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Nursing home abuse takes many forms: emotional, financial, neglect, and physical assault are just a few. Nursing Homes are full of vulnerable elders who are the most susceptible to abuse. Many suffer from dementia or other disabiltiies and are unable to tell anyone aqbout the abuse they are suferring or are not aware of it.

The infographic below provides information regardnig the severity of nursing home abuse issue and warning signs of abuse. Incidents of nursing home abuse are rarely reported to the proper authorities. No matter what form it takes, nursing home abuse is wrong and needs to be stopped.

Nursing Home Abuse Infographic

Nursing Home Abuse infographic brought to you by Sokolove Law

I hope this helps you see signs of abuse if it is ocurring.
JL

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This week I came upon a blog entry at Bella Camilla. It was poignant. I want to share it with you as it tells such a beautiful story and one that is not all that uncommon in a nursing home setting.

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It was a busy morning, about 8:30, when an elderly gentleman in his 80’s arrived at the hospital to have stitches removed from his thumb. He said he was in a hurry as he had an appointment at 9:00 am. The nurse took his vital signs and had him take a seat, knowing it would be over an hour before someone would be able to see him. I saw him looking at his watch and decided, since I was not busy with another patient, I would evaluate his wound. On exam, it was well healed, so I talked to one of the doctors, got the needed supplies to remove his sutures and redress his wound.

While taking care of his wound, I asked him if he had another doctor’s appointment this morning, as he was in such a hurry. The gentleman told me no, that he needed to go to the nursing home to eat breakfast with his wife. I inquired as to her health.

He told me that she had been at the nursing home for a while and that she was a victim of Alzheimer’s disease. As we talked, I asked if she would be upset if he was a bit late.

He replied that she no longer knew who he was, that she had not recognized him in five years now. I was surprised, and asked him, ‘And you still go every morning, even though she doesn’t know who you are?’

He smiled as he patted my hand and said,  ‘She doesn’t know me, but I still know who she is.’

JL

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One thing that is becoming more prevalent is healthcare consumers becoming more aware. The Internet has a wealth of information for consumers, and  sorting through and making use of that information is how each of us can be more active in directing our own healthcare. Healthwatch MD put out a video on the concept of patient as part of the healthcare team. No longer is the team just the doctor and nurses, now it is everyone, doctors, nurses, social workers, clergy, therapists, family and patients, to name just a few. Take a few moments to watch Dr. Leigh Hamby, chief medical officer for Piedmont Healthcare, discuss this concept.

Hospital Safety: You are Part of Your Healthcare Team

Remember, to be your own advocate!

JL

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In this second part regarding how Nursing Home and Hospital Surveyors look at pain management in the nursing home we are going to look at some of the definitions they use for common concepts. If you remember, the State Operations Manual (SOM) provides much guidance to Nursing Home and Hospital surveyors on how to investigate and survey facilities. In regards to pain managment, the guidance provides the following definitions at F309 in Appendix PP:

“Addiction” – a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addiction is characterized by an overwhelming craving for medication or behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Adjuvant Analgesics” refers to any medication with a primary indication other than pain management but with analgesic properties in some painful conditions.

“Adverse Consequence” – an unpleasant symptom or event that is due to or associated with a medication.  Examples would include impairment or decline in a resident’s mental or physical condition or functional or psychosocial status and various types of adverse drug reactions and interactions.

“Adverse drug reaction” (ADR) is a form of adverse consequence that may be either a secondary effect of a medication that is usually undesirable and different from the therapeutic effect of the medication or any response to a medication that is noxious and unintended and occurs in doses for prophylaxis, diagnosis, or treatment. The guidance goes on to explain to nursing home and hospital surveyors that the term “side effect” is often used interchangeably with ADR; however, side effects are actually one of five ADR categories. The other categories of ADRs are hypersensitivity, idiosyncratic response, toxic reactions, and adverse medication interactions. A side effect is an expected, well-known reaction that occurs with a predictable frequency and may or may not constitute an adverse consequence.

Complementary and Alternative Medicine” (CAM) –  a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine.

Non-pharmacological interventions” are approaches to care that do not involve medications, generally directed towards stabilizing or improving a resident’s mental, physical or psychosocial well-being.

“Pain” – an unpleasant sensory and emotional experience that can be acute, recurrent or persistent. The guidance then breaks this down further and provides the following descriptions of several different types of pain:

“Acute Pain” – generally pain of abrupt onset and limited duration, often associated with an adverse chemical, thermal or mechanical stimulus such as surgery, trauma and acute illness;

“Breakthrough Pain” – an episodic increase in (flare-up) pain in someone whose pain is generally being managed by his/her current medication regimen;

“Incident Pain” – typically predictable pain that is related to a precipitating event such as movement or certain actions; and

“Persistent Pain” or “Chronic Pain” – a pain state that continues for a prolonged period of time or recurs more than intermittently for months or years.

“Physical Dependence” is a physiologic state of neuro-adaptation that is characterized by a withdrawal syndrome if a medication or drug is stopped or decreased abruptly, or if an antagonist is administered.

“Standards of Practice” refers to approaches to care, procedures, techniques, treatments, etc., that are based on research and/or expert consensus and that are contained in current manuals, textbooks, or publications, or that are accepted, adopted or promulgated by recognized professional organizations or national accrediting bodies.

“Tolerance” is a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce the same effect or a reduced effect is observed with a constant dose.

So with those definitions Nursing Home and Hospital Surveyors are more prepared to evaluate the pain management program in a Long Term Care Facility. The knowledge they gain from these guidelines also serve them well as they look at pain management in other facility types. It is, though, more common to find inadequate pain management in a long term facility. We will continue with the discussion of pain management the n ext time. Meanwhile, keep yourself informed as to what is required of facilities, whether nursing home, clinic, hospital, hospice, dialysis or whatever. You are then more empowered to watch for, comment on, and report problems you see.

Remember, Be your own advocate!

JL

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