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Nursing Home Staffing Regulations: A Necessity that Sometimes Gets Overlooked

Last week we talked about Hurstbourne Care Centre at Stony Brook, a Louisville adult care facility which will be forced to have its Medicare agreement terminated due to poor conditions that were negatively affecting both the health and safety of its residents. Situations like this happen all too often and are extremely painful for both the residents and their family members. In a second blog posted earlier this week, we shared advice for family members who might one day find themselves in a similar situation.

Why are such conditions allowed to happen, though? Nursing homes and adult care facilities are heavily regulated and inspected by agencies like Centers for Medicare & Medicaid Services (CMS) and Adult Protective Services, but issues still sometimes fall through the cracks. In most cases, poor conditions can be linked back to one thing that is often overlooked—improper facility staffing regulations.

To understand why facility staffing regulations sometimes falter, first we must understand the other systems of regulations that are in place. There are separate federal and statewide staffing standards that nursing homes and adult care facilities are expected to uphold. In most states, each day and night shift must have a registered nurse (RN) or licensed practical nurse (LPN) who is available at all times. In addition, nurse’s aides (NAs) are also present at all times.

According to federal regulations, a facility’s expected number of staff members is proportionally based off the number of beds in the facility. Unfortunately, that number dictates the amount of hours nurses work instead of the amount of nurses present. This often results in fewer nurses working longer shifts instead of more nurses working shorter shifts. Both types of shifts can result in sufficient levels of care, but gaps and oversights in nursing and care duties tend to increase during long shifts which can be especially taxing.

It’s in a facility’s best interest, naturally, to create facility regulations which require its nursing staff to work shifts that result in the best care possible. If a facility fails to keep the correct nursing staff ratios or forces its staff members to work extra-long shifts, poor conditions like those found at Hurstbourne Care Centre at Stony Brook may easily result. Improper scheduling or charting can also be at fault.

One other possible issue could be the fact that the federal regulations aren’t as useful as they could be for larger facilities. A facility with 150 beds might require the exact same amount of nurses that a facility with 200 beds requires, for instance, simply due to the way in which the hours-per-bed ratio is calculated. The number of required RNs and LPNs on duty also does not change no matter the amount of beds a facility has. This potentially means that the larger facilities have residents that rarely—if at all—get to see the RN or LPN on duty. In extremely large care centers, this can lead to poor care.

Larger facilities have a few options to deal with this predicament. They can hire additional nurses or organize the nursing shifts to best utilize the time of each staff member. Given the fact that Hurstbourne Care Centre at Stony Brook is a facility which houses 125 residents, it seems extremely likely that the facility failed to do one or more option. It’s also possible that the nurses themselves were not being properly supervised or that staffing regulations weren’t being enforced at all.

Adult care facilities not only have a responsibility to uphold federal regulations, but they also have a responsibility to create and enforce facility regulations that help ensure their nurses and staff members issue the best care they can. Without proper staffing regulations, even the best of nurses can falter and overlook a resident’s care sheet. It’s uncertain for now what exactly was at fault at Hurstbourne Care Center at Stony Brook, but with proper facility regulations in place, those poor conditions may have been completely prevented.

For family members of residents staying at the facility where this unfortunate tragedy occurred, there is legal help available. Requesting legal aid can potentially help keep Hurstbourne Care Center or any other facility from making mistakes that endanger the lives of others. Legal aid can also help you get your loved one into a new, safe facility and help your entire family get through this troubled time.

Steps for Protecting a Loved One from Unsafe Nursing Home Conditions

Making the decision to place a loved one into a nursing home or adult care facility can be one of the most difficult decisions you’ll ever have to make. How can you trust they’ll get the proper care? Between local organizations and federal, state, and facility regulations, adult care facilities are watched with a rather critical eye. If anything should happen at a facility which may detriment the health and/or safety of the residents, the officials will be notified quickly and appropriate action will be taken. Cases where this is deemed necessary do not happen often, but they aren’t completely unheard of.

One such case recently struck close to home at Hurstbourne Care Centre at Stony Brook, located in Louisville, KY. We reported on the incident in detail last week. The adult care center was investigated by federal health officials after multiple complaints were filed. The investigation found that the facility was endangering the health and safety of its residents by failing to follow doctor’s orders, monitor past injuries, and keep the patient’s rooms properly clean. One patient was even found in bed with ants crawling on them at the time of the inspection.

