My Elder Advocate

Nursing Home Evictions: Know Your Rights

2009-10-16T11:42:13-07:00

By Jack Halpern

Nursing homes are generally prohibited from moving residents. They can transfer or discharge residents from the home only for certain reasons and, even then, only when they follow specified procedures.

My Elder Advocate has a 100% success rate in preventing these evictions. Call 212-945-7550.

In order to lawfully transfer or discharge a resident, the home must be able to prove that it has complied with all the procedural requirements and that the transfer or discharge is for one of the few allowable reasons. Absent such proof, the transfer or discharge must be disallowed or, if the resident has already been moved, the resident must be allowed to return to the bed, room and facility from which the resident was transferred.

There are several reasons why a nursing home may try to evict a resident. From a nursing home’s perspective, the ideal resident does not require expensive care, places few demands on staff, and pays the home at the "private pay" rate. Because Medicaid and Medicare typically pay much lower rates than homes receive from their private pay clients, facilities may try to limit the size of their Medicaid-covered populations. Residents judged by the home to be "difficult" may become a target for eviction or transfer--often to a less appealing nursing home or to a psychiatric hospital. The home may claim that, regardless of the patient’s medical needs or desire to stay in the facility, Medicare-covered or "respite" admissions are time-limited (cutoff points of 20 or 90 days are often cited).

For a nursing home resident, few events are as traumatic as an involuntary transfer or discharge. At best, such occurrences are stressful and disruptive. At worst, "transfer trauma" will leave a frail elderly person frightened, disoriented, and isolated from friends and families, causing irreparable psychological and physical harm. Medical studies indicate that the rate of death will 5 to 9 times higher for residents who are transferred.

The transfers and discharges discussed here include any time the home moves a resident outside of that facility, including transfers to a hospital. There are separate rules and procedures for transfers from one room to another room within the same nursing home.

When can a nursing home resident be transferred or discharged?

A resident can never be discharged or transferred if moving the resident is "medically contraindicated," i.e., if the transfer would be more harmful than letting the resident stay.

If the transfer or discharge will not be harmful, a nursing home can only require a resident to leave in five situations:

1. Medical care the resident requires can not be provided in a nursing home setting.

2. The resident no longer needs nursing home care because the resident’s condition has improved.

3. The health or safety of other individuals in the home is endangered.

4. In the case of a self-pay patient, the resident has not paid for care at least fifteen days.

5. The home plans to cease operations.

The need for particular types of medical care or for extensive care should seldom be the basis for a transfer. Staffing levels should never be a factor. Nursing home law requires that appropriate, individualized care be provided to every resident of every nursing home. Nursing homes are always required to adjust the staffing levels of nurses, therapists and aides as needed to provide the best care possible for all residents.

A nursing home can not evict residents covered by Medicaid when the home decides to drop out of the Medicaid program. In this situation, the home must continue to provide care and accept payment from Medicaid for all those in residence when the home decided to withdraw from the Medicaid program.

What is the procedure for proposed transfers or discharges?

Usually, a nursing facility must give you, your guardian, conservator or legally liable relative a written notice, at least 30 days, and no more than 60 days, before a transfer or discharge from one facility to another. A shorter notice is allowed in emergency situations or for residents recently admitted. The nursing home must comply with all of the following notice requirements even if the home claims that the resident "consented" to the transfer or discharge. This is necessary to ensure that residents are made aware of their rights and afforded the opportunity to appeal.

If the written notice does not contain any of the following information, the discharge or transfer would be unlawful. The notice must include:

* The reason for transfer or discharge.

* The date of the proposed transfer or discharge.

* The location to which the nursing facility proposes to transfer or discharge you.

* Your right to a hearing to contest the transfer or discharge.

* The procedures you must follow to request a hearing.

* The date by which you must request a hearing in order to prevent the transfer or discharge from occurring before the hearing is held. The date given must be at least ten days from your receipt of the notice from the facility.

* Your right to represent yourself or have legal counsel, a relative, friend or other person represent you at the hearing.

* If you are being transferred to a hospital, information regarding holding your bed and readmission to the facility. The name, mailing address and telephone number of Long-term Care Ombudsman.

Should the facility prepare a discharge plan for me?

A resident may not be discharged unless the nursing home have developed a written discharge plan. The discharge plan must:

Be developed by your doctor or, the nursing facility's medical director together with other medical staff.

Consider the possibility of placement near your relatives, spouse, guardian or conservator.

Include a written evaluation of the effects of the transfer or discharge on you and a statement of how the nursing facility will make the transfer or discharge less disturbing.

Outline the care and kinds of services which you will receive upon transfer or discharge.

Except in an emergency, the nursing facility must give you, your doctor, guardian, conservator or legally liable relative, a copy of the discharge plan at least 30 days prior to the transfer or discharge.

Can a transfer or discharge be appealed?

The resident always has the right to appeal a discharge or transfer.

If you receive notice of a proposed transfer or discharge, it is important to start the appeal within 10 days of your receipt of a transfer or discharge notice. If you file an appeal during this 10 day period, you can not be moved until a hearing is held and a written decision is issued.

An appeal, however, can be filed within 30 days of receipt of the transfer or discharge notice. An appeal can be filed even if you have already been moved.

Legal services organizations and the long-term care ombudsman can provide assistance with transfers and discharges.

Facilities that attempt to transfer residents in violation of the law or without providing them with the required advance written notice can be sued. The courts are authorized to issue injunctions to prevent transfers, to order facilities to reverse transfer, and to make nursing homes pay residents compensatory and punitive damages.

Governor Paterson Signs The Nursing Care Quality Protection Act

2009-09-30T18:06:27-07:00

Due largely to the efforts of the New York State Nurses Association, My Elder Advocate and other advocacy organizations, on September 17th, 2009 Governor Paterson signed the Nursing Care Quality Protection Act, which requires healthcare facilities to disclose information about nurse staffing to state regulators and the public. The measure has been a top priority for the New York State Nurses Association. As the amount of care from registered nurses has a significant impact on patients' health and safety, consistent documentation is needed to determine staffing patterns in hospitals. Numerous studies have shown that higher nurse staffing is associated with lower rates of infection, cardiac arrest, and other complications. The bill passed the State Assembly by a unanimous vote earlier this year. The legislation requires each hospital to report the numbers of RNs and LPNs providing direct care and the ratio of patients to nurses; the number of unlicensed personnel providing direct care; the incidence of adverse patient events such as medication errors and injuries; and the method the hospital uses for determining and adjusting staffing levels.

A Largely Unknown Veterans' Benefit - Worth Knowing About

2009-09-24T09:54:05-07:00

The Veterans' Administration offers an Improved Pension with Aid and Attendance (A&A) benefit that is largely unknown. Unfortunately, this most important benefit is overlooked by many families with Veterans or surviving spouses who need additional monies to help care for ailing parents or loved ones. Check out www.VeteranAid.org

Check out Barbara Friesner's (www.AgewiseLiving.com) radio show on Radio America. She interviews Debbie Burak, Founder ofVeteranAid.org.

