My Elder Advocate

Report Finds Hazardous Conditions at Senior Centers

2008-07-31T11:51:38-07:00

New York Times

An audit by the city comptroller’s office found dangerous conditions at a sample of 20 of New York City’s 329 senior centers, the comptroller, William C. Thompson Jr., announced on Thursday.

“Simply stated, D.F.T.A.’s lack of follow-up is putting seniors at risk for injury,” Mr. Thompson said, referring to the city’s Department for the Aging, which awards contracts to provide groups to run the centers. “It is mind-boggling that many of the hazardous conditions uncovered by my office were previously cited by D.F.T.A. in its own annual assessments. We were provided with little evidence of any efforts on its part to work with center management and landlords to correct these problems.”

In a detailed response contained within the 48-page audit report [pdf] Edwin Méndez-Santiago, the commissioner of the department, defended its oversight, while pointing out that it was the contractors’ responsibility to maintain proper physical conditions, which he said were subject to regular monitoring. Mr. Méndez-Santiago wrote in a letter dated June 13 to John Graham, a deputy comptroller:

The Department can and does conduct its required oversight and monitoring; it is our contracted service providers’ responsibility to maintain safety and cleanliness in the first instance and to respond to the Department’s monitoring findings. We will always work to support and follow through on their efforts, and ensure they meet their contractual obligations. In this vein, we are concerned about the lack of recognition in your audit report of the providers’ responsibility in maintaining physical conditions of senior centers.

The department also said in a statement on Wednesday, “The Department for the Aging requires safe and well-maintained senior centers. DFTA will continue to work closely with community providers who are responsible for managing the day-to-day operations of the centers to ensure that facility related issues are corrected in a timely basis.”

At 12 of the 20 centers, the audit found fire and safety problems, including locked or blocked exit doors, a lack of illuminated exit signs, and inadequate lighting or broken handrails in exit passageways.

In 14 of the 20 centers, auditors found hazardous conditions in bathrooms, including damaged or missing tiles; peeling paint; rust and mildew on the sides of stalls, floors, and ceilings; dirty toilets and floors; and toilets, urinals, and sinks that did not function properly.

Nine of the 20 centers were found to have problems with their kitchens, including filthy stoves, dirty refrigerators and freezers, and a lack of internal thermostats and temperature controls in refrigerators and freezers.

The directors at 7 of the 20 centers complained that landlords and building managers would not pay for exterminators.

Mr. Thompson’s office had previously issued an audit on the centers in June 2005, which also found that many were not properly maintained.

SEX, LOVE AND NURSING HOMES

2008-07-04T07:32:35-07:00

SEX, LOVE AND NURSING HOMES

Death of spouse ups odds of nursing home care

2008-05-31T05:12:56-07:00

An older person's likelihood of entering a nursing home or other long-term care facility is particularly high immediately after the death of a spouse, new research indicates.

"It may be related to the loss of social and instrumental support, in the form of care and help with daily activities such as help in cooking, cleaning, and shopping formerly shared with the deceased spouse," Nihtila said.

"Second, grief and spousal loss may cause various symptoms, such as depression and anxiety, loss of appetite, sleep disturbances, fatigue and loss of concentration that could increase the need for institutional care." She added. "Furthermore, grief may cause increased susceptibility to physical diseases."

The research team analyzed how the death of a spouse affects the likelihood of entering institutionalized care among nearly 141,000 Finnish adults aged 65 and older. All of them were living with a spouse at the beginning of the study and were followed for five years.

"The data were unique in that they covered a large number of persons bereaved during the follow-up and gave the dates of bereavement and of first admission into institutional care," Nihtila and colleagues explain in the American Journal of Public Health.

Results showed that the risk of entering long-term institutional care was higher among older adults who had lost their spouse than among those living with their spouse. "The excess risk of institutionalization was highest during the first month after the spouse's death -- more than three times higher among both men and women -- and decreased with time from bereavement, stabilizing at approximately 20% to 50% higher over 1 to 5 years," Nihtila noted.

The researcher thinks home help services "should be targeted to the bereaved immediately after a spouse's death to reduce the need for institutional care."

SOURCE: American Journal of Public Health, July 2008 (online May 29, 2008).

Murder, She Writes

2008-05-02T11:17:02-07:00

Read this comment by a reader of My Elder Advocate Blog. Hospitals are complicit in the murder and destruction of our elderly nursing home patient's. WHEN WILL THIS HOLOCAUST END!

A new comment from “Carmen ” was received on the post “A Typical Monday Afternoon at Sheepshead Nursing Home” of the weblog “My Elder Advocate”.

Comment:
It is sad to say that the Nursing Homes are not the only ones abandoning the elderly. My husband was sent to the hospital from the Nursing Home for needed surgery. I had to push them to send him to the hospital but that is another story. While doing the pre-op tests they discovered all kinds of things wrong with him from being malnourished to dehydration and bacterias and more but no one thought to inform me. I had been battling the NH about his daily care and it was like pulling teeth to get information out of them..The "care" was negligible. After his death I was able to get the hospital records and saw all these red flags..I questioned the assistant director about them not calling in social services and his response was that many if not all the patients they get from nursing homes are in poor condition..sort of ..par for the course. It did not occur to the hospital that maybe the condition these patients are in is not due to old age and illness but due to the conditions they are being forced to endure. No one at the hospital questions the state of these patients..It is assumed that they are the way they are due to illness or old age. Patients are being pushed to die sooner by not giving them adequate nutrition and fluids and the hospitals are complicit in their silence. There is no excuse for the hospital not informing the spouse of their findings and then the spouse can make an informed decision about their care...Not wanting to rock the boat, the hospitals are helping the elimination of these patients by their silence. I call these cases Mini-Schiavos..The patient is slowly being starved and dehydrated and the spouse comes in and sees the PEG tube solution and assumes everything is alright..Little did I know that the solution was not adequate for him. I was just being given the illusion that he was being given nutrition...but it was just that, an illusion. Magdalena

Calfornia Nursing Homes Kill Residents

2008-04-29T12:28:52-07:00

That is correct...it is not a misstatement. I did not mean to say that two residents died as a result of neglect or abuse.

The nursing homes at issue are located near Sacramento, California. The nursing homes at fault are English Oaks and Marysville Care Center and here is what happened. At English Oaks a 91-year-old resident was choking on fruit and no one at the home provided the Heimlich maneuver - he died! At the Marysville Care Center an 84-year-old resident's head became stuck between the bed and a railing - she died. Both reports come from the California Department of Public Health. English Oaks also was fined in 2001 for not monitoring the feeding tube of a patient who got an infection and died. These facilities have a long history of serious violations.

Both facilities were owned by the same company, which received a "double citation" for these tragedies. A double citation...you have got to be kiddin me...someone needs to go to jail!
SEE NEWS STORY

Crisis of age requires cure

2008-04-06T12:55:54-07:00

Financial Times

Every day an estimated 6,000 Americans turn 65. Four years from now, that figure will swell to 10,000 people a day so that by 2030, one in five Americans will be 65 or older. At the same time, geriatrics programmes across the US are shrinking, the number of certified geriatricians is falling relative to the population, physicians are disenrolling from Medicare, and fewer medical students are choosing careers in geriatrics.

