Articles Posted in Understaffing

According to the World Health Organization, dementia is one of the major causes of disability and dependency among older people. Dementia, which is a syndrome in which there is a deterioration in memory, behavior and thinking, causes many who suffer from it to lose the ability to perform their regular activities.

Elders are stricken with dementia far more than any other age group. In many cases, dementia is the reason an elder moves into a nursing home. Dementia is also often to blame for what is known as “elopement” or in layman’s terms, wandering. Elders with dementia may develop wandering tendencies, wherein due to cognitive impairment, they begin to wander around their nursing home unsupervised and without an escort.

Wandering may lead to serious injury as the result of falling. In some cases wandering has even led to death, in cases where residents have wandered outside of their residential facility. Though rare, wandering is dangerous enough that lawmakers included provisions to protect against it in the 1987 Nursing Home Reform Act. The law required that nursing homes must provide residents with adequate supervision in effort to prevent elderly patients from wandering. That means of course, that nursing homes must be properly staffed.

Elder abuse in any form is strictly prohibited by California law. In addition to physical abuse and neglect, medication errors in nursing homes are considered a form of elder abuse. Unfortunately, due to insufficient staffing in many long term nursing facilities, errors in the type and amount of medications administered to residents occur with alarming frequency. While in many cases there may be no detrimental side effects to an elder who is given the incorrect medication, or the wrong dosage; in many other cases, the error can prove fatal.

For example, if two patients’ medications are mixed up, and incorrectly administered, the outcome can be disastrous. A diabetic who is mistakenly given a fellow patients’ heart medication may not under normal circumstances have a negative reaction. However, if that heart medication happens interacts with other medications she is taking, or causes side effects that the patient can’t sustain; the mistake can result in death.

Other medications must be taken consistently in order for them to be effective. Therefore, missing a dose of the proper medication can have devastating consequences on the elder who has missed their dosage. Other medication errors that may occur in nursing homes include:

In another sign of just how serious California is about protecting elders from abuse; a jury in Sacramento recently awarded the children of an elderly woman who was abused in a long term assisted living facility, a whopping $23 million.

The jury ordered Emeritus Corp to pay damages after finding them guilty of malice, oppression and fraud in its handling of 82 year old Joan Boice, who suffered from Alzheimer’s disease. Within just months of being admitted to the Emeritus at Emerald Hills facility in Auburn, CA, Boice developed bed sores, which were later listed as a leading cause of her death.

According to the Sacramento Bee:

The use of physical and chemical restraints in California nursing homes is sometimes a necessary way of protecting patients from injuring themselves and others. When used excessively and, more importantly, without consent, the practice becomes outright abusive. Often this method is used not simply to protect the patient, but rather to make a staff member’s job easier. Overuse of restraints is exacerbated by the growing number of understaffed nursing facilities.

Physical restraints are used to keep patients from wandering around the facility, a potential hazard for the patient and others. A nursing home is required by law to have the resident’s consent before using a physical restraint. Symptoms of physical restraints include sores or bruising on the arms and legs, usually on the ankles and wrists.

Chemical restraints involve the administering of powerful psychotropic drugs to sedate and confine the patient by taking away his or her cognitive abilities. These drugs are not permitted under any circumstances unless the nursing care facility outlines a legitimate medical reason for their use and further provides the frequency and dosage. Because most people are not familiar with the side effects of psychotropic drugs, it can be more difficult to identify chemical restraints than physical restraints.

Psychotropic drugs are administered to nearly 60% of all California nursing home patients, a 30% increase since 2000, according to a report by California Advocates for Nursing Home Reform. A May 2011 study by the Office of Inspector General in the U.S. Department of Health and Human Services found that 305,000, or 14%, of nursing home patients had Medicare claims for atypical antipsychotic drugs. The study was requested by a member of Congress concerned by the number of drugs being prescribed unnecessarily and the cost to taxpayers. The study also determined that 22% of the atypical antipsychotic drugs associated with the claims were not administered in compliance with standards established by the Centers for Medicare and Medicaid Services.

Some common psychoactive drugs are:

  • Anti-Psychotics: These drugs are prescribed for psychosis, schizophrenia, and bipolar disorder. Nursing homes often prescribe anti-psychotics to dementia patients despite the FDA’s strong warnings that they can be fatal to residents with dementia. Haldol, Seroquel, and Zyprexa are common antipsychotics.
  • Anti-Depressants: Common brands are Prozac and Zoloft. Nursing homes have been known to over-prescribe these medications. They can have dangerous side effects such as impaired motor skills, which increase the risk of a patient falling while under a nursing home care.
  • Anti-Anxiety drugs: These drugs also tend to be over-prescribed, and lead to impaired motor skills. Ativan and Valium are popular anti anxiety drugs.
  • Sedatives/hypnotics: Restoril and halcyon are brands commonly administered to patients.

These drugs can be helpful to your loved one’s condition, but it is important that you thoroughly research any prescribed medication and thoroughly interview the prescribing doctor as to why the drug is being prescribed and what its potential side effects are.

If a doctor recommends psychoactive drugs for your loved one, a few questions you will want to ask are:

  • What is the medical condition that necessitates the use of this psychoactive drug?
  • What is the frequency with which the drug will be used?
  • Over what period of time will the drug be used?
  • What are the possible side-effects?
  • Are there any reasonable alternative treatments?
  • What are the interactions with other drugs being used?

Signs of possible psychotropic drug use are: fatigue, impaired motor abilities, unexplained changes in weight, mood swings, deterioration in mental skills, and hallucinations, among others.

If you see these symptoms, and have not given consent to the use of psychoactive drugs, you should consider making inquiries to your doctor and nursing home staff. You or your loved one can refuse medical treatment, or revoke prior consent to any medical treatment. It is important to note that nursing homes are forbidden by law from threatening to evict patients for refusing chemical or physical restraints.
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With the aging of America, more and more older people will be living in nursing homes than ever before. According to available data, there were 39.6 million people in 2009 who were 65 years of age or older. That represented nearly one out of every eight Americans or almost 13% of the U.S. population. Estimates are that there will be roughly 72 million of these older Americans by 2030, causing concerns about the type and extent of prescription medications that are administered to nursing home residents.

Naturally, as we age it is necessary to take various medicines for heart conditions, high blood pressure, high cholesterol levels, diabetes, Parkinson’s and Alzheimer’s, among other things. Because of this most people 75 years of age or more take over 11 different prescription medications during any given period of a year, according to the American Association of Retired Persons (AARP). This requires a committed nursing home staff to see that medications are administered timely and properly.

Problems are encountered when undertrained and undersupervised staff give the wrong medication, an incorrect dosage or overmedicate their residents, leading to often catastrophic results. An unintentional but common error is the mixing up one patient’s medication for another’s during a hectic shift. These mistakes can result in serious drug interactions and even death. Another medication issue is the consistency with which it is administered. Many prescription medications require a consistent, rather than sporadic, dosage, in order to be effective and safe for the patient. Finally, there is an overall tendency in nursing homes across the country to overmedicate those who call these facilities home. Sometimes it is caused unintentionally by undertrained and underqualified staff members, and unfortunately sometimes it is intentional in order to calm and restrain a disoriented or combative resident. The use of prescription medication in the form of anti-psychotic drugs to calm or restrain the elderly can be illegal, but studies have shown that roughly 25% of all nursing home patients are given them. Unfortunately, the Food and Drug Administration (FDA) has reported that more than 15,000 nursing home patients die on an annual basis due to the unnecessary administration of these anti-psychotic medications. For others, the administration of these medications serves to diminish the quality of their life as they remain in a drug induced daze.
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