ACTION ALERT: URGE THE GOVERNOR TO SIGN The Nursing Care Quality Protection Act

2009-08-19T08:57:04-07:00

ACTION ALERT URGE THE GOVERNOR TO SIGN A1752-a/S3527: Nursing Care Quality Protection Act

Click here to send an email now!

Legislative bills A1752-a/S3527 require hospitals, nursing homes and diagnostic and treatment centers to disclose to the public staffing and patient outcomes such as numbers of staff providing direct care on each unit and each shift;

incidence of negative care such as medication errors, patient injury, decubitus ulcers, and infection; methods used for determining and changing staffing levels; complaint data including information on investigations of complaints; degree of compliance with acceptable standards; and the findings of inspections.

Although some of this is already required for nursing homes under federal law (e.g., posting of staffing information and inspection results), they are crucial for the other types of facilities and the additional requirements are needed for nursing homes.

My Elder Advocate believes that it is critical that this bill become law for a number of reasons. It is crucial for consumers to be knowledgeable about facilities that care for them; they should know how a facility is determining how much direct care staff they need (especially if they are reducing staff), how well complaints are investigated, and what kinds of negative outcomes are occurring; and the very fact that these issues will become public will be a strong incentive for facilities to maintain more appropriate direct care staffing and compliance with standards of care.

Please send an email or fax to the Governor today to urge him to sign this bill and empower New Yorkers to become active and informed in protecting themselves and their loved ones in hospitals, nursing homes and diagnostic and treatment centers.

ACTION ALERT URGE THE GOVERNOR TO SIGN A1752-a/S3527: Nursing Care Quality Protection Act

Click here to send an email now!

Keith Olbermann Talks About Nursing Homes In Special Comment

2009-08-04T16:45:54-07:00

Visit msnbc.com for Breaking News, World News, and News about the Economy

NEW POWER OF ATTORNEY LAW FOR NEW YORK

2009-07-16T13:52:04-07:00

MORE SAFEGUARDS BUT MORE COSTLY AND COMPLEX By Jennifer Cona*, Esq.

Under the revised power of attorney (POA) law that takes effect in New York on September 1st, baby boomers and seniors will have greater protection, but they will also pay more for a more complicated document.

With an increasing number of people becoming incapacitated due to Alzheimer's, strokes and other disabilities, the need for and use of powers of attorney is on the rise. An agent, usually a trusted family member, is appointed by the principal to handle their financial affairs if they are unable to do so themselves. The agent is granted the power to take care of all finances including banking, investments, real estate transactions, paying bills and making monetary gifts.

Over the past few years, several cases have been cited where family members used the person’s funds to benefit themselves and not the principal he/she represents. This prompted the NYS government to closely scrutinize the existing POA law and make major changes to it emphasizing the obligations of the agent.

Some of the key changes to the POA in New York State include:

- Detailed instructions and defined responsibilities for the agent

− Signature by the agent before a notary public

− Statutory Major Gift Rider for asset transfers and gifting over $ 500 that specifies amounts, recipients and types of assets to gift

− Ability of the principal to appoint a monitor to oversee the agent

_ Special court proceeding to challenge the validity of a POA, remove an agent, compel a bank to accept the POA and more

As the new POA is more complicated, contains additional provisions and riders, and will require greater review and explanation with an attorney, individuals will incur higher attorney fees for the document. However, until September 1, people have the opportunity to obtain a POA under the existing law, which is simpler and costs less money to execute.

By having an elder law attorney draft the instrument, you can also include specific powers to carry out your wishes regarding estate, asset protection and Medicaid eligibility goals.

Ms. Cona advises that those who already have a POA do not need to execute a new one. However, anyone who is not clear about the powers they have delegated or would like to insure that they are in compliance with the law should consult with an attorney.

On September 30th, GDGC will sponsor a free seminar in their Melville, LI office on the new power of attorney laws and what seniors and their families need to know. Participants will also have the opportunity to meet with a GDGC elder law attorney to review their POA. Reservations can be made by calling: 631-390-5000.

*Jennifer Cona, Esq., is managing partner of Genser Dubow Genser Dubow & Cona, recognized as a leading elder law and estate planning firm on Long Island. Ms. Cona has been featured in many publications and appeared as a guest on television and radio programs. For more information on GDGC and elder law/estate planning, visit their website at: www.genserlaw.com

NAVIGATING ELDER LAW

2009-07-14T08:23:36-07:00

My Elder Advocate and Jack Halpern, mentioned in this article! NAVIGATING ELDER LAW - BusinessWeek - Zimbio.

Fair Pay for Caregivers

2009-07-12T10:45:48-07:00

Fair Pay for Caregivers

Appeals court rules that nursing homes can be sued for private civil rights violations

2009-07-12T10:28:46-07:00

Appeals court rules that nursing homes can be sued for private civil rights violations

Who Will Stop the Massacre?

2009-07-07T17:28:26-07:00

By Martha Deaver* President, Arkansas Advocates for Nursing Home Residents. wwww.aanhr.org

My name is Martha Deaver. I would like to tell you about some of the abuses that occurred in 1999 to my mother, mother-in-law, and other residents in a Beverly Nursing Home, Riverview Manor, in Morrilton, AR. In March of 2000 I had my mother and mother-in-law moved to St. Andrew's Place, a one-owner nursing facility located in Conway, Arkansas. This was an attempt to find better care for my loved ones. The Arkansas State Office of Long Term Care has investigated all of the abuses that I am going to tell you about. The background evidence, which are hundreds of documents, were obtained through the Freedom of Information (FOI) department, in order to prove this story.

My mother's name is Helen Steger. She was a Registered Nurse and the wife of an Air Force Colonel. She has four daughters. Her youngest child has Down-Syndrome. My mother cared for my sister, Mary Ann, at her home until the day of her accident. While taking Mary Ann out for a Sunday drive, my mother suffered a stroke.

For almost seven months, I took my mother to four different rehabilitation centers so she could receive therapy to try to bring her back physically and mentally. Some improvement was made. She was able to talk on the phone, to eat a normal diet, to move her arms and legs enough to be up all day in a wheel chair. I was finally told that there was no hope for any more improvement. It was a truth that I had already accepted since I was by her side every day and saw her struggles. I knew in my heart that nothing else could be done to improve her condition further. I then needed a place to help maintain her current condition.

Before my mother's stroke, my father had obtained a Long Term Care Policy in her name. The provision in the plan was that my mother must be admitted into a Long Term Care Facility. We would not be allowed to receive the coverage and care for her at home. It became clear to my family after only a few months that the facility we had chosen was not acting in my mother's best interest. I immediately obtained legal guardianship over my mother. This forced the nursing home to answer to me about her care. Due to poor staffing, I soon realized that I needed to be there with her daily. I also hired private sitters to come seven (7) days a week to be sure that someone was there if she needed anything.

