Nurse Aide Turnover at Nursing Homes

We've talked a lot here about things you can look at when trying to choose a nursing home or assisted living facility for a loved one. 

This article in today's New York Times highlights an important factor to examine when you are looking at the quality of care in any given nursing home:  nursing aide turnover.  According to the article, more than 70% of nurse aides  change jobs within a given year. 

The work that nurse aides do is invaluable.  They provide the majority of hands-on care to nursing home residents, assisting them with eating, bathing, hygiene, and getting around.  Given the difficult nature of this work, it is important that the aides are well-trained, working in a supportive environment, and being paid adequately for the work they do. 

Unfortunately, as the article points out, this is very often not the case.  Most troubling, high nursing aide turnover usually results in poorer care for the residents. 

Frausto Family Sues Bio Care

Today, the Harvey Law Firm filed a Complaint against Bio Care, New Mexico Learning Center, Paul Montano and Leah Montano, for mishandling the remains of Johnny Frausto.  The lawsuit was filed on behalf of Johnny Frausto’s widow, Mrs. Sharon Frausto, and his daughter, Ms. Chaunnah Bates.

Johnny Frausto died of pancreatic cancer on January 10, 2010 and his dying wish was to make a contribution to the advancement of the prevention and treatment of cancer.  A hospice company recommended Bio Care to Mrs. Frausto as a reputable company.  Bio Care promised Mrs. Frausto and Ms. Bates that Mr. Frausto’s body would be treated with dignity and respect.  Bio Care represented that they would harvest Mr. Fausto’s organs and then return the remaining part of his body for cremation.  After weeks of being told that Mr. Frausto’s body was “not ready” to be returned, Mrs. Frausto and Ms. Bates began to be concerned. 

Their worst nightmare was revealed on March 30, when local news stations reported that Bio Care was being investigated in connection with improper shipments of human body parts to a medical waste facility in Kansas.  Later, Mrs. Frausto and Ms. Bates learned that investigators found bodies and body parts at the Bio Care facility in Albuquerque, some in a freezer that was no longer working.  Among the body parts found at Bio Care, OMI was able to identify Mr. Frausto’s torso based on an identification of his pacemaker.  At this time, Mrs. Frausto and Ms. Bates do not know the location of Mr. Frausto’s head or limbs.  They are horrified and devastated.

We believe this is simply another example of the inexcusable failure to treat everyone with dignity and respect. 

 

 

Nursing Home Operator Cathedral Rock Corporation Fined by State

As the Santa Fe New Mexican reports today, Cathedral Rock Corporation recently paid $4000 in fines as part of a settlement agreement with the New Mexico Aging and Long-Term Services Department.

In December 2009, Cathedral Rock was issued a notice of violation after concerns raised by the state's Long-Term Care Ombudsman involving the Sunshine Haven and Silver City Care Centers.  The violation stemmed from the nursing home's plan for inappropriate resident transfers and discharge, but also involved misinformation conveyed to nursing home employees about the ombudsman's involvement and approval of the plan. 

Disturbingly, once the ombudsman's office was actually involved, and stopped the planned, improper transfer, Cathedral Rock senior staff criticized the ombudsman's office and also publicly criticized the staff who were thought to have contacted the ombudsman.

Under New Mexico law, ombudsmen have both the right and the duty to investigate any claims of nursing home resident abuse or neglect.  It is not proper for a nursing home to interfere with their right of access, or to retaliate against staff or residents for contacting the ombudsman's office. The law specifically states that  "No person shall institute discriminatory, disciplinary or retaliatory action against any resident, employee or other person for filing a complaint, providing information to or otherwise cooperating with a representative of the [ombudsman's] office." 

In addition to the fine, as part of the settlement, Cathedral Rock issued an apology to its staff for its "inappropriate and unprofessional behavior."

We reported earlier this year on the penalties imposed on Cathedral Rock for Medicare and Medicaid fraud, and about the cases pending against the Cathedral Rock nursing homes in Santa Fe.  Cathedral Rock operates 10 nursing homes in New Mexico: 

Santa Fe Care Center

Casa Real (Santa Fe)

Sunshine Haven (Lordsburg)

Silver City Care Center

Bloomfield Nursing and Rehab

Clayton Nursing and Rehab

Espanola Valley Nursing and Rehab

Red Rocks Care Center (Gallup)

Raton Nursing and Rehab

Country Cottage Care and Rehab (Hobbs)

More Strategies for Choosing a Nursing Home

This week's New York Times' Health section offers suggestions for families choosing a nursing home for a loved one.  

The article recognizes that, unfortunately, the majority of nursing home placements come after a person has been hospitalized, and that families often have very little time to fully explore their options.  However, many of these suggestions are useful even if you do not have much time before you have to decide upon a particular nursing home. 

The article suggests that you visit medicare.gov, and use their Nursing Home Compare tool to help get a picture of the facilities in your area.  We covered this topic in more detail here

The article also emphasizes the importance of visiting potential nursing homes, preferably at different times of the day, and using this checklist to review basic aspects of the nursing home. 

