Blood thinners can be dangerous, but nursing homes aren’t monitoring patients
Blood thinners are very common prescriptions for nursing home residents.
Drugs like warfarin—the generic name for Coumadin—keep the blood flowing smoothly throughout the body.
It’s an effective drug, but the dosage has to be carefully monitored.
- Too much warfarin causes internal bleeding.
- Too little warfarin results in blood clots, and strokes.
- Warfarin interacts badly with some medications, including antibiotics.
Patients on blood thinners are supposed to have regular blood tests to see how long it takes the blood plasma to clot.
It sounds like a simple test, necessary to regulate a useful drug.
Since 15% of nursing home residents take blood thinner, it is alarming that nursing facilities are failing to regulate the dosage, according to the recent investigation by Propublica and The Washington Post.
“Coumadin is the most dangerous drug in America.”
Rod Baird, president of Geriatric Practice Management, said “Coumadin is the most dangerous drug in America,” because it is so easy to get the dosage wrong.
After a nursing home failed to give a patient her Coumadin for 50 days in a row — and didn’t perform a blood test — the woman had multiple blood clots in her legs. She suffered permanent injuries, and had to undergo multiple surgeries.
A nursing home resident in Texas was given Coumadin for 34 days —without a doctor’s order, and without monitoring. By the time he was sent to the hospital, blood was pooling in his mouth.

1 in 6 nursing home residents take a prescription blood thinner. Since it is so common, many nursing homes are not regulating warfarin – or even do blood tests.
The Propublica investigation points to 165 nursing home residents were hospitalized or died after errors in dosing or monitoring warfarin in patients.
That is far too many warfarin errors, but it doesn’t even come close to the estimate from the 2007 study in the American Journal of Medicine.
Based on the yearlong study, researchers estimate nursing homes have an annual 34,000 fatal, life-threatening, or serious medical events from blood thinners.
That is a very large gap between the number of warfarin-related errors that are believed to occur—and the number actually reported in government inspections.
While the investigative reporting doesn’t explain the gap, the federal government has since asked health inspectors to watch for errors by nursing home staff in regulating blood thinners.
Center for Medicare and Medicaid Services is designing tools to help state health departments monitor nursing homes’ prevention and response to medication errors.
Find a nursing home in Washington and see recent inspections.
Image by Alisa Machalek, NIGMS/NIH [Public domain], via Wikimedia Commons
How to Check on an Elderly Relative’s Health and Safety
Holidays are a great opportunity to visit elderly friends and relatives. It’s an opportunity to check in on their health and safety, without being too invasive.
Conversation
Ask questions without interrogating. Find out if they have a normal routine, are getting around easily, and if there are any new health concerns. If you can, offer to do some small tasks around their home. Simple things like replacing light bulbs, or vacuuming the stairs, can be difficult for an elder with limited mobility.
- What did you do today?
- When did you last see the doctor?
- Is there anything you need done around here?
Personal Observation
Sometimes, it’s easier to observe health and hygiene than it is to ask direct personal questions.
- Are they wearing clean clothes? Shoes or slippers that are safe for the floor surfaces?
- Are their glasses dirty or broken?
- Do they appear to be losing weight?
- Do you notice any injuries, like bruises or limping?
Around the home:
While you’re there, casually observe conditions in and around the home.
- Is there healthy food available?
- Are there funny smells that might indicate a problem, such as burned food or mold?
- Are their medications stored neatly? Are any refills needed?
- Is the bathroom safe, or are there signs of a fall?
At an Assisted Living Facility or Nursing Home:
If it’s an assisted living facility, or nursing home, there are additional considerations.
- Do they appear comfortable with the staff? With other residents?
- Is the facility clean and orderly?
- Do they know when meals and medications are coming next?
- Is there evidence of incontinence problems, or other physical needs not being directly addressed?
If you observe any problems or concerns at the Assisted Living Facility or in a Nursing Home, talk to the caregiver or floor nurse before you leave.
Get contact information, and promise to follow up make sure the problem is addressed.
1 in 5 nursing home residents are abused – by other residents
Cornell University has completed the first study on resident-to-resident violence and aggression in nursing homes.
The studied behaviors ranged widely, from physical attacks and sexual violence to invasive acts, like going through another resident’s possessions.
The study gathered data for more than 2000 residents in 10 nursing homes. The researchers interviewed residents, and pulled reports by nursing home staff and inspectors for a 4-week period.
- 16% of residents experienced verbal abuse, defined as cursing, screaming or yelling
- 7 % reported physical abuse— hitting, kicking or biting
- 3 % experienced sexual abuse, such as genital exposure, inappropriate touching, or attempts for sexual favors
- 8 % reported inappropriate, disruptive or hostile behavior by other residents
These are surprisingly high rates of resident-on-resident abuse. Skilled nursing facilities tend to be run similarly to hospitals, as the residents require more physical care than assisted living facility residents.
Yet, nurses and staff had only reported a fraction of the abuse that the residents experienced.
This is more evidence that a facility’s staffing levels are a big indicator of the likelihood of abuse—not only from staff, but also from other residents.
Researchers noted that residents accused of abusing other residents were often somewhat cognitively disabled, but physically capable of moving around nursing home.
