I say this is BOGUS. It smells of a selfishness I can’t describe.

A Bibb County, Georgia, jury awarded the family of James Davis $1.16 million in compensatory damages on Thursday after he died in September 2002 from an infection stemming from falls and negligent care at North Macon Health Care Nursing Home in Macon, Georgia. The family chose to let their loved one die with dignity instead of undergoing an amputation and putting in a permanent feeding tube, a decision defense attorneys criticized during the trial.

Davis was a 62-year-old stroke victim with a paralyzed right side who was confined to a motorized wheelchair. He fell nine times during his one-year stay at the nursing home. One fall from a wheelchair fractured his right hip and required hip replacement surgery.

One June 1, 2002, less than a month after the hip replacement surgery, he fell again. This time he fell out of his bed, which did not have its side rails up. The fall split open his hip at the surgical wound site where it became infected. Court testimony showed the staff did not follow hospital orders to clean the wound for four days and he became infected with his own urine and feces. Surgery to treat the infection was unsuccessful. As a result, Mr. Davis developed severe circulation problems in his leg and the doctors offered an option of amputation from the hip down, along with a permanent feeding tube. Doctors also recommended the patient and family consider only comfort care.

His family decided against the surgery, making a “comfort only” or hospice care decision. “The quality of my father’s life vastly deteriorated and would have become worse,” said Scott Davis, the man’s son. Since Mr. Davis did not have a living will, Scott made the painful decision to let his father die with as much dignity as possible. “This was the more humane option instead of undergoing more operations that would rob him of his dignity, leave him on a feeding tube and an amputated leg,” he said.

Nursing homes that are located in high heat zones must be careful to protect residents. AC systems are mandatory in some regions and others-not. At the very least, portable units, fans, and extra water is needed. The problem I have with lawsuits about this stuff is– the condition of so many residents might be the cause of a death during a heateave. I guess this is where documentation is vital.

After hearing four weeks of testimony, a jury in St. Louis will decide whether a nursing home in University City should pay the daughter of a resident who died there during a heat wave in April 2001.

Freddie Burns, 70, was among four women who died within 48 hours after the temperature rose above 95 degrees inside the Leland Health Care Center, 894 Leland Avenue.

The St. Louis County medical examiner ruled that all four died of hyperthermia - overheating.

[…]
The case now rests with jurors, some of whom appeared fidgety at the end of their fourth week. One juror told the judge he worried about missing a business trip next week; another slouched in his chair. The jury has the weekend off. They will resume deliberations on Monday.

Lakin argued that Leland workers improperly fed and cared for Burns and falsified records about her care. He said the center had no plan for handling various crises.

On the warm weekend in April, the staff failed to turn on the air-conditioning system, bring in portable air conditioners or move residents, he said.

Leland and other nursing homes “have to learn they can’t handle our elderly in a big-box, discount approach,” he said.

Leland’s lawyer, Gregory Minana, told the jurors that asking $18 million was “obscene.”

18 Million IS OBSCENE.

There are many resources available, online, for CNA’s, DON’s and others.

One great resource is National Clearinghouse on The Direct Care Worker.

This site has a lot of information on practice models, training programs, retention programs, supervision issues…almost all relate to the work of the CNA.

One example:

Iowa CareGivers Association: Certified nursing assistant mentor training program

Description: Veteran nursing assistants who complete a training program serve as peer mentors for new nursing assistants entering the field.

Objectives

* To improve the quality of resident care by improving CNA training
* To encourage personal and professional growth for senior CNAs
* To reduce new nursing assistant turnover rates by improving their orientation and training

There are MANY of these programs listed here. The site offers relevant information on each program:
Description, Sponsoring Organization, Setting, Target Group, Start Date, Objectives, Key Components, Results, Outcomes, Evaluation, Lessons Learned, Costs/Funding, Contact Info, and other resources. Well worth checking out!

Ever hear of the PACE program??

HARLTON— A new program in Central Massachusetts is giving area elders an alternative to nursing home care by providing comprehensive services in and out of their homes.

The only service of its kind in Central Massachusetts, Fallon Community Health Plan’s Summit ElderCare is a Program of All-inclusive Care for the Elderly, known as PACE. The program provides comprehensive medical care, prescription drugs, home support services, transportation and adult day care.

