Up in Canada an investigation is under way. A nursing home resident died as a result of a fall, out of a mechanical lift.

The faulty lift equipment that caused the death of an east Toronto nursing home resident had already malfunctioned twice within the same long-term care chain, according to a health ministry document obtained by the Star.

Leisureworld Caregiving Centres documented the two earlier incidents when the same type of lift broke down at another home in its chain, last November and December, according to the ministry’s May 8 letter to Health Canada, warning of safety hazards. The letter said there were no injuries as a result of the first two malfunctions.

It was not until Wally Baker’s April 30 death that Leisureworld replaced the lifts (motorized equipment used to move residents from bed to chair to toilet) throughout its 26 homes in Ontario. But chief executive officer David Cutler said the company took action to address the problems last November and December, including contacting Health Canada, which monitors nursing home equipment.

Wow. Pardon me for a moment here. I have worked with all kinds of mechanical lifts, of every variety and made by most manufacturers. Some are better than others; some are easier to use. None ever presented a hazard to my residents though, as long as I used the equipment correctly. We were trained by the manufacturers on how to use each lift, through the years, as we got them. I really don’t understand how this happened.

Has anyone ever experienced a close call with a lift? Was it the lift itself, the staff using it improperly a (lack of training on the proper use)? Was it the resident being unsafe and jeopardizing the transfer? I’ve seen that happen many times as well.

Across the pond we see similar issues we face daily. Getting residents up at 5:30am is considered abuse.

A NURSE was reported to watchdogs after she ordered dementia patients out of their beds at 5.30am.

The Care Commission upheld a complaint that up to 18 elderly residents were taken out of their beds and left to sit in a lounge until breakfast.

Some residents had to wait more than two hours before they could be fed when the kitchen staff arrived for work at 8am.

Joyce Lynn, a district nurse, works part-time at Greenhills Care Home in Biggar, Lanarkshire, where the abuse allegedly took place.

And she works as a nurse attached to Lady Home Hospital in Douglas, also Lanarkshire.

Sounds familiar.

Watchdogs who examined the claims of early starts for patients were told that some of them were taken out of bed and left to doze in their wheelchairs in the residents’ lounge.

One source said: “Some of them just wanted to go back to bed but they were just left in the lounge to sleep there. Sometimes they didn’t even get a cup of tea until breakfast.

“Some were put in baths at that time in the morning. It was ridiculous.”

Lynn was a staff nurse on night shift and sources claim that she maintained there was not enough time for the day shift to get everyone up in time for breakfast.

The source said: “If we protested, we were told to just get on with it.”

The Care Commission gave the home 24 hours to stop disturbing patients at such an early hour.

They ruled: “The practice of disturbing residents at early hours of the morning will cease.

It happens here in the US often. But we don’t think of it as abuse.

A reminder as to why it’s SO important to wash your hands:

LONDON (AP) - Nurses who didn’t wash their hands and left patients lying in soiled beds were cited in an official report blaming mismanagement for the deaths of 90 people who contracted a bacterial infection in hospitals in southern England.

“Significant failings” at all levels contributed to infections of more than 1,000 patients at three hospitals, the Healthcare Commission said Thursday.

The patients were infected with Clostridium difficile, or C. diff, which can cause diarrhea, colitis and other intestinal problems, officials said.

“The Healthcare Commission has passed the copy of the report to us and that is being reviewed,” said a spokesman for Kent Police, speaking on condition of anonymity in line with force policy.

The report into the spread of the highly contagious bacterium said nurses at three hospitals run by the Maidstone and Tunbridge Wells NHS trust were often too busy to wash their hands and left patients in their own excrement.

Across the pond they’re having HUGE problems battling these germs and bugs. It sounds like hand washing isn’t on top of the things nursing staff do over there.

For all the talk about how much better health care is in Great Britain, when I read articles like this I cannot agree with the pundits. Great Britain is far behind the US when it comes to health care, especially with it’s older citizens. The US is decades ahead on all matters related to nutritional health of our nursing home residents.

Hospitals and care homes are to face a major inquiry into the way frail elderly people are allowed to go hungry.

It follows research backed by charity studies that more than half of all older patients are at risk of malnutrition.

Ministers have agreed to support the investigation into which patients arrive on wards or in homes suffering from malnutrition and how their treatment is handled.

The inquiry comes in the wake of reports which say malnutrition among the elderly is widespread and that nurses and staff regularly neglect to ensure that vulnerable people are helped to eat meals.

Meals are left out of the reach of patients or residents, critics of hospital and care home standards have alleged.

They say that staff frequently fail to help patients eat, or remove meals before they have had a chance to eat them.

