Studies and Statistics

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

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.

 

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?

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.

LGBT elderly face higher risk of abuse and neglect

Many elderly people who identify as gay, lesbian, bisexual or transgendered are more likely to be abused or neglected.

For generations of LGBT who lived through decades of discrimination, this is the final indignity.

Research compiled by the National Center on Elder Abuse foundhttp://www.ncea.aoa.gov/images/Logos/ncea_logo.gif:

  • 29% of the LGBT elders surveyed had actually been physically attacked;
  • 65% reported verbal abuse, threats of violence, sexual assault, and discrimination, and other victimization; and
  • 8% had been abused or neglected by homophobic caretakers.
  • LGBT are more likely than heterosexual elders to live alone – and social isolation is a big risk factor for abuse; and
  • They are also less likely to seek help for abuse.

The data is comparatively limited, and compiled from the few peer-reviewed studies on the elderly LGBT community (which also speaks to the problem of discrimination).

However, it’s clear that more effort needs to be made to address and prevent elder abuse in the LGBT community.

Many LGBT elders lived with stigmatization for much of their lives—we owe them dignity and protection in their golden years.

Nursing Home Statistics

I was ran across this info at the American Association for Justice website, and thought it was worth republishing here.

Nursing Homes by the Numbers

Scope of Abuse and Neglect
Percentage of U.S. nursing homes with staffing levels too low to provide adequate care. 90%
Profit Motives and Care
Suspicious accounting transactions identified by U.S. News & World Report in 2000. $3.4 billion
Drop in nurse assistants’ hours per resident per day. 16%
1.4 million  —  Current number of people who are living in U.S. nursing homes,1
20,673  —  Complaints of abuse, gross neglect, and exploitation on behalf of nursing home and “board and care” residents in 2003. 1 in 14  —  Number of incidents of elder abuse reported to authorities. 3

90%  —   Percentage of U.S. nursing homes with staffing levels too low to provide adequate care. 4
PROFIT MOTIVES AND CARE IN THE NURSING HOME INDUSTRY$75 billion  —   State and federal financing of nursing home industry in 2006. 5

$34 billion  —   Contribution of nursing home residents and their families in 2001. 6

$3.4 billion  —   Suspicious accounting transactions identified by U.S. News & World Report in 2000. 

31%  —  Extent to which deficiencies in care in for-profit nursing homes was higher than in non-profit nursing homes in 2006. 8

16%  —  Drop in nurse assistants’ hours per resident day. 

$1.2 million  —  Amount Veena Ahjua, operator of a 314-bed New York nursing home, paid herself in 2000. 10

1 million  —  2006 Salary of Genesis HealthCare Corporation CEO, George V. Hager, Jr. 11

$23,193  —  Median annual salary of a Certified Nurse Assistant 2008. 12

4.55  —  Recommended minimum hours of direct nursing care per resident per day. 13

3.7  —  Actual hours of direct nursing care per resident per day. 14

Sources

  1. National Center for Health Statistics  Health, United States, 2007, Table 117
  2. National Center on Elder Abuse http://www.ncea.aoa.gov/ncearoot/Main_Site/pdf/publication/FinalStatistics050331.pdf
  3. Karl Pillemer and David Finkelhor (1988), The Prevalence of Elder Abuse: A Random Sample Survey, The Gerontologist, 28: 51-57.
  4. Correspondence from Senator Chuck Grassley and Representative Henry Waxman to Mr. Thomas Scully, http://www.democrats.reform.house.gov/Documents/20040830113115-11866.pdf (visited Feb. 3, 2005); citing U.S. Department of Health and Human Services (HHS), Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, 2001.
  5. “At Many Homes, More Profit and Less Nursing” Charles Duhigg, New York Times, September 23, 2007.
  6. Id
  7. Id. In the article, a former fraud investigator said, “You never have anything show up as profit… They show these really skinny operating margins, so they can always plead poverty.”
  8. Centers for Medicare & Medicaid Services, Nursing Home Data Compendium 2007
  9. Christopher H. Schmitt, The New Math of Old Age, U.S. News & World Report, Sept. 30, 2002. quoting University of California researcher Charlene Harrington.
  10. Id
  11. Genesis HealthCare Proxy Statement http://www.sec.gov/Archives/edgar/data/1236736/000110465907017133/a07-4061_1defm14a.htm
  12. Salarywizard.com  Certified Nursing Assistant – Nursing Home 2008 data http://swz.salary.com/salarywizard/layouthtmls/                                                                                            swzl_compresult_national_HC07000412.html
  13. Charlene Harrington et al., Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1998 Through 2004, Department of Social and Behavioral Sciences, University of California, August, 2005, http://www.pascenter.org/documents/OSCAR2005.pdf (visited Sept. 21, 2006).
  14. Id.