The PACE model was developed in San Francisco during the 1970s as an alternative to nursing home care. Its success, and subsequent funding by the U.S. Department of Health and Human Services, led to its replication.

Here is more about the PACE program; I think more communites should look into these things. Nursing homes are just not where anyone wants to be.

Programs of All-inclusive Care for the Elderly (PACE) serve seniors with chronic care needs by providing access to the full continuum of preventive, primary, acute, and long term care services. PACE Programs take many familiar elements of our traditional health care system and reorganize them in a way that makes sense to families, health care providers and the government programs and others that pay for care.

Check them out and THINK.

I hear, often, about supply shortages in nursing homes. Seems this is becoming more and more common.

QUESTION:
Does your facility provide enough supplies- soaps, shampoos, briefs, wipes, deodorants, razors ect?

What happens when your facility runs out- say- in the middle of the order cycle?

Have you complained about this? If so, what were you told??

Reader Kim asks the QUESTION of questions: (from comments)

Hi everyone, I was wondering if anyone has an idea about how I can get 6 residents up, washed up, changed, dressed, and in the dining room, between 7am and 8?

I need to be able to accomplish this in order to keep my job.

What I used to do when I worked in the nursing homes- is a quick wash up- literally, change their briefs, put a housecoat on the resident, teeth in and/or brushed/ hair combed and bring them to the DR’s…it helps when you have co workers who will work together on this.

Anyone else have any advice???

Nurses and aides are working together to promote better and safer patient/staff safety protocols. Some are seeking legislation.

At Westerly Hospital, both members of the CAT scan team have sustained virtually identical back injuries lifting patients, and been forced to take time out of work to recover. They’re not the only ones, either, according to Jan Salsich, president of the nurses’ union at the hospital.

With nurses lifting an estimated 1.8 tons per shift, Salsich said, and as the median age for nurses reaches the mid-40s and patients grow heavier, nurses and certified nursing assistants (CNAs) are increasingly at risk of hurting their backs and shoulders.

“I and my co-workers suffer chronic pain,” said Salsich, speaking on her cell phone from outside her chiropractor’s office.

Health care workers have some of the highest job-related injury rates, both in Rhode Island and nationwide. In 2004, Bureau of Labor Statistics figures show, the state’s hospitals reported about 1,600 workplace injuries or illnesses, or 9.8 per 100 full-time workers. They had 69 percent more injuries involving lost work time, and double the average back injury rate.

Nursing homes reported about 1,400 injuries or illnesses, or 11.1 per 100 full-time workers – more than twice the private-sector average of 5.2 per 100. Nationwide, hospitals and nursing homes together reported more than half a million injuries and illnesses.

Now, after years of working with their employers to reduce their risk of injury, health care workers’ unions have turned to the General Assembly for help.

A bill introduced by state Rep. Grace Diaz, D-Providence, a former CNA herself, would require every licensed health care facility to set up a committee, chaired by a nurse, to develop a safe patient handling program, with policies aimed at preventing musculoskeletal disorders among workers and injuries to patients.

The measure, called the Safe Patient Handling Act of 2006, would also require facilities to implement rules to virtually eliminate manual lifting, transferring and repositioning of patients, except in life-threatening emergencies or other extraordinary circumstances.

A related article: Caring for The Obese

Some good advice from HealthCare Review- New England Edition.

What difference would it make in your health care facility if morale was even better, if all departments treated each other as valued internal customers, if labor and management saw each other as equals and allies, and if everyone had a “how can I help out?” mindset?

This is valuable for CNA’s…who tend to bicker and banter more than others who work in nursing homes…

What can you do to spread goodwill?
Regardless of whether you are a frontline worker or manager, you can:
• Look for opportunities to give people compliments.
• Look for opportunities to show appreciation. Think of all the people who help you do your job or make your life a bit easier.
• If you have a disagreement with someone, rather than trying to prove them wrong, focus on first understanding their perspective.
• If you’re experiencing ongoing conflict with someone, rather than engaging in “payback” behavior or holding a grudge, make the first move to get things out in the open and resolve them.
• If you believe you’re getting bad internal customer service from another department, rather than responding with antagonism and resentment, try to engage them in productive conversation.
• If someone who has a history of not being helpful to you asks you for help, rather than pay them back by refusing, model helpfulness to them, and perhaps let them know in a low-key but direct way that you would appreciate their helpfulness in the future.
• If you’re upset with something your supervisor did, rather than holding a grudge and talking behind his or her back, talk to your supervisor directly.

