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The Psyche Workshop's

The Sad Truth about Elder Care

 

by
Rosalie Marie Musumeci


Copyright © 2008 by Rosalie Marie Musumeci
All Rights Reserved.  No part of any art / literary content works herein may be reproduced (make copies), adapted (make new versions), distributed or published, performed in public, or displayed.




In February 2008 my mom became sick.

Within a short time she found it more and more difficult to walk and so the hospital advised she go for rehabilitation at a nursing home for a few weeks, before she would return back home to us. So began the search for a nursing home and rehabilitation center. It quickly became clear to me that my mom and other people in need would probably fair better very slowly crossing the street at a red light. My opinion sounds pretty drastic, doesn't it? Well my research left me in a fatal state of dismay and disgust. This is my research study about Nursing Homes / Rehabilitation Facilities.

My mom stayed one night in the nursing home which was recommended by the hospital. My brother stayed with my mom for the one night she was there. They left first thing in the morning after my brother relentlessly all through the night kept asking for water for my mom which she never received.


There are between 16,000 and 18,000 nursing homes / rehabilitation centers in the U.S. I randomly selected one nursing home from each of the fifty states. As you read the deficiencies, I'm sure you will agree that the state of nursing homes is beyond belief, beyond anything we care to imagine, and yet, here it is! Still, I did wonder if it could be that in my random selection I picked the worst. I wish I could say that this is what happened. Caring for another should be so simple, especially for those people who chose to be in a caring profession. Shame on them! If you find yourself in such a situation, you will have to choose one. Ask questions! Ask many questions! Make the nursing home aware that you are aware! You must stay on top of it! Be relentless! There isn't any other choice! This is the sad truth about elder care!


Deficiencies in Nursing Homes and Rehabilitation Centers
  • According to the reports I researched, there are 1,710 deficiencies in the 50 nursing homes (one from each state).
  • Each nursing home had multiple deficiencies, some more than others. Some nursing homes kept repeating the same deficiencies.
Deficiencies of Health

Staff and Quality

  • The nursing homes did not follow all laws and professional standards.
  • The staff did not allow the residents to refuse treatment or refuse to take part in an experiment.
  • They did not allow the residents the right to choose activities, schedules and health care according to their interests, assessment, and plan of care.
  • The staff did not tell the residents completely about their health status.
  • The nursing homes did not honor all of the residents' rights as residents of the nursing homes and as citizens or residents of the United States.
  • The doctors did not always see the care plan at every visit and make notes about progress and orders in writing. They did not visit residents regularly, as required. They did not keep accurate and appropriate medical records, and did not provide written records when residents were transferred or discharged. In addition, they did not keep residents' personal and medical records private and confidential. Also, clinical information was not kept safe, so that it would not be lost, destroyed or used by the wrong person.
  • The residents were not allowed to easily see the results of the nursing homes' most recent survey. They did not listen to the residents or family groups or act on their complaints, or if they did act, it was not quickly.
  • The residents did not have privacy in their bedrooms.
  • The staff did not send and promptly deliver unopened mail to residents.
  • The staff did not properly hold, secure, manage and provide proof of residents' personal money which was deposited with them. In addition, they did not quickly give the residents' personal money to the heads of his or her estate after the resident's death.
  • The nursing homes did not post nurse staffing information.
  • The nursing homes did not set up a group who would be legally responsible for writing and setting up policies for leading and running the nursing homes. They did not have a panel of people to review and ensure quality. They did not hire a properly licensed administrator.
  • The staff did not administer care in a way that led to the highest possible level of well-being and quality of life for the residents. Also, they did not provide care in a way that would make residents have dignity and self-respect. In addition, the care both inside and outside of the nursing homes did not meet professional standards of quality. They did not use a registered nurse at least 8 hours a day, 7 days a week. They did not have enough nurses to care for residents in a way that would maximize well-being. They did not get proof that nurse aides had the training and skills that the State requires, and in fact, did not make sure that the nurse aides had the skills to be able to care for residents. They did not review the work of each nurse aide every year; or give regular training for the nurse aides.
  • The staff did not tell or put in writing to the residents or their representatives, how long the nursing homes would hold the residents' bed when he or she temporarily left the facility.