My husband's mother lived in another Beverly facility in Morrilton, Arkansas. My husband and I decided it would be easier to care of them together in the same nursing home. We moved my mother-in-law to Riverview Manor, with my mother, and obtained Durable Power of Attorney to ensure decisions were made in her best interest, too.

Within three months, I was forced to start filing complaints on poor care to the Arkansas Office of Long Term Care. My repeated attempts to bring these complaints to the Administrator and Director of Nurses were being ignored by the facility and by Beverly Enterprises Corporate Office.

My mother, mother-in-law, and many other residents were not only neglected, but also abused. I have thousands of documents and taped conversations to prove the atrocities that happened against my loved ones. The abuses and neglect that occurred to my mother-in-law include, but are not limited to:

• She was found in bed with a washrag shoved in her rectum in order to stop her from having bowel movements because they where tired of changing her diaper.

• She was found with a fist-sized bruise in the middle of her chest after being abused. The pictures are shocking!

• They were cited for overdosing my mother-in-law on psychotropic drugs. These drugs are considered a chemical restraint. They require less care in the psychotropic drugged condition. This happens in many nursing homes across the country. This is done regularly to keep the nursing home from having to hire more employees.

• My mother-in-law is a diabetic, the doctor ordered her blood sugar level to be taken monthly, and the nursing home was cited for going four (4) months without following the doctor's order. This also happened to other residents.

• My mother-in-law was left up in her wheel chair for five (5) hours, unattended. This neglect caused her to have a level four (4) bed sore [a level four (4) bed sore is the worst level of bedsores “ the lesion goes all the way to the bone]. The doctor's orders stated that she should be in her wheel-chair no more than thirty(30) minutes.

• My mother-in-law was verbally abused by a worker who had been turned in repeatedly by other residents and their families in the facility for physical and verbal abuse.

• My mother-in-law was infested with head lice two times within a four month period.

• My mother-in-law received numerous unexplained cuts and bruises. My mother also suffered many abuses in this facility that include but not limited to:

• She had a red alert strip on the front of her chart to show a drug she was seriously allergic to. She was given the drug anyway in spite of what was on her chart. The reaction put her in ICU for two weeks where she almost died.

• My mother's narcotics were found missing twelve (12) times. The facility was aware that this was attributed to one nurse.

• They were cited for failure to investigate the missing narcotics, and they were cited for failure to stop it from continuing.

• My mother was found with a baseball-sized bruise on her leg that no nursing home employees could explain.

• The nursing home was cited for failure to notify my mother's physician when she became severely ill.

The following are some of the abuses that happened to other residents: • A resident was given a shot of insulin that was meant for his roommate. This man was not even a diabetic!

• The nursing home was cited for failure to notify the residents' doctors when they became severely ill.

• A resident was given the wrong dosage of medication twenty-three (23) times in a one-month period.

• The nursing home was cited for falsifying documents pertaining to injured residents.

• An employee was turned in for hitting a man who was dying with cancer. The nursing home was cited for failure to investigate this employee about prior reports of abuse. These abuses were reported by family members and coworkers . The nursing home was also cited for failure to protect this man from abuse!

• The state investigator also stated in her report, âœThe facility failed to investigate and report and protect the residents seven (7) times.

• Nurses where told to ignore complaints about abuse on employees because of short staffing.

• They were cited by the state officials for failure to protect the residents from abuse, failure to report the abuse that occurred to family members or authorities, failure to protect the residents from further abuse, and failure to investigate allegations of abuse when family members and employees were reporting abuse.

The state investigator told me that through her investigation she was sure that my mother would be retaliated against for my role in the investigation. She suggested putting private sitters on the midnight shift, too. I took her suggestion. She will confirm this entire story. Beverly Enterprises spokesperson, Dan Springer, stated in an Arkansas Democrat Gazette interview that these abuses were simple things that needed to be worked on.

I realized I could no longer trust that my mother and mother-in-law would be safe in a Beverly Enterprise facility after the state investigator told me she felt like my family members would be in danger of retaliation. This forced me to have to move my loved ones. I searched www.medicare.gov website and thought I had found a nursing home that would better care for my two family members. The website showed nothing that alarmed me.

Upon entering St. Andrews Place in Conway, in March 2000, my mother's condition had deteriorated greatly. She was totally paralyzed, only able to blink her eyes, and was completely fed through a tube in her stomach.

Within approximately two to three months, my mother began to mysteriously have one seizure after another. These were the first seizures since her stroke. No one could explain why she was suddenly having them. In August, 2000, two nurses informed me they had failed to give my mother her anti-seizure medication. I knew this probably had not been the first time her medications had been administered incorrectly. I went straight to the administrator and informed him that I would be filing a complaint with the Arkansas Office of Long Term Care. He told me that he did not consider this situation to be neither abuse nor neglect, and he put this statement in writing! I have this document.

As administrator and head of the facility, I expected him to ensure that my mother's medications where given properly and I told him this in no uncertain terms.

On August 5, 2000, I filed a complaint with the Arkansas Office of Long Term Care informing them that my mother's vital medications were not being given, and that I had the nurses on tape admitting it. My complaint was not investigated until October 2, 2000. After the state investigators finally showed up, they discovered that the nursing home had no system in place to document what medications the residents received, or if the residents of the facility had received any medication. This endangered every resident in the nursing home. The facility received a fifteen thousand dollar ($15,000.00) fine, as the state and federal documents show. The nursing home was cited for putting its residents in the highest degree of danger that a nursing home can be guilty of by state and federal law, Immediate Widespread Jeopardy (This meant that every resident was endanger of serious harm or death).

Other citations in the October 4, 2000 state survey were, but are not limited to: • Leaving a rubber tourniquet and needle in the arm of my mother-in-law causing her hand and arm to turn black. • Being responsible for a woman receiving hundreds of ant bites while she slept. The pictures I have are shocking! • The nursing home was cited for not investigating a nurse after a family member reported her for shoving their mother down in her wheel chair. • My mother in laws leg was ripped open while she was being transferred from her wheel chair to her bed. They were cited for transferring her with two employees instead of three as her doctor had ordered. • They were cited for leaving my mother-in-law up in her wheel chair for eight (8) hours unattended causing a bed sore. • They were cited for failure to give my mother her vital anti-seizure medication. • It was also discovered that my mother's vital ant-seizure medication was being measured incorrectly when it was being given. 50mg of her Valporic Acid was being left out four times a day. This explained her multiple seizures.

The nursing home was infuriated with me. They knew I was responsible for the $15.000.00 fine they received. They were very aware I was an advocate that knew state and federal regulations. I also had assisted other family members that were not aware of their rights on how to file complaints when their loved ones were abused in this nursing home.

When I realized that so many families were unaware of their rights, I started advertising "Free Residents Rights" in the local newspapers. The nursing home not only hated me, but they also feared me. On October 18, 2000, they became aware of who filed the complaints, and by October 23, 2000, they placed temporary restraining orders on my husband, my son, and me. They claimed that I was a danger to the residents, that I was placing the facility in danger of losing its Medicare funding, and several other bizarre allegations (Refer to restraining order).

