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Articles Posted in Inadequate Staffing

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For many elderly and disabled residents of Tennessee, help completing day to day tasks can make a huge difference in their quality of life and happiness. Thankfully, Tennessee’s Choices in Long-Term Services and Supports (or Choices for short) program offers a crucial service to help care for adults (age 21 and older) with a physical disability and seniors (age 65 and older). The program provides services to assist eligible residents with daily living activities in their homes, on the job, or in their communities. These daily activities can include home-delivered meals, pest control, household chores, but also services like a personal emergency response system call button that can be used to get help in an emergency. The program allows the disabled and elderly to lead productive lives and stay involved in their local communities, but also provides these services in nursing homes if needed.

While the Choices program provides important benefits to many residents of Tennessee, there is currently a severe shortage of caregivers that is affecting thousands of people in need. Caregivers in the Choices program are required to be hired by managed care organizations, or MCOs, but as of late caregivers have missed appointments with citizens needing their services. Many times, a local senior center has accepted a contract from the government to provide citizens these crucial services. However, the Tennessee Justice Center in Nashville, which fights for those without a voice, recently sent a letter to the state requesting an investigation of just how many MCOs fail to provide regular and timely home based services. It is crucial that MCOs take responsibility for hiring the necessary number of caregivers to provide services to citizens in need, but they must also ensure that caregivers are properly trained and certified.

In a particularly striking example, Knoxville citizen, Army veteran, and cancer patient Joseph Davis’ caregiver missed multiple consecutive appointments at his home in the month before his passing. Joseph Davis’s wife June was unable to assist her husband, and relied on the assigned caregiver to help provide crucial services for Joseph. Their son Matt was forced to miss work frequently without notice to help care for his father when his assigned caregiver missed appointments. The lack of certified caregivers available to assist Joseph Davis receive the care he needed placed a huge burden on him and his family.

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Staffers from the Special Investigations Division of the House Government Reform Committee recently reported that between 1999-2001, 30% of nursing homes across the United States were cited for some form of abuse. In total, 5,283 nursing homes and similar facilities were cited for more than 9,000 instances of abuse. While these are staggering figures, they do not take into account the numerous other violations that were not caught.

The abuse reported came in many forms. Examples include bedsores, providing insufficient medical care, malnutrition, dehydration, accidents, poor sanitation, and improper hygiene. Of the 9,000+ instances of abuse, more than 1,600 were bad enough to cause “actual harm to residents or to place the residents in immediate jeopardy of death or serious injury,” according to the report. Some incidents were more serious than others. Some of the most serious involved sexual and physical abuse. Review of the violations revealed residents were hit, slapped, punched, choked, and kicked. Others suffered verbal abuse coming from nurses and other staff members.

Why does abuse like this continue to occur? Safety organizations have been asking this question for decades. Many nursing homes are understaffed, which means nurses and employees are forced to work long shifts. This can lead to mental errors, such as giving a patient the wrong medication. If a nurse must cover someone else’s post, he or she may forget to check on a patient at necessary intervals. Further, overworked employees can become frustrated easily, and physical abuse can manifest itself if an employee takes that frustration out on residents. Inadequate staffing can occur for a multitude of reasons. One is a limited supply of qualified nurses. Another is if a nursing home deliberately places its profits over the well-being of residents and chooses to save money by hiring less staff.

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A Missouri man has filed suit against St. Sophia Health & Rehabilitation Center, a facility located in Florissant, MO, claiming the nursing home allowed his mother to die after leaving her in a hot tub for eight hours. Geriatric Management runs this nursing home, and they own 22 nursing homes across four states. The victim, 88, suffered from Ahlzheimer’s, dementia, depression, heart disease, hypertension, and muscle weakness, among other medical conditions. The lawsuit accuses St. Sophia of understaffing, claiming the facility did not provide sufficient support for all patients in the home, which allowed his mother to remain in the hot tub unattended. After her death, government officials investigated and inspected St. Sophia, finding that many residents were in “immediate jeopardy.”

Understaffing is a major issue at nursing homes across the country. While nursing homes are required to provide sufficient resources to properly care for their patients, this does not always happen. Instead, some facilities deliberately choose to place profits over people, knowing they can save money by hiring less staff members. Other times, nursing homes simply cannot find enough qualified workers who have the necessary skills and training, such as a certified nursing assistant (CNA).

An understaffed nursing home can create a chaotic environment. Without enough staff members, those who are employed may feel overwhelmed and exhausted. This can lead to mistakes like failing to check on patients when required, medication errors, and leaving patients unattended for long periods of time, similar to the 88-year-old Missouri woman with difficulty moving/walking being allowed to remain in a hot tub for eight hours without anybody coming to check on her. It can also lead to frustration among staff members that be taken out on the patients. Nursing homes should provide compassionate care, but overworked, tired, and stressed employees are more likely to abuse patients or use chemical restraints to deal with patients whom they feel are unruly.

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A recent study shows that delirium can be linked to mortality rates in nursing homes. The report, authored by Dr. Martin M. Forsberg of the Rowan University School of Osteopathic Medicine, found that roughly 18% of the nursing home population suffers from delirium. Delirium is a serious disturbance in mental abilities that results in confusion, abnormal thinking or behavior, and affects perception, attention, and mood. Another characteristic of delirium is restlessness.

At first glance, the signs of delirium may look a lot like dementia, which is a byproduct of Alzheimer’s disease, but the two are different conditions. Dementia as a result of Alzheimer’s primarily affects an individual’s memory and intellectual abilities, while delirium is displayed more in abrupt spurts of confusion. One key difference is inattention, as individuals suffering from delirium have trouble focusing on one idea or task. On their face, the two conditions may appear almost indistinguishable, which is why many nursing home patients who suffer from delirium are misdiagnosed as having Alzheimer’s, which means they do not receive the proper medical care.