Also important in choosing the right home for your loved one is the nursing home's guiding philosophy.  The article suggests that you ask about "person-centered care" and "consistent assignment," burgeoning trends in the nursing home industry that can increase the quality of resident care.  While person-centered care focuses on allowing the residents to make their own schedules and maintain a degree of autonomy, consistent assignment focuses on the staff of the nursing home.  In a nursing home which practices consistent assignment, the same caregivers, nurses, and doctors attend to the same person as regularly as possible--allowing them to create lasting relationships, which positively affects the resident's care.  High staff turnover, on the other hand, can mean that resident care suffers--which is why the article suggests that you avoid nursing homes with over 50% annual turnover. 

Finally, it recommends you call your local Ombudsman's program to learn more about facilities you may be considering.  In New Mexico, the Ombudsman's bureau is a division of the state Aging and Long-Term Services Department.  Information on this program can be found at its website.  In New Mexico, there are five local and regional ombudsmen, in addition to the State Ombudsman. 

Santa Fe New Mexican Features Story about Harvey Law Firm Clients

This week, the Santa Fe New Mexican featured a story about two pending lawsuits against Santa Fe nursing homes operated by Texas-based nursing home corporation Cathedral Rock. The article featured interviews with Harvey Law Firm owner, Dusti Harvey, and her clients, the family of Mary Abeyta.

Ms. Abeyta died in March 2008 at Christus St. Vincent Regional Medical Center at the age of 84. “[T]he family claims the stitches in her forehead, pressure sores on her tailbone as well as dehydration, weight loss and malnutrition were the fault of the nursing home.”

“It’s difficult to put someone you love in a nursing home," said Laura Jean Abeyta, a St. Michael's grad who works as a juvenile probation officer in Española. "She was our gift, we trusted this place to take care of her."

The story also featured interviews with Regional Ombudsman Gail Trotter and U.S. attorney Dorothy McMurty, who handled the criminal case in Missouri against Cathedral Rock, which I discussed in a previous post.

McMurtry, Harvey and Trotter all emphasized the importance of family vigilance. "The best nursing home is the one closest to your home," said Harvey. Trotter meanwhile urged family and residents to “speak up, tell somebody what's going on."

The story also contains links to the following helpful websites:

 

Hand-Washing Can Prevent Infections

A recent New York Times article, Doctor Leads Quest for Safer Ways to Care for Patients, highlights the critical importance of hand-washing in patient safety. Although the article is directed at patient safety in hospitals, the same principle applies to nursing homes. 

According to this article, most hospital doctors only wash their hands 30-40% of the time! Even the doctors at the better hospitals only wash their hands 70% of the time. Dr. Peter J. Pronovost of Johns Hopkins Hospital in Baltimore implemented a checklist that required hand-washing and empowered nurses to enforce the checklist. As a result of the checklist, infection rates went down to almost zero.

In our cases, we have heard stories from nurses and CNAs about how budget cuts have led to a shortage of sterile gloves, which are necessary for many routine procedures. We’ve heard about nursing staff having to reuse gloves on different patients while doing wound dressing changes. We’ve heard about people doing peri-care without hand-washing either before or after the process. For a person who has a weak immune system, a facility-acquired infection can be deadly. 

Dr. Pronovost suggests that patients ask about a facility’s infection rate. Before anyone touches you or your loved one, ask that person whether he or she has washed her hands. This simple action can prevent unnecessary infection and premature death.

Using Surveys to Learn More About a Nursing Home, Part II

As I mentioned in my last post, looking at state nursing home surveys can be a very helpful tool in your quest to learn more about a particular nursing home. 

Now I will walk you through the information you can find at the New Mexico Division of Health Improvement website

In Step 1, you choose your provider type from the drop-down menu.  "Nursing Homes" is the third entry from the bottom. 

For Step 2, you can search by city, county, or provider name.  If you are trying to look at all nursing homes in Albuquerque or Bernalillo County, the result list may be too long; if you have difficulties, you can narrow it to just one particular nursing home. 

Once you have the information screen for a particular nursing home, it will show you the facility's name, address and phone number.  It tells you its Medicaid, Medicare, License number, and License expiration date.  It also tells you the name of the nursing home's current administrator, who owns the nursing home, and how many beds it has.   

There are three icons directly below this information:  View Map, View Reports, and View Statistics.  For our purposes, we are going to focus on "View Reports."

Once you've followed that link, you will have a listing of surveys conducted at this facility.  Usually, the most recent survey appears first.  It will tell you the type of survey--"health" or "life safety code"; the event ID; the dates the surveyors were at the facility; and the highest citation code.  It will also let you look at the survey itself, via a link at the bottom of that section. 

For your purposes, the most important information is likely contained within the "highest citation code" section, and the most recent surveys themselves.