Of course the problems are the same: Not enough staff to assist with meals…but what about the standards? And why is this ONLY beginning to get attention in GB? We’ve known about nutritional problems in elderly who reside in nursing homes, here in the US for YEARS. so much that it is regulated by our government.

The Daily Mail has highlighted neglect of older people in its Dignity for the Elderly campaign.

Last year the Government launched its own ‘Dignity in Care’ campaign aimed at ending, among other abuses and instances of neglect, malnutrition of older people because care staff are too busy or otherwise pre-occupied to help them eat.

The new survey will involve medical and support workers in hospitals and staff in care homes who will answer detailed questions about their screening of newly-admitted patients and residents over three days later this month.

Professor Marinos Elia of BAPEN said: “Malnutrition is preventable and if treated early can improve outcomes for patients and residents.

“In the long run, treatment saves the NHS and social care system money as the cost of treatment is small compared with the potential benefits to be gained.”

Like the US, GB will face many obstacles when they try to “fix” this problem; and the NHS certainly won’t pay more for any fixes that are recommended. Nations all over the world are discovering the bad results of long term care facilities- and a few are looking at alternatives instead of short term fixes.

Here’s a twist: American elderly are going to Mexican nursing homes and assisted living facilities because the costs are far less than anything in the US…

AJIJIC, Mexico — After Jean Douglas turned 70, she realized she couldn’t take care of herself anymore. Her knees were giving out, and winters in Bandon, Ore., were getting harder to bear alone.

Douglas was shocked by the high cost and impersonal care at assisted-living facilities near her home. After searching the Internet for other options, she joined a small but steadily growing number of Americans who are moving across the border to nursing homes in Mexico, where the sun is bright and the living is cheap.

For $1,300 a month — a quarter of what an average nursing home costs in Oregon — Douglas gets a studio apartment, three meals a day, laundry and cleaning service, and 24-hour care from an attentive staff, many of whom speak English. She wakes up every morning next to a glimmering mountain lake, and the average annual high temperature is a toasty 79 degrees.

“It is paradise,” says Douglas, 74. “If you need help living or coping, this is the place to be. I don’t know that there is such a thing back (in the USA), and certainly not for this amount of money.

She’s right. Absolutely right.

What are some of the benefits of moving to Mexico?

Many expatriates are Americans or Europeans who retired here years ago and are now becoming more frail. Others are not quite ready for a nursing home but are exploring options such as in-home health care services, which can provide Mexican nurses at a fraction of U.S. prices.

Correct.

And:

Retirement homes are relatively new in Mexico, where the aging usually live with family. There is little government regulation….
[...]
Residents such as Richard Slater say they are happy in Mexico. Slater came to Lake Chapala four years ago and now lives in his own cottage at the Casa de Ancianos, surrounded by purple bougainvillea and pomegranate trees.

He has plenty of room for his two dogs and has a little patio that he shares with three other American residents. He gets 24-hour nursing care and three meals a day, cooked in a homey kitchen and served in a sun-washed dining room. His cottage has a living room, bedroom, kitchenette, bathroom and a walk-in closet.

For this Slater pays $550 a month, less than one-tenth of the going rate back home in Las Vegas. For another $140 a year, he gets full medical coverage from the Mexican government, including all his medicine and insulin for diabetes.

“This would all cost me a fortune in the United States,” said Slater, a 65-year-old retired headwaiter.

More than a fortune.

But there are some problems:

The U.S. Embassy said it had no record of complaints against Mexican nursing homes, but some residents in the Lake Chapala area reported bad experiences at now-defunct homes.

The first home that Jean Douglas lived in after she moved from Oregon was staffed by “gossips and thieves,” she said. It went out of business.

Irene Chiara of Los Angeles also lived in a home that was shut down by Jalisco state authorities.

“It was filthy, and the food was very bad. It was all made in the microwave,” she said.

Some Mexican managers also underestimate the costs and difficulty of running a retirement home. Two hotels turned into assisted-living facilities, The Spa in San Miguel de Allende and The Melville in the Pacific Coast city of Mazatlán, recently abandoned the business, their managers said.

“It was very expensive to run it,” said Luis Terán, manager of The Melville.

Some managers said they were especially selective when admitting foreign residents, to make sure they’ll be able to pay. Medicare, Medicaid, the Department of Veterans Affairs and most U.S. insurance companies will not cover care or medicine as long as patients are outside the United States.