The research team is planning to use the same methods to study assisted living facilities. It will be interesting to see if those facilities are any safer: about 60% of assisted living residents suffer from dementia.
Diagnosing mild traumatic brain injuries in elderly patients
Traumatic brain injuries (TBI) are a significant problem in older adults.
Mild traumatic brain injury (MTBI): brain injury caused by the bruising, tearing or swelling of the brain.
In persons aged 65 years and older, TBI is responsible for more than 80,000 emergency department visits each year. Three-quarters of these visits result in hospitalization.
Falls are the leading cause of TBI for the older adults (51%) and motor vehicle traffic crashes are second (9%). With MTBI, the older age is known to negatively influence outcome after the injury.
Elderly people with a MTBI may have a higher risk of serious complications such as a blood clot on the brain.
Signs and symptoms of an MTBI in elderly patients:
- Headaches that get progressively worse;
- Increased confusion;
- Listlessness, tiring easily;
- Crankiness;
- Sad or depressed mood;
- Change in eating habits;
- Change in sleeping patterns;
- Lack of interest in routine activities;
- New vision problems;
- Loss of balance or unsteady walking.
Failure to identify brain injuries is a common problem: an MTBI diagnosis is often missed when other serious injuries are present.
This problem is compounded for elderly people with other illnesses or injuries. Often, victims ignore their symptoms, and try to “tough it out”. I have seen this in numerous brain injury cases in my years as a trial lawyer.
An elderly person should see a doctor as soon as possible after suffering a bump or blow to the head, even if there are no immediate signs or symptoms of a traumatic brain injury.
See also: Understanding Mild Traumatic Brain Injuries
Photo courtesy of hin255, FreeDigitalPhotos.net
Reports of abuse and neglect are hidden and uninvestigated
California’s Department of Public Health (CDPH) had a problem: a big backlog of reports of abuse, neglect or theft.
The state agency is charged with investigating any claims that nursing assistants and home health aides have abused, neglect, or otherwise mistreated patients.
Five years ago, nearly 1000 of those claims were quietly closed.
The Center for Investigative Reporting looked into this and determined that since 2009, most of claims of abuse, neglect and theft reported to the CDPH have been closed after very limited investigations. The public health investigators were never contacting the victim, or even leaving the office to look into claims.
Sometimes, they were simply closing cases —without any review or investigation at all.
Because of this tactic, the Center for Investigative Reporting found limited information about the closed abuse and neglect claims. But they did find hundreds of uninvestigated reports of:
- Serious injuries
- Suspicious deaths
- Physical and sexual assaults
In many of these claims, caregivers were not only never punished; but also, kept their licenses and moved on to other facilities.
Putting “elderly, sick and disabled” at risk
CDPH has the duty of protecting vulnerable patients.
Instead, their actions are putting thousands of people at risk. Health care workers who were accused of harming patients are still out there, and still working.
Statewide, public health investigators in 2012 finished 81 percent of their cases without taking action against an accused caregiver, up from 58 percent in 2006.
See The Center for Investigative Reporting: Quick dismissal of caregiver abuse cases puts Calif. Patients at risk
Many elderly or infirm victims will never get justice in California. The victims and their families may never even know what happened to their claims.
This shocking report reminds us that it is crucial for people to have the ability to sue when they are harmed by nursing home abuse or neglect. Unfortunately, that right is being eroded every day.
How did a Seattle cabbie steal a $164,000 from an elderly woman – with state investigators watching?
This post originally appeared at Coluccio-Law.com.
Last week, King County prosecutors filed charges against 56-year-old David G. Money for stealing from an elderly nursing home patient.
The two met when Mr. Money picked her up as a fare a few years ago. Since then, the woman has written $164,000 in checks to Mr. Money, and another $90,000 in suspicious checks to herself.
The Seattle PI story has more details, but the timeline raises a lot of questions.
1. Nearly 2 years ago, a Chase bank employee flagged the elderly woman’s account when Money brought her in and tried to cash out $98,000.
2. The employee held up the transaction, and reported it to Washington elder abuse investigators. They started looking into the matter in November 2012.
3. Shortly after that, a state social worker met with Mr. Money. A cursory investigation into Mr. Money would have shown a bankruptcy claim in 2009, in which he claimed to have a serious gambling problem.
4. Presumably, DSHS would have met with the victim as well: she is a childless widow reportedly suffering from dementia.
5. Mr. Money had been made the sole beneficiary of the woman’s will, and had been given power of attorney over her estate.
6. Yet, Mr. Money was just arrested.
By the time police were involved, the woman had $100 in her primary bank account.
Did elder abuse investigators let this go on for two years?
Red flags were raised. The bank employee (rightfully) flagged the victim’s account, but apparently Mr. Money continued pilfering money from her for two more years.
The right people – including elder abuse investigators and the police – were alerted.
Yet, by the time Mr. Money was stopped, he was the beneficiary of at least $164,000, and possibly another $90,000 from suspicious checks the victim wrote to herself.
What happened between November 2012 when investigators were alerted, and police stopped him?
Money is charged with first-degree theft, and is currently free on bond.
There are a lot of unanswered questions in this case that may help explain what happened, or may point out some serious gaps in Washington state’s handling of financial elder abuse.
This post originally appeared on the author’s law practice website, Coluccio-Law.com.