Next to the "highest citation code," if there is a code, you will see a link for the "Scope/Severity Grid" next to it.  (If there is no code, that means that no violations were found in that survey.)   

This grid is very helpful in understanding the severity of the problems that the surveyors noted at the nursing home. The letter that appears in front of the "highest citation code" will correspond to a letter on the grid.  An "A" code shows that the problem was isolated and did not actually cause harm to anyone, but has some chance of causing minimal actual harm to the residents.  At the other end of the spectrum, an "L" code violation means that there was widespread conduct that caused immediate jeopardy to the residents' health or safety. 

Once you've gotten a sense of the severity of the problems, you can view the survey itself.  "Health" surveys typically discuss resident treatment and resident rights.  "Life Safety Code" surveys typically discuss the physical condition of the facility, and whether it is in compliance with fire and other safety codes. 

The top of the survey  has administrative information.  What interests us, though, is the narrative in the left-hand column:  "Summary Statement of Deficiencies." 

Here, assuming violations were found in the survey, you will see a description of the violation.  First, the surveyor states the language from the regulation that they are using to guide them.  This is followed by what the facility did that was not in compliance with the regulation.  It will typically say that "this REQUIREMENT is not evidenced by...", and then describes the problem(s) the surveyors observed at the facility. 

On the right-hand side, the facility writes its "Plan of Correction," which includes a response to the survey's criticism, and a plan of action to remedy the deficiencies the surveyors cited. 

These surveys are often fairly dense and can be hard to read, but hopefully, they will help provide you with another tool when you have the difficult task of  choosing a nursing home for a loved one. 

Using Surveys to Learn More About a Nursing Home, Part I

We've spoken before about important factors to consider when choosing a nursing home for your loved one

You also have another tool, one that can be very useful, when you are looking at a particular nursing home or choosing from several nursing homes. 

The State of New Mexico's Division of Health Improvement conducts evaluations of nursing homes on at least a yearly basis, and more often when there is a complaint about a particular home.  These evaluations include a visit to the nursing home by a team of health care professionals, and usually last several days. 

These evaluations, called "surveys," seek to make sure that the nursing home is following the state regulations for nursing homes.  While the surveyors are at the nursing home, they observe conditions in the nursing home, and also review the medical chart of randomly selected residents.  They look at all aspects of the nursing home's care, from its food to its maintenance to its staffing levels.

When they have finished their observations at the facility, the surveyors fill out a series of forms, detailing any problems that they observed.  They state which regulations, if any, were not being properly followed, and discuss details of those deficiencies.  They then give a copy of this survey to the nursing home, which has to then come up with a "Plan of Correction," showing that they are taking steps to correct the problems the surveyors found.   

At this web site, you can search by the nursing home's name for its surveys. In an upcoming post, I will tell you more about how to use this web site, and how to interpret the information you find there. 

Nursing Home Residents in Haiti Dying, Waiting for Help

The 84 remaining residents of Haiti’s Port-au-Prince Municipal Nursing Home are waiting for food, water and medicine. According to Associated Press reports, other survivors have shared some food and medicine with dying residents, but large-scale foreign aid has not arrived.

"Several elderly residents were nearing death, staff said. They gasped for air, motionless amid the mayhem of a makeshift tent city erected by survivors on the grounds of the nursing home in an impoverished downtown neighborhood.”

Photos show the nursing home residents begging for food, without medicine or care, awaiting death.

Increasing Concerns About Nursing Homes Owned by "Fundamental"

We have grown deeply concerned about nursing homes in New Mexico owned by a national company called “Fundamental.” The Harvey Law Firm is currently pursuing several lawsuits against various “Fundamental” nursing homes:

Vida Encantada in Las Vegas (four cases)

• A woman died in 2006 after suffering from unexplained leg fractures, infected pressure sores, malnutrition and dehydration. Records show that she was incontinent and suggest that she may have been left laying in urine and feces for prolonged periods of time.

• A man died in 2007 after suffering from falls, numerous pressure sores, infection and contractures.

• A woman died in 2007 after suffering from pressure sores, dehydration and malnutrition.

• A woman died in 2008 after suffering from a lack of oral hygiene, dehydration, urinary tract infections, contractures and pressure sores.

Valle Norte in Albuquerque (closed in 2008)

• A woman died in 2008 after suffering from numerous unexplained falls leading to fractures, lack of hygiene and a failure to communicate abnormal lab results to her doctor.

Albuquerque Care Center

• A woman who needed full assistance died in 2008 after suffering from unexplained fractures and infected pressure sores.

Casa Maria in Roswell

• A woman died in 2007 after her son arrived at the nursing home earlier in the day to find his mother in acute pain and suffering from a leg fracture.

We are interested in talking to any potential witnesses, either employees or other family members with loved ones in any of these nursing homes, who may assist our investigations into these incidents. 

These nursing facilities currently owned by "Fundamental" were also owned by companies called "THI" or "Trans Healthcare."

In order to conduct your own investigation into a nursing home, you can visit the Nursing Home Compare website.