When Mark Lachs, an internist who specialises in the care of the elderly, looks into the not-so-distant future, he sees millions of retirees and not enough doctors. “The baby boomers are moving through the belly of the beast and are coming out 65,” he says. “The numbers are just overwhelming; about 7,000 geriatricians for millions of older people.”

“We are in a significant crisis – it is no longer looming,” says Lachs, a professor of medicine and a chief of the division of geriatrics and gerontology at Weill Medical College of Cornell University. “The manpower deficit extends from the physician level to the frontline workers and everywhere in between.”

The consequences are dire; unless systemic changes are made, the “silver tsunami” of retiring baby boomers will cripple the country’s health systems. Consider this: there are 7,128 board certified geriatricians in the US, or one geriatrician for every 2,546 Americans 75 or older, according to the American Geriatrics Society. By 2030, that ratio is expected to drop to one geriatrician for every 4,254 older Americans.

Usually, when public and private resources fail to address a societal problem, philanthropy is the answer. Yet ageing, for the most part, is ignored by foundations and donors. Why think about old people when there are glamorous causes with star-studded fundraisers and celebrity spokespeople? (Think malaria or the plight of refugees in the developing world.)

“Ageism is alive and well in our society,” says Corinne Rieder, executive director and treasurer of The John A. Hartford Foundation, the largest private foundation in the US focused exclusively on ageing and health. “We really live in a youth culture. This is also true for medical education.”

This age-defying quest is fuelled by best-selling books with titles such as How Not to Look Old and a society that celebrates the virtues of Botox parties and plastic surgery. For many, thinking about old age means confronting uncomfortable topics such as dementia and Alzheimer’s disease. But as Atul Gawande put it in an article last year in The New Yorker, “people naturally prefer to avoid the subject of their decrepitude”.

Some believe this aversion affects funding decisions. “Older people and ageing are not seen as sexy topics and oftentimes the people on [foundation] boards are ageing and this can be painful to think about. They are in denial themselves,” says Brian Hofland, head of the international ageing programme at The Atlantic Philanthropies, the world’s largest private funder of ageing issues.

Yet ageing is a universal issue. Gara LaMarche, Atlantic’s president and chief executive, says any foundation that does not take this into account in its strategies is not seeing the whole picture.

“Ageing is not a niche funding area or a special interest group. The number of funders with a primary focus on ageing, like our close friends at The John A. Hartford Foundation, will always be finite, though it too needs to grow,” he told the 2007 annual meeting of Grantmakers in Aging (GIA), a national membership association. “But the number of foundations which ought to be concerned with ageing is almost infinite, for no funder ought to get away, in this day and, well, age, with saying ‘we don’t do ageing’.”

A small group of US foundations has embraced funding programmes to prepare for the dramatic ageing of the population.

Through their grants, foundations are tackling issues that range from researching and treating elder abuse to changing how society views older people and helping more doctors, nurses, psychiatrists, social workers and other health professionals receive the necessary training.

For The Donald W. Reynolds Foundation, a private philanthropy that funds journalism, ageing care, and cardiovascular research, the way to improve the quality of healthcare for elderly people across the US is to strengthen all physicians’ geriatrics training. To help achieve this goal, it provides “geriatric training grants” – of up to $2m each – to medical schools.

“We are not in the business of training people to become geriatricians. We are in business of training all physicians, no matter what field they enter, to better care for frail older people, so it includes both faculty and practising physicians,” says Rani Snyder, a senior programme officer for Reynolds.

This skills shortage was highlighted in a 2002 report – “Medical Never-Never Land: Ten Reasons Why America is Not Ready for the Coming Age Boom” – by the Alliance for Aging Research, a non-profit advocacy group in Washington, DC. It warned the US would fall far short of the 36,000 geriatricians needed by 2030 “unless effective steps” were taken to train new providers.

Six years on, the outlook remains bleak. For academic year 2006-07, 468 first-year fellowships in geriatric medicine were available, and only 253, or 54 per cent, were filled, according to the American Geriatrics Society. For the same year, there were 136 geriatric psychiatry fellowship first-year training slots, and half went unfilled.

“The population numbers clearly point to older patients dominating the healthcare delivery in the US and most of the developed world but we have been rather phobic about geriatrics, geriatric medicine and ageing,” says Daniel Perry, executive director of the Alliance for Aging Research.

An ageing population is a triumph of medical science, but longevity has downsides that extend far beyond wrinkles. Having enough geriatricians and geropsychiatrists – as well as primary-care doctors trained in caring for the elderly – is one way to ensure that older people have access to a better quality of life.

This is because caring for older adults is not simply a matter of treating older versions of middle-aged patients. Many common diseases of adulthood, such as depression, have different characteristics in the elderly than in younger people. And the elderly tend to have multiple problems: the average 75-year-old has three chronic medical conditions and regularly uses about seven prescription drugs, as well as over-the-counter remedies.

“The internal medicine is really complicated and really interesting. Rarely is it just heart failure. It could be heart failure plus diabetes, plus depressive disorder, plus cataracts,” says Lachs, who is also director of geriatrics for the NewYork-Presbyterian Healthcare System.

He spends much time encouraging doctors to become geriatricians. But it is difficult; the pay is a lot lower than most other medical specialisations and the field lacks prestige. “Geriatric medicine remains an under-subscribed field for people coming out of medical school,” he says. “Yet if you do anything other than paediatrics you will be seeing mostly older people.”

The Hartford Foundation is working to change this. One of its initiatives – centres of excellence in geriatric medicine and training – was designed to address the shortage of geriatric faculty members in US medical schools. The centres are a network of 26 medical schools at which about 70 per cent of the future professors of geriatric medicine receive training. Hartford also funds similar initiatives in nursing and social work.

Funding geriatric medicine is just one area where philanthropy can make a big difference. To achieve wider impact, however, ageing needs to move from an orphan to a mainstream issue. More big funders also need to emerge as Atlantic and Reynolds are limited-life foundations, spending themselves out of business.

To help raise awareness, GIA, in partnership with Atlantic, has launched EngAGEment, a two-year pilot programme to introduce new community, family and private foundations, as well as corporate grantmakers and wealthy individuals, to philanthropy focused on the many issues facing the elderly.

Carol Farquhar, GIA’s executive director, says ageing “is coming into its own” and the organisation’s membership has swelled from fewer than 60 foundations eight years ago to 115 today. Still, this is minuscule considering there are about 70,000 private foundations in the US.

“It is important to note that there is a seat for everyone at the table,” Farquhar says. “There are more needs and issues than funding resources. Ageing can be meals on wheels; an elaborate research project; or taking a national model and bringing it to the community for less than the cost of the original grant. There are many opportunities for partnering and collaboration. Ageing is very broad – you can pick your issue and really make an impact.”

