California Nursing Home Abuse Lawyer Blog

Medicare's 'No-pay' Rule Has Lead to Improvements in Infection-Control in Health Care Facilities

Sun, 20 May 2012 09:48:35 -0800

When it was first adopted, Medicare's 'no-pay' rule was a controversial topic in the world of healthcare. Under the 'no-pay' rule, healthcare facilities are not eligible to receive Medicare funding for treatment of conditions acquired within the facility. However, this rule has actually proven to be beneficial to improving quality standards of healthcare facilities, as hospitals and nursing homes now have a greater incentive to prevent infections and other conditions from developing under their watch.

While many different conditions are can be facility-acquired, the three most common were various types of infections related to surgical procedures and the use of catheters. Some other examples of common infections include Methicillin-resistant Staphylococcus aureus (MRSA), scabies, Clostridium difficile (C. difficile), and sepsis. In a recent study by the American Journal of Infection Control, reported by American Medical News, it was found that 70% of professionals now claim that they are spending more time educating their staff on infection prevention techniques as a result of the 'no-pay' rule.

This is not the first incentive program that Medicare has implemented, however.
For example, another recently enacted Medicare program makes the amount of funding provided to a healthcare provider directly contingent upon its quality rating. Meanwhile, the Department of Health and Human Services will award healthcare agencies up to $216 million in funding for reducing preventable injuries.

While they have proven to be beneficial, the necessity of incentive programs highlights the many conditions that can develop as a result of nursing home neglect and understaffing. Some nursing homes will even "downcode" serious conditions in order to relieve themselves of liability and continue to receive funding from government healthcare agencies. This dangerous practice further decreases your loved one's chances of receiving the care that he or she requires. Because nursing homes and other healthcare facilities have incentives to hide conditions from government health agencies, it is important for you to be extremely attentive of your loved one's health. Rather than blindly accepting the nursing home's assessment of your loved one's health condition, you should often examine your loved one yourself. It is important for you to be aware of all these abuses before choosing a nursing home for your loved one.

Strategies to Maintain Physical Health that You and Your Loved One's Nursing Home Should Know About

Fri, 18 May 2012 17:52:09 -0800

Recently, the Wall Street Journal published several articles about the maintenance of physical health through old age. One article, published in the "Health Matters" column discusses how to stay healthy even through old age. The article specifies middle age as the critical time to prevent physical decline. Although it may be apparent that exercise is a key factor in staying healthy, specialists emphasize that it is important to modify daily exercise routines in order to minimize injury. Studies have shown that many middle age adults eventually injure themselves from exercise routines, and consequently stop exercising altogether. It is important to address any pain that is experienced with a physician, as this may be a precursor to more serious problems that will eventually lead to physical decline.

The Wall Street Journal's "Health Blog" featured a related article titled "Preventing Physical Decline in Middle Age Helps Preserve Good Health Later in Life." This article was inspired by a study that is currently being conducted by the Center for Medicare and Medicaid Services and the Bloomberg School of Public Health at Johns Hopkins University. The study is called the National Health and Aging Trends Study (NHATS) and observes the dependency of elderly adults upon others for assistance in activities of daily living. Such activities include walking, showering, dressing, and getting out of bed. The study hopes that its findings will help to improve quality of life for elderly adults in the future. Statistics today actually show that trends of disability levels among the elderly are declining. These optimistic results can be attributed to the many studies that have focused on improving the physical health of the elderly.

For example, the development of a new exercise regime called resistance training has led to a range of benefits, both mental and physical, for elderly adults. Resistance training involves exercises that are performed against an external, opposing force that increases as muscle strength improves. Various studies have proven that physical therapy can also have many unexpected benefits, including improvements in incontinence and mental well-being.

While skilled nursing facilities should be implementing these physical exercises into their residents' daily routines, many homes, unfortunately, are so understaffed that they are unable to supervise such activities. Instead, many resort to the use of physical restraints, which has actually been linked to a decline in mobility in elderly adults. Not only is the use of physical restraints harmful to your loved one, however, but it is a direct violation of his or her rights as a patient if not used properly, such as when its done for the convenience of the nursing staff, and not the benefit of the patient.

Los Angeles Nursing Homes Found to Have Chronically Understaffed Levels of Registered Nurses

Wed, 16 May 2012 11:45:56 -0800

A recent article titled "Caring for elders: the role of registered nurses in nursing homes" emphasized the great importance of staffing a sufficient amount of registered nurses (RNs) in nursing homes. The article refers to RNs as the "linchpin" of nursing homes as they are expected to organize innovative activities, exercise clinical judgment, and deal with ethical dilemmas while linking together different departments. The study discussed in the article conducted various interviews with RNs from different nursing homes. The conclusion was that the responsibilities of RNs are absolutely crucial to nursing homes, but many factors such as understaffing and a lack of communication often stand in their way of doing their job properly which in turn leads to a lower quality of care.

