February 2011 Archives

February 22, 2011

Pilot Project Finds Behavioral Interventions Drastically Reduce Use of Medications

As a Pennsylvania nursing home lawyer, I've written here several times before about the controversial practice of using psychiatric medications to control the behavior of dementia patients. Dementia can make patients argumentative or violent towards others, and it can also cause them to put themselves in danger. As a result, it's become a common practice to prescribe antipsychotic medications to these patients "off label," which means the drugs aren't approved for controlling dementia symptoms. I and many other Philadelphia medical malpractice lawyers have criticized the practice as unsafe, especially after studies began showing that certain atypical antipsychotics actually increased the rate of death in dementia patients. Now, a New York Times Well blog entry dated Feb. 15 suggests an alternative: a pilot project at Minnesota nursing homes that seeks to replace drugs whenever possible with behavioral interventions.

The Awakenings project trained the entire staff of one nursing home in how to calm and reassure patients, and talk to them without insisting on facts that the patients won't accept as true anymore. The home's director of nursing said just holding the patients' hands is sometimes enough to calm them down. When those steps were in place, the home began to reduce or eliminate psychiatric medications whenever possible and agreed to by the families. In the end, all of the residents taking antipsychotics and 30 to 50 percent of those taking antidepressants were able to stop the medications. The post said the behavioral interventions were expensive because they required two additional staff members, but the results were so strong that the program has been expanded to all of the homes owned by this home's parent company.

The experiment also uncovered the reasons for the outbursts from one patient, an unnamed woman in her 90s. The woman would grimace and cry out, had never spoken once since she entered the home and showed no clear signs of recognition when her children visited. At the beginning of the project, she was on the antipsychotic Risperdal, the anxiolytic Ativan and an antidepressant. But after Awakenings took her off most of her psychiatric medications, she was able to speak enough to tell caregivers that she was crying out in physical pain. She was also able to communicate with her family and even take part in games at the home before she eventually died of complications from the dementia.

As a Philadelphia injury lawyer, I'm pleased to see that nursing homes are considering alternatives to medicating dementia. As the post notes, medications are sometimes called "chemical restraints" because their purpose seems to be less to treat a medical problem than to make the caregiver's life easier. This essentially robs the patient of his or her ability to live fully so that nursing homes don't have to pay for the full amount of staff members they need (with Medicare, Medicaid or the family picking up the bill). As this blog post shows, it can also keep patients from communicating their actual medical or personal needs. And even worse, it's now well established that atypical antipsychotics increase patients' risk of stroke, diabetes and other serious health problems that are only exacerbated by age. Under these circumstances, using drugs as a substitute for adequate staffing could be considered a form of Pennsylvania nursing home abuse.

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February 15, 2011

Patient in Pennsylvania Nursing Home Dementia Ward Beats Another Patient to Death

As a Pennsylvania nursing home lawyer, I was shocked and saddened to read about the death of a nursing home patient at the hands of another patient. The Tribune-Democrat of Johnstown, east of Pittsburgh, reported Feb. 14 that 70-year-old Theodore Shaw died at the Cambria Care Center in Ebensburg after another patient repeatedly slammed a door into his head. The second patient has not been named, but has been transferred to a secure dementia ward in another nursing home owned by the same parent company. Both men were residents of the secure 60-bed dementia ward at the Cambria Care Center. Both the state police and the Pennsylvania Department of Health are investigating the incident, including whether the men's dementia played a role.

A spokesperson for the nursing home's parent company, Grane Healthcare, said the perpetrator had never shown any indication of violence in the past. But on the evening of Feb. 12, nursing home staff members reportedly found him repeatedly slamming a door into the head of Shaw as he lay on the ground. They believe it was intentional. Two workers suffered reportedly minor injuries as they tried to stop the attack, but Shaw died in a hospital two days later. In addition to the criminal investigation by Pennsylvania state police, the Department of Health is looking into whether either patient should have had constant supervision. If it finds that Cambria Care Center should have supervised the patients more closely, the nursing home would be required to come up with a plan to correct the problem and could also face fines or other penalties.

As a Philadelphia medical malpractice lawyer, I certainly hope this home is not guilty of lax supervision. Most people think of Pennsylvania nursing home abuse as an act committed by caregivers. This does happen and is inexcusable, but danger can also come from other residents. That's especially true for dementia patients, who are literally not in their right minds. Because dementia patients can hurt themselves or others without realizing it, nursing homes have a special obligation to watch them closely - including separating them into special wards, as this home did. Failure to correctly supervise patients could constitute nursing home neglect. When a patient is hurt as a result of this kind of neglect, families should talk to a Pennsylvania injury lawyer about their legal options for securing justice and fair financial compensation.

