Staffing is Important

Many of the incidents of neglect and abuse which occur in a nursing home or elder care environment is due to a lack of adequately trained professional nursing, and other staff members.

What Does the Law Require?

Minn. Stat. Sec. 144A04, Subd. 7 (2009).
My understanding is that since the RUG-III classification began, we’re back to the 2.0 hours as the minimum. (Rules section 4655.5600 refers to boarding care homes.)

Subd. 7.Minimum nursing staff requirement.
Notwithstanding the provisions of Minnesota Rules, part 4655.5600, the minimum staffing standard for nursing personnel in certified nursing homes is as follows:
(a) The minimum number of hours of nursing personnel to be provided in a nursing home is the greater of two hours per resident per 24 hours or 0.95 hours per standardized resident day. Upon transition to the 34 group, RUG-III resident classification system, the 0.95 hours per standardized resident day shall no longer apply.
(b) For purposes of this subdivision, “hours of nursing personnel” means the paid, on-duty, productive nursing hours of all nurses and nursing assistants, calculated on the basis of any given 24-hour period. “Productive nursing hours” means all on-duty hours during which nurses and nursing assistants are engaged in nursing duties. Examples of nursing duties may be found in Minnesota Rules, parts 4655.5900, 4655.6100, and 4655.6400. Not included are vacations, holidays, sick leave, in-service classroom training, or lunches. Also not included are the nonproductive nursing hours of the in-service training director. In homes with more than 60 licensed beds, the hours of the director of nursing are excluded. “Standardized resident day” means the sum of the number of residents in each case mix class multiplied by the case mix weight for that resident class, as found in Minnesota Rules, part 9549.0059, subpart 2, calculated on the basis of a facility’s census for any given day. For the purpose of determining a facility’s census, the commissioner of health shall exclude the resident days claimed by the facility for resident therapeutic leave or bed hold days.
(c) Calculation of nursing hours per standardized resident day is performed by dividing total hours of nursing personnel for a given period by the total of standardized resident days for that same period.
(d) A nursing home that is issued a notice of noncompliance under section 144A.10, subdivision 5, for a violation of this subdivision, shall be assessed a civil fine of $300 for each day of noncompliance, subject to section 144A.10, subdivisions 7 and 8.

This website is not intended to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation.

If you or a loved one has suffered an injury from neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to klabore@mnnursinghomeneglect.com, or call Ken at 612-743-9048.

If you have a family member in a nursing home and assuming you have permission it makes sense to know the medications being given by the nursing home to the resident. There are many reasons to track the medications a resident in a nursing home is taking including the ability to monitor for adverse reactions or changes in condition that may be related to the medication or a combination of medication. Family members should also know what medication a resident is being given in the nursing home to ensure that there is not over medication - or medication mismanagement (such as providing a pain medication which is prn (as needed), even when a resident is not experiencing symptoms of pain). The result could mask symptoms related to other conditions and most often can create other serious risks such as a risk of falling, choking, etc. Many times the medication is considered psychotropic and if over prescribed has a functional result of putting residents in an altered state of mind, usually making them less active, creating additional risks including pressure sores.

There are other reasons to know the medications being prescribed such as how they effect a resident’s appetite and thirst level (the staff may need to ensure adequate nourishment and hydration). A resident and their family should also be familiar with the medication itself, how it looks, the amount prescribed, the times taken, etc.., this helps reduce the chance of being given the wrong medication - and reducing the possibility that narcotic medications which are have been know to be taken by nursing home staff, see recent news-story about medication theft.

Make sure you are aware of what antipsychotic medications your loved you is taking.

According to an article from May 26, 2008, published in the New York Times: Elderly people with dementia who are given antipsychotics, even for a very short period of time, are more likely to end up in the hospital or even die, new research shows.

Many experts feel behavioral interventions should be tried first and antipsychotics used as a last resort, “when the behavior or the psychiatric symptoms are really out of control and causing complete distress not only for the person suffering from Alzheimer’s, but for caregivers all around them,” said Maria Carrillo, director of medical and scientific affairs at the Alzheimer’s Association in Chicago. “It’s important to work these things out with the physician and, of course, do follow-up very closely together, so you can make sure these antipsychotics are having the effect you want and, if not, discontinue them immediately.”
The findings were published in the May 26 issue of theArchives of Internal Medicine.

Antipsychotic drugs are commonly used to treat some of the behavioral complications of dementia, including delirium. Newer antipsychotic medications such as Zyprexa (olanzapine) and Risperdal (risperidone) have been available for about a decade and have largely replaced their older counterparts.

