Share

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

Tags: , , , , ,

Share

When you become aware of mistreatment of a nursing facility it is important to get your loved one the medical treatment they need and then get into ‘fact collection mode’.  In fact collection mode, you are beginning to collect information about the incident, acts of the nursing home staff and medical condition of your loved one. Doing some preliminary work before you meet with a lawyer will prove for a more effective meeting.

Don’t assume you won’t forget information regarding the incident. As time goes on, your memory will begin to fade. The following steps will help you organize your thoughts during a stressful time and to give an attorney the information he needs to work best on your behalf.

Despite the urge to block out the unpleasant facts and circumstances leading to an injury, much of the information listed below should be obtained as soon after an incident as feasible.  The following information will prove to be valuable in both assessing the facilities responsibility and potentially as evidence to be used at trial.

Photographs– Take pictures of the physical injuries themselves, the area where the incident took place and if possible, the people involved.  In cases involving particularly gruesome medical conditions (pressure sores, amputations, surgical wounds) no medical record can do justice to what your loved one experienced.  Use a real camera as opposed to a camera-phone as the photos will be better quality.

Start Writing– Write down as much information about the incident or events as you can remember. Write some more. Details can be particularly helpful in the course of litigation as many nursing homes have high rates of employee turnover that can make obtaining information difficult.  Concentrate on: names, dates, room numbers, names of facilities and medication dosages (if relevant).

Medical Chart– The medical chart from a nursing home and / or hospital is crucial to determining what a facility may have done or failed to do that resulted in injury or death.  If your loved one sustained an injury that resulted in subsequent medical care at a hospital, these records will be important as well.

Chronology– This does not need to be one’s life story.  However, if a condition developed over time or there are multiple facilities that may responsible for the injury or condition, it is important get the correct names and general dates of admission at health care facilities.  The names of doctors who provided medical can be helpful as well.

Other Relevant documents: Healthcare Power of Attorney, wills, death certificates, pre-injury photographs, autopsy reports and nursing home inspection reports all can be helpful when meeting with an attorney.  Bring them with.

There really is no such thing as providing a lawyer with too much information.  An experienced nursing home lawyer will be able to sort through the materials and determine what information is relevant to your case.  Further, a law office that regularly handles nursing home matters should be able to access much of the above information with the use of properly executed medical authorizations. 

The bottom line is that you should not let your inability to access certain information delay from meeting your meeting with an attorney as soon as you are comfortable.  Meeting with an attorney soon after an incident will provide the best opportunity to secure information relevant to your case.

Jonathan Rosenfeld represents individuals and families in cases against nursing homes and long-term care facilities.  Jonathan is the author of the Nursing Homes Abuse Blog

Admin Note: Thank You Jonathan for your great Guest post. To all my readers, if you have soemthing you would like to say or something you would like to see, please feel free to e-mail me!

JL

Tags: , , , , , ,

Share

In the previous post we started talking about Immediate Jeopardy. There are some triggers which, when seen, should clue the hospital and nursing home surveyor or survey team into looking further to see if there is an IJ situation. Although CMS doesn’t consider the triggers to be all inclusive, they are a good starting point. CMS has placed the issues and triggers into a chart for the surveyors. I have copied that chart here for your perusal. The chart and other information can be found in the SOMAppendix Q.

 

Issues

Triggers

A. Failure to protect from abuse.

1. Serious injuries such as head trauma or fractures;

2. Non-consensual sexual interactions; e.g., sexual harassment, sexual coercion or sexual assault;

3. Unexplained serious injuries that have not been investigated;

4. Staff striking or roughly handling an individual;

5. Staff yelling, swearing, gesturing or calling an individual derogatory names;

6. Bruises around the breast or genital area; or Suspicious injuries; e.g., black eyes, rope marks, cigarette burns, unexplained bruising.

