nursing homes

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Bullying Is Ageless: Conflict And Violence Widespread In Nursing Homes, Study Finds

Ulrich Joho/flickr

Ulrich Joho/flickr

By Nell Lake
Guest Contributor

For Eileen, who is disabled and reliant on a wheelchair to get around, life in a nursing home isn’t easy. Particularly when it comes to the other residents: “There’s this guy,” she says. “He made advances to me all the time. I did not want his advances. Many times I had to take my grabber and actually strike him to get him to leave me alone.” Another resident, Eileen says, is a “real bully. She has terrorized quite a few people. She tries to boss people around. She says harassing things.”

In coping with this type of hostile behavior, Eileen (who asked not to be identified) has plenty of company. New research released last week shows that aggression among residents in nursing homes is widespread and “extremely high rates of conflict and violence” are common, according to study author Karl Pillemer, professor of gerontology in medicine at Weill Cornell College of Medicine in New York. His stark findings, presented at the annual meeting of the Gerontological Society of America: One in five people living in the nursing facilities studied was involved in at least one “negative and aggressive encounter” with another resident during a four-week period.

“In most environments — say my work environment at a university — someone yelling at me angrily is so unusual that it would keep me up all night worrying about it,” Pillemer says. Yet such conflict in nursing homes appears to be routine.

Abuse and Mistreatment

As part of the study, researchers examined patient records at ten nursing homes in New York state, interviewed staff and residents, and recorded incidents through direct observation. In a sample of more than 2,000 residents, 16 percent were involved in incidents of cursing, screaming, or yelling; about 6 percent in physical violence such as hitting, kicking, or biting; one percent in “sexual incidents, such as exposing one’s genitals, touching other residents, or attempting to gain sexual favors”; and 10.5 percent in events researchers labeled “other” — residents entering rooms uninvited, for example, or rummaging through others’ belongings. Continue reading

When Nursing Homes Are No Longer The Last Stop For Patients

Two years ago, Dorothy Holmes, then 75, was in the cozy pink bathroom of her mobile home getting ready to shower when she fell. It’s the type of accident that’s pervasive among older Americans — and it’s often the very thing that triggers the end of independence.

“I got a big spot on my head, it almost conked me out,” Holmes said in her soft voice.

She heard her husband come down the hall, “and when he turned the corner all I heard was, ‘Oh God, honey, what did you do now?’ After that I don’t know anything cause I passed out,” Holmes recalled.

Dorothy Holmes shortly after her fall. (Courtesy)

Dorothy Holmes shortly after her fall. (Courtesy)

Holmes spent almost three months in a hospital near her home in Belchertown, Mass. Her heart stopped a few times, she had breathing and memory problems, and doctors removed an ulcer as big as a grapefruit. Even with continuous nursing care, the wound wouldn’t heal.

“Every day the girls came in and changed it and cleaned it. Then I had to take,” Holmes paused, “what do you call it when they help you learn to walk and everything?”

Physical therapy — which continued for more than a year in a nursing home. These days, patients are often transferred from a hospital to a nursing home to recover. But some never leave.

“The only thing I worried about was not getting out. I kept saying to him and one of my daughters, ‘You’re not going to keep me here are you?’ ”

Holmes worried her children and her husband wouldn’t be able to handle her care at home. Continue reading

A Checkup On One Of America’s Most Expensive Patients

Sue Beder is among the 5 percent of American patients who account for half of all the nation’s health care dollars (Photo: Martha Bebinger/WBUR)

By Martha Bebinger
WBUR

In April, we introduced you to one of America’s most expensive patients. Stoughton’s Sue Beder is 66 and has had multiple sclerosis since she was 18. She sees half a dozen doctors, takes 21 prescribed medications, and is typically in and out of the hospital twice a year. You can listen to her story here.

Beder is one of the 5 percent of patients we often hear about who account for half of all health care dollars in the United States. As one of the most expensive patients, Beder is at the epicenter of Massachusetts’ efforts to save money while improving her care.

Late last year, Beder signed up with an agency, Senior Whole Health, that receives the money Medicare and Medicaid expect to spend on Beder and pools that into one budget. It’s an approach the state plans to expand to 110,000 disabled patients across Massachusetts. Senior Whole Health pledges to spend less than the government would spend and, in exchange, the agency gets to decide how best to spend the money to keep Beder healthy.

Beder couldn’t have been happier with the move. The agency put handrails in her bathroom and started buying all her vitamins and lotions. It supplied adult diapers so that she wouldn’t get out of bed at night and risk a fall. The agency is doing all this to help Beder stay home. That’s where she wants to be, and it’s cheaper than moving her into a nursing home.

So is this idea working? Is spending more money up-front on this home-based care helping Beder avoid costly medical care? Continue reading

ProPublica Launches New Site To Investigate Nursing Homes

Check out Propublica’s new interactive tool for DIY nursing home investigations. The database allows anyone to search over 20,000 nursing home inspection reports, most fairly recently posted online, that encompass “nearly 118,000 deficiencies.”

Charles Ornstein, ProPublica’s lead reporter on the Nursing Home Inspect project explains:

Why is this so cool and helpful? This is where you can look for patterns of problems at nursing homes in your area.

Searching for the phrase “pressure sore” returns 2,121 results. Searching for the phrase “bed sore” returns 1,946 results, some of them duplicates. But other words that also can return deficiencies related to bed sores include: decubitus, purulent and pus, as well as stage iii and stage iv (phrases that describe the most serious and dangerous sores, but can also describe cancer progression).

Another example: Sexual assaults. Though uncommon in nursing homes, 88 reports include “rape” and 120 include “sexual assault” (there is some overlap). A broader search for the word “sexual” yields far more results, 787. Continue reading

Daily Rounds: Drug For ‘Emotional Incontinence’; Health Reform Repeal?; Early Autism Therapy; Medicare Nursing Home Ruling; Medical Pot Docs

New Drug Approved For Emotional Incontinence : NPR The Food and Drug Administration has approved the first drug that could help people like Bailey who suffer from PBA. PBA is caused when disease or injury creates a malfunction in the brain circuits involved in expressing emotion. (npr.org)

Health care repeal unlikely for GOP – The Boston Globe “Republicans are also aware that though the health care overhaul is unpopular, its component parts are quite popular. Simply repealing the entire act sounds better than allowing insurers to discriminate against children with preexisting conditions, or bringing back the days of lifetime limits on coverage, or telling insurers they do not have to cover dependents up to age 26.” (Boston Globe)

Autism Therapy Beginning at 6 Months – NYTimes.com The treatment is based on a daily therapy, the Early Start Denver Model, that is based on games and pretend play. It has been shown in randomized trials to significantly improve I.Q., language and social skills in toddlers with autism, and researchers say it has even greater potential if it can be started earlier. (The New York Times)

Medicare Coverage Standards Are Too Strict, Courts Find – NYTimes.com Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care. (The New York Times)

Medical marijuana doctors help make pot available in California – USATODAY.com Fourteen years since Californians passed the first-in-the-nation medical marijuana law, pot is not just for the sick. Hundreds of medical marijuana doctors, operating without official scrutiny, have helped make it available to nearly anyone who wants it. (USA Today)