On January 15, 2000, while under a restraining order, I was called at four (4:00am) and told, by a nurse, that my mother had a high temperature and was vomiting large amounts. The nurse had diagnosed my mother with a urinary tract infection. The doctor's order was to obtain a urine sample in the morning and do not send to the emergency room. After hearing of my mother's condition, I toldthe nurse to immediately go to my mother's room and re-assess her to see if her lungs were clear. The nurse assured me that her lungs were clear, but that she would check them again and call me back. Thirty minutes later, I received a phone call stating that they were immediately transferring her to the emergency room (I have tapes of both conversations with this nurse).

My mother's diagnosis in the emergency room was respiratory failure from vomit in the lungs. I was informed that she would not survive. I insisted on her being transferred to see her specialist in Little Rock, where she stayed in ICU on life support, for almost two months. The specialist said that my mother had to have lain there choking on her vomit for four to six (4-6) hours in order to develop such a fatal infection.

It took these two months to finally get a court date, but it was too late for my mother. The restraining orders were dropped when they were appealed in front of a chancery court judge. The saddest part of this miscarriage of justice is while I was waiting for the court date, my mother died in ICU from the abuse. She died on March 12, 2001. I postponed her funeral by one day to meet the court date. I wanted my mother to have her day in court!

The facilities administrator admitted to the judge that he did not have one eyewitness to any of the accusations on the restraining orders he had obtained against my son, my husband, or me. Keep in mind, the administrator signed under oath that all the accusations in the restraining order could be proven. He brought to court no proof! The Director of the Complaints Department with the Office of Long Term Care cited St. Andrew's Place for not allowing visitation with our two family members pertaining to the restraining orders. They still would not allow us to visit and got away with not allowing us to visit until it was ordered by the the judge after the death of my mother!

I have obtained thousands of documents to prove this story to be factual and true. In my research on this nursing home, I found ten more abuse surveys in a one year period that are shocking. One bazaar finding was that after being find $15,000.00 in October, the next month they were cited in another abuse survey for failure to do criminal background checks on 11 employees and failure to do tuberculosis tests on five employees. They have also been cited for more medication errors.

There has been no justice and because I have yet to get any criminal charges filed against either nursing home, I have been forced to file civil law suits against bothnursing homes. Someone has to hold them accountable! This massacre has to be stopped!

These are the abuses in two different nursing homes to my family members. There are thousands of abuses occurring daily all over the United States! The hundreds of news reports and the governments own studies prove this. The public has to be made aware that these abuses are going on. Maybe then, serious changes can be made in the care of our precious elderly. They deserve to live their last days out in peace and comfort! *ABOUT THE AUTHOR Martha Deaver began her work as an advocate for the rights of nursing home residents in the late 1980’s when her grandmother was a resident of an Arkansas nursing home. She joined The Arkansas Advocates for Nursing Home Residents in 1998 and became a member of the board of directors in 2001. In January of 2008 Martha was elected President of The Arkansas Advocates for Nursing Home Residents.

Martha’s mother and mother-in-law where victims of nursing home abuse. Martha Deaver began her work as an advocate for the rights of nursing home residents in the late 1980’s when her grandmother was a resident of an Arkansas nursing home. She joined The Arkansas Advocates for Nursing Home Residents in 1998 and became a member of the board of directors in 2001. In January of 2008 Martha was elected President of The Arkansas Advocates for Nursing Home Residents. Martha’s mother and mother-in-law where victims of nursing home abuse.

In 2005 Martha Deaver was honored by NCCNHR for her long-term commitment to protect the rights of nursing home residents. She was presented with the Janet Tulloch Memorial Award in Washington, DC. Governor Mike Beebe wrote a letter of recommendation.

In June, 2006, Martha Deaver’s tragic experiences with two Arkansas nursing homes was featured in “Ladies Home Journal” in a report titled, “It Broke My Heart That I Couldn’t Protect My Mom.” The journalist of this report, Michael J. Weiss, won a journalism award in Washington, DC from NCCNHR after the report was published.

Martha Deaver has worked with the Government Accountability Office by providing information and data to assist in the production of several GAO reports. After supplying numerous complaint surveys to the GAO, Martha was asked to be the spokes person for the announcement of complaint survey data being added to the government nursing home compare web-sight.

Martha Deaver worked for three years supplying information and data to Trudy Leiberman, the director of the Consumer Union dealing with health issues for Consumer Reports. After the three years, Martha hosted Trudy in Arkansas for one week while traveling the state to meet with nursing home owners, nursing home residents and their families, reporters, long-term care agency directors, and the Arkansas Attorney General. This culminated in one of Consumer Reports most in-depth outlooks on America’s Nursing homes that was released in 2006. The article was titled, “The Crisis in America’s Nursing Homes.”

NYC Closing Peter's Place-Shameful (AUDIO)

2009-06-24T09:05:00-07:00

Jack Halpern

FATHER'S DAY

2009-06-21T17:46:14-07:00

Before I piss everyone off, I would like to wish all Dad’s a Happy Father’s Day, especially those in nursing homes who don’t have children and families to visit them. In my immediate family we don’t celebrate Mother’s Day or Father’s Day. Not because we think that my wife and I don’t need a special day. We just think that we don’t need a special day to love each other. “Everyday is Father’s Day”, yelled Rabbi Wainkrantz in Yeshiva Ohel Jacob. We all hate to stand on restaurant lines anyway. I looked up the derivation of this day and found the following:

The idea for creating a day for children to honor their fathers began in Spokane, Washington. A woman by the name of Sonora Smart Dodd thought of the idea for Father's Day while listening to a Mother's Day sermon in 1909.

Having been raised by her father, William Jackson Smart, after her mother died, Sonora wanted her father to know how special he was to her. It was her father that made all the parental sacrifices and was, in the eyes of his daughter, a courageous, selfless, and loving man. Sonora's father was born in June, so she chose to hold the first Father's Day celebration in Spokane, Washington on the 19th of June, 1910.

In 1926, a National Father's Day Committee was formed in New York City. Father's Day was recognized by a Joint Resolution of Congress in 1956. In 1972, President Richard Nixon established a permanent national observance of Father's Day to be held on the third Sunday of June. So Father's Day was born in memory and gratitude by a daughter who thought that her father and all good fathers should be honored with a special day just like we honor our mothers on Mother's Day.

And I thought it was a holiday created by card companies and tie companies. There is a reasonable explanation for why I personally disdain these days, and it goes back to my early days when I started working in my first nursing home.

I was only twenty four years old, and my job was to supervise the cleaning and maintenance staff. I was required to work every year on these day, because the place was always packed with visitors. Visitors who only showed up twice a year, I might add. I had to be there for the complaints. Yes there were many complaints. One son complained about his mom’s bed being wobbly. I told him that his mom was in another room. Sorry it’s been a long time since his last visit.