While RNs may also do office work and other administrative tasks, these tasks can be delegated to other staff as the skill set of an RN can be better utilized elsewhere. The article stresses that RNs should really be focusing on direct patient care, such as maintaining a good relationship with their residents and exercising clinical judgment. If RNs maintain a good relationship with their residents, they will in a better position to direct other administrative tasks to other staff to ensure that the nursing home is providing the best quality of care.

An RN is becomes tied down with office work usually when the facility is understaffed and do not have enough staff to delegate the proper responsibilities. An RN complained about this understaffing and incorrect delegation of duties saying, "Handling invitations to tender, equipment and resident inventory, billing, and drafting quality control documents could be delegated to others. We actually spend little time building a relationship and communicating (with the resident)." When RNs do not have time to maintain a good relationship with their residents due to understaffing, it becomes nearly impossible to carry out individual care plans for their residents, which is extremely important for ensuring safety of residents and preventing falls.

Previous studies have shown the staffing levels of RNs and the amount of RN direct care time are correlated with avoidable nursing home injuries such as pressure sores, urinary tract infections, and falls. Because of this, it becomes increasingly important that nursing homes both hire enough RNs and allow RNs to carry out their proper responsibilities. Undervaluing the role of an RN could seriously compromise the quality of care. Unfortunately, as this article has shown, many nursing homes do ignore the importance of a proper caregiver-patient relationship, and disregard the importance of staffing nursing homes properly.

When choosing a nursing home, it is important to ensure that the well-being of their residents and the human element of care is one of the most important priorities for the facility. While this may seem obvious, many nursing homes do not have their resident's health as a first priority. This is both inexcusable and a violation of a patient's rights.

Protect Your Loved One from the Dangers of Chemical Restraints and Polypharmacy

Tue, 15 May 2012 11:42:09 -0800

Medication is intended to improve the quality of a patient's life by reducing uncomfortable symptoms or by curing a disease. However, taking more medication does not equal to receiving more benefits. In fact, the consequences of using too many medications at once, or polypharmacy, can be extremely harmful and counterproductive. An article published by Hovstadius and Petersson looks at the different factors that lead to excessive polypharmacy and discusses the alarming finding that polypharmacy is most lethal and occurs most commonly in adults aged over 65 in nursing homes.

The article says that one of the most common risk factors for excessive polypharmacy is age. As the prevalence of disease increases with age, the amount of medication prescribed also increases. The prevalence of polypharmacy has also been increasing as new medications and technology are being discovered. In the entire national population, the prevalence of polypharmacy in the age group 80 to 89 years is 75.1%, and the percentage continues to rise as age increases. Elderly adults also often forget to take certain medications as they already have so many types of medications to keep track of, which is another reason why polypharmacy can be so dangerous.

Another factor associated with polypharmacy other than age is poor self-perceived health, poor life satisfaction, declining ability to function and declining cognitive capacity. Many nursing home residents who suffer from dementia also suffer from depression. This depression can usually be treated by non-pharmacological methods, such as daily social activities, simple exercises, and independence tasks. Unfortunately, many nursing homes do very little to ensure that their residents have a good quality of and good outlook on life as many nursing homes do not have these options of activities available for their residents. Rather than treating patients with non-pharmacological methods, nursing homes often use drug treatments or chemical restraints,which in turn leads to a higher likelihood of polypharmacy occurring.

Perhaps the most common consequence of polypharmacy is harmful drug-drug interactions. The effect of one medication can be influenced by another medication, and result in a harmful side effect. The risk for drug-drug interactions increase greatly as a patient is taking more medications. For example, a patient on 10 different drugs has 45 possible one-to-one drug interactions. Even more harmful is a disease-drug interaction, which occurs when a disease is worsened by a drug prescribed for a reason other than to treat the disease. This is highly common in nursing homes because many nursing home residents have diseases such as Alzheimer's, but are also given unrelated medications such as nutritional supplements or urinary tract infection antibiotics.

Due to the severe consequences of polypharmacy, it is important to be aware of the risk factors that lead to polypharmacy and ensure that you or your loved one are not being prescribed unnecessary medications. Unfortunately, as many nursing homes are understaffed, instead of providing the proper care and treatment, unnecessary drugs such as chemical restraints are often improperly used.