Nursing home patients restrained, greed is not

2008-03-29T07:29:47-07:00

By Saul Friedman-Newsday

Politicians and other soothsayers tell us how as a nation we honor and care for the oldest generation, our parents and grandparents, many of whom are ill or frail and need some comfort, security and dignity in their last years.

If that is true, why is it that the residents of more than 4,000 of the nation's 16,000 nursing homes risk getting bedsores that can sicken, disable and kill, or find themselves in restraints when they have to go to the bathroom because there's not enough staff to look after them?

Here's one reason: Contrary to popular belief, many, if not most, for-profit nursing homes are potential moneymakers. And the smaller the underpaid and non-skilled staff is, the more money can be made. But although much of the money paid to nursing homes -- hundreds of millions of dollars -- comes from Medicaid and Medicare, the government often has no idea where and to whom these proceeds go.

These are among the conclusions of nursing home experts, and advocates and lawyers for residents, who have analyzed the latest data, completed in November, by the Centers for Medicare and Medicaid Services (CMS) but fully released just recently under pressure from Congress.

Entitled the "National List: Nursing Homes Targeted for High-Risk Pressure Ulcer [bedsores] and/or Physical Restraint Improvement," it names some 4,000 nursing homes that were found deficient last year in these two important categories of care.

The prevalence of bedsores and the use of restraints are indicators of neglect and insufficient staff.

Last month CMS followed up with names of 131 "Special Focus Facilities" (SFF), which CMS described as "nursing homes that have failed to improve significantly after being given the opportunity to do so." CMS added, "once a facility is an SFF, state survey agencies are responsible" for following up with frequent inspections until the facility shows improvement. If it doesn't, it could lose its accreditation.

The list of 4,000 homes targeted for improvement because of bedsores and restraints included more than 140 facilities in New York State. But only one New York home, in upstate Niskayuna, was included among the SFFs that were added to the list and have not shown improvement. Families may search lists at http://www.cms.hhs.gov/Quality ImprovementOrgs/Downloads/ NursingHomeChart.pdf and http://www.cms.hhs.gov/ CertificationandComplianc/Downloads/SFFList.pdf

More than 95 percent of U.S. nursing homes participate in Medicare and/or Medicaid, and in 2001, in response to widespread complaints about the conditions in many homes, CMS reported to Congress 91 percent of the facilities did not have sufficient staff to prevent harm to residents and 97 percent failed to comply with the Nursing Home Reform Law. The report, by a consulting firm, established the connection between good patient care and adequate, well-paid staffing.

"Strong evidence supports the relationship between increases in nurse staffing ratios and avoidance of critical quality-of-care problems," the report concluded. "A strong relationship was found between nursing assistant retention and whether facilities were" among the worst in providing quality care. It suggested modest increases in the salaries of registered nurses and overworked nurses' aides usually paid less than minimum wage.

A 2007 study, by the University of California at San Francisco, of nursing home staffing from 2000 through 2006 found that the average number of registered nurses in facilities had declined by 8 percent as the number of lower paid, less trained nursing assistants had increased and that deficiencies doubled in the 105 homes studied.

The study found that nearly 40 percent of all nursing homes had sanitary problems, and a third had quality-of-care problems. And the number of patients who were confined to their beds or chairs increased in relation to low staffing, an indication of poor quality care. Law professor Charlene Harrington, who ran the study, told members of Congress that under current law, nursing facilities and their owners need not account to Medicare and Medicaid for how they spend the money they are paid.

If the failure to hire sufficient and adequately trained staff is a matter of money, Toby Edelman, an attorney for the Center for Medicare Advocacy, a nonpartisan group, points out that nursing homes owned by Manor Care Inc. based in Toledo, the nation's largest nursing homes chain, were among the facilities cited as deficient by the CMS.

In December, Manor Care was acquired by the Washington-based private equity firm, Carlyle Group, for $6.3 billion.

According to Bloomberg News, it was the seventh buyout of a nursing home chain in 2007 and the eighteenth in four years. Advocates for patients and unions representing nursing assistants opposed the sale of Manor Care, predicting staffing would be further cut. Their fears were understandable, for The New York Times last September reported that as investment companies have acquired nursing homes, "they have often reduced costs, increased profits, and quickly resold facilities for significant gains" leaving residents "worse off."

Edelman said Manor Care's former chief executive, Paul Ormond, got as much as $186 million when his company was sold. "Using federal wage guidelines for nursing home workers," she wrote, "we calculated that Manor Care's 278 nursing homes could hire an additional 5,346 certified nurse aides or an additional 2,198 registered nurses [with that money]. Like all nursing home chains, most of Manor Care's revenues come from ... Medicare and Medicaid. How should our public dollars be spent? On one man's windfall, or certified nursing assistants and registered nurses in nursing homes?"

Prescription Abuse Seen In U.S. Nursing Homes

2008-03-27T10:54:20-07:00

In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals -- including antibiotics, AIDS drugs or medicine to treat high-blood pressure.

One reason: Nursing homes across the U.S. are giving these drugs to elderly patients to quiet symptoms of Alzheimer's disease and other forms of dementia.

Nearly 30% of the total nursing-home population is receiving antipsychotic drugs, according to the Centers for Medicare & Medicaid Services, known as CMS. In a practice known as "off label" use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not. CMS says nearly 21% of nursing-home patients who don't have a psychosis diagnosis are on antipsychotic drugs.

That is what happened to a woman listed in New York state health department inspection records as Resident #18. The 84-year-old Alzheimer's patient, who lives at the Orchard Manor nursing home in Medina, N.Y., likes to wander and roll her wheelchair around her unit, according to a report filed earlier this year, and sometimes she nervously taps her foot.

To address her behavior, which was considered disruptive, Resident #18 was given a powerful antipsychotic drug called Seroquel, a drug approved for schizophrenia and bipolar disorder. Resident #18 is not psychotic and Seroquel -- like other atypical antipsychotics -- carries a "black box" warning that elderly dementia patients using it face a higher risk of death.

"She is a handful," says Thomas Morien, administrator of Orchard Manor. "Other residents complain about her because often at night, she will get up and go to their rooms." The patient has since been taken off the drugs.

The growing off-label use of antipsychotic medicines in the elderly is coming under fire from regulators, academics, patient advocates and even some in the nursing-home industry.

"You walk into facilities where you see residents slumped over in their wheelchairs, their heads are hanging, and they're out of it, and that is unacceptable," says Christie Teigland, director of informatics research for the New York Association of Homes and Services for the Aging, a not-for-profit industry group. Her research, which she believes reflects national trends, shows that about one-third of dementia patients in New York's nursing homes are on antipsychotics; some facilities have rates as high as 60% to 70%. "These drugs are being given way too much to this frail elderly population," Dr. Teigland says.

Federal and some state regulators are pushing back, questioning the use of antipsychotic drugs and citing nursing homes for using them in ways that violate federal rules. New York has increased its focus on antipsychotics in nursing homes, training inspectors to spot signs of medication abuse. Last month, the Arkansas attorney general filed suit against Johnson & Johnson and two of its units, claiming, among other things, that they "engaged in a false and misleading campaign" to promote its antipsychotic drug Risperdal to geriatric patients.

