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.

Coumadin prescription blood thinner for nursing home patients

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

Nursing home claims sex abuse of dementia patient “consensual”

The unnamed dementia patient is confined to her bed at Cashmere Convalescent Center.

She cannot speak, and is nearly deaf.

How could she have consented to the predatory sexual advances of another nursing home patient?

Nursing Home Sexual Abuse Report Video KOMO Seattle

KOMO reporter Jon Humbert talked to the abused patient’s family, and reviewed the state investigation of this case

But that’s what the nursing home claimed.

According to the KOMO news investigation, the offending patient—a man who also has dementia—was seen forcing the bed-ridden woman and other patients to touch his genitals on several occasions.

A housekeeper who observed his sexual abuse yelled at the man to stop. She reported what she had seen to the nursing director.

The report says the Director of Nursing Services viewed what was going on as nothing more than consensual activities between dementia patients.

The nursing home noted the witness reports, but did not contact the state until after staff found the man fondling another patient’s breasts and called 9-1-1.

Keeping nursing home patients safe from sexual abuse

Every person who works in a nursing home or long-term care facility is considered a “mandated reporter” in Washington.

When there is reason to suspect that sexual assault has occurred, mandated reporters shall immediately report to the appropriate law enforcement agency and to the department.

 

 

– Wash. Rev. Code § 74.34.035

How many people at this nursing home had seen this man’s behavior, and had “reason to suspect sexual assault”?

The government report says the care facility:

  • Failed to recognize the man’s behavior as sexual abuse
  • Did not act to protect their patients
  • Violated the mandatory reporting rule

For these violations, Cashmere Convalescent Center was fined $6,300.

Washington Nursing Home Abuse Case at Cashmere Convelescent Center - Website

Cashmere’s website claims a “secure, therapeutic environment”.

 

 “We can offer you, or your loved one a secure, therapeutic environment made possible by a caring and well-trained staff.”

There is no patient security without transparency.

If you suspect abuse of a vulnerable adult in Washington, call 1-866-EndHarm (1-866-363-4276).

Nursing home aide punches elderly dementia patient, leading to his death

Frank Mercado, 77, was suffering from dementia and limited vision. He was a patient of the University Nursing Home in New York until his death in December 2014.

Nursing-home-aide-charged-nursing-home-patient's-death

CBS News: Bronx Nursing Home Aide Charged In Death Of 77-Year-Old Patient

A nursing home aide is facing criminal charges for Mercado’s death.

Reportedly, a fight had broken out between the nursing home aide and the elderly patient.

According to the prosecuting attorney, the aide punched the elderly man. After being assaulted, Mr. Mercado fell and was impaled on a piece of metal sticking out from a broken table.

He died from the injury.

The aide, a 41-year-old woman, had worked for University Nursing Home for 14 years. Yet, she apparently never learned to control an elderly dementia patient without the use of physical violence.

University Nursing Home is a small facility, but part of a large consortium of rehabilitation and home health companies called Centers Health Care. In the last four years, the state has found 19 life safety code deficiencies at the care facility. The statewide average was 11 safety code violations.

In one case, an 86-year-old woman’s hand was lacerated on nails sticking out from a wardrobe; in another, an 81-year-old man with dementia complained of shoulder pain and then developed large bruises on his arm that went uninvestigated. – nytimes.com

The nursing home employee has pleaded not guilty to criminal negligent homicide, assault and endangerment charges. No trial date has been set.

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.

Senior Care Corner is a great resource, and has some additional information and ideas for checking in on elderly people.

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.Coluccio-Law-elder-abuse-brain-injury

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

80% of Nursing Homes Lying About Staffing Levels

There is no question: the quality of resident care in a nursing home care is directly connected to staffing levels. Low staffing levels are consistently linked to a higher likelihood of elderly patient injury and death.

When nursing home companies report inaccurate staffing data, they are basically lying about resident safety.

A new data review on 10,000 nursing homes showed that the staffing levels they provided to Medicare—and listed on the Nursing Home Compare website—doesn’t match their financial reports.

A Center for Public Integrity just completed an analysis of nursing homes’ annual financial cost reports. The analysis found that up to 80% nursing homes are inflating their staffing levels.

About 25% reported twice as many staff hours as their payroll data actually shows.

Medicare’s rating should be based on real data

Medicare has a 1 – 5 star rating system for nursing homes. That data is made public so that families can make informed choices for elder care.

Currently, a facility’s rating is at least partially based on its self-reported staffing hours.

The rating system is supposed to be updated under a provision of the Affordable Care Act. Nursing homes will have to submit real payroll data for nurses, instead of just reporting their staffing hours. But it hasn’t happened yet — and it may take up to two more years.

In the meantime, assume that the 5-star rating system used on Nursing Home Compare data is flawed. So how do you know if a nursing home is safe?

Family of elderly man who died of neglect speaks out about forced arbitration

Evan’s father died with an oozing bedsore, about the size of a fist. He hadn’t had any food or liquid for 4 or 5 days.
Coluccio_Law_Nursing_Home_Neglect_Forced_Arbitration

Evan wanted to file suit against the nursing home for the neglect that caused his father’s death. He concluded that a jury trial couldn’t change what happened to his family: but it would send a message to nursing homes that abuse and neglect will not be tolerated.

The nursing home company informed Evan Press that he had no right to file a lawsuit for the wrongful death of his father.

The contract that they had used to admit his father to the facility had an arbitration clause.

Arbitration clause: you agree to give up your Constitutional right to trial, and instead submit any claims against the company to an arbitrator, who is chosen by the company, and paid by the company.

Now the nursing home is suing Evan Press, for attempting to break the arbitration clause.

Just another way to limit consequences

Nursing home companies that use contracts with arbitration clauses usually require a patient or representative to sign this contract before admittance.

Companies claim that patients aren’t giving up any rights or privileges when they sign these contracts— this is their explanation, as they ask the elderly resident to waive his Constitutional rights.

As arbitration has increasingly replaced court as the forum for dispute resolution, the amount of money recovered by abuse victims and their families has decreased—even as complaints about poor treatment have risen.

– Based on study done by nursing home industry itself

Forced arbitration doesn’t benefit consumers. It’s really expensive: attorney’s fees aren’t covered, and the company can force you to travel to wherever they choose to hold the arbitration, which is often an incredible inconvenience.

Plus, you can’t appeal a decision from a binding arbitration. If you don’t agree with an arbitrator’s decision, there is no next step.

And there is no public record of the arbitration meeting, as there is with a jury trial.

For families like Evan’s, there is limited and unjust recourse for the unnecessary death of a loved one.

 

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.The_center_for_investigative_Reporting

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.

Anyone can report financial elder abuse to Washington DSHS

Anyone can report financial elder abuse to Washington DSHS

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.  

About Kevin

Kevin Coluccio was recently named one of the Top 10 Super Lawyers in Washington State. He has long history of successful elder abuse/neglect cases and has a stellar reputation for getting results for his injury clients in serious car crashes, pedestrian accidents, trucking accidents, maritime claims, and asbestos injury cases.