B. Failure to Prevent Neglect

1. Lack of timely assessment of individuals after injury;

2. Lack of supervision for individual with known special needs;

3. Failure to carry out doctor’s orders;

4. Repeated occurrences such as falls which place the individual at risk of harm without intervention;

5. Access to chemical and physical hazards by individuals who are at risk;

6. Access to hot water of sufficient temperature to cause tissue injury;

7. Non-functioning call system without compensatory measures;

8. Unsupervised smoking by an individual with a known safety risk;

9. Lack of supervision of cognitively impaired individuals with known elopement risk;

10. Failure to adequately monitor individuals with known severe self-injurious behavior;

11. Failure to adequately monitor and intervene for serious medical/surgical conditions;

12. Use of chemical/physical restraints without adequate monitoring;

13. Lack of security to prevent abduction of infants;

14. Improper feeding/positioning of individual with known aspiration risk; or

15. Inadequate supervision to prevent physical altercations.

C. Failure to protect from psychological harm

1. Application of chemical/physical restraints without clinical indications;

2. Presence of behaviors by staff such as threatening or demeaning, resulting in displays of fear, unwillingness to communicate, and recent or sudden changes in behavior by individuals; or

3. Lack of intervention to prevent individuals from creating an environment of fear.

D. Failure to protect from undue adverse medication consequences and/or failure to provide medications as prescribed.

1. Administration of medication to an individual with a known history of allergic reaction to that medication;

2. Lack of monitoring and identification of potential serious drug interaction, side effects, and adverse reactions;

3. Administration of contraindicated medications;

4. Pattern of repeated medication errors without intervention;

5. Lack of diabetic monitoring resulting or likely to result in serious hypoglycemic or hyperglycemic reaction; or

6. Lack of timely and appropriate monitoring required for drug titration.

E. Failure to provide adequate nutrition and hydration to support and maintain health.

1. Food supply inadequate to meet the nutritional needs of the individual;

2. Failure to provide adequate nutrition and hydration resulting in malnutrition; e.g., severe weight loss, abnormal laboratory values;

3. Withholding nutrition and hydration without advance directive; or

4. Lack of potable water supply.

F. Failure to protect from widespread nosocomial infections; e.g., failure to practice standard precautions, failure to maintain sterile techniques during invasive procedures and/or failure to identify and treat nosocomial infections.

1. Pervasive improper handling of body fluids or substances from an individual with an infectious disease;

2. High number of infections or contagious diseases without appropriate reporting, intervention and care;

3. Pattern of ineffective infection control precautions; or

4. High number of nosocomial infections caused by cross contamination from staff and/or equipment/supplies.

G. Failure to correctly identify individuals.

1. Blood products given to wrong individual;

2. Surgical procedure/treatment performed on wrong individual or wrong body part;

3. Administration of medication or treatments to wrong individual; or

4. Discharge of an infant to the wrong individual.

H. Failure to safely administer blood products and safely monitor organ transplantation.

1. Wrong blood type transfused;

2. Improper storage of blood products;

3. High number of serious blood reactions;

4. Incorrect cross match and utilization of blood products or transplantation organs; or

5. Lack of monitoring for reactions during transfusions.

I. Failure to provide safety from fire, smoke and environment hazards and/or failure to educate staff in handling emergency situations.

1. Nonfunctioning or lack of emergency equipment and/or power source;

2. Smoking in high risk areas;

3. Incidents such as electrical shock, fires;

4. Ungrounded/unsafe electrical equipment;

5. Widespread lack of knowledge of emergency procedures by staff;

6. Widespread infestation by insects/rodents;

7. Lack of functioning ventilation, heating or cooling system placing individuals at risk;

8. Use of non-approved space heaters, such as kerosene, electrical, in resident or patient areas;

9. Improper handling/disposal of hazardous materials, chemicals and waste;

10. Locking exit doors in a manner that does not comply with NFPA 101;

11. Obstructed hallways and exits preventing egress;

12. Lack of maintenance of fire or life safety systems; or

13. Unsafe dietary practices resulting in high potential for food borne illnesses.

J. Failure to provide initial medical screening, stabilization of emergency medical conditions and safe transfer for individuals and women in active labor seeking emergency treatment (Emergency Medical Treatment and Active Labor Act).

1. Individuals turned away from ER without medical screening exam;

2. Women with contractions not medically screened for status of labor;

3. Absence of ER and OB medical screening records;

4. Failure to stabilize emergency medical condition; or

5. Failure to appropriately transfer an individual with an unstabilized emergency medical condition.

 

When determining if there is a finding of IJ, the nursing home and hospital surveyor or survey team must look for the components of IJ.