Abuse, Neglect, Mistreatment, Isolation and Physical Restraint

  • The nursing homes did not protect residents from all abuse, neglect, mistreatment or isolation. In fact, they actually hired people who had a legal history of these atrocities, so then, of course, when there were occurrences, they did not report them. The nursing homes also used physical restraints.

Medical Care

  • The residents did not have a complete care plan that would meet all of their needs, with timetables and actions that could be measured. They did not have a complete care plan within 7 days of their admission. If there was a care plan, it was not prepared with the care team, including the primary nurse, doctor, resident or resident's family or representative. And also, if there was a care plan, it was not followed.
  • The staff did not tell the residents about Medicaid benefits: eligibility, services covered, and how to apply. They also did not give the residents the names and addresses of State groups that could also help.
  • The staff did not always give or get lab tests, x-rays, or other tests to meet the needs of residents. They did not quickly tell the doctors the results. They also gave tests without the attending doctor ordering them. In addition, they did not keep signed and dated reports. In addition, residents did not get dental care.
  • The nursing homes did not help residents who couldn't care for themselves with eating/drinking, grooming and hygiene. And for those residents who could care for themselves, they did not receive treatment/services to be able to continue with their self-care.
  • The staff did not give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers) and help restore eating skills, if possible.
  • The staff did not give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.
  • The staff did not properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.
  • The staff did not immediately tell the resident, doctor, and a family member if there was a major change in resident's physical/mental health, or if there was a need to alter treatment significantly.
  • Residents who entered the nursing homes without a catheter were then given a catheter, even when it is was unnecessary.
  • Residents with reduced range of motion did not get proper treatment and services.
  • The staff did not give residents enough fluids to keep them healthy and prevent dehydration.
  • The nursing homes did not have a program to keep infection from spreading. In fact, when residents were sick, they were not kept apart from well residents. They did not clean and store sheets, towels and other linens in a way that prevented the spread of infection. The nursing homes did not get rid of garbage properly, and there was not a program to prevent/deal with mice, insects, or other pests. Not surprisingly, staff members did not wash their hands when needed.
  • At least once a month, the nursing homes did not have a licensed pharmacist check the drugs that the residents were taken. The staff did not have drugs and other related products which were needed every day. The staff did not keep residents free from drugs. The staff did not properly mark drugs and other similar products. The staff did not make sure that residents were safe from serious medication errors, such as, the rate of medication errors (wrong drug, wrong dose, wrong time) was 5% and higher. Residents who took drugs were given too many doses, or took medications for too long a period of time. The staff did not make sure that the use of drugs was carefully watched, however, when they did watch, they did not stop or change drugs that cause unwanted effects.
  • The nursing homes did not develop/implement required procedures for the administration of immunizations.
  • The staff did give the right treatment and services to residents who had mental or social problems adjusting. They did not make sure that residents didn't become withdrawn, angry or depressed if these problems did not exist before.
  • The staff did not provide social services for related medical problems.
  • The nursing homes did not have adequate and comfortable sound and lighting in all areas.
  • The nursing homes did not have areas which were homelike and comfortable.
  • The nursing home did not provide needed housekeeping and maintenance. 

Food

  • The nursing homes did not use properly trained paid feeding assistants. They did not provide licensed nursing supervision of the feeding assistants. They did not properly monitor the feeding of its residents. They did not store, cook, and give out food in a safe and clean way. They did not stop employees, who had a disease that could spread, from having direct contact with residents or food.
  • The staff did not provide 3 meals daily at regular times. They did not serve breakfast within 14 hours after dinner. They did not offer a snack at bedtime each day.
  • The staff did not prepare food that was nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. They did not offer other nutritional food to residents who would not eat the food served. They did not make sure that residents were well nourished and that their nutritional needs were met.

Assessment

  • The staff did not screen residents when they are first admitted to send them to an area with special care for people with developmental disabilities or mental illness, if needed.
  • The staff did not make a complete assessment that covered all questions for areas that are listed in official regulations. They did not make sure that all assessments were accurate, coordinated by an RN, done by the right professional, and were signed by the person completing them. They did not do the resident's assessment every 3 months, or do a new assessment after any major change in residents' physical or mental health.

