Inadequate Training, Chronic Understaffing, and Pharmaceutical Marketing in Nursing Homes: Jim Bordas Discusses an AARP Special Report
For those of you that received an AARP bulletin/newspaper, you will note in the July-August 2014 edition that there was a special report on antipsychotics in nursing homes. This article, written by Jan Goodwin, discusses a case involving Patricia Thomas, who went to a California nursing home with a broken pelvis. The only prescriptions that she had used were for blood pressure and cholesterol, and she had an inhaler for a pulmonary disease. By the time she was discharged 18 days later, her daughter claims she wasn't her mother anymore. She was withdrawn, slumped in a wheelchair, head down, chewing on her hand, and her speech was garbled. Within a week, she was dead. She ultimately filed suit against the nursing home, and a representative for AARP learned of the suit and wrote the special report.
AARP quoted Charlene Harington, a professor of nursing and sociology at the University of California San Francisco, who stated that as many as 1 in 5 patients in the nation's 15,500 nursing homes are given antipsychotic drugs that are not only unnecessary, but also extremely dangerous for older patients. She continued to say that the problem stems from inadequate training and chronic understaffing, as well as an aggressive push by pharmaceutical companies to market their products.
This is a problem with nursing homes, as the law firm of Bordas & Bordas has seen in the numerous nursing home cases we've handled, including Meredith v. Heartland, which resulted in a $50 million verdict in Clarksburg, West Virginia. The Meredith case was one of the largest verdicts in the country the year it was tried. Through our investigation of Meredith and other cases, we have found that nursing homes are grossly understaffed. The homes are run mostly by certified nursing assistants who basically have little or no training; the only requirement in some cases is either a high school diploma or its equivalency. The CNA's are usually grossly underpaid and the nursing homes are understaffed, even at the level of certified nursing assistants. For the most part, nursing homes put profit over people, thus ultimately causing injuries to the people that we entrust to them.
The AARP report, while focusing on the misuse of antipsychotic drugs, which often times are used as chemical restraints simply to make life easier on the nursing home employees, goes on to discuss how families are being kept in the dark, and touches upon the justice department's efforts to try to prevent the type of misconduct that has been found in the nursing home industry. The poor care of our loved ones in nursing homes has become so prevalent that this past March, the United States Inspector General of Health and Human Services stated that 1/3 of Medicare patients in nursing homes suffered harm, much of which was preventable. The AARP article further states, "The government, taxpayers, nursing home residents, as well as their families and caregivers should be outraged and seek solutions to the problems that exist in the nursing homes." AARP discusses, as I did above, that most of the patient care in nursing homes falls to certified nurses' assistants, whom they indicate need as little as 75 hours of on-the-job training to get certified. To show the disparity in the rules and regulations for different types of people dealing with the bodily needs of human beings, AARP reports that if you want a license to be a hairdresser you need 1,500 hours of training.
Like AARP, I have found that the nursing home facilities appear to be highly medicalized, but doctors are rarely there. Bordas & Bordas, through their investigative work, has found that if doctors are at the nursing home at all, they are there only once a month. The doctors are sometimes telephoned to write orders to admit people to hospitals, but the doctors themselves very seldom see and treat the nursing home residents. Another interesting topic concerning the nursing home business is that most states require a certain minimum number of nursing hours be spent on a patient per day. Unfortunately, these nursing hours can be from the certified nursing assistants who have very little or no other medical training, certainly not licensed practical nurses, registered nurses, physician's assistants or doctors.
As is often the case, and mentioned above, particularly with for-profit nursing home businesses, the businesses put profits over people. One of the most common ways that profits can be increased in these businesses is by reducing the number of employees on the payroll, particularly LPNs and RNs who require much bigger hourly pay rates than the minimum wage being paid to certified nursing assistants.
The long and short of all of this is that when you are about to put a loved one in a nursing home for either rehabilitation or much longer care, do your homework both on the internet and by personal visitations to the facility. Call lawyers in your area to find out what their knowledge may be of a particular nursing home. Also, when visiting a nursing home, take notice as to your own senses. For instance, is there a foul odor coming from the nursing home from the moment you open the door? Are there call lights on throughout the hallway? Are there people in the hallways and common areas in wheelchairs slumped over? Does there appear to be very few staff around? When you see the staff that are there, are they talking among themselves and does the conversation appear to be about things other than patients? Do you notice that the nursing home employees are gathered in break rooms, lunch areas, and so forth at times that you would not expect them to be there? These things are indications that something is not right with that nursing home and that your loved one may be put in jeopardy if admitted.
If there is a foul odor, you should suspect and be alerted to the fact that the residents may not be taken to the bathrooms in a timely fashion or that they are lying in their diapers that have not been changed. The problem with residents not being changed in a timely manner is that this may lead to serious bed sores (decubitus ulcers), sometimes so severe that they may cause widespread infection that may cause death. Another issue with nursing home residents not being treated timely, (i.e., call lights, bells not getting responded to) is that this may cause people who are not sufficiently capable of mobilization to leave the bed to go to the bathroom and suffer serious falls, resulting in injury or death.
All in all, I have never met anybody who wants to go to a nursing home. Most people whom I have met who have had the unfortunate need to place a loved one in a nursing home do so only after they have tried everything they can to care for their loved ones.
One of the only ways to prevent future abuse and neglect of patients in nursing homes is for the families of abused victims to speak out and file the appropriate complaint with the state agencies or with the courts. My firm feels a public responsibility and duty to discuss these nursing home issues with people, and if the problems that are presented to us are significant enough to warrant legal action, we are willing to appropriately act.