The first component of IJ is Harm, which is divided into actual and potential. To determine which one it is the nursing home and hospital surveyor or survey team asks the following questions:

  • ActualWas harm an outcome? Does the harm meet the definition of IJ? In other words, has the facility’s failure to comply with the requirements actually caused serious injury, harm, impairment, or death?
  • PotentialIs potential harm likely to occur? Does the potential harm meet the definition of Immediate Jeopardy? In other words, is the facility’s failure to comply with the requirements likely to cause serious injury, harm, impairment, or death to an individual?

The second component of IJ is Immediacy. The investigator looks to see if the harm or potential harm is likely to occur in the very near future to this particular person or to others in the facility, if immediate action is not taken.

The third component of IJ is Culpability. Here the surveyor or the survey team is looking to answer the following questions:

  1. Did the facility know about the situation? If so when did the facility first become aware?
  2. Should the facility have known about the situation?
  3. Did the facility thoroughly investigate the circumstances?
  4. Did the facility implement corrective measures?
  5. Has the facility re-evaluated the measures to ensure the situation was corrected?

The nursing home and hospital surveyor or survey team considers the facility’s response to any harm or potential harm that meets the definition of IJ. Just because the facilty’s staff  say they did not know about a particular issue or situation does not excuse that facility from knowing about and preventing IJ. The survey team or surveyor uses his or her experience and knowledge to determine if the circumstances could have been predicted. The nursing home and hospital surveyor or survey team should continue to investigate enough information has been gathered in order to evaluate any prior indications or warnings regarding the jeopardy situation and the facility’s response. The crisis situations in which a facility did not have any prior indications or warnings, and could not have predicted a potential serious harm, are very rare.

So what happens if a facility is found in Immediate Jeopardy? Do they get closed down? No, not immediately. The facility is given a period of time in which to correct the deficiency. CMS works with the state survey agency and tells them each next step to follow. There are many opportunities for the facility to correct situation, but when necessary, CMS will initiate termination from participation, meaning the facility will not be eligible to receive federal monies for the care of patients/residents.

Be safe and be informed!

JL

Tags: , , , , , ,

Share

The Centers for Medicare and Medicaid (CMS) have a classification for crisis situations in which the health and safety of individual(s) are at risk. This classification is called Immediate Jeopardy (IJ).

CMS developed guidelines for surveyors of nursing homes and hospitals to use to help determine if the circumstances they are seeing pose an Immediate Jeopardy to a patient or resident’s health and safety. The guidelines assist Federal and State Survey and Certification personnel and Complaint Investigators in recognizing situations that may cause or permit Immediate Jeopardy in a nursing home or hospital as well as to almost all other certified Medicare/Medicaid entities. The surveyors can apply these principles and guidelines to all types of surveys and investigations: certifications, recertifications, revisits, and complaint investigations. The main goal of having these guidelines is to help the surveyors and investigators identify and prevent serious injury, harm, impairment, or death.

CMS has provided some definitions for the surveyors.

Immediate Jeopardy is defined as a situation in which the provider’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

Abuse is defined as “The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish.”

Neglect is defined as a “Failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.”

In order to determine if there is an IJ situation, the nursing home and hospital surveyor or survey team will keep in mind that only one person needs to be at risk. They will also consider that serious harm, injury, impairment, or death does NOT have to occur before considering Immediate Jeopardy. Harm can come from both abuse and neglect and psychological harm is as serious as physical harm. The serious harm, injury, impairment or death may have occurred in the past, may be occurring at present, or may be likely to occur in the very near future as a result of the jeopardy situation. In other words, a situation that can cause any of the problems above may or may not be currently happening, but if there is a potential for it to happen, that can constitute an IJ situation. Harm does not have to occur before the surveyor or survey team can consider or call IJ.

In order to call an IJ, the nursing home and hospital surveyor or survey team must also consider if the facility either created a situation or allowed a situation to continue which resulted in serious harm or a potential for serious harm, injury, impairment or death to individuals and if the facility had an opportunity to put corrective or prevention measures in place. During the investigation the surveyor/investigator will investigate and answer the following questions: Who was involved? What harm has occurred, is occurring, or most likely will occur? When did the situation first occur? Where did the potential/actual harm occur? Is it an isolated incident or a facility-wide problem? Why did the potential/actual harm occur?

In the next post I will discuss the triggers for IJ.

Keep safe and be informed!

JL

Tags: , , , ,