They complained about the food, about the nurses, and trhe furniture anything to assuage their guilt for putting their parents in a nursing home. Some children fought with their parents about money and inheritances. Some children asked for money, and some had to be evicted because their parent’s did not want to see them. The two day a year kids.

The moral of the story is that if your parent is in a nursing home, everyday is Father’s Day. Statistics prove that those residents who have active participation by a family member or a friend, live longer, and are more protected from neglect and abuse. The more you yell (not about silly stuff- see http://myelderadvocate.typepad.com/blog/2008/12/how-to-complain-about-a-nursing-home.html) the safer they will stay.

If you can’t be there, try to get someone to visit and advocate for them.

This is Scrooge saying, Happy Father’s Day and may you all stay forever young.

Compassion and the Individual

2009-06-21T08:29:43-07:00

Compassion and the Individual. What our elders need is COMPASSION. Here is an expert on the subject, His Holiness, The Dalai Lama.

Dusk-to-Dawn Therapy for Dementia’s Restless Minds - NYTimes.com

2009-06-14T14:53:27-07:00

Dusk-to-Dawn Therapy for Dementia’s Restless Minds - NYTimes.com.

How a Long Island Nursing Home Empire Got Its Way « Michael Amon

2009-06-14T12:19:50-07:00

How a Long Island Nursing Home Empire Got Its Way « Michael Amon.

Now Ain’t The Time for Your Tears- Part One

2009-06-06T14:36:25-07:00

But you who philosophize disgrace and criticize all fears, Take the rag away from your face. Now ain't the time for your tears. Bob Dylan-The Lonesome Death of Hattie Carroll Local Watchdog Group Accomplishes Nothing

After many years of trying to tame that beast, that is the New York State Department of Health, The Long Term Care Community Coalition (LTCCC) came up with absolutely nothing.

No new laws that protect Nursing Home Residents

No significant fines against nursing homes that kill their residents, (The DOH is still limited to fining no more than $2,000.00 per violation).

An archaic survey system that allows a bunch of morons at the DOH to decide what constitutes harm to a resident, based on outdated criteria. The DOH still does not speak to residents during surveys.

Check out the article below. Before you do, get yourself a tall scotch. I am livid and mad as hell!

LTCCC Directors Speak at NYS Surveyor Training (Read Full Article Below)

“Over 110 inspectors were present in each of two sessions. The presentation: Residents have the answers: How listening to residents is key to a successful survey outcome.”

Gag me with a friggin spoon. Is that the best they can come up with? Is it a wonder that nursing home care is so horrible?

Now I remember a time when LTCCC had a brass pair of balls. Cynthia Rudder fought like a lion to protect nursing home residents and DOH listened carefully when she complained about the care. Unfortunately, at that time DOH surveyors were on the side of NH residents. You had tough surveyors who fought for residents. Surveys were tough, and homes that did not comply with the law would find themselves in hot water. Nursing home administrators would loose their jobs if a surveyor was not happy with the care.

That is not the way it is anymore, and Cynthia knows it. Today’s DOH could not find a violation in a nursing home, if it bit them in the ass. They are lazy, uncaring, stupid and grossly under- trained. I would say underpaid, but for what they do, they are overpaid. If a surveyor shows initiative at DOH they go the way of the trash. Why would a Nurse even want to work for DOH. Oh, I forgot. The hours are great! There is very little work to do! Your meals are free! Call DOH at 4:30 PM and you can’t find a soul in the office. A perfect gig for a loser nurse who should never have been a nurse in the first place.

About two years ago, I attempted to solicit Ms. Rudder’s help with Split Rock Nursing Home. Split Rock NH is a concentration camp in the Bronx. Residents die there about as regularly as Mao used to trim the population in China.

Fortunately for Split Rock, the owners are very politically connected (Chuck Schumer, Andrew Coumo). Chuck Schumer used to be a good guy, now he will take money from the Mafia, if he could get away with it.

I filed about a dozen complaints against Split Rock, with DOH. These complaints were based on my personal experiences, at various hours at Split Rock. Cynthia Rudder spoke to some creep at DOH. She told me to be patient until they “do their investigation”. I told her to “bite me.”

They did their investigation and found “no credible evidence” in support of my serious complaints. I’m not just a family member complaining about the bad food. I’m a Licensed Nursing Home Administrator, with thirty five years of experience working in the trenches. I could tell you whether a nursing home is good or bad within thirty seconds of entering the facility. My complaints are very detailed, very specific in both time and place. I don’t file frivolous complaints.

In the time that DOH took to do their investigation, three residents at Split Rock were murdered (that I know about). One of these victims, was a fifty five year old mother of five named Maria. Maria was shot by her boyfriend five times, and set on fire. She survived and spent six months at Jacobi Hospital, in their burn unit. Then suddenly her savior angel quit on her. She was transferred to Split Rock NH.

Although Split Rock had no proper policies and procedures to handle burn victims, they admitted Maria. As anyone knows, the worst thing for a burn victim is infection. Split Rock is famous for poor infection control. A Petri Dish is cleaner. Maria was sent back to Jacobi Hospital five times with infections. And five times she was returned to Split Rock. One hot summer day I visited Maria. She had at least a hundred flies buzzing around her, like a carcass in the desert. The odor coming from her bandages could knock over an elephant. Not a nurse in sight, it was lunchtime. When I complained to the administrator, he had me removed from the facility by security. I kept DOH informed about this situation on a regular basis, to no avail.

Five bullets could not kill Maria. Setting her on fire could not kill her. Split Rock Concentration Camp was up to the task. One day the nurse on her unit refused to give Maria her pain medication, to punish her for something. Maria threw herself out of bed so violently, that when she hit her head on the ground, the thud could be heard on the floor below. Maria died a month later at Jacobi Hospital. Her five children take very little comfort that DOH found “no credible evidence”, to support my complaints against this house of horrors.

The last paragraph of the article below really set me off. “Both Richard and Cynthia enjoyed working with the surveyors and the surveyors indicated that they appreciated the presentations and felt that they had learned a lot.” How warm and fuzzy.

Cynthia and Richard listen up. I’m sure that all my readers who beat themselves up because they abandoned their parents, in their direst moments of need, and placed their parents in a nursing home (most involuntarily) are going to feel warm all over. They will be thrilled that 110 DOH morons who were supposed to take care of their murdered parents, finally learned that it is harmful to a resident, not to have their hearing aide for ten months. What a huge breakthrough! I have a flash for you. When a resident loses their hearing aide (usually because the aide throws them into the laundry) most nursing homes will not replace them ever, because the facility has to pay for them.

I would suggest that LTCCC follow up in the next twenty years, with training entitled:

1. Is it harmful to a NH resident to have a Decubitus Ulcer (bedsore), the size of a grapefruit in their asses (rectal area, let’s not be gross).

2. Is it harmful for residents to call the NH Complaint Hotline after being told by their aide, that they will be beat up.

3. Is it harmful to be hepped up on dangerous drugs, so that a resident can be chemically restrained (especially during surveys).

