residential care facilities.

“It is equally important for the legislature to act on pending legislation that will require annual criminal background checks on employees with access not only to the residents of these facilities, but also to their personal and financial information as well. All too often, we have found individuals who have fallen through the loopholes in the law. That is why it is so important to conduct these background checks annually,” Cox said.

Recently, Cox’s health care fraud unit completed several investigations involving employees working in violation of Michigan statutes regarding criminal background checks for nursing home employees. Cox’s office noticed several employee applications with incorrect information, as well as an incorrect effective date of the statute. As a result, the Attorney General sent an Abuse Alert to Michigan nursing homes notifying them of the legal requirements.

The alert sent statewide continues Cox’s efforts to protect Michigan’s most vulnerable adults in residential care facilities. In May of this year, Cox’s office sent all Michigan residential care facilities copies of the report “Michigan’s Resident Care Facility Criminal Background Checks.” This report was based on an investigation by Cox’s Health Care Fraud Division that uncovered that 25 percent of residential care facility employees that commit crimes against residents since 2002 had past criminal convictions. Of more than 5,500 certified nursing assistants (CNAs) studied, 9 percent had a total of 836 outstanding criminal warrants and 3 percent, or 170, had past criminal convictions. These results were confirmed when the backgrounds of entire employee populations at four nursing homes across Michigan revealed 58 of 618 employees, or more than 9 percent, had 101 outstanding warrants, and that 68, or 11 percent, of the staffs had past criminal convictions.

“I know the vast majority of residential care facilities and the employees that work in them share my concern for the well-being and safety of our vulnerable adults,” noted Cox. “I hope this alert will provide assistance and enable my office and Michigan’s residential care facilities to continue our efforts to provide a safer environment for Michigan’s most vulnerable.”

Source: Michigan Attorney General’s Office

Infection rates for the elderly are higher than average.

MONDAY, Nov. 28 (HealthDay News) — An aging population is helping drive up hospitalization rates for infectious diseases among older American adults, according a new report from the U.S. Centers for Disease Control and Prevention.

Reporting in the Nov. 28 issue of the journal Archives of Internal Medicine, CDC researchers analyzed national hospital discharge data to estimate hospitalization rates for older adults from 1990 through 2002.

Over that period, there were about 21.4 million infectious-disease hospitalizations among older adults and 48 percent of those listed the infection as the primary diagnosis.

Between 1990-92 and 2000-02, there was a 13 percent rise in infectious-disease hospitalizations, from 449.4 to 507.9 hospitalizations per 10,000 older adults.

Hospitalization rates for lower respiratory tract infections and kidney, urinary tract, and bladder infections did not change significantly between 1990-92 and 2000-02. However, there were dramatic increases in the rates of heart infections, infections and inflammatory reactions to prosthetic devices, and postoperative infections — up 240 percent, 130 percent, and 80 percent, respectively.

The rate for septicemia (infection of the bloodstream) increased 22 percent.

“The hospitalization rate for IDs (infectious diseases) increased slightly among the older adult U.S. population during the 13-year study and was associated with the aging of the older adult population,” the study authors wrote.

Reducing the rate of hospitalization linked to infection “should be a high priority given the projected population growth among older adults in the United States,” they said.

More information

The American Geriatrics Society has more about infectious illness and older adults.

This is sad.

SATURDAY, Nov. 26 (HealthDay News) — Judy McKellar has endured the devastation of Alzheimer’s twice — both her parents struggled with the disease before their deaths.

“I think it’s one of the most devastating diseases on the planet,” McKellar, who lives in Tualatin, Ore., said. “It robs you of the person one memory, one moment, one brain cell at a time.”

McKellar’s parents lived on their own for years after their diagnoses, with McKellar providing the care that let them remain in their own home.

“I would stay a few weeks, and then be away a few weeks,” she said. “When I was away, we would have other people who would come in.”

Caregiving for someone with Alzheimer’s disease, she added, is both “rewarding and overwhelming.”

An estimated 4.5 million Americans now have Alzheimer’s, the most common cause of dementia in people over 65. The health care costs associated with treating those patients exceed $100 billion a year. And as baby boomers grow older during the next few decades, the number of victims and the dollar costs of care are expected to almost quadruple, according to the Alzheimer’s Association.