A spokesman for Janssen LP, one of the Johnson & Johnson units that manufactures Risperdal, says, "We are prepared to vigorously defend ourselves against these claims."

Setting Limits

The $122 billion-a-year nursing-home industry's use of drugs raises complex issues in an aging society. Revulsion against practices such as tying down and sedating disruptive elderly patients led in 1987 to a landmark federal law, signed by President Reagan, that set limits on how and when nursing homes can physically, or chemically, restrain a patient. Since then, a rising population of elderly people suffering dementia has entered nursing facilities, many of which have overburdened staff.

The vast majority of antipsychotic medicines paid for by Medicaid are atypical antipsychotic drugs, thought to have fewer of the side effects typical of older drugs. Many were introduced in the 1990s to treat schizophrenia, and have become huge sellers for pharmaceutical companies. Nursing homes turned to the drugs to try to calm dementia patients and to maintain safety and order in their facilities.

The newer antipsychotics are more expensive than older ones. A dose of Seroquel, for instance, can cost more than $4 at retail, while Risperdal can cost more than $5 a pill retail; older antipsychotics can cost less than a dollar per dose.

In all, atypical antipsychotics rang up U.S. sales of $11.7 billion last year, up from $6.6 billion in 2002, according to IMS Health, a health-care information company. Doctors last year filled 45.4 million prescriptions for atypical antipsychotics, compared with 33.6 million five years ago, IMS Health says.

Schizophrenic patients, for whom the drugs were originally intended, make up 1.1% of the U.S. population, or 2.4 million people over 18, according to the National Institute for Mental Health. It says 2.6% of Americans suffer from bipolar disorder, for which the drugs were later also approved.

Marketing atypical antipsychotic drugs for use in treating dementia is banned, since the drugs aren't approved for such use. Still, drug companies have reached out to those who take care of incapacitated patients. For instance, the March 2007 issue of Annals of Long-Term Care, a publication of the American Geriatrics Society that caters to doctors and long-term care specialists, carries a multipage ad for Seroquel. The ad says in large type that the drug has been approved for treatment of bipolar depression.

A spokesman for AstraZeneca Pharmaceuticals, the maker of Seroquel, says "bipolar depression afflicts adults of all ages, including seniors." He noted that the warning of dangers to elderly patients was prominently featured in the ad.

Seroquel had global sales of $3.4 billion last year, making it one of the industry's blockbusters. U.S. sales were $2.5 billion. For the past two years, Seroquel has been the No. 1 drug purchased by Medicaid.

AstraZeneca says it "does not recommend Seroquel for uses other than its approved indications in schizophrenia and bipolar disorder." The company noted the warning on the labels "of all drugs of this class" regarding use in dementia patients. "Decisions about medical treatment are made by physicians," the company says.

Nursing homes often find it difficult to balance the demands of caring for certain patients against the pressure to keep staff costs down. The economics of elderly care can work in favor of drugs, because federal insurance programs reimburse more readily for pills than people.

The use of antipsychotic drugs comes amid a wider debate about how to care for the rising numbers of seniors, many of whom have behavior problems stemming from dementia. They can be difficult to manage, at home or in an institution. They can cry, lash out, wander or even be violent, to themselves or others. There aren't many effective methods to calm them, doctors say.

A big question is whether to use a medical model -- administering antipsychotics as the way to alleviate distressing symptoms of dementia -- or trying to find other ways to help these patients.

The Centers for Medicare & Medicaid -- the federal agency that oversees the two huge tax-funded insurance programs that cover the elderly and the poor -- has "initiated a more rigorous process to oversee appropriate use of medicine," says Chief Medical Officer Barry Straube. He says the number of nursing-home inspections that result in citations for violating drug-misuse rules has jumped by nearly 50% between 2004 and this year. Action is being taken and the increased vigilance is working, CMS says.

Dr. Straube says CMS -- which both funds and oversees nursing homes -- "is very concerned about the quality of care in nursing homes and has taken steps within its authority to discourage inappropriate use of all drugs, including psychotropic medications."

In 2005, the most recent year for which total expenditure figures are available, Medicaid spent $5.4 billion on atypical antipsychotic drugs. It spent less on AIDS drugs ($1.58 billion) and medications to lower cholesterol ($2.1 billion). These figures don't include rebates the government receives.

High use of antipsychotics in a nursing home can be an indicator of inadequate staffing, says Bruce Pollock, president-elect of the American Association of Geriatric Psychiatry. "We know the more staffing there is and the higher quality of care, the less the antipsychotic usage," he says.

Neurological Disease

Psychosis is a severe psychiatric illness which frequently includes delusions or hallucinations. Alzheimer's is a neurological disease that can be accompanied by either psychosis or severe behavioral symptoms, such as aggression or agitation. Dr. Pollock, a professor of neuropsychiatry at the University of Toronto, says one problem is that the psychosis in Alzheimer's disease is not the same as psychosis in younger patients with schizophrenia.

America is facing a public health crisis over the care of those with dementia, Dr. Pollock says. "We are left with the atypicals because we have nothing else," he says. These drugs have a role to play, he says, but "nonpharmacologic treatments" should be tried first.

In New York, the state Health Department is stepping up its focus on antipsychotic use in nursing homes. Two years ago, it issued 16 citations involving medication misuse; this fiscal year, there were 67. Records of a state inspector's visit to the Orchard Manor nursing home earlier this year offer a glimpse of the problem.

The report profiles an 84-year-old woman identified, to protect her privacy, only as "Resident #18." She was confined to a wheelchair with a "lap buddy" -- a restraining device that prevents her from getting up. Her "primary" behavior issues are that she "self propels in wheelchair and enters other rooms," the report said. Resident #18 "is usually understood and usually understands," the report said. She suffers from Alzheimer's disease, but isn't psychotic.

Still, she was placed on the antipsychotic drug Seroquel, along with Haldol, an older, less-expensive antipsychotic.

New York regulators found in that case, Orchard Manor violated the federal requirement to refrain from giving patients "unnecessary drugs." The facility was ordered to submit a new plan for treatment. There was no fine.

Mr. Morien, Orchard Manor's administrator, says the facility submitted a plan within 14 days. He says the small, rural home provides excellent care. The facility may not have adequately explained to state officials its reasons for putting Resident #18 on antipsychotics, he says. He says she is off the drugs now.

It comes down to staffing, he says. Taking care of patients such as Resident # 18 requires many more people able to watch them. Yet under the current reimbursement system, where the government spends billions on these drugs, he says it is hard for a facility such as his to make ends meet.

"We are a nonprofit; we have not made a penny in years," he says. Mr. Morien says there are certain patients with behavioral issues, and "no matter what you do, you can't control them, and physicians will try different medications for them." But he says his facility tries to use drugs only as a "last approach to a behavioral problem."

Most dementia patients who become agitated are trying to communicate a deep-felt need or want, says Jeffrey Nichols, vice president for medical services at New York's Cabrini Eldercare Consortium, a nonprofit group. When they cry out, are they simply being combative or are they delusional and in need of a tranquilizer? Maybe neither, says Dr. Nichols: "They may be in pain."