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February 9, 2011

Pennsylvania Nursing Home Receives Second Round of Citations From State DPW

As a Pennsylvania nursing home lawyer, I was very interested in a report of trouble at a Pittsburgh-area nursing home. As the Pittsburgh Business Times reported Feb. 9, Katera's Kove in Beaver County has been cited and fined and had its license downgraded by the state for the second time in about six months. The 79-bed facility in Wampum, Penn. received a second provisional license Jan. 31, after receiving a first one last July. It was also cited for problems including inadequate staff training and re-using medical equipment, which raises sanitation issues. Katera's Kove Inc. has until Feb. 17 to correct those problems or face fines of $1,704 a day. Its owner, Lynn Katekovich, said this would not be a problem.

Last year's inspection of Katera's Kove resulted in an admissions ban, fines and citations for problems including improper food storage and failure to document when medication was given. At that inspection, it had four repeat violations, including allowing smoking in unapproved areas, missing equipment from first-aid kits and burned out light bulbs in six rooms. Katekovich said at the time that she felt the DPW's enforcement was selective and planned to appeal. That appeal did not happen, and the admissions ban was lifted. The late January inspection found more problems, including the re-use of a glucometer and its equipment with multiple patients. The devices test diabetics' blood to monitor blood sugar, and use disposable lancets to pierce the skin for sanitary reasons. Katera's Kove was cited for disinfecting this equipment with alcohol and re-using it. Katekovich said this had been approved by the DPW in the past, but "all of a sudden you get an inspector who doesn't think it's sanitary."

As a Philadelphia medical malpractice lawyer, I agree with that inspector. In fact, so does the Pennsylvania Department of Public Welfare, which specifically warns against (PDF) using the same glucometer, lancets and test strips in multiple patients. This is an important part of basic sanitation for any medical facility, but it's especially important at a nursing home, where the elderly and immune-compromised population lives in a close space that encourages the spread of disease. No doubt re-using a glucometer and equipment saves money, but an outbreak of disease spread in this way could harm the patients and eventually cost far more, in medical costs and costs related to a Pennsylvania nursing home abuse lawsuit. If this is typical of the home's attitude toward sanitation, it's no surprise that the DPW is keeping an eye on Katera's Kove. As a Philadelphia injury lawyer, I hope the inspection and publicity improves policies at this home before a patient is harmed

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February 1, 2011

Pennsylvania Legislature Considers Medicaid Cuts That Could Affect Nursing Homes

As a Pennsylvania nursing home lawyer, I was interested to read an article about an ongoing debate in the state legislature on cutting Medicaid costs to balance the budget. The Pocono Record reported Feb. 1 on the proposal and the debate surrounding it in Harrisburg and around our state. New governor Tom Corbett campaigned in part on a promise to cut the budget, and he had enthusiastic support in some areas. But state Sen. Pat Vance, who is a former nurse, told a York County audience recently that there just isn't much left to cut because most of the Medicaid funding goes to the elderly and disabled. The state Department of Public Welfare said the elderly are the fastest-growing group of Medicaid recipients in Pennsylvania.

Medicaid costs are a problem in every state, with an aging population and medical advances that prolong lives. In Pennsylvania, the elderly are 14 percent of all Medicaid recipients but incur 33 percent of costs. About 50,000 of the estimated 2 million Pennsylvania Medicaid enrollees are in nursing homes; another estimated 35,000 are in alternative care such as small group homes or in-home care. Vance promoted in-home care in her speech, noting that it's less than half the cost of nursing homes ($25,000 instead of $60,000 per patient per year). Ironically, however, alternative care may be cut from the state budget because that coverage is not federally required, as nursing home care is. Stuart Shapiro, president of the industry group Pennsylvania Health Care Association, said cutting in-home care would likely mean family and friends would care for the recipients instead, with "a tiny percentage" going to nursing homes.

As a Philadelphia injury lawyer, I find that difficult to believe. Families use in-home caregivers because they don't usually have the skills needed to care for someone with a serious disability, or the money to quit their jobs and become full-time caregivers. Families who lose their safety nets would likely turn to Medicare or even sell an older loved one's home in order to get that person needed, professional care. That would be a shame, because in-home care offers advantages beyond financial savings. Keeping patients in familiar settings is easier on them personally, and in-home care avoids some of the institutional problems with nursing home care. Caregivers are more likely to be consistent and familiar with the patient's needs, and less likely to be overwhelmed by work and forget important things or commit Pennsylvania nursing home abuse. And of course, no community of other patients reduces exposure to communicable diseases. As a Philadelphia medical malpractice lawyer, I hope the state takes a long view on elder care when doing the hard work of cutting the budget.

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