I wonder how many of these people are medically fragile? And how many will become so sooner than later, and what will come of their care needs? A lesson from this newer trend, for American nursing homes AND those who work for them: Keep an eye on costs. Unions which drive up wages and benefits might begin losing residents to Mexico. We’re already losing American aides with Mexican immigrants who take our jobs (at far less pay…) The free markets can fix all of this if we allow it. Too many regulations and third party players are ruining nursing homes.

Outsourcing the care of our elderly. To India.

After three years of caring for his increasingly frail mother and father in their Florida retirement home, Steve Herzfeld was exhausted and faced with spending his family’s last resources to put the couple in a cheap nursing home.

So he made what he saw as the only sensible decision: He outsourced his parents to India.

Today his 89-year-old mother, Frances, who suffers from advanced Parkinson’s disease, gets daily massages, physical therapy and 24-hour help getting to the bathroom, all for about $15 a day. His father, Ernest, 93, an Alzheimer’s patient, has a full-time personal assistant and a cook who has won him over to a vegetarian diet healthy enough that he no longer needs his cholesterol medication.

Best of all, the plentiful drugs the couple require cost less than 20 percent of what they do in the U.S., and salaries for their six-person staff are so cheap that the pair now bank $1,000 a month of their $3,000 Social Security payment. They aim to use the savings as an emergency fund, or to pay for airline tickets if family members want to visit.

In the end, it’s always about money over much else. I find this option, as it is, a sad example of the selfishness of American people.

This is very sad, and it shouldn’t have happened. But in the far away world of Russia where things are not at all like they are in the US, this is not that unusual.

KAMYSHEVATSKAYA, Russia — Flames engulfed a nursing home in this village without a fire station Tuesday, killing 62 frail and elderly residents after the night watchman ignored two alarms and emergency teams took nearly an hour to arrive. At least 30 people were injured.
[...]
Authorities blamed the nursing home disaster on safety violations at the home, toxic building materials used in a renovation, negligence by the staff and the nearest firehouse being about 30 miles from Kamyshevatskaya, a town on the Azov Sea in southern Russia.

Many of the 93 elderly residents of the home were too frail to escape on their own, and nearly all of those who did get out suffered injuries.
[...]
Emergency officials said a night watchman ignored two fire alarms before reporting the blaze around 1 a.m. and it took firefighters in Yeisk almost an hour to get to Kamyshevatskaya, where the fire station was closed last year to save money. The blaze was reported out around 5 a.m.
[...]
Officials said a fire alarm system that had not been fully installed signaled three times, but a watchman ignored the first two alarms and reported the fire only after he saw flames.

In addition, nursing home staff were absent from their posts, slowing efforts to find keys and open an emergency exit, officials said. The officials also said the nurse and three orderlies on duty weren’t enough to quickly evacuate the building.

A foreign perspective on American nursing homes.

A report published November 21, 2006 by the Lewin Group indicates that the percentage of very senior adults (aged 85 or older) in nursing homes has sharply declined over the past two decades. The report, titled “Nursing Home Use by ‘Oldest Old’ Sharply Declines,” traces trends in nursing home admissions since 1985. The percentage of adults over 65 years of age in nursing homes decreased 0.6% since 1985, but the rate among those aged 85 or older dropped 7.2%. Meanwhile, the number of people in that age group nearly doubled. If seniors had continued to use nursing homes at the rate they did in 1985, the current nursing home population would be nearly 2 million. Instead, with a current nursing home population of 1.3 million, over 600,000 seniors have elected to not use nursing homes.

Interesting…One would gather that US nursing home population is growing. It’s not. And that’s not a bad thing.

Where have these people gone? The report indicates several factors contributing to this decline. An increase in the health and financial wealth of seniors has reduced the need for nursing home care and permitted seniors greater flexibility to choose their preferred services. At the same time, nursing homes have changed, focusing their long-term care on Medicaid residents and their short-term post-acute rehabilitation care on Medicare residents. Furthering the decline in nursing home use has been the substantial increase in the number of alternative long-term care facilities (e.g. assisted living facilities, residential care facilities for the elderly, group homes, and home and community-based services). With a population of 1 million residents, these facilities nearly rival nursing homes. The report also identifies increased availability of private long-term care insurance and active efforts by state legislatures as additional factors contributing to the decline in nursing home use.

I think we have a ways to go though…getting seniors and the elderly out of nursing homes is great…let’s bring them back home though instead of placing them into assisted living, group type homes. After all, home is where the heart should always be.

The decline in nursing home use has accelerated since 1999, when state and federal lawmakers imposed new initiatives to reduce the number of Medicaid recipients in nursing homes. One of these initiatives is the National Family Caregiver Support Program, part of the 2000 Reauthorization of the Older American’s Act. The Program allows states to provide a continuum of caregiver services to best meet caregivers and individual needs, making it possible for seniors with disabilities to remain at home and in their community longer. Other initiatives include President Bush’s New Freedom Initiative and Congressional funding for grants from Real Choice Systems Change, providing states seed money and assistance to shift the balance of senior care away from institutions and toward community living.