Dr. Nichols, who oversees a 240-bed nursing home, says that for dementia patients, antipsychotic drugs "don't work very well and they are significantly overused." The use of such drugs to care for agitated dementia patients is "like hitting a TV on the side," he says.

In a statement, the American Health Care Association, which represents for-profit, investor-owned and nonprofit nursing homes, says facilities "work closely with doctors to ensure that medications prescribed are meeting the individual needs of each patient." Nursing homes are "treating an older, more frail population of seniors with increasingly complex care needs," the group says.

The use of atypical antipsychotic drugs in nursing homes continues despite scientific papers that question the benefits of using them on dementia sufferers in light of the risks. Earlier this year, the federal Agency for Health Care Research and Quality reviewed existing research and noted the drugs can trigger strokes, induce body tremors, fuel weight gain and affect an elderly person's gait, increasing their chances of falling.

'Black Box' Warning

The Food and Drug Administration issued a "black box" warning on using the drugs for dementia patients in 2005. But the FDA stopped short of banning such use; officials say they give physicians the leeway to prescribe the drugs if they think it will help this difficult-to-treat population.

Some doctors are now switching back to older, cheaper antipsychotics, such as Haldol, the FDA says. The older drugs had fallen into disuse, but don't have a black-box warning. Now, the FDA says it's weighing putting a black-box warning on those drugs, too.

In Massapequa, N.Y, a nursing home was recently fined by the state for injecting 90 doses of Haldol into a 96-year-old Alzheimer's patient. The woman, identified only as Resident #2, enjoyed listening to music and getting her nails polished, according to a state report. But when agitated, she banged her hand on the table and sometimes yelled.

One aide found it was possible to calm her by offering ice cream and chatting with her, the report said. But other staff gave her the drug Haldol. Between August 2006 to February of this year, she received 90 doses of injectable Haldol, the report said. The facility, Parkview Care and Rehabilitation Center, paid a $2,000 fine for medication misuse.

"It is a unique situation," says Steve Seltzer, Parkview's administrator. "I know that this is not the nature of this facility." He described Resident #2 as an especially difficult case, who reverted to her native European language, making it hard to communicate. As a result of the state's action, "staffing changes were made," he says. The woman was later given a teddy bear as both a way to calm her down and to provide a cushion so she wouldn't hurt herself.

She passed away last Friday.

Fighting Bedsores With a Team Approach - New York Times

2008-03-13T08:18:07-07:00

Link: Fighting Bedsores With a Team Approach - New York Times.

A Typical Monday Afternoon at Sheepshead Nursing Home

2008-02-05T18:07:24-08:00

By Jack Halpern

I recently came to know a nice elderly woman, who we shall call Mrs. Rothman. Her husband, Alan was placed in Sheepshead Nursing Home in Brooklyn after a recent hospitalization. This nursing home, although mediocre at best is near Mrs. Rothman’s home. Sadie is in her eighties and very frail herself. I had the opportunity to place her husband in a better home, but she would not get the opportunity to visit him.

Sadie called me a few days later and could not understand why Alan was soaked in urine whenever she came to visit him. He would sit, strapped in his wheelchair for long periods of time soaked in urine. Sadie felt bad for the staff because her husband had a urinary problem that required that he be changed more often.

Sadie, welcome to the world of substandard nursing home care. Yesterday, I decided that since I was in the area for a meeting, I would visit Alan at Sheepshead NH and apologize on behalf of the human race for the indignities that he must suffer. I dreaded visiting this dump because I was certain that I would find, exactly what I found. Oh, how I hate to be right.

I stroll into the building, dressed in my expensive blue pinstriped suit, my Armani tie, and cashmere coat. I have to say, I looked impressive. Not impressive enough for the yawning “security” guard. He did not so much as lift an eyelid or ask me who I was, or what is my business at the home. I asked him if I should sign in and he said “yeah, sure”. I signed in as George W. Bush visiting Donald Rumsfeld. Warning sign #1.

I went to Alan’s room on the fourth floor. On the way to his room I noticed four staff members hanging around in the hallway, just shooting the breeze (there goes the staff shortage argument). Not one member of the staff was wearing an ID Badge. Warning sign # 2. Why wear an ID when you are neglecting your residents? It’s not a good idea. I pass the nurses station. The nurse does not look at me; her face is buried in her charting. Sitting in the hallway at a little table is a blond Russian woman, who does not look at me, charting.

Why all the craze about charting? You see the New York State Department of Health does not really care if you are giving good care. They only care that you are charting that you are giving good care. Charting the care is a lot easier than actually giving it. When the DOH comes to inspect during it’s annual “unannounced” announced time, they will be looking only at the charts. So charting is important.

Mr. Rothman is not in his room. I go into the “day” room. In the day room I find about twenty five elderly residents assembled at tables, doing absolutely nothing. One orderly is sitting at a table with a couple of patient charts, pretending to chart. He is watching TV. He really does not want to be there. I ask him to point out Alan for me. He throws up his arms, so I find him myself. Residents are asking to go to their rooms, or go to the bathroom. Our man does not even move a muscle. His arm is stretched out under his head. He is resting.

I decide to take Alan to his room. As I approach his room, an aide tells me that he can’t be in his room because he is going to fall. He has to return to the day room with the other corralled residents.

I ask the charting nurse (one of the least friendly people I have met in a long time) if I can speak to Mr. Rothman’s social worker. Apparently she is out to lunch and no one else can help me. I ask for a nursing supervisor. I’m told that I have to go downstairs to the nursing office. The nursing office is closed. I ask the guard to page a nurse for me. Now he wants to know who I am. I tell him that I am Alan’s twin brother from another mother. Goes right over his head but he pages a supervisor for me.

Finally, I am face to face with an authority figure, another blond Russian lady who grimaces at me. She meets my handshake with two limp fingers and asks me what my problem is. She is not wearing an ID Badge either. First I tell her that I find it disturbing that staff members including herself are not identified. I inform her that this is clearly against the law. She is not very affected by my observation. She just wants to get back to whatever it is that she is not doing.

If I sound a little facetious here, it’s because I am being facitious. I’m pretty pissed by now, no pun intended. What the heck, it’s my damn blog.

I try to explain that my friend, Sadie is always finding her husband soaked in urine. Blondie tells me that Alan is very confused. “What does his confusion have to do with not being taken to the bathroom”, I ask. Blondie is confused by my confusion.

I suggest to her that it would a good idea to take residents to the bathroom when they need to go instead of having them all sitting in the day room with one orderly, while the rest of the staff hangs out.

According to the horrible people at the NYS Department of Health, 39% of the residents at this nursing home are High-Risk Long-Stay Residents Who Have Pressure Sores, as compared to the county average of 17%. The state average is 12%.

DUH!! Maybe there is a direct correlation between a higher than normal average of bedsores, and residents who constantly lay in their own waste.