Make Sure Your Loved One's Nursing Home Is Not Using Drugs that Cause Falls

Sun, 13 May 2012 09:24:47 -0800

Depressive symptoms are common in patients suffering from dementia. Because of this, many patients are given anti-depressants, or selective serotonin uptake inhibitors (SSRIs). Research has shown that increased use of SSRIs is associated with an increased amount of falls in the elderly population, however details are still lacking on the exact relationship in the specific population of nursing home residents. A recent study published by the British Journal of Clinical Pharmacology shed light on the issue by looking specifically at the details of the relationship between SSRIs and injurious falls in the nursing home population. The study found that higher doses of SSRIs increase the risk of falls by three-fold. As falls are becoming increasingly common in nursing homes, it is important to understand all the risk factors that contribute to falls.

The study analyzed daily drug use and monitored falls over a two year period for residents who were able to walk independently (with or without a walking aid). All 248 patients studied met the criteria for dementia. To emphasize the huge effect drugs had on the rate of falls, the study cited one example from one of the patients they studied. An 85 year old female resident, who was on no SSRIs, hypnotics, or sedatives, had a risk of an injurious fall (per day) of 0.12%. After placing her on a dosage of SSRIs, her risk of an injurious fall (per day) jumped up to 31%. What is even more shocking is that her dosage was only 0.25DDD (Defined Daily Dose), whereas the average dosage given to nursing home residents is 1.00DDD. This means that the risk of an injurious fall increases by 198% when you place a patient on SSRIs or other various forms of drugs.

The study also points out the dangerous cycle of drugs and falls. Many nursing homes argue that drugs not only alleviate symptoms but also prevent falls when in fact the opposite is true. Behavioral disturbances like agitation and aggressive behavior (for which SSRIs are often recommended) often lead to an increased fall risk, which in turn lead to a higher drug dosage. Also, increased dosage of SSRIs has not even been shown to be more effective on depressive symptoms. In fact, there is very weak support for the idea that SSRIs are an effective treatment for patients with depression and dementia. Due to these reasons, the study urges clinicians and nursing home staff to prescribe SSRIs to their patients with due caution as to not increase the risk factor for falling.

Despite the consequences of SSRIs, the use of SSRIs and other drugs is quite common in nursing homes. In fact, a huge problem nursing homes often have is that many residents are on too many drugs at once. In previous studies, polypharmacy has already proven to be extremely detrimental to patients, but as this study has shown, the use of drugs can also greatly increase the incidence rate of falls. Many studies have offered more effective alternative treatments for dementia symptoms, but these alternative treatments require an adequate amount of staff to carry out the treatment. Unfortunately, many nursing homes are understaffed which is ultimately the reason why polypharmacy and easily avoidable falls occur.

A New Therapy that Los Angeles Nursing Homes Should Use to Treat Dementia

Thu, 10 May 2012 09:13:46 -0800

Dementia is a degenerative disease that can cause many behavioral and psychological symptoms that make patients difficult to care for. Although medications for these symptoms exist, not many studies have been able to provide conclusive evidence that medications such as acetylcholinesterase inhibitors are actually directly involved in relieving symptoms of dementia. As a result, many studies are now looking at non-pharmacological treatments that involve social interaction, simple physical activities, and other daily activities.

A study published in 2012 tested a treatment known by the acronym "MAKS": "M" for motor stimulation, "A" for activities of daily living, "K for cognitive stimulation (German word is kognitiv), and "S" for a short introductory phase or a spiritual element (discussing topics such as happiness or singing a song). The results were very positive; the MAKS treatment significantly reduced symptoms of dementia for the 146 residents that participated in the study. Two therapists and one aide conducted the MAKS therapy for 6 months (6 days a week, 2 hours a day). Each 2 hour session started with the introductory phase in which a simple group activity was conducted to make everyone feel included. Then, 30 minutes was allotted to motor exercises, such as bowling, croquet, or balancing a tennis ball on a Frisbee and passing it to one's neighbor. Another 30 minutes was spent on cognitive tasks, and then the last 40 minutes were spent on an individual activity such as preparing a snack or crafting with wood or paper.

After 6 months, participants in the study were less likely to exhibit challenging behavior such as running away and being aggressive and were generally happier. This improved social behavior, decrease in challenging behavior, and improvement in mood was most evident in residents with mild dementia. This study successfully showed that the MAKS therapy can greatly slow down the progression of dementia at an early stage.

Additionally, the study found that not only did the MAKS treatment work, but it also resulted in more long-term results than drug treatments. The MAKS treatment also had no side effects, as opposed to the side effects of drug treatments. The study implies that due to the overall advantage of the MAKS treatment, it is important that nursing homes treat their patients using similar non-pharmacological treatments whenever possible. The MAKS treatment and non-pharmacological treatments similar to it are much cheaper in price compared to the price of drugs, but call for an adequate amount of staff at hand to conduct group activities and to properly supervise each and every resident. Unfortunately, many nursing homes are understaffed, which is why drug treatments are used in place of other more effective and safe treatments.

