Any business must make a profit in order to continue its existence. The danger for nursing home residents is that the most probable way nursing homes will have to adjust to reduced income and reimbursement is to decrease the number of staff to take care of their patients.

Our clients already report incidents which make it clear that nursing homes are frequently understaffed. For example one of our clients who needed help to go to the restroom had to call out for help to anyone passing by in the hallway because his call bell was not being answered. He was ignored and eventually tried to go to the bathroom by himself, fell and broke his hip. The fall could just as easily have resulted in a blow to his head, brain damage and death.

Understaffed nursing homes are unlikely to be able to provide sufficient care to prevent bedsores. A bedsore prevention program requires that the nurses turn and reposition their patients every two hours. If there are not enough people in the nursing home staff, it will be difficult for the nurses simply to remember to turn and reposition each patient much less to actually do it. Bedsores can become infected since intact skin is the body’s best defense to infection. Especially in light of some of the new “superbugs,” these infections can cause death.

When legislatures and the federal government are considering reduction in the reimbursement for nursing home care, they should also consider the likelihood of a substantially increased death rate for nursing home patients. At Zimmet & Quarles we urge you to contact your legislators, especially the Florida Legislature,  to ask them to consider the real dangers of reducing nursing home reimbursement.

A particularly dangerous form of infection for nursing home patients is often a result of taking antibiotics. Clostridium difficile, usually abbreviated as c. diff., has become more widespread and deadly for nursing home and hospital patients.

Many hospital and nursing home patients have to take antibiotics for some type of infection. For example, very sick nursing home patients sometimes have to use a catheter because of a urinary tract disorder. This raises the risk of a urinary tract infection which requires an antibiotic to resolve.

Unfortunately the use of the antibiotic can cause the death of both the bad bacteria causing the infection and good bacteria in the digestive tract. This creates an opportunity for the c. diff. organism to grow. Public health officials have recently estimated that the disease is now killing from 15,000 to 20,000 people per year.

One of the ways the disease causes death is through severe dehydration. C. diff. causes extended and serious diarrhea which in turn can result in dehydration. Therefore at any time a nursing home resident has had a course of antibiotics followed by diarrhea it is especially important for the resident’s family to be on the lookout for signs or symptoms of dehydration.

We have seen a growing number of cases in which the nursing home staff in Daytona Beach, Volusia County, Deltona and Ormond Beach do not recognize the symptoms of severe dehydration soon enough. For information about these nursing homes see the Florida Nursing Home Guide. A nursing home resident should be transferred to the hospital emergency room for treatment of severe dehydration as soon as possible. Therefore, if you start to see symptoms of even mild dehydration insist that a physician evaluate your family member.

Symptoms of dehydration include thirst, muscle weakness, headache, dizziness, lightheadedness, dry mouth, lack of sweating, shriveled skin that does not bounce back when pinched into a fold, low blood pressure, rapid heartbeat, delirium, altered mental status, and fever. For more information on c. diff. see a recent article in the New York Times by Tara Parker-Pope, Stomach Bug Crystallizes an Antibiotic Threat, and for more information on dehydration see an article on the Mayo Clinic website.

]]> http://www.daytonanursinghomeandmedicalmalpracticelawyer.com/death-by-antibiotics-in-a-nursing-home/feed 0 http://www.daytonanursinghomeandmedicalmalpracticelawyer.com/medicare-rates-two-nursing-homes-the-lowest-in-volusia-county http://www.daytonanursinghomeandmedicalmalpracticelawyer.com/medicare-rates-two-nursing-homes-the-lowest-in-volusia-county#comments Wed, 18 Mar 2009 13:40:25 +0000 Daytona Nursing Home and Medical Malpractice Lawyer http://daytonabeachinjurylawyer.wordpress.com/?p=24 Medicare rates nursing homes throughout the country with a five star rating system created to help consumers and their families to compare nursing homes. The ratings are based on health inspections, staffing levels and a variety of quality measures. Trained inspectors from state agencies do on-site inspections. Federal surveyors check on the state agency work to make sure they are following the national process.

The ratings look at the number of staff compared to the number of residents and how many of the staff are trained nurses.  Many of the nurses in nursing homes are not registered nurses. A substantial number of nurses working in nursing homes have a license as a licensed practical nurse, “LPN.”  These nurses have much less training than registered nurses.

The ratings take into account the differences in how sick the nursing home residents are in each nursing home since that will make a difference in how many staff are needed. A nursing home with insufficient staff is much less likely to be able to provide the quality care and attention necessary to prevent residents from falling and from developing bedsores.

Medicare explains that the Five-Star Quality Rating System is not a substitute for visiting nursing homes. When evaluating whether a nursing home will meet your needs, it is important to use the Five Star Rating together with other sources of information.

The two lowest rated nursing homes in Volusia County as of the date of this article were Woodland Terrace Extended Care in Deland and Sandalwood Nursing Center in Daytona Beach. Both of these nursing homes were rated only one out of five stars.