The scary part of this story is that I observed this in the middle of the day. I get depressed just imagining what happens in the evening hours and the weekend. I don’t have to imagine, I know. The owner and administrator of this facility don’t give a damn.

At no time during the forty minutes that I spent at Sheepshead Nursing Home, did I observe any staff member interact with a resident. Warning sign #3.

BE VERY AFRAID!

Sentosa Corporation Persecutes Nurses

2008-01-27T15:38:41-08:00

Sentosa Corporation, purveyors of poor nursing home care throughout it's twenty five nursing homes in the State of New York, is persecuting a group of Philippine Nurses, who walked off the job to protest poor care at the facility they worked at.

Nurses who quit face criminal charges
They are accused of endangering lives of terminally ill kids

(01-27) 04:00 PST Riverhead , N.Y. -- For months, the nurses complained that they were subject to demeaning and unfair working conditions - not what they were promised when they came to America from the Philippines in search of a better life. So they abruptly quit.

But in doing so, they put more than their careers at risk: Prosecutors hit them with criminal charges for allegedly jeopardizing the lives of terminally ill children they were in charge of watching.

The 10 nurses and the attorney who advised them were charged with conspiracy and child endangerment in what defense lawyers say is an unprecedented use of criminal law in a labor dispute. If convicted of the misdemeanor offenses, they face up to a year in jail on each of 13 counts, and could lose their nursing licenses and be deported.

The case has unfolded against the backdrop of a chronic nursing shortage in the United States. All of the defendants were from the Philippines, which exported 120,000 nurses last year.

One defendant was a doctor back home and a top scorer on the country's medical board exams, but decided it was more lucrative to be a nurse in the United States. Others had respectable medical jobs back home and viewed their work in New York as a dream come true.

"Coming to the United States is like the fulfillment of your nursing career," said Maria Theresa Ramos, who arrived on Long Island in 2004.

The nurses are backed by several Filipino organizations in the United States, as well as both the New York and California state nurses associations, which fear prosecuting nurses who quit their jobs could set a bad precedent.

Prosecutors say the nurses' resignations - without notice - on April 7, 2006, jeopardized the lives of children at Avalon Gardens in Smithtown, where some of the patients are on ventilators and required constant monitoring.

None of the patients suffered ill effects, but an indictment alleges the nurses knew their sudden resignations would make it difficult to find replacements. Their trial is scheduled to begin Jan. 28.

The nurses claim that they were sent to work at facilities they never signed up for, and made to perform tasks they deemed demeaning and below their job descriptions. There were also disputes about scheduling and pay. Sixteen other nurses and one physical therapist also walked off the job at other facilities, but they were not charged because they did not care for terminally ill children.

Lawyers for the 10 nurses say one of the nurses remained on duty when resignation letters were submitted. They insist that the nurse - Ramos - stayed four hours past the scheduled end of her shift to ensure that the patients received proper care.

The nurses contend they are facing prosecution because influential Democratic officials - Sen. Chuck Schumer and Suffolk County District Attorney Thomas Spota - took interest in the case at the behest of an attorney for Sentosa Health Care, which operates Avalon Gardens.

The defense has asked Gov. Eliot Spitzer to appoint a special prosecutor, a request being considered in Albany.

"If I could get a special prosecutor, I have no doubt that this case would be dismissed in a heartbeat," said defense attorney James Druker, a former federal prosecutor who represents all 10 nurses. "I just want somebody fair and independent."
Spota opposes a special prosecutor and insists he exerted no special influence on the case.
"Their reason for asking for a special prosecutor is they say I have a close personal, political and financial relationship with the owners of Sentosa," Spota said. "Wrong. I don't have any relationship."
The case also has attracted attention in Manila, where hearings in the Senate and House of Representatives were held last month.
After the nurses complained they were being mistreated, a suspension order was issued against a Sentosa Health Care affiliate in the Philippines. But the suspension was later lifted, and the nurses believe that decision was politically motivated because Schumer got involved.

He sent letters in June 2006 to the Philippines Overseas Employment Administration and the Philippines Labor Secretary, and later to Philippines President Gloria Macapagal Arroyo, asking that they meet with Sentosa representatives and then "take any actions that you consider appropriate."

The POEA head, Rosalinda Baldoz, said the dismissal of the nurses' complaint was not the result of political influence.

Defense attorneys noted that Schumer's Long Island finance chairman, attorney Howard Fensterman, also represents Sentosa. Fensterman's office referred calls to a public relations representative, who derided the allegation.

"This is on its face and in its substance a pathetic smokescreen to divert attention from the fact that 10 nurses got up and left pediatric patients on ventilators in a deliberate act of labor sabotage," said Gary Lewi, speaking on behalf of Fensterman and Sentosa.

Schumer said the letters were the result of his efforts to ease the nationwide shortage of nurses and to seek due process on behalf of a New York company. He said they had "no connection whatsoever" to political donations made by Sentosa executives.

"There are many times that a company will call us up and say a foreign country is treating it unfairly. I regard it as part of my job to help New York companies," he said.

Defense attorneys say they are perplexed why the case is proceeding to trial because two separate state-agency investigations cleared the 10 nurses. Spota said the legal standards for a prosecution differ from those of the state agencies.

He said the nurses and their attorney had the chance to tell their side at a grand jury proceeding - an unusual event in a misdemeanor case - but all declined to testify.

Ramos and the other nurses have since found employment elsewhere. She works at Stony Brook University Hospital, also on Long Island, but still tears up with emotions at the prospect of being criminally prosecuted.
"It's really devastating for us. ... How can it happen in America?" she said.

The State's Deadly Neglect

2007-11-25T12:23:31-08:00

State fines of less than $1,000 for ignoring broken bones, dehydration and the like are unlikely to be taken seriously by nursing homes. But the state has seemed almost afraid until now to punish Haven Healthcare, the owner of 15 nursing homes in Connecticut, for substandard care that has cost lives and caused suffering. SEE

Sentosa Corporation: Politics, Corruption & Death

2007-11-13T16:06:28-08:00

I saw thousands who could have overcome the darkness,
for the love of a lousy buck, I watched them die. Bob Dylan

Sentosa Corporation, operated by two morally corrupt individuals, Ben Landa and Bent Philipson through their political ties to some very powerful politicians, has been allowed to build a network of 25 Nursing Homes in the State of New York. See Newsday Article

Sentosa Corporation operates some of the worst nursing homes in the State of New York. The worst nursing home of the bunch is SPLIT ROCK NURSING HOME in the Bronx (More on Split Rock in a later post). Blog Post On Split Rock (ABC Nursing Home)

The conditions at Split Rock are the same at most of the Sentosa facilities (albeit to a lesser degree in some of their facilities, but not many).

The corrupt, inept, and complicit New York State Department of Health turns a blind eye, because of Sentosa's connections and probably direct payoffs (my opinion, based on the lack of DOH supervision). DOH Complicit in Abuse

CONDITIONS AT SENTOSA CORP. FACILITIES (AND MANY NY STATE FACILITIES) INCLUDE:

1. Bedsores(Decubitus Ulcers)- More residents die in facilities as a result of bedsores, then from any other illness. Bedsores Among the Nursing Home Population. These residents are not turned every 2 hours as required by law. Adding poor nutrition and poor infection control to the mix and you have a recipe for disaster. The only reason that these facilities are not cited for more bed sore cases is because nursing homes are not charting them, the DOH doesn't physically check bed bound residents (they don't even speak to residents during inspections), and hospitals are not reporting cases of NH residents admitted with bedsores.

