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Articles Posted in Nursing Home Abuse

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nursing homes are facing staff shortage putting at risk residentsAmidst growing concerns about the quality of care in nursing homes, the Centers for Medicare & Medicaid Services (CMS) recently introduced proposed guidelines aimed at improving staffing levels. However, a new estimate by the Kaiser Family Foundation (KFF) has revealed that a staggering 81% of nursing home facilities nationwide, and a staggering 90% of for-profit facilities, would need to hire additional registered nurses (RNs) or nurse aides to meet these standards.

Under the proposed rule, nursing homes would be required to maintain a minimum of 0.55 RN and 2.45 nurse aide hours per resident day, along with having an RN available on staff 24/7. This rule is a response to long-standing concerns about inadequate staffing negatively affecting the care provided to nursing home residents.

Predictably, industry leaders have voiced their reservations about this proposal, arguing that a nationwide nursing shortage makes it nearly impossible for facilities to meet these staffing targets. The effects of the COVID-19 pandemic have further exacerbated this issue, with many workers leaving their positions due to burnout, low wages, and the intense stress associated with caring for vulnerable populations during a public health crisis.

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nursing home patients are more than ever at risk of neglect and abuseConditions at for-profit nursing homes worsened during the pandemic and patients suffered from it according to a recent report by by the House of Representatives’ Select Subcommittee on the Coronavirus Crisis.

The Subcommittee looked at 5 for-profit chains that operate around 850 nursing homes with a total of 80,000 residents during the first months of the pandemic. According to the report these corporates are structured in an opaque way that allow them to shed responsibilities and protect themselves from being accountable for patient neglect or abuse.

The House of Representatives’ Select Subcommittee on the Coronavirus Crisis found that work conditions were horrendous for the personal at these nursing homes with on average one nurse having to care for 30 patients. As a result, patients waited for hours, sometimes days for basic care. The report highlights a case of a patient who vomited on herself and was cleaned two days later or another patient who had to wait for hours just to get water.  Staff not only were forced to share personal protection equipment because of shortage but also pressured and threatened to work even though they were sick with Covid19. As a result, infection spread faster among already weak residents and staff. So far it is estimated that 160,000 nursing home residents and 2,600 nursing home workers died from Covid19.

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injured hand of an elderly patientSadly elder abuse is quite common in the US. It is estimated that 5 to 10% of elders suffer abuse of various types such as physical or psychological abuse, financial exploitation  or neglect. Often those who are abused suffer multiple types of abuse together. Depression, chronic illness hospitalization and placement in nursing homes are often the direct consequences of these abuses. When an elder has little contact with the outside world except for his or her oppressors, the physicians are often the only ones who can determine if abuse occurs and raise the alarm. When physical abuse occurs, elder patients who show up at the emergency room often pretend they fell.  A good emergency physician should be able to differentiate between fall injuries and abuse injuries and raise the alert if necessary.

A recent study  published in the Annals of Emergency Medicine and led by Tony Rosen, Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, in New York compares the injuries of 78 elder patients who were physically abused with the injuries of 78 elder patients who unintentionally fell. Here are some of the findings:

  • Bruises could be a sign of abuse. 78% of elders who were physically abused suffered bruises compared to 54% of those who fell
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injured hand of an elderly patientIn New York State, many nursing home residents are neglected because the facilities are significantly understaffed.  Most nursing homes are run by corporations that are more interested in increasing their shareholder profit rather than making sure their residents are proprely taken care off. Additionally,  the staff is so poorly paid, between $12.50 Upstate NY  to $15 an hour in New York City, that it is difficult to recruit people especially during the pandemic. In comparison, fast food workers are making $14.50 an hour in New York.

New laws signed to prevent understaffing will only take effect next year

Recently Andrew Cuomo signed new laws requiring nursing home and hospitals to form clinical staffing committees that include front-line nurses and other direct care staff when setting annual staffing standards for units. Additionally, nursing home facilities will be required to have a minimum daily average of 3 1/2 hours of nursing care per resident. These two laws will only take effect in January 22 and do not include a raise in the minimum wage for workers (read more in Healthcare Dive)

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injured hand of an elderly patientA policy instituted in 2017 that restricted fines to a maximum one-time amount of $22,320 to nursing homes violating safety standards, even if violations were persisting, has been reversed.

The reversal of the policy comes 6 months after the AAARP Foundation filed a Lawsuit with the help of  a Washington based law firm to fight this policy.

The 2017 policy  instituted by the Federal Centers for Medicare & Medicaid Services (CMS) endangered the lives of nursing home residents as well as their employees.

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nursing home abuseVictims of nursing home abuse , hospital neglect or medical malpractice in New York State not related to Covid-19 can legally hold healthcare professionals responsible for their negligence again.