How You Can Avoid Burnout and Still Care for Your Aging Parents

Mon, 07 May 2012 16:51:22 -0800

Many couples nowadays work simultaneously and take care of both their aging parents and their children. Coined the "sandwich generation", these couples may experience a burnout as they have to focus on their job, care for their children, their marriage and the health of their aging parents. A study published in the Social Psychology Quarterly looked at what factors attributed to these burnouts and coping methods for successful couples. In interviews from the study, one of the most frequently mentioned stress factor was caring for aging parents, which was reported to be even more difficult than caring for young children.

The couples who were interviewed pointed out that much of the stress that comes from taking care of elderly parents comes from watching their decline in health each visit, and that having the support from their partner helped them immensely. The study found that lower rates of couple burnout correlated with lower rates of job burnout, and that one of the most important coping methods associated with reducing couple burnout was visiting their parents together. Visiting their parents together therefore strengthened their marriage, and reduced the stress of seeing their loved ones in a compromising situation.

Coping with the difficult task of watching the health of your loved ones decline is only one of the many stresses that families have to deal with. Families that decide to choose a nursing home for their parents are presented with a whole new array of stresses. With the wide array of choices, it becomes difficult to decide which facility will provide the best care with the most convenient location. As the article suggests, an important part of making the decision is making it together. It is also important, before making the decision, to visit the facility together to ensure that the facility has all the needs of your loved one, and staff that will offer professional care.

If you or your loved one is seeking a nursing home, the main issue to keep in mind is ensuring that the nursing home is not understaffed. In order to provide the proper care, one of the most basic requirements is that the nursing home has enough staff to give attention to each resident. Understaffing can lead to a wide array of problems, including malnutrition at mealtimes, an increased amount of falls, increased likelihood of pressure ulcers, and possible misuse of physical restraints.

Falls: Psychological Impact and Prevention Methods

Mon, 16 Apr 2012 09:07:49 -0800

According to the American Geriatrics Society Foundation for Health in Aging, approximately half of nursing home residents experience falls each year. Because falls are such a common accident, it is important that nursing homes understand how to handle the situation immediately after a fall, and the best ways to prevent falls. An article by the Assisted Living Column emphasizes that falls not only cause physical injury, but also psychological damage that may lead to more falls in the future. The article also stresses the importance of caregivers at nursing homes to be educated about the nature and impact of falls.

The psychological impact of falls is important as it almost always leads to more falls. After falling once, older adults become fearful of falling again, and so engage in less physical activity. This reduction of physical activity results in reduced mobility, which is a risk factor for a second fall. In a long-term residential facility such as a nursing home where residents are unfortunately at a risk of experiencing falls, staff should be trained on preventative measures.

The article emphasizes the importance of proper prevention methods. The staff at the nursing home should be aware of all the risk factors and work to eliminate as many of these risk factors as possible. Many of the risk factors for falls are environmental factors; the floor may be too smooth or slippery, rooms and hallways may have inadequate lighting, or furniture placement might be dangerous. All of these factors are things that can be easily fixed with an observant and knowledgeable staff. Unfortunately, a problem in many nursing homes is that the nurses often give a lack of direct care. Direct care involves physical and psychological treatment of the patients, while indirect care mostly involves administrative tasks. If there is a lack of direct care for the residents, it becomes increasingly difficult for staff to take notice of the environmental hazards that the nursing home may have.

Another major risk factor is the type and amount of medication that the patient is on. A study done by the Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) found that those who were on psychoactive medications were more likely to experience a fall due to the medication's side effects. Unfortunately, psychoactive drugs are one of the most frequently used drugs in nursing homes. Nursing homes often find it more convenient to use psychoactive drugs to prevent episodes of agitation. However, rather than using psychoactive drugs, nursing homes should provide more direct care and should not be using chemical restraints to subdue their residents as this is a direct violation of the Patients' Bill of Rights.

A Patient Safety Culture and Reduced Use of Physical Constraints Leads to Better Safety Care

Fri, 30 Mar 2012 11:20:31 -0800

A study published by The Gerontologist found that nursing homes that focused on creating a culture of patient safety which involves using less physical restraints, resulted in lower mortality rates, lower rates of failure to rescue, decreased chances of medical errors, and more days between serious safety events. A culture of patient safety involves ensuring that the nursing home or hospital is engineered both physically and systematically to enhance the safety of the patients and residents. It also involves a blame-free environment in which individuals are able to report errors with fear of punishment. Lack of a culture of patient safety can lead to staff that is afraid of reporting mistakes, which leads to the increased use of physical restraints.