The facility is currently scheduled to have its Medicare agreement terminated by the end of July. Until that time, residents are being transferred to other facilities where they can be properly cared for.

Cases like this are rare, but extremely worrisome—especially when they occur locally. Conditions similar to those noted above are horrible for both the residents to experience and family members to witness. What can the family members of patients do when conditions like this are noticed? How is appropriate action taken? Here are three steps:

Gather Information and Evidence

When you first witness negligent care or unsafe/unhealthy conditions, you must first evaluate exactly what you’re dealing with. If the patient is in immediate danger, contact the police and other officials immediately. Safety should always be your #1 concern.

If the conditions aren’t immediately endangering, you have more time to find out what happened and how it happened. Speak to your loved one and gather as much information as possible. If it looks like they were bruised, for example, ask them how it happened and let them tell you the whole story. Be there to emotionally support them if they seem agitated and/or upset. Search for evidence such as other bruises and restraint marks and take pictures if you can in case evidence is asked for at a later date. Obtain records of any medical reports filed.

Direct Attention to the Conditions

Unfortunately, oversights do happen in nursing homes and adult care facilities. Residents often fall, for example, when they try and get up by themselves due to the fact that staff members aren’t available as often as they should be. Most adult care facilities are severely understaffed. There’s a large difference between an incident that occurs due to an oversight and one that occurs due to negligent behavior or incorrect staffing procedures, however. Even in understaffed facilities, every resident depends on the facility’s staff to remain safe and healthy.

It’s often a good idea to bring up the condition or incident with multiple staff members as soon as possible after the incident occurs. Express your concern and compare what is said with the story your loved one told you. If the situation is immediately remedied and the unsafe conditions are made safe again with the explanation of an oversight, further action may not be necessary, but you will want to be sure to keep a close eye on the situation to make sure it doesn’t happen again.

If any staff members act like they don’t know what happened or do not care, make note of that staff member’s name and shift and ask to speak with someone else—preferably someone higher up. Ask for a doctor consult if necessary and request to be present. Trust your inner instincts when you speak to facility staff members. If you ever get the impression that they do not care about their residents, it may be time to move forward in taking action.

Follow Up with Action

If at any point you feel as though the conditions at the care facility aren’t improving or that your loved one’s condition seems to be worsening, you have every right to take action as quickly as possible by doing any or all of the following:

  • Finding a new facility to place your loved one in or simply removing them from the endangering facility
  • Contacting your local elder abuse organization to help protect other residents (Kentucky residents can contact the Kentucky Elder Abuse Hotline)
  • Filing a complaint with adult protective services
  • Contacting a personal injury lawyer or nursing home abuse attorney

Taking these actions will ensure that your loved one remains safe as well as help protect other residents at the facility in question. By filing a complaint, you potentially help open an investigation similar to the one opened at Hurstbourne Care Centre at Stony Brook.

Louisville Adult Care Center Scheduled to Lose Medicare Funding Due to Unsafe Conditions

Hurstbourne Care Centre at Stony Brook, located in Louisville, KY, is currently scheduled to have its Medicare agreement and funding terminated as of July 25th due to a state-led investigation which questioned the level of care residents were receiving. The investigative report found that the adult care facility was jeopardizing the health and safety of its residents.

As reported by local news, the Kentucky State Survey Agency began investigating the facility on May 22nd after receiving numerous complaints. When the resulting report was presented to the facility on June 24th, the following statement by Sandra Pace, Health and Human Services Associate Regional Administrator, was issued:

“The survey found that your facility was not in substantial compliance with the participation requirements, was providing substandard quality care to residents, and that conditions in your facility constituted immediate jeopardy to residents’ health and safety.”

The investigators found one resident whose room had been infested with ants. The ants were even crawling on his/her bed and body which was understandably frightening to the resident. Another resident was found to be nutritionally compromised due to a doctor’s order for weekly weigh-ins and food intake monitoring which was not being followed. A third resident had an eye injury that hadn’t been monitored by facility staff members for several weeks.

The entire Statement of Deficiencies which lists the citations involved can be found here.

Conditions like those noted above suggest that facility staff members were being negligent and that proper staff regulations to help prevent negligence may not have been followed. Several agencies will be working closely with the facility, Centers for Medicare & Medicaid Services (CMS), Adult Protective Services, and other local programs to assist the 125 residents with relocation to new facilities of their choosing. Numerous agencies will stay on-site during the transition period to ensure residents receive the appropriate levels of care in the meantime.