More Shelters at Nursing Homes for Abused Seniors

A recent U.S. News & World Reports article talks about a topic that The Elder Abuse Watchdog has covered before: nursing homes and retirement villages are offering refuge for the growing number of abused elderly.

The article cites an alarming statistic: one in 10 adults over the age of 60 is abused or neglected, according to a study by the Medical University of South Carolina. More surprising is that the elderly victims are most frequently abused by their own children or someone in their own family.

Photograph taken on the grounds of the Weinberg Center for Elder Abuse Prevention

Photograph taken on the grounds of the Weinberg Center for Elder Abuse Prevention

Like the Shalom Center that I wrote about earlier this year, a few more are popping around the country. The Hebrew Home began in 2005 with its Harry & Jeanette Weinberg Center for Elder Abuse Prevention in New York.  About six other nursing homes followed suit.

According to the U.S News article, the Hebrew House is meeting with other nursing homes, so we will likely see more emerge in the coming years.

Tony Palumbo, county attorney for Anoka County (where Crest View is located) points out that a victim’s behavior will be sudden as opposed to slow and gradual.  Mr. Palumbo created the Stop Abuse and Financial Exploitation (SAFE) initiative. SAFE’s mission is to protect seniors from financial abuse, which is one of the most common forms of elder abuse.

Hospitals, police, and social services staff are those typically referring senior citizens who show signs of abuse to the Weinberg Center. The CEO of Crest View Senior Communities (who has replicated the Hebrew Home model for its shelter) in Minnesota, Shirley Barnes explains the importance of neighbors staying vigilant and watchful.

Roughly 2 million senior citizens abused, neglected, or exploited each year

According to an AP article that I read on Huffington Post, the number of senior citizens in this country will practically double. The number of those over 85 years old is growing even more rapidly. Sharon Merriman-Nai, project director of the Clearinghouse on Abuse and Neglect of the Elderly based at the Univ. of Delaware suggests that at least 2 million seniors are abused, neglected, or exploited each year, according to the article.

That’s  1 out of every 10 elders suffering some form of exploitation and abuse.

In this Tuesday, Jan. 8, 2013 photo, caregiver Kim Bauer, right, pauses as the elderly woman she is helping looks at a decorative fireplace at Cedar Village retirement community, in Mason, Ohio. The woman she is helping has suffered abuse by a relative. The Shalom Center that is a part of the community helps the woman by offering shelter, along with medical, psychological and legal help, to elderly abuse victims in this northern Cincinnati suburb. The center asked that her identity be protected for this story because the close relatives who allegedly abused her don't know where she is. Photo: Al Behrman

 In this Tuesday, Jan. 8, 2013 photo, caregiver Kim Bauer, right, pauses as the elderly woman she is helping looks at a decorative fireplace at Cedar Village retirement community, in Mason, Ohio. The woman she is helping has suffered abuse by a relative.  Photo: Al Behrman

The Shalom Center is a part of the community in Cedar Village Retirement Home in Mason, Ohio. The center helps elder abuse victims by offering shelter, along with medical, psychological and legal help, to elderly abuse victims in this northern Cincinnati suburb. The center asked that the identity of the lady in the wheelchair photographed on the right be protected for this story because the close relatives who allegedly abused her don’t know where she is.

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.