2. Poor Staffing- The refuge of the substandard nursing home operator for the last 20 years has been crying that there is a "nursing shortage". While there is a nursing shortage in this country, there is a greater shortage of qualified supervisory nursing personnel.

Sentosa hires many of their supervisory nursing employees through their own agency in the Philippines. Sentosa hires these people under false pretenses, often promising them high wages and great living arrangements, free movement, and moving expenses. When these promises are not kept, these good people become very disillusioned. Their complaints are met by Sentosa's high priced attorneys and political connections (Schumer and Pataki.) See Information on Sentosa Nurses

The cultural divide between local nurses aides and foreign supervisors is very wide. This leads to a lack of proper supervision which then leads to neglect and abuse. Rounds in these facilities will often find some nurses aides in residents' rooms watching the soaps or sleeping, especially at night. Foreign nurse supervisors are overwhelmed and afraid of intimidation. Most nurses aides want to do their jobs, but the bad aides, combined with lack of supervision, rule the roost. You can often find caring staff members carrying an uneven share of the burden, handling 12-15 residents while others handling only 6-8. Despite the "nursing shortage", Sentosa Corp., regularly cuts staff on weekends and nights. See Article

3. No Minimum Required Staffing in New York State- New York State unlike most other states, has no minimum on the direct patient care hours that must be spent per patient, per day. While most nursing home watchdog agencies use a minimum of 4.13 hours, NY facilities average about 3.6, and Sentosa averages about 3.2. It is hard to verify these figures as accurate, since the Department of Health does not compare the NH figure's to actual payroll figures. Employees at a number of Sentosa facilities have reported severe shortages on the weekends.

Since a number of Sentosa Corp. facilities also have Adult Day Care Programs, they are probably including these non-direct care employees in their averages. Obviously I can't be certain of this, since I don't have access to their books. The Department of Health has a lax policy as concerns Sentosa facilities.

4. Backround Checks- Most of the Sentosa Nursing Home's have been cited repeatedly by the DOH (Citations by DOH don't have much teeth, therefore are often repeated) for Failure To: 1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.

5. No Real Criteria for Admitting Residents- The only criteria for admission to Sentosa Corp. Nursing Home's is the ability to fill a bed. Any warm body will do. This criteria leads to a volitile mix of residents. Anything goes Included in this mix are:

Bariatric Residents-These residents are obese (400-600 pounds), and are usually in hospitals to lose weight and get counseling in order to go through a surgical procedure to radically reduce their weight. Most nursing homes will not accept these residents because they are below 50 years old and don't have age related diseases. Hospitals have found a haven in Sentosa Corp., who welcomes these residents because they are fairly independent, require little care, provide high reimbursement, and occupy beds for long periods of time.

At Split Rock Nursing Home in the Bronx they accept a steady flow of these people from Jacobi Hospital (a hospital as close to hell as possible on this earth, except for their burn unit which is excellent. I guess they have experience with fire.) Many of these residents are tough street thugs who intimidate the elderly residents, expose themselves, steal their belongings and money, and hang out in the streets at night. At Split Rock, these residents are not even on Diets, nor do they receive proper counseling. Many of them have a history of mental disease. At Split Rock and other Sentosa facilities, these residents are forced to turn over their Social Security checks, although the facility is not entitled to them. I've witnessed this with my own two eyes. The DOH overlooks all this because Medicaid saves a lot of money.

Psychiatric Residents-Sentosa Corp. nursing homes have a greater proportion of these residents than most nursing homes. By now you know the criteria. The problems are the same as above, but add the drain on whatever poor psycho-social services these facilities have.

Alzheimer's Residents- These residents are the most abused residents in sub-standard nursing homes today. Many of them do not have family member. They are not able to speak up for themselves. Putting these residents in with the above is cruel and volitile.

Ventilator Residents- Usually these residents offer no significant problems to other, they themselves are in danger. Since most Sentosa facilities are sub-standard and suffer from poor infection control, this population is in grave danger. In 2005 a ventilator patient died (murdered) at Split Rock Nursing Home, from lack of oxygen. The facility was fined a small amount of money. I don't think that there was a law suit because these facilities go out of their way to find residents without families. It's much easier like that. Most Sentosa facilities don't even have a volunteer program. Who would want to volunteer at these places. Sentosa discourages volunteers unless thay are blind.

6. Many Other Problems-I will talk more about Sentosa in future posts.

Mssrs. Philipson and Landa are extremely generous to any politician that can make things happen for them. They contribute both to Democrats and Republicans (how very bi-partisan). These politicos will do anything necessary for them. They have no regard for the elderly or the nurses that work hard to protect them.

Sentosa contributes and raises big bucks for charities. Reverse Robin Hood. The State of New York pays them $500 Million a year, without much question. Not one of their charity dollars goes towards improving the lives of the elderly.

LETS END ELDER ABUSE NOW, FOR THEM, US, AND OUR CHILDREN.

Senior Moments: Preparing in advance for a hospital stay eases burdens on family

2007-11-06T14:46:52-08:00

There's a good chance your aging parent will require hospitalization at some point, especially if he or she has chronic health conditions. If your parent relies primarily on you for assistance, it's important to do some preparation in advance even if it's only thinking about what will happen. LINK

Nursing Home Abuse Bill Sits in Congress, as Elder Abuse Reaches Epidemic Proportions

2007-11-06T14:07:29-08:00

A nursing home abuse bill, the Elder Justice Act, has been under consideration in Congress for the past five years but has received scant attention and has yet to be passed. Although nursing home and elder abuse are serious and growing problems in this country, the nursing home abuse bill has never even been voted on. While no one in Congress opposes the nursing home abuse legislation, few are trying to push it through the legislative process.

Congressional critics say that the Elder Justice Act has not been passed for a number of reasons that have little to nothing to do with the bill itself. For one thing, Congress has been distracted by the war in Iraq and partisan bickering. But for the most part, they say the Elder Justice Act has been allowed to collect dust because the issue of nursing home abuse has not garnered the kind of media attention it deserves. This past summer, while much of the media was focused on the problems of Paris Hilton and Brittany Spears, Congress held hearings on nursing home abuse. Those hearings were not covered by one major TV news network.

But the issue of nursing home abuse should be getting more attention, just based on the shear numbers of elderly affected by this crime. Though it concedes that the true number is probably much higher, The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse. According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to having witnessed, and even participating in, acts of abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse. There are nearly 1.4 million Americans living in nursing homes right now, and that number is expected to more than double in the next decade. As it does, advocates for the elderly and disabled fear that incidences of abuse will continue to climb as well.