While the national average for percent of high risk, long stay residents who had bedsores is 12% Woodland Terrace’s percentage was 42%. Similarly the national average for low-risk patients is 2% and Woodland Terrace’s percentage was 23%.

For staffing standards, Woodland Terrace ranked two stars out of five based on the number of staff hours per resident. While the average number of CNA hours in Florida for each resident is three hours, Woodland Terrace’s was one hour, 34 minutes. This means the nursing assistants at Woodland Terrace had substantially less time to turn and reposition their assigned residents.  Thus, it is no surprise that more Woodland Terrace residents had bedsores.

When evaluating whether or not a nursing home is best for your needs or whether a nursing home is providing good care to someone you love, the information in this rating system can be very helpful. For more information and for the ratings for each nursing home in Volusia County you can go directly to the Medicare website.

The fact that bedside rails are considered a restraint is normally a surprise to our clients. In fact anything that interferes with a patient’s freedom of movement is a restraint and is subject to legal regulation. This is morally correct because as a culture we have decided we want to respect other’s independence even if they are elderly and in a nursing home. Our federal government and state legislatures have passed laws giving nursing home patients rights to be free and Independent. However, many of the people in nursing homes suffer from dementia or have some other mental difficulty which keeps them from understanding their situation.

In these circumstances, a spouse or child often ends up having to make decisions about how to best provide quality care to ensure a patient’s safety. The problem with medical care is that every medical intervention has risks associated with it. For instance if we decide to use a seatbelt to keep an elderly patient from getting out of a wheelchair because the patient is very unsteady on her feet and we are afraid she will fall and break a hip, we limit the patient’s independence and may interfere with her chances of recovering the ability to walk with a steady gait. On the other hand if we do not use the seatbelt and the patient gets out of the wheelchair, falls and breaks a hip, the patient may experience excruciating pain, will likely have to undergo an operation to repair the hip and the risks of other medical complications and an earlier death go up.

Even bedside rails have some risks. Patients have been injured being caught between the mattress and the bedside rails. And the bedside rails interfere with the patient’s freedom of movement in a way that is mentally distressing to the patient. For example what if the patient wants to get up to go to the bathroom, a nurse is not readily available to respond to a call bell and the patient cannot get out of bed because of the side rails?

Although there are no easy answers to these kinds of questions which arise all the time in hospitals and nursing homes we are most likely to get to the best result if family members, the doctor, nurses and other health care providers involved all work together to make the best decision. Federal regulations are in place to protect the patient and also to be sure that health care providers carefully think through decisions about restraint use.

Despite what anyone may tell you to the contrary, restraints are, in fact, allowed under the law applicable to nursing homes and they may have a place for a particular patient. The challenge, however, is to carefully think through the decision about restraint use or non-use for each individual resident to get to the best decision.

The federal regulation for nursing homes provides that, “the resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident’s medical symptoms.” Therefore, restraints are allowed when required to treat the resident’s medical symptoms and are not for the purpose of discipline or convenience.

The State Operations Manual which provides guidance to nursing homes also makes it clear that restraints are allowed under appropriate circumstances. “Medical symptom” is defined as an indication or characteristic of a physical or psychological condition. The manual explains that, “the resident’s medical symptoms should not be viewed in isolation, rather the symptoms should be viewed in the context of the resident’s condition, circumstances, and environment.” The manual also explains that a physician’s order alone is not sufficient to warrant the use of a restraint and that there should be some type of process for gradual reduction of the use of restraint if appropriate. A legal surrogate or representative cannot give permission to use restraints for discipline or convenience and the facility may not use restraints in violation of the regulation solely based on a surrogate’s request or approval.

The Operations Manual contains a checklist of questions that are helpful in describing the type of thorough thought process that should be completed when deciding on restraint use or non-use. Paraphrased, they are as follows:

1) What are the medical symptoms that lead to the consideration of the use of restraints?

2) Are the symptoms caused by failure to meet the resident’s needs, provide rehabilitation / restorative care, provide meaningful activities, or manipulate the resident’s environment?

3) Can the medical symptoms be eliminated or reduced?

4) Have alternatives to restraints been attempted?

5) Does the facility use the least restrictive restraint for the least amount of time while adequately monitoring restraint use for the resident?

6) Did the resident or legal surrogate give informed consent after explanation of risks, benefits and alternatives?

7) Does the facility use the physical restraints protocol to evaluate the appropriateness of restraint use and has the facility re-evaluated the need for restraints?

Family members with loved ones in Volusia County, Daytona Beach, Ormond Beach and Florida nursing homes serve the interests of their loved ones if they have this information and insist that the nurses and doctors carefully think through these questions before making any decisions about the use of restraints. Restraints do have a place in the list of medical care options, but they should be carefully considered before being used.