Physical restraints are a controversial care process used on individuals with difficulties transferring and with behavioral disorders. Nursing homes often resort to the simple method of using physical restraints to limit falls rather than attempting to fix the underlying problems in management that lead to these falls in the first place. In reality, physical restraints do not prevent falls. In fact, the study found that nursing homes that use less physical restraints report less falls per year. Physical restraints have also been shown to increase the likelihood of death, injuries, and functional decline. Nursing homes often resort to physical restraints because they are uneducated about better safety methods. Staff should be trained in teamwork, documentation, and reporting and discussing safety issues. Each resident has different health needs, and so a specific care plan should be adopted for each individual to prevent falls, rather than resorting to the use of physical restraints.

The study also found that the nursing homes that heavily rely on physical restraints and less on a patient safety culture also tend to be understaffed. Unfortunately, understaffing is a problem in most nursing homes, and so many nursing homes are not providing the proper quality of care for their residents to ensure their safety from falls and critical errors made by staff. The use of physical restraints due to understaffing is also a direct violation of a patient's rights, and is simply inexcusable.

The results from this study show that there needs to be an obvious push in nursing homes towards building and the importance of adopting a proper patient safety culture and hiring enough properly trained staff to give quality care to the residents. A nursing home should not only provide resident autonomy, and a comfortable living environment, but also a safe culture to ensure that its residents are kept at the highest level of physical and mental well-being as possible.

Recent Study Reveals Nursing Home Staff's Nonchalant Attitude towards Pressure Ulcer Prevention and Care

Thu, 29 Mar 2012 18:47:55 -0800

The March 2012 issue of the Journal of Clinical Nursing studies trends in pressure ulcer prevention in skilled nursing facilities in its article titled "Registered Nurses' Attention to and Perceptions of Pressure Ulcer Prevention in Hospital Settings." Pressure ulcers continue to be a major problem in nursing homes and yet, many facilities fail to prioritize the prevention of these wounds, although they are one of the greatest sources of unnecessary suffering among the elderly. The study reaffirms this problem and observes that Registered Nurses (RNs) typically undervalued the importance of pressure ulcer prevention techniques.

Before reporting the actual procedures and results of the study, however, the article first discusses important prevention techniques that it would be considering when observing nursing homes and their ability to effectively prevent pressure ulcers. First off, pressure ulcer prevention must be administered from an early stage. The study reports that identifying and treating the problem early on can actually decrease the chances of the development of a pressure ulcer by 50%. Some common and effective prevention methods include repositioning and usage of support surfaces, such as foam or air mattresses. Nutrition was also found to be important. Patients who took nutritional supplements were able to successfully lower their chances of developing pressure ulcers.

The study consisted of two parts. The first portion involved an interview with the RNs. Highlights of these interviews reveal a heavy reliance of RNs upon their assistant nurses. Instead of providing direct care themselves, RNs delegated many duties to assistant nurses, admitting that they did not have time to implement or supervise these activities themselves. This confession presents the widespread issue of understaffing in skilled nursing facilities. Even when staff as a whole is sufficient in numbers, nursing homes are often lacking in their employment of RNs. Previous studies have confirmed that direct care from RNs specifically is especially important in the prevention of pressure ulcers, as well as many other health complications that are encountered in nursing homes. With regard to quality of staffing, the truth of the matter is that assistant nurses are much more prevalent and highly staffed than RNs in skilled nursing facilities. This reality makes it especially important for you to ensure that these nurses are well-educated and trained to provide your loved one with the care that he or she needs.

In addition to being knowledgeable of pressure ulcers, and other health-related issues that the elderly may encounter, nurses must also possess basic administrative, organizational, and communication skills in order to allow for the smooth operation of a skilled nursing facility. Many nurses who participated in the study admitted that they felt that the documentation of procedures and treatments was an unnecessary, cumbersome step in the caretaking process. RNs trusted that their assistant nurses were implementing prevention techniques, even if there was no documentation of them. However, careful and accurate documentation of medications, treatments, and health problems is absolutely necessary in optimizing the quality of care that a patient receives. By keeping a patient's medical files organized, physicians and other third parties can more easily assess the condition of the patient, and thus prescribe the most effective treatments.

Proper documentation also contributes to the formation of an effective care plan. Nurses who participated in the study, however, claimed that no specific care plans were necessary in caring for patients suffering from or at high risk for pressure ulcers. RNs said that pressure relief was done automatically and that no specific policy was necessary because the nursing staff already knew what to do. If a patient showed signs of a pressure ulcer, then assistant nurses were simply to reposition the patient often and report the pressure ulcer to RNs. Such a mentality truly undermines the individual needs of each patient. No two patients are exactly alike. Therefore, it is absolutely necessary that each patient has a care plan that has been specifically tailored to suit his or her needs.

