This is another good article, reflective of what happens ROUTINELY in Nursing Homes. We have bare bone minimums on staffing and yes some of the staff are completely derelict but for sake of a warm body for state documents they remain.These atrocities are absolutely preventable with adequate staff. While many here work in the hospital environments remember when you write thos legislators and speak on behalf of Nurses, do not forget to address Long Term Care professionals. We are becoming more and more burdened with the complex patients being admitted. In Florida it is completely legal to staff 1 nurse to 60 paients (nights),
1 nurse to 45 patients (evenings), and 1 nurse to 30 patients (days).
These patients are not just LTC but post-op hips, knees, fractures, infectious disease, short and long term rehab, oncology rehab and respite, not to mention the large populace of mental illness and dementia (whole thread can be made on that topic especially in Florida with lack of mental health facilities and the staffing nightmares that go along with them)
Read this article and do not hold back, if we get attention from legislators they need to read this.
A Call For Action
A.L. DeWitt, RRT, JD http://www.cost-quality.com/restpast/v7i1a2.html
Volume 7, #1
M.R. was a 72-year-old man who was beaten to death in a nursing home. When the man who beat him to death pleaded guilty to first degree elder abuse, he revealed his four prior assault convictions. Later investigation revealed that the abuser had a felony warrant from another state for a drive by shooting. The nursing home hired him without finding the criminal background.
R.C. was a 92-year-old woman with congestive heart failure. Her condition was terminal. Instead of receiving the loving care an attention she was entitled to, and that the nursing home had promised to provide, she was found covered head-to-toe in ants - ants crawling in and out of her vagina - by the nursing staff. Her daughters picked ants off of her as she lay dying.
T.M. was a 90-year-old Alzheimer’s patient. The nursing home staff refused to let her granddaughter visit because the granddaughter complained about the lack of care. After a local court enjoined the home from restricting her visitation, the woman had to be taken out of the facility when she suffered four broken ribs and three crushed vertebrae in a fall that she “dreamed.” The physician at the hospital discovered a bruise on her back in the shape of a shoe.
I represent these families.
These case histories reflect an epidemic of abuse and neglect in American nursing homes. Several years ago, when I practiced as a respiratory therapist, I worked for a facility that required physicians to report child abuse. One physician didn’t want to do that because he said “I don’t want to be sucked into the legal morass of testifying against my patient’s family.” I disagreed. I saw that physician’s duty to report to be higher than the inconvenience to himself in doing so. In one case I went to the hospital administration to force the physician’s hand in a case of horrific injury to a child.
Now, ten years later, I find myself in a similar situation. I find patients like E.B. who come into the emergency room near death. The paramedics report that she hadn’t been eating or drinking for a week. The medical record at the nursing home establishes that she hadn’t had a bowel movement in more than a week. And the medical record does not have a single nursing note for five days before she is found near death from advancing pneumonia. Instead of being alarmed by the condition of patients coming in from nursing homes, the physicians at the local hospitals seem almost to expect it. Instead of taking action when a BUN shows complete renal failure from dehydration, they simply fail to comment on it - perhaps not wishing to be drawn into the legal morass of testifying against the local nursing home.
“Not my job,” one physician told me. “That’s what the Division of Aging is for.”
Perhaps, but the Division of Aging is woefully understaffed and unprepared to protect elders. If physicians would simply call aside family members and tell them that their loved one should not be in renal failure because of dehydration, if they would simply point out that lab results suggested malnutrition, then perhaps the Division of Aging might be alerted in time to do something about it.
Recently I spoke with my friend who works at our local office of the Division of Aging. I asked how many reports he received from physicians about elder abuse and neglect. “About one or two a year. Nurses call in reports all the time, but doctors routinely don’t.”
But the first rule of medicine is “do no harm.” If a physician sends a patient back to the nursing home knowing they are subject to abuse or neglect, then the act of sending them back is doing them a very real, very personal harm. If physicians don’t draw the line in the sand, no one else will do it for them.
Unless and until physicians start fulfilling their duties to report nursing homes for questionable care, the phenomenon of abused and neglected elderly patients presenting to the ER for care will continue. The population is aging. Nursing homes are becoming crowded. And the care the patients receive is getting more and more scarce.
“We have a policy that the staffing budget should NEVER EVER exceed forty percent of the daily Medicaid budget,” a nursing home president wrote in a memo to all his administrators. “There will be no exceptions. If you cannot meet this budget I will be forced to place the offending party on written warning.” Nursing home companies want revenue. They want more patients, but they don’t want to provide the patient care. If there were a sign above this nursing home administrator’s office it would read: “It’s the money, stupid!”
This single-minded drive toward the almighty dollar leads to horror stories like the one referenced above (R.C.). From the nurse’s deposition in this case we learn:
Q. And when we’re talking about R.C., we’re talking about a situation in which she was literally covered in ants?
Q. From head to toe?
A. Yes. She had ants everywhere.
Q. They were swarming all over her body?
Q. And are you aware that her daughters came into the facility to visit their mother and walked into the room and found their mother completely covered in ants?
A. It was bad.
Q. What do you mean?
A. They were crawling in and out of — by her vagina. They were on her face, around her ears. I mean it was really bad. It was bad. I didn’t know the family had found her like that. I just know that the time they had come and said, “Well, what do we do?” I said, “One, get her out of the room. If you have to, bathe her. You know, get rid of them.”
There can be no excuse for allowing patients to be attacked by ants in a nursing home, and there can be no excuse –from an infection control point of view– for allowing caregivers to be hired from a homeless shelter. One nursing assistant put it this way:
A. I’m saying that when they were not careful about who they hired and once they hired them, they would not fire them until it was– We had one guy there that worked night shift, Roy and Roger, and one was fired because they got in a fistfight on night shift in the middle of the building. That was after weeks of fighting in the middle of the night, screaming at each other, and Roger, his brother, was finally fired when he was caught sneaking back into the building and hiding in places to sleep during the day because he was one of the ten people they had from the Salvation Army at one time.
Q. When you say people working at the Salvation Army—
A. No. People living at the Salvation Army were working there.
Q. Because they were homeless?-
A. Yes. They had— And it wasn’t just a couple. When they couldn’t find any staff, they’d go wherever they could to get a body.
There are lots of good nursing homes where care is administered properly with love and attention. But there are also many that function as the nursing home above does. If you see elder abuse, your job as a health care provider is to do more than treat the injuries. Your obligation is to report the facts and let the state’s regulatory body do the investigation.
In twenty years or so, it could be you in that bed, covered with ants.
A. L. DeWitt, RRT, JD is an attorney in Jefferson City, Missouri, and a member of the CQ Editorial Board. He represents physicians, therapists, and other healthcare professionals, and can be reached at (888) 717-7575.
[ June 08, 2001: Message edited by: Chellyse66 ]