Yesterday, NY Governor Andrew Cuomo signed a law that rolls back the legal immunity that nursing homes and hospitals were granted during the coronavirus crisis

Since yesterday these institutions can again be held liable in criminal prosecutions and lawsuits.

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injured hand of an elderly patientA recent study at a New York emergency room compared the injuries of  elderly patients who suffered physical abuse with the injuries of elderly patients who suffered unintentional fall.  The reason for the study was for the emergency room professionals to be able to identify “red flags” for elderly abuse.  Elderly abuse in New York and elsewhere is largely under-reported. Often abused seniors who show up at the emergency room tell the staff that they fell.

“The first place that many vulnerable older patients turn for care is the emergency department,” said lead study author Tony Rosen, MD, MPH, FACEP, assistant professor of emergency medicine at Weill Cornell Medicine and director of the Vulnerable Elder Protection Team based at New York-Presbyterian/Weill Cornell Medical Center’s emergency department. “Emergency physicians have a unique opportunity to identify the ‘red flags’ for elder abuse. Improving the ability to recognize, treat, and prevent these incidents can improve the lives of millions of older patients.”

The study looks at a total of 156 elderly patients who showed up at the emergency room of a New York Hospital.  The researchers compared 78 cases of injuries related to abuse with 78 cases of injuries related to unintentional fall. They  found specific differences between unintentional  fall injuries and abuse injuries:

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covid-19-2Dozens of resident at The Harlem Center for Nursing and Rehabilitation died from Covid-19 but the facility  failed to report them.  The nursing home was slapped with violations from the NY Health Department for hiding the deaths of 25 residents.

The facility was reported by a neighbor who recorded a video showing at least 20 bodies in black bags being transported out of the nursing home and piled into trucks. At the time, the nursing home had only reported 5 deaths. It is is now facing a fine for failing to protect its residents and under-reporting the number of deaths.

While nursing homes as well as hospitals are immune from most neglect lawsuits during the pandemic, they are legally obligated to disclose the number of  residents who died from the coronavirus. According to an executive order that was released by Andrew Cuomo on April 17,  nursing homes have to report coronavirus deaths to family members within 24h. Nursing homes that don’t comply can be fined $2,000 per undisclosed death and risk the revocation of their license as well as criminal prosecution.

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food-safety“Unsafe food handling” was the third most common citation for American nursing homes in 2018 behind “lack of infection prevention and control” and “accidents related to  hazards, lack of supervision or devices” according to data from the from the Center for Medicare & Medicaid Services. From 1998 to 2017, The Center for Disease Control recorded 230 food outbreaks in nursing homes resulting in 54 deaths, 532 hospitalizations and 7648 sickened residents.

33 % of all nursing homes in the nation were cited for food safety violations last year.  Among them, the nation largest chain of nursing homes, Genesis Healthcare had 47% of its nursing homes cited for food safety violations. The chain owns around 400 nursing homes in 27 states.

Unsafe food handling incidents reported at nursing homes all over the country recently included hundred of mouse droppings on the hood of the stove, flies in under-cooked hamburgers, moldy ice machines, mysterious debris in meat slicer and of course numerous complaints of cockroaches invasions and employees not washing their hands before handling food. These unhealthy conditions can potentially sickened and killed fragile nursing home residents.

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When a nursing home is understaffed, patients have a higher risk of getting neglected. Studies show that patients in understaffed nursing homes have a higher risk of  weight loss, malnutrition, dehydration, pneumonia, infections and bedsores. When there is not enough staff, nursing home patients do not get proper attention and as a result neglect and medical errors can occur. Additionally working conditions in understaffed nursing homes are difficult. Nursing homes who are trying to minimize their costs are not hiring as many registered nurses and certified nurse assistants as they should and stretch the existing staff as much as they can. Stressed and overworked workers get frustrated and that’s when nursing home patient abuse has the highest risk to occur.

It is estimated that approximately 90% of nursing homes are understaffed in the US. Many nursing homes do not have any registered nurse available for days. In an effort to crack down on this problem, Medicare recently revised its five stars ranking system and automatically downgraded to one star the staffing ranking section of all nursing homes that do not have a registered nurse on site for four or more days instead of 7 or more days in the previous ranking. As a result 1638 nursing homes in the US now have a one star rating for their staffing.

The change in the staffing comes in the aftermath of a decision by the government last year to require nursing homes to submit payroll records to verify staff level. While analyzing the records, the Center for Medicare & Medicaid Services became alarmed by the frequency of under staffing of registered nurses. Registered nurses are the most qualified nurses. When staffing level increases so does the quality of care.

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