From its observations, the study concluded that prevention techniques were typically undervalued on an RN's list of priorities. It also concludes that assistant nurses were unable to recognize risk factors or diagnose the stages of a pressure ulcer as accurately as RNs. This fact further attests to the importance of direct care from RNs. If your loved one's nursing home is not providing your loved one with proper preventative measures for pressure ulcers, as a result of staffing issues, he or she may be a victim of nursing home neglect.

A Breakdown of the Different Types of Antipsychotic Drugs: What You Should Know Before Taking Them

Wed, 28 Mar 2012 18:42:57 -0800

A recent article titled, "Comparative Safety of Antipsychotic Medications in Nursing Home Residents" was published by the Journal of American Geriatrics Society. As reported by the article, an entire third of nursing home patients are prescribed antipsychotics at some point during their residence. Because such a large population of nursing home patients take these drugs, it is important to understand the risks associated with antipsychotic medications. This study breaks down the two types of antipsychotics and compares the risks associated with using each one. Typical antipsychotics, also commonly known as conventional antipsychotics, were developed in the 1950s. A second generation of antipsychotic drugs was later developed, and today these medications are called atypical antipsychotics.

The study concluded that in general, the use of atypical antipsychotics is more dangerous, as it was more often associated with negative side effects. These included an increase in cardiac problems, infections, and hip fractures. However, an exception to this was found with cerebrovascular issues, in which case, atypical antipsychotics appeared to pose less of a risk. We hope that your loved one never finds the use of antipsychotic medications necessary, but if he or she does, it is important to understand risks and side effects, in order to do an educated cost-benefit analysis of taking such drugs.

The study also notes that the effectiveness of antipsychotics in Alzheimer's patients is outweighed by the risks. Although symptoms for various cognitive diseases may appear to be similar, effective treatments for each one are often very different. Inaccurately diagnosing and treating a cognitive disease can be very dangerous, and even lead to death of a patient. Because there are so many fine details that must be understood and considered prior to beginning an antipsychotic drug regimen, it is important that the nursing home staff is trained and knowledgeable in such matters. As many nursing homes are, unfortunately, extremely understaffed, it is common to find nurses who are unable to properly and accurately diagnose and treat various medical problems. It is important that you are aware of this widespread problem, so that you and your loved one can hopefully avoid its many consequences.

One such consequence is the use of chemical restraints. Because the nurses in understaffed facilities are usually pressed for time, they will often automatically resort to the use of drugs, instead of first assessing the patient and considering other treatments that may be safer and more effective. This is especially important in dementia patients. In 2005, the FDA issued a warning of excess mortalities associated with antipsychotic use in adults with dementia. Since then, many studies have been conducted on the various uses of antipsychotics and their overall effect on quality of life in patients who suffer from dementia. The results have all suggested that behavioral therapies are the most effective treatment for dementia patients. In fact, the use of antipsychotics has actually been proven to worsen symptoms of dementia, such as agitation. It is important that you consider the many alternative methods that exist for treating dementia before resorting to the use of antipsychotic medications.

The study concludes by emphasizing the importance of monitoring a patient's dosage of medications. Close and careful monitoring can prevent consequences of polypharmacy from occurring. The most efficient way to monitor drug use and antipsychotic treatments is to maintain organized and detailed medical records. Studies have actually proven that improper documentation of antipsychotic drug usage leads to a higher rate of death in skilled nursing facilities.

Recent Study Links Deficiency Citations for Physical Restraints to Staffing Issues in Los Angeles Nursing Homes

Tue, 27 Mar 2012 18:37:41 -0800

A study in the March 2012 issue of the Western Journal of Nursing Research, titled "Nursing Home Deficiency Citations for Physical Restraints and Restrictive Side Rails" brings attention to the use of physical restraints in skilled nursing facilities. The study is unique because it includes restrictive bed rails in its definition of a physical restraint, whereas most studies conducted previously have not.

Nursing homes often justify the use of physical restraints by making the claim that they prevent falls. However, the study confirms that restraints do not actually prevent falls. Instead, they actually pose a safety hazard to patients who often become entangled in or strangled by these devices.

Furthermore, they are often linked to health complications such as pressure sores and incontinence. Physical restraints can also be emotionally damaging to elder adults who already feel embarrassed by their loss of independence in activities of daily living. The use of physical restraints can also lead to psychological problems such as depression, isolation, agitation, and a loss of dignity.

In its analysis of the facility's staffing levels, the study broke down the different types of caregivers. High staffing levels of Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) were correlated to fewer deficiencies for physical restraints and bed rails. However, when the facility employed a high number of nurse aides, with a relatively low level of RN and LPN staffing, it was found that the nursing home was more likely to receive deficiency citations for physical restraints. These results show that merely looking at overall staffing levels is not always sufficient in determining the quality of care that a nursing home will be able to provide. In addition to looking at numbers and ratios, one must also consider the types of staffing before making a decision to reside at a skilled nursing facility. Previous studies have also proven the importance of direct care from RNs, specifically, to prevent pressure ulcers and other health complications.