Wow…someone is actually crediting President Bush with an idea that is really good and that has worked well. Figures, this praise comes from another country.

Nursing home operators should keep these trends in mind when planning for the influx of Baby Boomers. According to the report, “[I]f the demand for nursing homes continues to decline at just half the rate of the national average over the past 20 years, the use rate among older adults would drop from a projected 3.2 percent to 2.5 percent in 2030.” Because maximum bed capacity and an increase in resident census is not guaranteed, providers should carefully consider their business model and projected plans for the next 10 and 20 years, as well as the growing market for alternative long-term care options. On average, compared to a skilled nursing facility, it is easier and quicker to obtain a license to operate and assisted living facilities or residential care facilities for the elderly.

I would heed this advice if I were a nursing home operator. For sure. The coming of the boomers might see the decline in the need for nursing homes, instead of the conventional thinking we will need more.

Across the pond they have identified a new strain of MRSA. It’s only a matter of time when we will see this in the US.

A healthy hospital worker died after contracting a deadly new strain of MRSA that had never before been reported as a cause of death in hospitals.

Four other workers at the same hospital also contracted Panton-Valentine Leukocidin-positive (PVL) MRSA, with two of their friends, said the Health Protection Agency. An investigation subsequently found that the strain had killed a patient at the hospital earlier this year.

The strain, which is particularly virulent, attacks healthy young people and can cause symptoms ranging from minor infections in the skin and soft tissue to a form of pneumonia that can kill in 24 hours.

The outbreak, which has only just been reported, was identified when a previously healthy female healthcare worker, named only as “Case One”, developed a severe MRSA infection and pneumonia and died after emergency surgery in September, the agency said.

The bacterium that she had contracted, PVL-positive MRSA, had never been found to cause a death inside a hospital. It was contracted by at least three other workers in two wards in a West Midlands hospital, and two of their friends.

It was also found to have caused the death of a patient at the hospital in March.

A statement from the agency said: “Eight cases of PVL- positive community-associated MRSA have been identified among individuals in a hospital and their close household contacts in the West Midlands. Four of these individuals developed an infection, two of whom subsequently died.”

Doesn’t sound good- these new germs keep mutating and turning into things we cannot treat.

This is something I have heard about recently. Where I work, the patients are sent out for the initial DX but promptly brought back to us. They get their treatments in my facility. Mind you this is in Canada- the story here. But we’re seeing here in the US too.

Hamilton, ON — There may be no advantage to taking nursing home residents to hospital for treatment of pneumonia. They can do as well if they receive the same medical treatment at their residence, a study conducted by McMaster University researchers and funded by the Canadian Institutes of Health Research (CIHR) has shown.

When nursing home residents are routinely hospitalized with pneumonia, they may become susceptible to other health risks, including a reduction in their quality of life and a decline in functional health. The transfers also place a major burden on the healthcare system in emergency departments and hospital wards, particularly during influenza season.

In contrast, treatment at home can significantly save health care costs, estimated to be $1,200 per patient treated for pneumonia.

“The data have important implications for the delivery of health care services for both long-term care facilities and acute care hospitals,” says Mark Loeb, principal investigator and professor of medicine and an infectious disease expert. “We estimate that implementation of the clinical pathway could result in a savings of $84 million Canadian annually. In the U.S., the cost savings could approximate $831 million annually.”

Dr. Mark Loeb and his colleagues at McMaster University’s Michael G. DeGroote School of Medicine conducted a randomized controlled trial of 680 residents in 22 nursing homes in the Hamilton area. They assessed hospital admissions, length of hospital stay, mortality, quality of life, functional status and cost.

They found that by following a defined standard of care to treat pneumonia, essentially bringing hospital care to the nursing home, hospitalizations were reduced by over half -� 10 percent of residents versus 22 percent in the group who had usual care. There was a substantial cost savings of more than $1,200 per resident, with no increase in mortality.

The defined clinical pathway included the use of oral antibiotics, portable chest x-rays, oxygen saturation monitoring, rehydration and close monitoring by a research nurse.

“The results of Dr. Loeb’s study point to ways seniors can receive the best available health care with the least possible disruption at a stage in their lives when any disruption can be a significant source of stress,” said Dr. Morris Barer, scientific director of the CIHR Institute of Health Services and Policy Research. “This study is a compelling example of how evidence gained through health research can save money and strengthen our health care system.”