4. You get the point.

If any of my reader’s feel that I sound particularly facetious, mad, and acerbic they are correct. I am so mad.

But you who philosophize disgrace and criticize all fears, Take the rag away from your face.Now ain't the time for your tears.

________________________________________________________________________

LTCCC Directors Speak at NYS Surveyor Training.

Richard Mollot, Executive Director and Cynthia Rudder, Director of Special Projects, participated at March trainings for New York State nursing home surveyors.

Over 110 inspectors were present in each of two sessions. The presentation: “Residents Have the Answers: How Listening to Residents is Key to a Successful Survey Outcome,” began by raising awareness of the losses faced by residents who enter a nursing home and how life in a nursing home can compound these losses. Urging the surveyors to focus on the spirit of the regulations, the directors let the inspectors know how important they are to the residents because they have the power to make things better. Surveyors were asked to think about a number of different scenarios and discuss what kinds of information they needed in order to decide if a deficiency should be written and at what level of seriousness the deficiency would be rated at.

One Scenario:

A facility was cited when a resident was found to be hard of hearing and even though a hearing aid was ordered, the resident had not received her hearing aid when the survey was conducted (10 months later).

Surveyors were asked to rate this deficiency in terms of its severity. Was it a potential for harm or was it harm? (Note: this deficiency was rated originally as only having a potential to harm the resident).

Surveyors made a number of recommendations for getting the information they needed: speak to the resident and family; look into the resident’s level of activities before and after the assessment; look into staff training; look into why the hearing aid was not in place and if the facility tried any other ways of making sure the resident was not isolated. Most of the surveyors believed that this situation should be rated as harm.

Both Richard and Cynthia enjoyed working with the surveyors and the surveyors indicated that they appreciated the presentations and felt that they had learned a lot.

Nursing home used outdated consent forms in Risperdal case

2009-05-13T13:53:34-07:00

Nursing home used outdated consent forms in Risperdal case.

Assault With A Deadly Weapon

2009-05-12T17:52:14-07:00

On February 18, 2009, Attorney General Jerry Brown announced the arrest of a nurse, physician and a pharmacist of a skilled nursing facility operated by the Kern Valley Healthcare District in Lake Isabella, Kern County. All were charged with elder abuse for forcibly administering psychoactive medications for their own convenience and for causing the deaths of three residents. Facing criminal charges are Gwen Hughes, the former director of nursing, Debbi Hayes, the former pharmacist, and Dr. Hoshang Pormir, a staff physician and the facility's medical director. Hughes and Hayes are also charged with assault with a deadly weapon.

The allegations are reminiscent of One Flew Over the Cuckoo's Nest. Gwen Hughes, the former nursing director, is reported to have ordered staff to inject numerous residents with powerful, dangerous antipsychotic medications without any medical justification. According to the charges, groups of staff held down at least two residents and injected them with drugs that reduced them to a zombie-like state. In addition to the three deaths, other residents suffered severe medical and psychological trauma. When drugging triggered behavioral problems, even stronger drugs were ordered and administered. Many residents and family members were not informed that psychoactive drugs were being used.

The year-long investigation by the Attorney General's office was triggered by a Department of Public Health investigation in January 2007 that first documented the widespread drugging and brought a rare finding of "Immediate Jeopardy."

"These people maliciously violated the trust of their patients, by holding them down and forcibly administering psychotropic medications if they dared to question their care," Attorney General Brown said. "This is appalling behavior, which amounts to assault with a deadly weapon."

"Deadly weapon" is an apt description of antipsychotic drugs when used in this fashion. The U.S. Food & Drug Administration (FDA) has issued its most dire warning – known as a black box warning – that antipsychotic drugs cause elders with dementia to die. Although the FDA has never approved use of antipsychotic drugs to treat dementia, it is estimated that up to 40 percent of nursing home residents with dementia are subjected to antipsychotic drugs, such as Zyprexa, Seroquel, Risperdal and Haldol.

The Attorney General's action closely follows a landmark settlement by the U.S. Department of Justice (DOJ) on January 15, 2009 of criminal and civil charges against Eli Lilly for illegally marketing Zyprexa to doctors for unapproved use by elders and children. The company agreed to pay a record $1.415 billion in criminal and civil penalties.

The U.S. DOJ accused Eli Lilly of targeting its illegal marketing of Zyprexa to doctors who treat the elderly in nursing homes and assisted living facilities. According to DOJ, Eli Lilly did so despite lack of FDA approval for this purpose and known severe side effects for this population. Reportedly, Eli Lilly promoted use of Zyprexa by claiming it would help facilities sedate residents who would otherwise require more care.

Seroquel Anger

2009-05-03T17:59:20-07:00

Research has found that Seroquel anger is a serious side effect that can cause injury to patients who are taking this atypical antipsychotic medication. Elderly patients who are taking Seroquel for the treatment of dementia or Alzheimer's seem to have the greatest risk of suffering from Seroquel anger. Several studies have indicated that Seroquel use can actually worsen a patient's dementia and Alzheimer's symptoms.

SEE MORE:Seroquel Anger -Defective Drug Information.

These Drugs Are Not To be Used On Elderly Dementia Patients

2009-05-03T17:31:18-07:00

Jack Halpern

When an Elderly Loved One Resists Care

2009-04-27T05:59:39-07:00

How many times has your mother refused to change her clothes? Has your father resisted getting out of bed? Has your wife pushed you away when you tried to brush her teeth? Many times a caregiver will be particularly frustrated by her loved one's refusal to help himself. At times she can't help but think that the person she cares for "36 hours a day" is going out of his way to make her miserable! The increasing irrationality of individuals with dementia makes it even harder on the caregiver.Individuals who resist care and assistance are trying to communicate to you. If dementia, stroke, vision loss, hearing loss or other illness limits one's ability to speak and convey information effectively, body language and physical actions take on a greater role in communication. Refusal to accept care, physical contact or participation in an activity is the individual's way of telling you something.

When your loved one resists care, step back calmly and think:

Are there any environmental factors such as lighting, shadows, noise, commotion or other external influences that are causing the problem now? (Before you say something, think about what you are going to say. Check your emotions and frustration before you speak. Your increased frustration can contribute to your loved one's agitation. (Put yourself in her shoes. Use your knowledge of her personal background to pinpoint patterns and reasons for her reaction. (Is this confrontation worth escalating?

Choose your battles wisely. A head-to-toe bath is not necessary every day or even more than once each week. Similarly, clothes do not have to be changed every day if they are not soiled. (Refusal to accept care or engage in once-pleasurable activities is a sign that something is amiss. The caregiver can assess the situation for specific complicating factor and make adjustments if necessary: (Refusal to get out of bed: illness - Assess physical factors such as injury from a fall, bruises, temperature/fever, urinary tract infection, or oral infection.