The study also showed that homes with large bed sizes were more likely to receive deficiencies for physical restraints. In discussion, the study suggested that this is due to the fact that communication between staff and patients is better in smaller homes because they allow for a tight-knit community that fosters interaction between patient and staff. However, this does not mean that larger nursing homes cannot provide the care that your loved one needs. It simply means that larger nursing homes need to employ a sufficient amount of staff to replicate the one-on-one, individualized care that is provided by smaller facilities.

Our belief, as supported by this study, that the use of physical restraints can be significantly reduced through proper staffing is also recognized by the Code of Federal Regulations. Title 42 part 483 has prohibited physical restraint use for purposes of discipline or convenience and maintains that restraints may only be used for medical reasons.

Daily Activities Can Alleviate Depressive Symptoms in Dementia Patients

Mon, 26 Mar 2012 17:46:56 -0800

Nursing home residents who suffer from dementia often also suffer from coexisting depression. Depression can cause a greater cognitive decline in dementia patients. However, because the overlapping symptoms of depression and dementia such as atypical presentation, lack of insight, and expression difficulties are often overlooked, nursing home residents who suffer from both depression and dementia do not get adequate treatment for both conditions. In lieu of overmedication, alternative methods can be used to alleviate the symptoms of depression. A study published in the American Association for Geriatric Pediatry offers alternative ways to treat depression. These depressive symptoms can be easily remedied by simple leisure activities done two or three times a week.

The study placed thirty-six residents from nine different nursing homes in Hong Kong in three different activities that they would engage in three times a week: mahjong, tai chi, and handicrafts. Results showed that tai chi alleviated symptoms very slightly, and most likely didn't provide the expected results because the physical movement was too difficult for most residents due to the lack of normal physical activity prior to the study. Results also showed that mahjong had a short-lived effect; symptoms of depression were alleviated immediately after the activity, but returned to baseline level at the follow-up 3 months later after stopping the activity. This means that if done regularly, mahjong will keep nursing home residents at a healthier state of mind, slowing down the cognitive decline of dementia that is caused by depression.

Unfortunately, activity levels in nursing homes are relatively low. The psychological well-being of residents is rarely a priority, and as a result, residents can suffer from both dementia and depression at the same time, causing great emotional distress and cognitive decline. The mahjong activity conducted in the study can be very easily implemented in nursing homes if nursing homes choose to make the effort to hire staff that is motivated to conduct these activities and rouse interest in the residents to engage in these activities. Most nursing homes are usually understaffed and therefore do not have the adequate resources to conduct such activities to improve the quality of care.

Additionally, the activity of choice does not need to be mahjong. The activity can be anything that rouses interest in the residents and whether the activity is doable given the residents' health limitations (tai chi was deemed too difficult for the residents in the study). The main point to keep in mind is that whatever activity is chosen, it needs to be done regularly. Even the effects of mahjong were limited after the activity was stopped for three months. All nine of the nursing homes that participated in the study discontinued mahjong as an activity despite the results of the study. The cognitive decline of dementia already progresses rapidly, and it is unfair to not implement such a simple activity into the daily lives of residents to prevent their condition from getting progressively worse. There is simply no excuse for nursing homes to have no meaningful activities whatsoever for their residents to participate in.

Five Steps that Nursing Homes Should Take to Counter Dementia-Related Agitation

Sat, 10 Mar 2012 16:28:04 -0800

An article in the March 2012 issue of the Journal of American Medical Directors Association titled "Is Your Nursing Home a Battlefield?" address the issue of dementia-related agitation in skilled nursing facilities. The article makes the analogy that nursing homes are often comparable to battlefields when dementia patients experience episodes of agitation and refuse care from nurses. Because this issue creates a negative dynamic between nursing home residents, their families, and the staff, it is extremely important to address the issue and understand the solutions that this article suggests.

The first solution is as simple as the elimination of words with negative, violent connotations. Words like "aggressive" and "assaultive" reinforce the idea that the resident intends to harm the caregiver. In actuality, patients who have episodes of agitation are not being violent; rather, they feel the need to defend themselves due to a lack of understanding as to what the intentions of the caregiver are and what purpose his or her actions serve. As a nurse, especially those who handle dementia patients, it is crucial to provide clearly articulated explanations to residents undergoing any form of care or treatment in the facility.

Secondly, the article emphasizes the importance of educating the facility's staff. This includes nursing aides, directors of nursing, charge nurses, and even the nursing home's administrators. In addition to having a staff that provides quality care, the skilled nursing facility needs to be adequately staffed. There is a strong correlation between quality and quantity with regard to staffing in nursing homes. Without an adequate amount of staff, it is nearly impossible to meet the high standard of care that each patient needs and deserves.