The two also differ by how they are brought on. Dementia as a result of Alzheimer’s is not always a normal part of aging. Currently, there is no cure for Alzheimer’s. Delirium, on the other hand, is normally caused by a combination of factors that make the brain vulnerable and trigger a malfunction in neuropathic activity. There may be a single contributing factor or a combination of factors including malnutrition, dehydration, sleep deprivation, emotional distress, chronic illness, and surgery or other medical procedures that involved anesthesia. For instance, a patient may suffer from a serious illness while simultaneously facing neglect from caregivers. Certain environmental factors may play a role in delirium. For example, the absence of a clock, television, or phone in a nursing patient’s room has been found to worsen the symptoms of delirium.

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There are over 15,500 nursing homes in the United States, housing roughly 1.4 million elderly and disabled adults. Many of our loved ones, including our parents and grandparents, require full time care in these facilities. When we cannot provide the necessary care for these individuals ourselves, we entrust nurses, doctors, and administrators to treat our family with the same care and attention that we would provide.

Many, if not most, nursing homes receive funds from Medicare and Medicaid and must be adequately staffed with a sufficient amount of properly trained employees, or risk the loss of funding in the future. While lawmakers have taken strides to ensure our loved ones are adequately protected, elder abuse and neglect affect the lives of thousands of American families each year.

It is absolutely vital for families considering moving a loved one into an assisted living facility to conduct thorough research into the quality of potential homes. A well-organized nursing home should be adequately staffed with administrators, dieticians, nurses, and nursing assistants, among other professionals. Proper staffing ensures that residents receive adequate care in all aspects of living and do not fall victim to neglect. Unfortunately, many nursing homes are understaffed, or the employees are under-trained.

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As in any business, there is usually a link between operational costs to run the business and the available profits for the owners.  This is a problem when the health and well being of the disabled or elderly residents are being disregarded. A Tennessee-based nursing home recently came under fire for failing to pay its utility bills and neglecting patients. Due to neglect, several patients developed pressure ulcers and genital wounds. Failing to timely indentify and treat the beginning stages of a pressure ulcer could be the difference between a full recovery rather than amputation, infection or even death. While the patients were receiving inadequate care, the co-founders of the nursing home were paying themselves annual salaries of $432,000 and $288,000 respectively. They also each drove a Porsche that was financed by the nursing home.

The stress of helping with aging family members is never easy, even in the best of circumstances.  Family members must cope with their own personal feelings of mortality, as well as the additional stress of providing both physical and emotional support to loved ones in this difficult time.  The attempt to absorb these additional responsibilities can be overwhelming.  Often, these hard working people are forced to reach out for help to assist with the care of their elderly or disabled relatives.  They may turn to places like a nursing facility, where they are told trained and skilled professionals are available around the clock, seven days per week, to monitor and care for their family members.

Unfortunately, the truth may be the facility is inadequately staffed, exposing the residents to dangerous conditions and failing to correct deficiencies from past inspections. Even if the facility is properly staffed, at least according to state minimum standards, that does not necessarily mean the residents are in good hands.  Some facilities fail to properly conduct background checks of the staff or volunteers, which could place residents at risk of assault or sexual abuse.  Moreover, the staff may not have the necessary training and/or education to properly care for and monitor the residents.

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The Tennessee legislature enacted a statute that transforms a lawsuit alleging that a “health care provider or providers have caused an injury related to the provision of, or failure to provide, health care services to a person, regardless of the theory of liability on which the action is based” is to be considered a healthcare liability action only.  No longer can these cases be referred to as medical malpractice cases under Tennessee law. The statute directs us to call these a “healthcare liability action,” no matter what is the actual theory of the case.

Forcing all causes of action that occur in a healthcare setting into “healthcare liability actions” matters quite a bit because it can transform the conduct of businessmen into “healthcare professionals.”   Thus, the standard of proof for a Plaintiff to prove that a “healthcare professional” acted with neglect requires expert proof.  Thus, a businessman making a decision to maximize profits by understaffing a nursing home must be called a “healthcare professional” because of this Tennessee law.

An example of how Tennessee law would work can be found in a New Mexico lawsuit where allegations of systemic understaffing in nursing homes by Preferred Care Partners Management Group have been alleged.  Understaffing is a serious problem in nursing home and long term care settings because any individual caregiver can only care for a certain amount of people before their work product declines and starts to suffer.  Thus, it is extremely important that nursing homes employ an adequate number of caregivers so a certain minimum amount of care is received by each patient.

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A Festus, Missouri nursing home was recently closed by state health officials due to what was apparently the most egregious neglect seen by that agency: neglect of the entire nursing home and its patients and staff by its parent company.

According to the St. Louis Post-Dispatch, the Benchmark Healthcare nursing home, owned by Chesterfield, Missouri based Legacy Health Systems, LLC, stopped receiving deliveries of food, medication, and supplies. The nursing homes telephones were shut off because the bills went unpaid. Trash began to pile up for lack of collection. Some nursing home employees reportedly used their own funds and even food stamps to buy groceries to feed the residents. However, residents with diabetes and other nutritional requirements were not getting their special diets. Then, the staff members’ paychecks began to bounce.

After receiving complaints from residents about their hunger, and discovering that some residents were not getting necessary medications for congestive heart failure, epilepsy and schizophrenia because pharmacy bills were not being paid, Missouri Department of Health and Senior Services officials closed the nursing home, after relocating approximately 60 residents to other facilities around Jefferson County. Most of the residents were individuals with mental health disorders, and were younger than 50 years old. A representative for the Missouri Coalition for Quality Care, a nursing home resident advocate group, called the situation “a disaster.”

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