In the termination letter received by Hurstbourne Care Centre at Stony Brook, it was stated that the facility can appeal the findings and request a hearing before an administrative law judge. It is unclear at this time whether or not the facility will choose to stay open.

If you or anyone you know is currently receiving care at this facility, now would be a good time to ensure their safety by helping them relocate to a different care center as quickly as possible. Find out if your loved one received any negligent care recently or in the past and make yourself available for any emotional support they should need.

Depending on the type of negligence that occurred and the timeframe, it may be possible to take legal action against the facility. For more information, please see our informational page on nursing home abuse.

Drugs and Alcohol Involved in Driving Fatalities

According to data from the National Highway Traffic Safety Administration, drugs and alcohol continue to be a major cause of Kentucky car accidents. The data shows that, nationally, drugs and alcohol were involved in fatal accidents, claiming 267,598 lives from 1995 and 2013, according to drugtreatment.com. Drugs or alcohol involvement accounted for 26 percent of all fatal car accidents over that time period.

South Dakota had the most fatal car accidents involving a legally drunk driver, 22.44 per every 100,000 residents. The next nine states in order were; Wyoming (19.02), Arkansas (18.68), Nebraska (18.54), Montana (16.85), Mississippi (16.42), Maine (15.12), Kentucky (14.98), Louisiana (14.63, and West Virginia (14.05).

North Dakota had the most fatal car accidents where the driver was under the influence of drugs, 8.03 for every 100,000 residents. The next nine states in order were: Wyoming (7.53), Montana (7.33), West Virginia (6.09), Kentucky (5.89), Arkansas (5.23), Vermont (4.56), South Dakota (4.20), South Carolina (4.07), and Alabama (4.05).

The study also broke down the fatality rate by county. In terms of drugs, the two counties with the highest number of drivers under the influence of alcohol and/or drugs were in Louisiana (Tangpahoe Parish and Livingston Parish). More specifically, two counties in Hawaii account for deaths where the driver was under the influence of cannabinoids (Hawaii County and Maui County). Four of the five highest rates for drivers under the influence of stimulants were in California whereas four of the five highest rates for drivers under the influence of depressants were in Tennessee. Narcotics, inhalants, and hallucinogens saw much more varied data, with the highest rates being spread around many different states.

In terms of drug use, cannabinoids were most common in the Northeast and parts of the Midwest, whereas stimulants were much more common on the West Coast. The vast majority of fatal car accidents are the result of alcohol, drugs, and/or distracted driving. In 2010 alone almost 1.5 million people were arrested under suspicion of driving under the influence.

If you have been involved in a car or truck accident with a driver under the influence of drugs or alcohol visit our frequently asked questions page for more information to help you protect your rights.

Felony charges for nursing home workers accused of abuse

Three medical professionals have been arraigned on felony charges of endangering the welfare of a physically disabled person and willful violation of health laws, after they were accused of dragging a bleeding and disabled patient across the floor of a nursing home in Queens, New York. Video surveillance shows the patient writhing in pain on the floor and bleeding from the head and neck for more than 20 minutes without treatment.

Nurses Funmilol Taiwo and Eshe Agbonkpolor and nurse’s aide Emmanuael Ufot were arrested this month as a result of the October 23 incident. They were all employees at the Peninsula Nursing and Rehabilitation Center where the incident occurred. The victim suffers from mental and physical disabilities and fell down near the nurse’s station, and nobody came to his immediate aid.

Here is what reportedly ensued after that point: Ufot put on rubber gloves, grabbed the victim by the arm and dragged him into his room. Approximately 25 minutes later, the victim came out of his room bleeding from his head and jaw. He then writhes on the floor, struggles to his feet, all while his bloody hospital gown is torn and even twisted around his neck. Taiwo and Agbonkpolor ignored the patient for 20 minutes. Then Ufot grabs the patient again and tries to drag him back to his room. After suffering head and neck injuries, the patient had to be taken to a hospital for emergency treatment.

All three employees were either fired or resigned from the facility. This nursing and rehabilitation center is a 200-bed facility that boasts “world-class care” and is “redefining the rehabilitation experience according to his website. This incident is simply the latest in a string of cases related to nursing home neglect or abuse that occur nationwide each year.

For more information on how to protect your loved ones from Kentucky Nursing Home Abuse and Neglect and what to do when you suspect it, visit our website at http://www.thomaslawoffices.com/practice-areas/nursing-home-abuse/.

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