Nursing homes have strict guidelines and policies to which all patients and nurses must abide. However, the article recommends that the facility maintain a certain degree of flexibility in implementing their policies and guidelines. This openness to modifying certain policies allows for care plans that are more individualized and receptive to the patient's specific needs. For example, if a patient tends to resist care early in the morning, perhaps the facility staff should consider a later wake up time.

The article also suggests that nursing home facility's give nursing aides more significant roles in decision-making. The abilities of nursing aides are often undermined, as it is often assumed that they are merely expected to carry out tasks assigned to them by directors of nursing. However, those who make these assumptions overlook the fact that nursing aides provide the most direct care to patients and interact with them on a daily basis. Therefore, the article recommends that nursing aides be included in care plan meetings. As they are most familiar with patients' needs and preferences, allowing nursing aides a role in decision-making will result in more effective care plans.

Lastly, the article asserts the importance of treatment for patients who reject care. Often, rejection of care is a sign of pain, delirium, delusions, or depressions. Therefore, patients must be carefully evaluated so that they can receive the proper care, before symptoms become more serious. As with every recommendation that the article has made, training of the facility's staff is instrumental in this step. Previous studies have shown that nurses often fail to recognize symptoms until it is too late and complications have progressed too far. Recognizing and diagnosing delirium poses and especially difficult challenge for nurses. For this reason, nurses must be trained to be observant and recognize the signs of various health complications that arise in skilled nursing facilities.

In addition to ensuring that the nursing home is adequately staffed, you should also be wary of the use of antipsychotic drugs to chemically restrain residents who suffer from dementia. Other than this being a direct violation of the Patients' Bill of Rights, it is also extremely dangerous and has been proven to actually aggravate episodes of agitation.

A Recent Study Confirms Adverse Effects of Polypharmacy in Los Angeles Nursing Homes

Fri, 09 Mar 2012 16:23:03 -0800

While we are fortunate to be living in a modern world that is constantly making advancements in the field of medicine, the side effects of pharmaceuticals can often be dangerous and have implications that must be assessed. The March issue of the Journal of American Medical Directors published an article titled "Exploring Variation in Rates of Polypharmacy Across Long Term Care Homes." The study on polypharmacy, which the article defines as "the use of multiple, concurrent drug therapies" produced startling results on just how many medications nursing home residents today are taking on average.

If a patient was on nine or more drug regimes at once, the study considered this a practice of polypharmacy and compared the quality of life of these patients to those who were taking fewer medications. The study found that patients subject to polypharmacy were more likely to have comorbidities. This group comprised about 15.5% of nursing home patients taking nine or more drugs simultaneously. Only 2.9% of patients were taking no drugs, and the remaining 81.6% were using anywhere between one and eight drugs at once. The most commonly used drugs include diuretics, proton pump inhibitors, and enzyme inhibitors.

Additionally, the study noted that in general, psychoactive drugs are also one of the most frequently used drugs in nursing homes. Previous studies have established that psychoactive drugs, although intended for treatment of illnesses such as schizophrenia, are often administered to patients who suffer from dementia. Because dementia patients may have episodes of agitation, nursing homes often find it convenient to sedate these residents with psychoactive drugs in order to prevent these episodes from occurring. However, this improper use of pharmaceuticals is an example of a chemical restraint and is in direct violation with the Patients' Bill of Rights. Furthermore, studies have concluded that the use of psychoactive drugs in dementia patients has reciprocal effects and can actually cause agitation and worsen the overall condition of the patient.

In addition to triggering agitation in dementia patients, drug use can also cause delirium. It is important that you monitor your loved one's drug intake, as well as the staff that is administering these drugs to him or her. Sometimes, understaffing and disorganization among staff can lead to mix-ups between patients' drugs. Taking another patient's drugs can have detrimental effects on health, and may even cause death. The study also noted that the more prescribing physicians a patient had, the more likely polypharmacy was to occur. This can be attributed to that fact that care facilities may not be properly documenting medical records. In terms of administration and management, documentation of medical charts is extremely important. All attending physicians must be able to clearly and easily see every medication that a patient is taking, in order to assess the costs and benefits of prescribing additional drugs.

Unfortunately, not all skilled nursing facilities have your loved one's best interests at heart. What you can do is make frequent visits to check up on your loved one's health and well-being. It is recommended that you have a general awareness of medications that are more likely to cause adverse drug reactions and overdoses. Also ensure to assess the facility's staffing levels and closely monitor nurses, because tampering with patients' drugs can sometimes occur in healthcare facilities.