The Elder Justice Act, while not a cure for nursing home abuse, would bolster efforts to combat this crime. The Elder Justice Act would set up separate elderly justice offices in the U.S. Departments of Justice and Health and Human Services, provide $400 million for state adult protective services over four years and create a federal coordinating committee among agencies to monitor and direct the government’s efforts. The bill would also establish forensic centers around the country to probe elderly abuse cases and give local prosecutors more support in bringing cases. And it would penalize nursing homes if they did not report crimes swiftly.

Last year, the Elder Justice Act was finally passed by the Senate Finance Committee, but it was never voted on by the full Senate. Now byzantine Senate rules mean that the nursing home abuse bill will have to go through several more committees before it is up for a vote. And some Senate watchers fear that, with a public more focused on the escapades of Brittany than the problems of the elderly, the Elder Justice Act will never be voted on.

Nursing homes owned by private equity face U.S. inquiries

2007-10-28T16:48:16-07:00

Hearld Tribune

Two U.S. congressional committees have announced that they will investigate business practices at nursing homes owned by private investment groups.

My Elder Advocate Launches Long Term Care Insurance Website

2007-10-17T14:59:59-07:00

My Elder Advocate help's people obtain quality long term care insurance. We are licensed in New York and New Jersey to sell insurance products. As with elder care services we deal only with reputable companies that have a proven track record of being there when you need them. We are specialists.

Check Out MyElderAdvocateLTCI.com

Long-term care insurance, an insurance product sold in the United States, helps provide for the cost of long-term care beyond a predetermined period. Long-term care insurance covers care generally not covered by health insurance, Medicare, or Medicaid.

Individuals who require long-term care are generally not sick in the traditional sense, but instead, are unable to perform the basic activities of daily living such as dressing, bathing, eating, toileting, getting in and out of a bed or chair, and walking.

Long-term care isn't necessarily long term. A person may need care for only a few months to recover from surgery or illness.

As an individual ages, there is an increased risk of needing long-term care. In the United States, Medicare will not cover the expenses of long-term care, but Medicaid will for those who can not afford to pay.

Age is not a determining factor in needing long-term care. About 40% of those receiving long-term care are between 18 and 64. The late actor Christopher Reeve who in 1995 at age 42 became paralyzed following an equestrian accident and required 9 years of long-term care. Once a health condition occurs long-term care insurance may not be available. Early onset (before age 65) Alzheimer's and Parkinson's disease are rare but do occur. Michael J. Fox was 30 when diagnosed with Parkinson's.

Please Help Me Fight Alzheimer's Disease

2007-09-30T08:47:27-07:00

There are five million people with Alzheimer’s disease. This disease is a scourge on our elderly. In nursing homes across the country, residents with this disease are among the most abused and neglected.

Please help eradicate this disease. Please open your hearts and your wallets.

PLEASE DONATE

Corporate Greed Plus Government Apathy Equals Nursing Home Death and Destruction

2007-09-23T13:46:25-07:00

According to the New York Times, thousands of nursing homes across the nation have been bought by large Wall Street investment companies. As such investors have acquired nursing homes, they have often reduced costs, increased profits and quickly resold facilities for significant gains.

But by many regulatory benchmarks, residents at those nursing homes are worse off, on average, than they were under previous owners, according to an analysis by The New York Times of data collected by government agencies from 2000 to 2006.

NY TIMES ARTICLE CONTINUES

Staten Island Hospital Neglects an Elderly Patient and Then Files a False Government Form to Cover it Up.

2007-08-31T07:34:37-07:00

By Jack Halpern

Richmond University Medical Center neglected an elderly patient so badly, that he developed a Stage Four Decubitus Ulcer (most severe), in a matter of weeks. The hospital then falsified an official New York State Department of Health document to cover it up

Mr. Jimmy Chow (not his real name) was admitted to Richmond University Medical Center after having a stroke. Before his stroke he led a very active life. People who are active do not develop Decubitus Ulcers. Bed bound patients in hospitals and nursing homes do. After being bed bound for just a few weeks at Richmond, Jimmy went from no ulcers to Stage IV ulcers (most severe).

A Decubitus ulcer is a pressure sore or what is commonly called a "bed sore". It can range from a very mild pink coloration of the skin, which disappears in a few hours after pressure is relieved on the area, to a very deep wound extending to and sometimes through a bone into internal organs. These ulcers, as well as other wound types, are classified in stages according to the severity of the wound.

The usual mechanism of forming a Decubitus ulcer is from pressure. However it can also occur from friction by rubbing against something such as a bed sheet, cast, brace, etc., or from prolonged exposure to cold. Any area of tissue that lies just over a bone is much more likely to develop a Decubitus ulcer. These areas include the spine, coccyx or tailbone, hips, heels, and elbows, to name a few. The weight of the person's body presses on the bone, the bone presses on the tissue and skin that cover it, and the tissue is trapped between the bone structure and bed or wheelchair surface. The tissue begins to decay from lack of blood circulation. This is the basic formation of Decubitus ulcer development.

The common areas of Decubitus ulcer formation and prevention is a basic nursing principle covered in nursing school curriculum (LVN/LPN or RN) and most nursing assistant programs as well.

The basic treatment of Decubitus ulcers is prevention. Prevention cannot be stressed too strongly. To this end, there are a number of devices designed to protect and prevent the formation of Decubitus ulcers. The decision of which device to use is based on the location and severity of the wound.

These devices may be a Medicare/Medicaid/Insurance-covered item when medically necessary. Most insurance's will cover any needed device, material, or equipment necessary to prevent and treat Decubitus ulcers. Prevention is the most humane and cost effective approach to care.

Prevention consists of changing position every 2 hours or more frequently if needed. This 2-hour time frame is a generally accepted maximum interval that the tissue can tolerate pressure without damage. Prevention also consists of protection and padding to prevent tissue abrasion, and maintaining hydration, nutrition and hygiene.

Jimmy’s family was never informed about these ulcers. They were requested to choose from a list of area nursing homes for Jimmy. Despite the severity of these ulcers, and knowing full well that most nursing homes are not equipped to handle stage IV ulcers, the hospital wanted to discharge Jimmy to a nursing home ASAP.

The hospital sent the nursing home a PRI (Patient Review Instrument). The PRI is a New York State Department of Health mandated patient assessment form that is supposed to accurately reflect the physical and mental condition of the patient. A nursing home may not accept a resident without this form. Filing a false PRI is a crime.

Jimmy’s PRI stated that he had a stage I Decubitus ulcer (least severe and easily treatable), which was not of much concern to the nursing home. When Jimmy was admitted to the nursing home the stage IV ulcer was discovered and clearly documented. Photographs were taken.

This case is not unique. Most hospitals file PRI’s that only reflect what the hospital wants the Home to know. The prime concern of the hospital is to empty the bed. In this particular case the receiving nursing home is an excellent one. Jimmy will get the best care. If however, Jimmy would have wound up in a sub-standard home, his death might be imminent.

Please God, use your power to end this wasteful destruction of our vulnerable elderly.

Let’s end ELDER ABUSE. If we don’t what can we expect for ourselves.