Faced with those mounting challenges, a growing number of people are choosing to devote themselves to the care of someone with Alzheimer’s.

McKellar’s mother, Bert, began suffering the effects of Alzheimer’s first, and she underwent a gradual decline.

“Mom wouldn’t remember things,” McKellar said. “She would, say, make cheese sandwiches, only you’d have bread and butter and no cheese. She’d just forget the cheese in cheese sandwiches.”

Alzheimer’s hit her father, Mac — who used to own his own construction company — later in life. But it struck him hard, robbing him of his ability to use proper judgment and solve problems.

The disease required patience from all the caregivers who watched over the couple.

“They would agree to have Sue, a neighbor, come in when we weren’t there,” McKellar recalled. “Then they would forget they agreed and they didn’t want to have outside help.”

But matters finally reached a point where McKellar felt like her parents weren’t safe in their house anymore. She and her brothers told them they needed to be moved to an elder-care facility.

“They were angry because you can’t reason with people who can’t reason,” McKellar said. “That’s an aspect of Alzheimer’s we don’t always quite get.”

That anger, she added, was matched only by her own guilt.

“You always wish you could do it some other way that would be better,” she said. “It was reassuring to know they had excellent care, but still there was concern. I’d go visit them as often as I could and my brothers would, too.”

Experts stress that caregivers have a responsibility to keep themselves mentally and physically healthy, both when caring for the person and if the person is eventually institutionalized.

There are several options available to a caregiver. Perhaps most important, he or she needs a support network of friends, family and relatives ready and willing to help, said Bonnie Lawrence, spokeswoman for the Family Caregiver Alliance.

“It can be as simple as asking a friend to pick up a prescription or some groceries,” Lawrence said. “Or just stopping by to see how you are doing.”

“The caregiver needs to feel good about themselves,” added Kathleen O’Brien, senior vice president for program and community services at the Alzheimer’s Disease and Related Disorders Association. “If you don’t feel good, you won’t respond well to a difficult situation,” she explained.

“If families are knowledgeable about the disease and know what to expect, they can be more empowered in dealing with the disease,” O’Brien said. “The most important thing is they get linked with helpful community resources they may need.”

McKellar’s mother died January 2002 at age 83. Her father followed in August 2002 at age 91.

“They were partners for their whole lives,” McKellar recalled. “My father, before he got Alzheimer’s himself, was able to do a lot of caregiving for my mother on his own.”

I wonder what happens when a hospital -out in a rural area- has no ASL Interpreter?? This is from my local paper.

It’s been more than two months, and still the frustration rises up in Joan Case’s face and hands like it was yesterday.

“They told me an interpreter would come, but they never showed up,” said Case, describing her experience during a medical emergency at an area hospital through Laurie Gilbert, a paid interpreter fluent in American Sign Language.

Case says her complaints have fallen on deaf ears.

“I’m ready to make some noise,” she said.

On Sept. 17, Case was at home in Weare, suffering from high fever and body aches. “I was in a lot of pain. I told my husband to call 911,” Case said. Her husband, Bill, also deaf, called for help using a TTY, or Telecommunications Device for the Deaf.

When EMTs arrived, Bill Case handed them a small white card with an 800-number for the Emergency Interpreter Referral System.

Case said the EMT gave the card to the emergency room nurse at Concord Hospital, who made a photocopy of the card and said she’d “take care of it.”

But no interpreter ever arrived, Case said.

Over the next three days Case endured a series of tests for heart problems she didn’t have because, said Case, the ER doctor misunderstood her symptoms. Eventually she was admitted and treated for cellulitis — she had a serious infection in her leg. It took two days before she was finally informed of the diagnosis, after asking a nurse.

Adding to her frustration, patients must use a phone to order daily meals rather than circling food choices on a paper menu. Case, who does not speak and has limited vision, said she was never told about the procedure. She said she had no meals her first day in the hospital.

She was discharged without an interpreter present.

A review of the interpreter referral system records shows no call was ever placed from Concord Hospital to the toll-free number over the course of her stay, said Susan Wolfe-Downes, executive director of Northeast Deaf and Hard of Hearing Services Inc. in Concord.

Joan Case fell through a huge crack in the state’s health-care system — it’s not the first time for Case, said Wolfe-Downes — and she’s not the only one who’s frustrated.