Researchers from the Institute for Clinical Evaluative Sciences in Ontario, Canada, compared 20,682 older adults with dementia living in the community with 20,559 older adults with dementia living in a nursing home between April 1, 1997, and March 31, 2004.

Each group was divided into three subgroups: those not receiving any antipsychotics, those taking newer antipsychotics, and those taking older antipsychotics such as Haldol (haloperidol). According to information gleaned from medical records, community-dwelling adults who had recently received a prescription for a newer antipsychotic medication were 3.2 times more likely than individuals who had received no antipsychotic therapy to be hospitalized or to die during 30 days of follow-up.

Those who received older antipsychotic therapy were 3.8 times more likely to have such an event, relative to their peers who had received no antipsychotic therapy.

A similar pattern, albeit less dramatic, emerged in the nursing home group. Individuals taking older antipsychotics were 2.4 times more likely to be hospitalized or die, while those taking newer drugs were 1.9 times more likely to die or be hospitalized during the 30 days of follow-up.

The study does, however, have its limitations. “It’s a carefully done study,” Kennedy said. “One flaw is that the [participants] weren’t randomly administered antipsychotics. There was some reason they were given an antipsychotic, such as aggression or agitation. It may have been done if they were recently admitted to the nursing home as part of the adjustment process.

Indeed, the authors acknowledged that about 17 percent of patients entering nursing homes start taking an antipsychotic within 100 days.
“For any of us, moving is like being sick. It takes a while to recover,” Kennedy said. “We need other sets of interventions besides medications. What that implies is more staffing and better training for staff, and that may not be a whole lot more expensive than medicines.”
More information

The Alzheimer’s Association has a statement on treating behavioral and psychiatric symptoms in Alzheimer’s patients.
SOURCES: New York Times article May 26, 2008. Gary J. Kennedy, M.D., director, geriatric psychiatry, Montefiore Medical Center, New York City; Maria Carrillo, Ph.D., director, medical and scientific relations, Alzheimer’s Association, Chicago; May 26, 2008, Archives of Internal Medicine
This website is not intended to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation.

If you or a loved one has suffered an injury from neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to klabore@mnnursinghomeneglect.com, or call Ken at 612-743-9048.

I see another story about falls in a nursing home and the “Fight Against Falls” as outlined in the Duluth News Tribune

Reasons for Falls (MOST ARE PREVENTABLE)

Improper Assist

-Attempting to get up on own when unable

Cognitive Changes can effect balance and ability to walk leading to falls

-Medication Error?
-Reaction to medication?
-Blood Sugars out of range?
-Illness/fever/flu?
-Septis?
-Dehydration?
-Stroke?

Would you agree that many falls that occur to the elderly are AVOIDABLE if:
-proper assist when needed?
-given adequate supervision when needed?
-no medication problems?
-redirected when necessary for resident safety?

Why is it important to avoid FALLS and fractures?
-Already frail
-Osteoporosis
-Fractures lead to pneumonia and death

Bedrest causes:
-Weak or ineffective cough
-Lungs Compress and fail to expand fully “atelectasis”, making infection more likely
-Aspiration of Food or Upper Airway Secreations
-Delirium related to post-anesthesia complications, pain , or the side effects of pain medications
-Poor Nutrition causing muscle weakness, which affects ability to cough, take breaths and coordinate swallowing muscles

Deaths related to falls can occur immediately, (subdural hematomas) But, often can take 6-12 months or more to occur due to cause death?

Additional Risks from Falls:

-UTI from indwelling bladder catheters and because of urinary incontinence related to fracture

-Surgical Wound Infections
-Blood Clots, Malnutrition, Pressure Ulcers, and Additional Fall Related to Fractures
-Further Additional Falls

Falls – A Minnesota and National Public Health Concern

• Falls are the number one cause of trauma deaths, non-fatal major
trauma and other trauma care in Minnesota. The vast majority of these
cases are among older Minnesotans.
• Minnesota’s fall death rate is almost twice the national average and it is
increasing. Every hour an older adult dies as the result of a fall.
• The total costs for non-fatal falls among Minnesotans 65 years of age
and older were $162 million for hospital charges and $20.4 million for
emergency department charges in 2005.
• Hip fractures are among the most serious fall-related injuries. Twenty
percent die within the first year post-fracture, half
never regain their previous level of functioning, and many are unable to
live independently after their injury.
• Falls among the elderly are driving health care costs and significantly
impacting quality of life for our older adults.