Deficiencies of Safety

 

Safety Plan

  • The nursing homes did not have a detailed, written plan for disasters, emergencies and evacuations, and they did not train all employees on what to do.
  • The emergency lighting in the nursing homes did not last at least 1 ½ hours.
  • The nursing homes areas were not free of dangers and so residents had accidents. The staff did not immediately tell a doctor and family. They did not have firmly secured handrails on each side of hallways.
  • The nursing homes did not have rooms that can be unlocked from inside without a key.
  • The nursing homes did not have proper exit designs. They did not have properly located and lighted "Exit" signs, and proper backup exit lighting. The exits were not accessible at all times and were free from obstructions. The exits did not allow residents to escape the building. They did not have any signs that stated exit doors were to be kept closed.
  • The nursing homes did not keep all essential equipment working safely.
  • The nursing homes did not have properly protected cooking facilities.
  • The nursing homes did not have properly constructed piped-in oxygen systems.
  • The nursing homes did not have properly installed electrical wiring and equipment, and a separate and independent backup electrical power source.
  • The nursing homes did not have proper medical gas storage and administration areas.
  • The nursing homes did not have weekly inspections and monthly testing of generators.
  • The nursing homes did not have proper power supply for life support equipment.
  • The nursing homes did not have enough outside airflow.
  • The nursing homes did not have heating and ventilation systems that were properly installed according to the manufacturer's instructions.
  • The nursing homes did not have enough backup water supplies for important areas of the nursing homes.
  • The nursing homes did not have a working call system available in each resident's room or bathroom and bathing area. They also did not have a private telephone available for use.
  • The nursing homes did not have properly installed hallway dispensers for alcohol-based hand rub.
  • The nursing homes did not have emergency showers.
  • The nursing homes did not have linen or trash chutes properly sized and located

Fire Safety Plan

  •  The nursing homes did not have fire safety features required by current fire safety codes.
  • The nursing homes used construction type and materials which were not approved.
  • The nursing homes were not designed, built, equipped, or well-kept to protect the health and safety of residents, workers, and the public.
  • The nursing homes did not have portable fire extinguishers, and an approved fire extinguishing system.
  • The nursing homes did not properly maintain smoke detectors and have automatic smoke detection system in all hallways.
  • The nursing homes did not have proper fire barriers, ventilation and signs for the transport of oxygen.
  • The nursing homes did not have an approved back-up procedure for a faulty fire alarm system. The installation, maintenance and testing program for fire alarm systems in the nursing homes was not approved. They did not have fire alarm systems that could be heard throughout the facility.
  • The nursing homes did not have properly working alarms on sprinkler valves. The automatic sprinkler system connected to the fire alarm system in the nursing homes was not approved, and maintained in working order. They did not have back-up procedures which were not in place for faulty automatic sprinkler systems.
  • The nursing homes did not have constructions that would resist fire for one hour. They did not have two-hour-resistant firewall in common walls. They did not have fire-resistant interior walls. They did not have fire-resistant room wall surfaces.
  • The nursing homes did not have smoke barrier doors that could resist smoke for at least 20 minutes. They did not have walls or barriers that would prevent smoke from passing through and would resist fire for at least one hour. The corridors and hallway doors did not block smoke. They also were not separated from common areas by walls constructed to limit the passage of smoke.
  • The nursing homes did not have proper stairway enclosures and vertical shafts.
  • The nursing homes did not have proper construction of ducts through walls designed to prevent smoke passage.
  • The nursing homes had at least two remote exits on each floor or fire section of the building which were deficient.
  • The nursing homes did not post no-smoking signs where oxygen was used, and where smoking was not permitted or allowed. They did not provide ashtrays where smoking was allowed.
  • The nursing homes did not restrict the use of highly flammable materials including curtains.
  • The nursing homes did not restrict the use of portable space heaters.
  • The nursing homes did not have externally vented heating systems.
Nursing Homes and Other Elder Care Links

The following guides are to help you make the best possible decision about the care for your loved ones.



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