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Nursing Home Neglect/Elder Abuse

A recent federal lawsuit against two Watsonville, Calif., nursing homes may offer a new approach to dealing with the persistent problem of such facilities overmedicating their residents. The lawsuit details multiple cases when the government says these drugs were inappropriately administered to patients. An 86-year-old man identified in the lawsuit as Patient 1 was admitted to Country Villa Watsonville West, he could speak clearly and walked in under his own power.

Within days the facility began giving him Haldol and Risperdal, drugs used to treat schizophrenia and bipolar disorder, and he became bedridden, stopped eating and developed bedsores and infections. Within days he declined precipitously, to the point where he was read his last rites in the hospital, according to Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform who represented the man and his family in a private suit that was settled out of court. The medications were given without his family's knowledge, without his informed consent, without good clinical indications for the use of the drugs.

Antipsychotics like Risperdal and Haldol come with black box warnings that say they could hasten death in elderly patients or people with dementia. Nevertheless, about a fifth of nursing home patients nationwide are prescribed antipsychotic drugs. The U.S. attorney for Northern California declined to comment on the lawsuit, but it claims that the two nursing homes provided "grossly inadequate, materially substandard and/or worthless services." Meanwhile, they received about $20 million from Medicare and Medicaid for those services.

A Ventura nursing home will pay more than a half million dollars in a settlement over antipsychotics. Ventura Convalescent Hospital's deal ends litigation filed in 2011 by over 300 patients, where families of residents said medication was being given without informed consent under the care of a skilled nursing facility physician. An outside monitor will also monitor the facility. The agreement will impose measures to ensure patients and family members understand the impact of powerful medications, including antipsychotic drugs that advocates for seniors say can be used to restrain patients with dementia.

California law requires that, for each new resident, a facility must “verify informed consent prior to the administration of psychotherapeutic drugs or use of physical restraints. As antipsychotics are being widely prescribed to patients with dementia who are in assisted living settings and nursing home, there's the potential for more cases like this one across the country.

Approximately 1.5 million elderly and disabled Americans live in nearly 17,000 nursing homes nationwide. As many of these nursing homes are under funded and understaffed, a disturbing incidence of neglect and abuse has been reported. Although estimates vary widely, the American Medical Association recently reported about one out of four older Americans experiences some type of abuse. Other estimates range between 500,000 and 200,000 victims per year.

Elderly residents of nursing are most at risk. The House Committee on Government Reform recently found nearly 9,000 instances of nursing home resident abuse over a two-year period. A recent investigation by the St. Louis Post-Dispatch found that thousands of our nation's parents and grandparents are being killed by neglect every year because nursing homes fail to provide them with basic care. The National investigation found thousands of aged residents of poorly supervised nursing homes lying virtually unattended in their own filth, suffering from bedsores, gradually dying from dehydration and inadequate nourishment.

In California more than three-fourths of nursing homes failed to meet federal standards, and more than four in ten violated state law mandating minimum nurse-staffing levels, according to a recent study by the California Health Care Foundation. This study also found significant instability in the nursing home workforce, with eight out of ten nursing employees leaving their jobs within a twelve month period.

Nursing homes with repeated safety compliance problems usually face only minimal penalties from the federal government, according to a Government Accountability Office report. Congress established "stringent" standards for nursing homes in 1987, but a recent GAO report found that nursing homes that repeatedly harmed residents were insufficiently penalized.

The report found that the Government rarely denies federal payments to nursing homes with compliance problems and usually imposes fines that are much smaller than the maximum of $10,000 per day. Federal officials generally impose fines no greater than $200 per day in part because of concern that larger penalties "could bankrupt some homes," according to the report. Nursing homes facing exclusion from Medicare and Medicaid often avoid penalties by temporarily improving care quality and then resume noncompliant practices, the report found. Senate Finance Committee ranking member Chuck Grassley (R-Iowa), who requested the study, said that the findings are "very discouraging."

Injuries sustained by residents due to neglect and abuse often involve the inappropriate use of physical restraints; joint contractors, overuse of sedatives, unnecessary use of urinary catheters, and victims suffer from a loss of mobility, pressure sores, and lack of nutrition with weight loss. We are available to evaluate injury claims resulting from nursing home abuse and neglect.

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