It’s a complaint heard daily by Aimee Stevens, lead referral specialist at NDHHS.

“What’s really unfortunate is that, in 2005, this kind of thing is still happening. Deaf people have been around since the beginning of time — and the Americans with Disabilities Act has been in place for 15 years,” Stevens said. “It’s not isolated to one hospital, either — it happens all over the state.”

Concord Hospital did not comment directly on Joan Case’s complaint, but issued a statement that read in part: “We are committed to quality patient care for all . . . we are one of only eight hospitals in N.H. to provide Deaf Talk, a new and promising technology which provides immediate access to interpretation services.”

State Department of Health and Human Services Commissioner John Stephen said it’s up to individual providers to make sure patients don’t fall through the cracks.

“This is the first time I’ve heard of a hospital having an issue or problem with compliance,” Stephen said, of Case’s experience. “There’s no question more can be done in this particular area to provide quality services for the hearing impaired.”

Andrew Stewart, who served recently as chairman of the New Hampshire Advisory Committee to the U.S. Commission on Civil Rights, says there’s no excuse for the lack of education or response within the state, and particularly the medical community, to the needs of the deaf and hard of hearing.

His committee issued a report in June detailing the problems of access to health care for those with limited English language skills — a cultural minority that includes the deaf and hard of hearing.

“It’s outrageous,” said Stewart. “That John Stephen doesn’t know about the problem says something about the system itself.”

Stewart said he heard testimony detailing people’s everyday experiences in a health-care system that falls short of adequate.

“We heard about extreme disadvantages faced by people arriving at hospitals — often with children in tow — lapses in communication that amount to civil rights violations,” Stewart said.

One solution may come through the Foundation for Healthy Communities, which recently received a grant from the Endowment for Health to specifically address such issues affecting the deaf, hard of hearing and other cultural minorities.

“It’s not just an issue of availability within a system to get an interpreter. We have to make sure a nurse, a doctor or other staffer in a given health-care system recognizes this need, and knows when to make use of it appropriately,” said Shawn LaFrance, the foundation’s executive director.

One such effort is a workshop, “Cultural Awareness in Healthcare,” open to health-care providers and scheduled for Dec. 15 from 11:30 to 4:30 p.m. at Crowne Plaza in Nashua.

Wolfe-Downes said a 2003 study conducted by her organization showed that access issues are the No. 1 concern among New Hampshire’s estimated 110,000 deaf and hard of hearing — a number rising annually thanks to the aging population.

“We have this card, this emergency service referral system in place already,” said Wolfe-Downes, holding up a replica of the little card Case tried to use back in September. “Our request fill rate is 100 percent, when we are contacted. But as you can see from Joan’s story, people are still falling through the cracks.”

I have always thought folks with dementia are in pain. This study makes sense to me.

The over-the-counter painkiller acetaminophen may help elderly adults with dementia become more active and socially engaged, the results of a small study suggest.

Researchers found that when they gave acetaminophen to nursing home patients who had moderate to severe dementia, the medication helped changed some of the patients’ behaviors. They tended, for example, to spend less time in their rooms and more time watching television, listening to music, reading or performing “work-like” activities.

The findings suggest that unrecognized, untreated pain in dementia patients keeps them from being as active as they can be, according to the study authors, led by Dr. John T. Chibnall of the Saint Louis University School of Medicine in Missouri.

“Pain treatment in this group may facilitate engagement with the environment,” they report in the Journal of the American Geriatrics Society.

Chronic pain is a common problem for elderly adults, stemming from conditions such as arthritis, bone fractures and nerve damage from diabetes. But Alzheimer’s disease and other forms of dementia can get in the way of diagnosing and treating chronic pain. Patients may, for instance, be unable to express what they are feeling.

What’s more, untreated pain may exacerbate problems associated with dementia, such as inactivity, agitation and depression.

To see if a mild painkiller could change dementia patients’ behavior, Chibnall and his colleagues studied the effects of 4 weeks of treatment with acetaminophen (Tylenol). Twenty-five nursing home residents with moderate to severe dementia spent 4 weeks taking three daily doses of acetaminophen and another 4 weeks taking inactive pills.

Overall, the study found that patients spent less time by themselves and more time being socially active when using acetaminophen. They also spent more time talking to themselves or an “imaginary other,” which, according to the researchers, is also a manifestation of heightened engagement.