I know it won’t work for every problem, every co-worker, but isn’t it worth a try???

The Concord (NH) Monitor has an editorial about the recent NH nursing home problem:

Belknap County Nursing Home has an excellent reputation, but last month, state inspectors found so many deficiencies in patient care that the home was told it was in “immediate jeopardy” of losing its Medicaid eligibility. Since 2002, the state has issued 18 “immediate jeopardy”warnings affecting 16 of New Hampshire’s 82 nursing homes.

Many of Belknap’s problems stemmed from poor record-keeping, but others were more serious. Too often, patients were not given their medicine on schedule. Some missed doses or got the wrong medicine. Bedsores went unreported or did not receive proper treatment. Fire codes in some areas weren’t followed, nor were dietary recommendations.

The nursing home is correcting the deficiencies, and its “immediate jeopardy” status has been lifted. But how did a good facility go bad so fast? There’s no single answer, but high turnover and a lack of leadership appear to be responsible.

Most nursing homes have three priority positions: administrator, nursing supervisor and director of social services. Belknap had changes in all three positions in rapid succession and a long vacancy between one nursing supervisor and the next.

Regular use of fill-in nurses contributed to the poor care. Unlike staff nurses, they know neither the patient nor the practices and culture of the home. They are also expensive. The difference in patient care is great enough that the marketing materials of some nursing homes boast that they are “agency free.”

Yeah…but not too many nursing homes can say they are “agency free” now. There is a HUGE problem with staffing- both nurses and aides. The pay isn’t great for aides and nurses in LTC make far less than nurses who work in a hospital setting.

Read the rest of this editorial—>

Two reports from Ohio- nursing homes under investigation.

Nursing home was scene of fatal beating
A Toledo man who, police said, had a mental disorder and dementia was arrested yesterday for allegedly beating an Alzheimer’s patient with a bathroom towel bar in a nursing home, causing the victim’s death.

Sharon John Hawkins, 62, is charged with murder in the death Friday of Norbert Konwin, 77. He was arrested at 12:30 p.m. at a treatment facility at 2051 Collingwood Blvd. and is being held without bond in the Lucas County jail pending arraignment today in Toledo Municipal Court.

What good does it do to arrest a person with Alzheimer’s disease/dementia? It’s not like they have too much control over themselves and it’s not like they have good judgement. Or memory. The only real crime here is the patient mix at this facility. Everyone who works with dementia residents knows they often go through a period of violent behaviors during the decline process. I also think if facilities are going house residents who are violent, more staff is needed to supervise. Plain and simple. Arresting the demented does nothing except waste tax payers dollars.

*****************************

The second article:

HIGHLAND HEIGHTS — The state investigation into the operations of Lakeside Heights Nursing Center is continuing, but no date has been set for when it will be finished.

“We are reviewing files seized,” said Corey Bellamy, assistant communications director of admin services in the state Attorney General’s office.

Kentucky Attorney General Greg Stumbo executed search warrants for the facility on Monday, April 3 after Medicaid and Medicare funding was pulled from the home because of numerous regulatory violations, including 12 that posed immediate threat to the health, welfare and safety of residents.

The two-day search warranted thousands of files for review.

“We’re going to move as quickly as possible. However, to just say it’s going to take a specific amount of time I cannot say,” Bellamy said.

According to Kentucky statues, a nursing home license can be revoked when there is “substantial failure to comply with the provisions” set forth by the state Health and Family Services Cabinet. The cabinet would notify the home by certified mail and include the reason for the action.

At that point the facility would have the option to appeal to the Franklin County Circuit Court.

According to the statutes “an appeal may be taken by filing a petition for review in the Franklin Circuit Court within 30 days after notice of the final decision.”

Beth Crace, public information officer for the cabinet, said if Lakeside Heights looses its license, it would be the first revocation under the current Inspector General Robert J. Benvenuti III.

“He’s been here about two years,” she said. She said she was unsure when the last Kentucky nursing home license was pulled.

In addition to loss of its operating license, the facility operators could face felony charges. Kentucky state law says knowing or wanton abuse or neglect of vulnerable adults are felonies. If investigators find residents were neglected and claims for Medicaid payments were filed, it is considered a felony fraud offense.

Lakeside Heights administrators did not return a phone call seeking comment.