Keep a thermometer handy and know how to use it. Make a point every day or so of inspecting skin for dryness, sores or bruises. Catching skin or mouth sores early on will limit long-term damage and illness. (Refusal to join family or participate in even small activities: environmental - Assess for too much noise, harsh lighting, or specific individuals who cause distress. Correct these distractions and integrate positive factors such as music, aroma, comfortable fabrics and warmer room temperatures.

Refusal to perform tasks and activities: depression - The inability to fully perform tasks for oneself can cause an individual to avoid those situations. Assist them as much as possible while encouraging them to do as much for themselves without embarrassment. This is time-consuming, but it is the best route for enhancing self-esteem and independence. (Refusal to take medication: physical side effects - Sometimes side effects result from medication that are unbearable to the recipient. Learn what possible side effects can occur from the drugs your loved one takes. Consult with the doctor to see if over-the-counter anti-nausea, anti-diarrhea, or anti-dizziness products can be taken with prescription medications.

Perhaps the medication can be taken at bedtime or mealtime to reduce side effects. When administering the medication, tell your loved one how it will help them and use distraction if side effects occur. (Refusal to bathe or change clothes: embarrassment - Limit other people's presence (even their voices), approach in a non-threatening way, undress/bathe one area at a time and keep the rest covered, speak calmly and tell your loved one what you are doing each step of the process. Talk about pleasant memories and stories as you are bathing/dressing. (Refusal to eat or clean teeth: illness, incapacity - Oral hygiene is essential for elderly persons since poor hygiene can make eating painful and compromise nutrition.

Don't let oral health get to a point where it is a problem. The sense of taste declines with age, so make efforts to improve the flavor of food, make it appear appetizing, and ensure that portions are of the right size and consistency. You may need to provide pre-cut portions or thickened liquids. See if better shaped utensils and plates help your loved one feed herself. (You may have to use your own creative ideas to get around resistance. One caregiver's mother often refused to settle down for dinner. So the caregiver helped her mother get dressed up a bit with a nice sweater, a brooch and her purse. The two dined out on the patio without incident.

If your loved one still resists care even after adjusting for other factors, remember that confronting your loved one at that time of heightened emotions may make both of you more agitated.

Did nursing home company buy Schumer's help? -- Courant.com

2009-03-29T08:14:12-07:00

Did nursing home company buy Schumer's help? -- Courant.com.

10 Sentosa nurses, lawyer to sue New York prosecutors | ABS-CBN News Online Beta

2009-03-29T08:07:05-07:00

10 Sentosa nurses, lawyer to sue New York prosecutors | ABS-CBN News Online Beta.

Prescription Abuse Seen In U.S. Nursing Homes

2009-03-08T09:17:51-07:00

In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals -- including antibiotics, AIDS drugs or medicine to treat high-blood pressure.

One reason: Nursing homes across the U.S. are giving these drugs to elderly patients to quiet symptoms of Alzheimer's disease and other forms of dementia.Nearly 30% of the total nursing-home population is receiving antipsychotic drugs, according to the Centers for Medicare & Medicaid Services, known as CMS. In a practice known as "off label" use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not. CMS says nearly 21% of nursing-home patients who don't have a psychosis diagnosis are on antipsychotic drugs.

That is what happened to a woman listed in New York state health department inspection records as Resident #18. The 84-year-old Alzheimer's patient, who lives at the Orchard Manor nursing home in Medina, N.Y., likes to wander and roll her wheelchair around her unit, according to a report filed earlier this year, and sometimes she nervously taps her foot.

To address her behavior, which was considered disruptive, Resident #18 was given a powerful antipsychotic drug called Seroquel, a drug approved for schizophrenia and bipolar disorder. Resident #18 is not psychotic and Seroquel -- like other atypical antipsychotics -- carries a "black box" warning that elderly dementia patients using it face a higher risk of death.

"She is a handful," says Thomas Morien, administrator of Orchard Manor. "Other residents complain about her because often at night, she will get up and go to their rooms." The patient has since been taken off the drugs.

The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing-home industry.

"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Federal and some state regulators are pushing back, questioning the use of antipsychotic drugs and citing nursing homes for using them in ways that violate federal rules. New York has increased its focus on antipsychotics in nursing homes, training inspectors to spot signs of medication abuse. Last month, the Arkansas attorney general filed suit against Johnson & Johnson and two of its units, claiming, among other things, that they "engaged in a false and misleading campaign" to promote its antipsychotic drug Risperdal to geriatric patients.

A spokesman for Janssen LP, one of the Johnson & Johnson units that manufactures Risperdal, says, "We are prepared to vigorously defend ourselves against these claims.

Setting Limits

The $122 billion-a-year nursing-home industry's use of drugs raises complex issues in an aging society. Revulsion against practices such as tying down and sedating disruptive elderly patients led in 1987 to a landmark federal law, signed by President Reagan, that set limits on how and when nursing homes can physically, or chemically, restrain a patient. Since then, a rising population of elderly people suffering dementia has entered nursing facilities, many of which have overburdened staff.

The vast majority of antipsychotic medicines paid for by Medicaid are atypical antipsychotic drugs, thought to have fewer of the side effects typical of older drugs. Many were introduced in the 1990s to treat schizophrenia, and have become huge sellers for pharmaceutical companies. Nursing homes turned to the drugs to try to calm dementia patients and to maintain safety and order in their facilities.

The newer antipsychotics are more expensive than older ones. A dose of Seroquel, for instance, can cost more than $4 at retail, while Risperdal can cost more than $5 a pill retail; older antipsychotics can cost less than a dollar per dose.

In all, atypical antipsychotics rang up U.S. sales of $11.7 billion last year, up from $6.6 billion in 2002, according to IMS Health, a health-care information company. Doctors last year filled 45.4 million prescriptions for atypical antipsychotics, compared with 33.6 million five years ago, IMS Health says.

Schizophrenic patients, for whom the drugs were originally intended, make up 1.1% of the U.S. population, or 2.4 million people over 18, according to the National Institute for Mental Health. It says 2.6% of Americans suffer from bipolar disorder, for which the drugs were later also approved.

Marketing atypical antipsychotic drugs for use in treating dementia is banned, since the drugs aren't approved for such use. Still, drug companies have reached out to those who take care of incapacitated patients. For instance, the March 2007 issue of Annals of Long-Term Care, a publication of the American Geriatrics Society that caters to doctors and long-term care specialists, carries a multipage ad for Seroquel. The ad says in large type that the drug has been approved for treatment of bipolar depression.

A spokesman for AstraZeneca Pharmaceuticals, the maker of Seroquel, says "bipolar depression afflicts adults of all ages, including seniors." He noted that the warning of dangers to elderly patients was prominently featured in the ad.

Seroquel had global sales of $3.4 billion last year, making it one of the industry's blockbusters. U.S. sales were $2.5 billion. For the past two years, Seroquel has been the No. 1 drug purchased by Medicaid.

AstraZeneca says it "does not recommend Seroquel for uses other than its approved indications in schizophrenia and bipolar disorder." The company noted the warning on the labels "of all drugs of this class" regarding use in dementia patients. "Decisions about medical treatment are made by physicians," the company says.