On the other hand, although certain behaviors showed positive changes, agitation and emotional well-being did not improve.

Still, Chibnall and his colleagues conclude, the findings suggest that treating pain with mild medications can help improve dementia patients’ social interactions.

“With further research and more aggressive treatment of pain,” they write, “nursing home residents with dementia may be helped to lead more interactive lives.”

McNeil Consumer & Specialty Pharmaceuticals, maker of Tylenol, supplied the medication used in the study.

SOURCE: Journal of the American Geriatrics Society, November 2005.

I wonder why this would be the case…

WEDNESDAY, Nov. 23 (HealthDay News) — The more education you have, the greater your risk for Parkinson’s disease — and doctors may be among those at highest risk.

That’s the conclusion of unusual research in the Nov. 22 issue of the journal Neurology.

Researchers from the Mayo Clinic College of Medicine in Rochester, Minn., studied the education levels and occupations of Parkinson’s disease patients living in Olmsted County, Minn., and compared them to people in the general population.

The medical information was collected from the records-linkage system of the Rochester Epidemiology Project to identify all those people in the county who developed Parkinson’s from 1976 through 1995. Their education and occupation was determined through phone interviews and a medical records review.

The study found that people with at least nine years of education were at increased risk of Parkinson’s disease and the risk increased with more education. Doctors had a significantly increased risk of Parkinson’s disease.

Construction workers, miners, oil well drillers, production workers, metal workers and engineers, occupations with presumed high physical activity, had a significantly decreased risk, the study also found.

I work in Rehabilitation nursing, and some of this rings true. Residents who get depressed often refuse care and treatment. This is a great article about this issue, if you work in this field, read it. Even if you don’t work in rehab, this is something you might find helpful.

Situation: M.J. is a 32-year-old female currently in an inpatient rehabilitation program. She was admitted 5 weeks ago S/P Motor Vehicle Accident, with a diagnosis of traumatic brain injury (TBI). The patient was engaged in the rehabilitation program and had progressed well until 2 weeks ago. Since that time, her appetite has decreased and she has lost 5 pounds. She reported feeling more tired and taking multiple naps during the day. She has been voicing more concerns about the hopelessness of her situation, has refused to go to therapy, and has denied that she is feeling sad. Nurses report that she has required more PRN pain control.

Consultation: Anne Gnnderson, GNP CRRN-A, an assistant professor at the University of Illinois Chicago College of Medicine, Department of Medical Education, and John Tomkounak, MD, associate dean of curriculum at Rosalind Franklin University Chicago Medical School, reply:

Major depressive disorder (MDD), referred to as simply depression, is a primary mood disorder. For many rehabilitation patients, depression is a common medical problem that affects the patient’s recovery. MDD, however, is often overlooked by healthcare providers and inappropriately (or inadequately) diagnosed for many patients who present with depressive symptoms. Numerous studies cite lack of time, lack of knowledge and skill, and the stigma associated with psychiatric illness as causes of this deficit.

In inpatient rehabilitation programs, depressed patients tend to use the program less effectively, make less progress, and have an increased length of stay. After discharge, depressed patients leave the house less often, do not become involved in recreational pursuits, and report having less contact socially (Wu, 1995). Patients and families often tend to minimize the depressive symptoms or treat the symptoms as something that is “expected” after a traumatic injury. With MJ., it could be easy for her family, and even healthcare providers, to brush off the symptoms as part of an appropriate response to a TBI. Depressed individuals are also less likely to be referred for, seek out, or successfully complete rehabilitation programs or to use adaptive devices (Horowitz, 2003). Rehabilitation providers must recognize the symptoms of depression and provide the necessary treatment for these patients as part of the overall treatment plan.

Read the rest of this article—>

It’s that time of the year again, when our hands get dry…it’s nasty and uncomfortable and doing what we do for work doesn’t help. Here’s an article about how dry hands can spread infection.

Hand-Care Products: the Gloves Are Off
By Cantrell, Susan

Studies have shown that a reason oft-repeated by healthcare workers as to why they aren’t always compliant with the Centers for Disease Control and Prevention (CDC)’s “Guideline for Hand Hygiene in Healthcare Settings”1 is because frequent washing causes dry, cracked skin. That’s not just an aesthetic problem; it’s an occupational hazard for themselves and their patients. Cracks in dry skin provide perfect hiding places for pathogens that can be transferred from Healthcare workers’ (HCWs) hands to sick patients in the blink of an eye.