What you can do –

⇒ Sign-up for the statewide falls prevention listserv. The listserv
is a vehicle to share information related to the falls prevention
initiative. To subscribe to the listserv, please visit:
http://mailman.stpaul.visi.com/mailman/listinfo/fallsprevention
⇒ Visit the Minnesota Falls Prevention Initiative website at
www.mnfallsprevention.org. The website contains more detailed
information related to conducting fall risk screenings and
assessments, implementing falls prevention interventions in your
community, linking community.
This website is not to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation. In addition to providing related information this blog may also be considered an advertisement for legal services.
If you or a loved one has suffered an injury or abuse in a nursing home or other care facility that serves the elderly in Minnesota, please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact attorney Kenneth LaBore, directly please send an email to klabore@MNnursinghomeneglect.com, or call Ken at 612-743-9048.

There is a whistleblower case in the news this week:
See star and Tribune Article: “Whistleblower gets green light to build false-claims case”

According to the news story a federal judge gave a green light to allow the plaintiff to being gathering information in support of allegations that the nursing home operator had submitted false Medicare and Medicaid claims.

False Claim Actions are also historically called “Qui Tam” claims permit private citizens the right to bring a private action in the place of government enforcement. These private citizens are called “qui tam relators”

There are many forms of Qui Tam or False Claim Action including:

• preparing a false record or statement or bill in order to get a false or fraudulent claim
paid by the government.
• conspiring with anyone else to have a false or fraudulent claim paid by the government.
• holding property of the government intending to defraud the government or intending
to conceal it from the government.
• creating or delivering a false or fraudulent receipt to the government for its property.
• fraudulently buying property of the government from someone who is not authorized to
sell that property for the government.
• making a false statement to fraudulently avoid paying a debt to the government or to
avoid delivering property to the government.
• causing someone else to submit a false or fraudulent claim.

Relators’ claims stem from the principal allegation that Defendants unlawfully billed Medicare and Medicaid for occupational and physical therapy services for the time Johnson and others watched Medicare and Medicaid recipients exercise, unsupervised, in the Wellness Center. Relators claim that these practices violated Minn. Stat. §§ 148.706 and 148.6432, and 42 U.S.C. § 1395i-3(d)(4). Defendants seek dismissal of Relators’ complaint on two grounds: (1) that Relators are prohibited from asserting their claims on CASE 0:08-cv-01194-DWF-JJK Document 54 Filed 02/13/12 Page 5 of 10 the basis of the public disclosure bar; and (2) that Relators have failed to allege fraud with sufficient particularity.

The court allowed the action to continue with the discovery phase of the lawsuit.
This website is not to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation. In addition to providing related information this blog may also be considered an advertisement for legal services.

If you or a loved one has suffered an injury or abuse in a nursing home or other care facility that serves the elderly in Minnesota, please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact attorney Kenneth LaBore, directly please send an email to klabore@MNnursinghomeneglect.com, or call Ken at 612-743-9048.

The Sun Newspapers had an article which reported that the Golden Living Center Nursing Home in Hopkins was alleged to be negligent by the Minnesota Department of Health concerning a resident who experienced significant weight loss over the period of a month and it was not reported to his primary physician or nurse practitioner.

As an attorney who handles nursing home abuse and neglect cases, I frequently see situations where residents do not receive the necessary nourishment and hydration required for sustaining health. Both state and federal regulations require that a nursing home provide adequate food and water pursuant to the following statutes:
Nutrition The nursing home must maintain acceptable parameters of nutritional status. (42 CFR § 483.25 (i))
Based on a resident’s comprehensive assessment, the facility must ensure that a resident:
(1) Maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident’s clinical condition demonstrates that this is not possible; and
(2) Receives a therapeutic diet when there is a nutritional problem. (42 CFR § 483.25 (i))
Hydration The nursing home must provide each resident with sufficient fluid intake to maintain proper hydration and health. (42 CFR § 483.25 (j))
The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.

Of all the forms of nursing home abuse and neglect failure to provide adequate nourishment and hydration is one of the easiest to prevent. Nursing homes are mandated by state and federal regulations to timely report any change in a resident’s condition to the treating physician and family, pursuant to 42 CFR § 483.10.

This website is not to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation. In addition to providing related information this blog may also be considered an advertisement for legal services.

If you or a loved one has suffered an injury or abuse in a nursing home or other care facility that serves the elderly in Minnesota, please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact attorney Kenneth LaBore, directly please send an email to klabore@MNnursinghomeneglect.com, or call Ken at 612-743-9048.