Nursing homes often find it difficult to balance the demands of caring for certain patients against the pressure to keep staff costs down. The economics of elderly care can work in favor of drugs, because federal insurance programs reimburse more readily for pills than people.

The use of antipsychotic drugs comes amid a wider debate about how to care for the rising numbers of seniors, many of whom have behavior problems stemming from dementia. They can be difficult to manage, at home or in an institution. They can cry, lash out, wander or even be violent, to themselves or others. There aren't many effective methods to calm them, doctors say.

A big question is whether to use a medical model -- administering antipsychotics as the way to alleviate distressing symptoms of dementia -- or trying to find other ways to help these patients.

The Centers for Medicare & Medicaid -- the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor -- has "initiated a more rigorous process to oversee appropriate use of medicine," says Chief Medical Officer Barry Straube. He says the number of nursing-home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.

Dr. Straube says CMS -- which both funds and oversees nursing homes -- "is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications."

In 2005, the most recent year for which total expenditure figures are available, Medicaid spent $5.4 billion on atypical antipsychotic drugs. It spent less on AIDS drugs ($1.58 billion) and medications to lower cholesterol ($2.1 billion). These figures don't include rebates the government receives.

High use of antipsychotics in a nursing home can be an indicator of inadequate staffing, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. "We know the more staffing there is and the higher quality of care, the less the antipsychotic usage," he says.

Neurological Disease

Psychosis is a severe psychiatric illness which frequently includes delusions or hallucinations. Alzheimer's is a neurological disease that can be accompanied by either psychosis or severe behavioral symptoms, such as aggression or agitation. Dr. Pollock, a professor of neuropsychiatry at the University of Toronto, says one problem is that the psychosis in Alzheimer's disease is not the same as psychosis in younger patients with schizophrenia.

America is facing a public health crisis over the care of those with dementia, Dr. Pollock says. "We are left with the atypicals because we have nothing else," he says. These drugs have a role to play, he says, but "nonpharmacologic treatments" should be tried first.

In New York, the state Health Department is stepping up its focus on antipsychotic use in nursing homes. Two years ago, it issued 16 citations involving medication misuse; this fiscal year, there were 67. Records of a state inspector's visit to the Orchard Manor nursing home earlier this year offer a glimpse of the problem.

The report profiles an 84-year-old woman identified, to protect her privacy, only as "Resident #18." She was confined to a wheelchair with a "lap buddy" -- a restraining device that prevents her from getting up. Her "primary" behavior issues are that she "self propels in wheelchair and enters other rooms," the report said. Resident #18 "is usually understood and usually understands," the report said. She suffers from Alzheimer's disease, but isn't psychotic.

Still, she was placed on the antipsychotic drug Seroquel, along with Haldol, an older, less-expensive antipsychotic.

New York regulators found in that case, Orchard Manor violated the federal requirement to refrain from giving patients "unnecessary drugs." The facility was ordered to submit a new plan for treatment. There was no fine.

Mr. Morien, Orchard Manor's administrator, says the facility submitted a plan within 14 days. He says the small, rural home provides excellent care. The facility may not have adequately explained to state officials its reasons for putting Resident #18 on antipsychotics, he says. He says she is off the drugs now.

It comes down to staffing, he says. Taking care of patients such as Resident # 18 requires many more people able to watch them. Yet under the current reimbursement system, where the government spends billions on these drugs, he says it is hard for a facility such as his to make ends meet.

"We are a nonprofit; we have not made a penny in years," he says. Mr. Morien says there are certain patients with behavioral issues, and "no matter what you do, you can't control them, and physicians will try different medications for them." But he says his facility tries to use drugs only as a "last approach to a behavioral problem."

Most dementia patients who become agitated are trying to communicate a deep-felt need or want, says Jeffrey Nichols, vice president for medical services at New York's Cabrini Eldercare Consortium, a nonprofit group. When they cry out, are they simply being combative or are they delusional and in need of a tranquilizer? Maybe neither, says Dr. Nichols: "They may be in pain."

Dr. Nichols, who oversees a 240-bed nursing home, says that for dementia patients, antipsychotic drugs "don't work very well and they are significantly overused." The use of such drugs to care for agitated dementia patients is "like hitting a TV on the side," he says.

In a statement, the American Health Care Association, which represents for-profit, investor-owned and nonprofit nursing homes, says facilities "work closely with doctors to ensure that medications prescribed are meeting the individual needs of each patient." Nursing homes are "treating an older, more frail population of seniors with increasingly complex care needs," the group says.

The use of atypical antipsychotic drugs in nursing homes continues despite scientific papers that question the benefits of using them on dementia sufferers in light of the risks. Earlier this year, the federal Agency for Health Care Research and Quality reviewed existing research and noted the drugs can trigger strokes, induce body tremors, fuel weight gain and affect an elderly person's gait, increasing their chances of falling.

'Black Box' Warning

The Food and Drug Administration issued a "black box" warning on using the drugs for dementia patients in 2005. But the FDA stopped short of banning such use; officials say they give physicians the leeway to prescribe the drugs if they think it will help this difficult-to-treat population.

Some doctors are now switching back to older, cheaper antipsychotics, such as Haldol, the FDA says. The older drugs had fallen into disuse, but don't have a black-box warning. Now, the FDA says it's weighing putting a black-box warning on those drugs, too.

In Massapequa, N.Y, a nursing home was recently fined by the state for injecting 90 doses of Haldol into a 96-year-old Alzheimer's patient. The woman, identified only as Resident #2, enjoyed listening to music and getting her nails polished, according to a state report. But when agitated, she banged her hand on the table and sometimes yelled.

One aide found it was possible to calm her by offering ice cream and chatting with her, the report said. But other staff gave her the drug Haldol. Between August 2006 to February of this year, she received 90 doses of injectable Haldol, the report said. The facility, Parkview Care and Rehabilitation Center, paid a $2,000 fine for medication misuse.

"It is a unique situation," says Steve Seltzer, Parkview's administrator. "I know that this is not the nature of this facility." He described Resident #2 as an especially difficult case, who reverted to her native European language, making it hard to communicate. As a result of the state's action, "staffing changes were made," he says. The woman was later given a teddy bear as both a way to calm her down and to provide a cushion so she wouldn't hurt herself.

She passed away last Friday.

Bush Lawsuit Restrictions Add to Grandma's Risk in Nursing Homes

2009-03-01T19:50:21-08:00

Bush Lawsuit Restrictions Add to Grandma's Risk in Nursing Homes .

For Elderly, Simple Steps Prevent Serious Injury

2009-02-03T11:16:23-08:00

For elderly, simple steps prevent serious injury

Caring for the Caregivers

2009-01-28T10:50:49-08:00

Editorial - Caring for the Caregivers - NYTimes.com.

Change In Medicaid Rules May Pose Stark Choices in New York State

2009-01-28T10:47:39-08:00

Change In Medicaid Rules May Pose Stark Choices in New York State - NYTimes.com.