Sprixx hand sanitizers

The problem of hand care is so serious that it garners much attention from high-profile regulatory and advisory agencies. The CDC considers skin dermatitis to be a critical healthcare issue.1 Thejoint Commission on Accreditation for Healthcare Organizations (JCAHO) surveils for compliance with the CDC’s hand-hygiene guideline as part of its National Patient Safety Goals.2 The National Institute for Occupational Safety and Health notes that “skin disorders are the number one occupational illness across all occupations and cost $1 billion annually.1 The Association for Professions in Infection Control and Epidemiology Inc., (APIC) advises HCWs to “insist on products that promote and maintain healthy skin, reduce transepidermal water loss, increase skin hydration (moisturization), and have low irritancy potential.”4

The stepped-up attention to hand care has industry constantly developing new and improved hand-care products to address this important problem.

What should you look for?

Makers of hand-care products are a source of valuable advice when it comes to effective hand care. They’ve spent a fortune researching what works before their products go on the market. They’re not inclined to risk losing that fortune and potential profits by placing products on the market that they don’t have reason to believe will perform. What do these experts have to say about what to look for in hand-care products?

Compatibility

Kirsten M. Thompson, technical service expert, Ecolab, St. Paul, MN, suggested looking for alcohol-based hand rubs and lotions that are compatible with other antimicrobial hand products, providing this example: “Compatibility of hand-care products is important, because persistent antimicrobial activity of chlorhexidine gluconate (CHG) could be diminished if you followed a hand wash containing CHG with a lotion that wasn’t CHG-compatible.” Steve Rausch, director of marketing, Apollo Corporation, Somerset, WI, concurred: “The most expensive products you can buy are those that don’t work.”

Skin-friendliness

“It’s also important for hand-care products to be skin- friendly,” observed Thompson. “If users don’t like a product, they won’t use it; so, look for a formulation acceptable to most users.”

Thompson also advised HCWs to use waterless hand rubs, such as Ecolab’s Endure 320 alcohol gel, that have emollients built in. “HCWs may have to wash their hands or rub their hands with a waterless product 40 to 50 times per day. Their hands can become dry and cracked, which hurts. Dry, cracked, bleeding hands are vulnerable to infection, and the bacteria they harbor can be difficult to eradicate. A hand-rub product that leaves an emollient behind not only can kill bacteria, it can preserve the integrity of the skin. The Endure line encompasses the entire spectrum of hand care: soap, alcohol-based hand rubs, surgical scrubs, and lotion, which are formulated to work well together. SkinSynergy is the basis for the Endure line. It’s a patented system used to formulate a family of products. The combination of products works as good, if not better, together than each component does separately.”

Read the rest of this article—>

It’s hard to know exactly what happened in this nursing home, to warrant the action it got from the state. Reading this article, the place sounds like a typical home. There must be a lot more to it though.

CLEMMONS, N.C. — A nursing home where state inspectors found patient care problems can’t admit new patients and the state recommended that Medicare and Medicaid payments be cut off if the problems aren’t fixed.

Inspectors visiting Clemmons Nursing and Rehab Center for a five-day inspection said three residents failed to get proper toilet care, the call system for patients to summon emergency help was inadequate and a patient who wandered to others’ rooms wasn’t supervised.

“The documented violations indicate that conditions in the facility are found to be detrimental to the health and safety of the residents,” according to a letter sent Nov. 9 from the state Department of Health and Human Services to the 120-bed home.

Of the 79 patients in the home Nov. 5, the state said 65 received Medicare or Medicaid.

Department spokesman Jim Jones said the state will work with county officials to find beds if necessary. Nearly 400 nursing homes are licensed by the state.

Frank Littriello, who owns the home, said he has submitted a correction plan and that the home should be in compliance by the end of the month. Jones said the plan had been approved and federal payments can continue if the home passes its next inspection

“It is not a catastrophic situation,” Littriello said. “We will get through this.”

State officials have received 163 complaints about the home in the last two years, and 64 complaints were substantiated.