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It’s been almost six months since Nursing Home Compare was launched, and all of the nations 15,600 nursing homes were listed and rated by the U.S. government. The reviews are in, and it’s no blockbuster, but it isn’t a flop.

For consumers, it’s been mostly a good thing. It is the most complete nursing home rating website, which provides information about nursing staffing, state inspections, allegations of neglect. But some consumer groups want more details included about inspection results, and how staffing hours is calculated. Just counting workers, they say, is no indicator of the quality of care.

The nursing home industry, which tried to delay the website’s rollout, says the grading system used by the site is misleading. Just because an allegation of neglect or abuse is made, it doesn’t mean it has been substantiated.

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One nurse twisted a patient’s jaw until he screamed. Another grabbed an elderly man by the shoulders and slammed him against a mattress. Our 70-year-old client was punched in the face by an angry nurse while giving our client a bath.

Charles Ornstein of the LA Times is out with an article today about problem nurses. He highlights a very troubling fact: It sometimes takes years for a formal complaint against a nurse to be addressed by the California Board of Registered Nursing. As Ornstein writes:

It’s a high-stakes gamble that no one will be hurt as nurses with histories of drug abuse, negligence, violence and incompetence continue to provide care across the state. While the inquiries drag on, many nurses maintain spotless records. New employers and patients have no way of knowing the risks.

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The U.S. Court of Appeals, 3rd Circuit has ruled that the Federal Nursing Home Reform Amendments grants residents of county-operated nursing homes the right to bring civil rights claims for allegations of abuse, neglect, or other care-related complaints.

The ruling arose in a case involving the 80-year-old Melvinteen Daniels, who died in a county-run nursing home as a result of neglect, malnourishment, and pressure ulcers. The family brought a lawsuit against the nursing home alleging, among other things, civil rights claims under Section 1983. Challenges to the claims wound their way through the courts and leading to yesterday’s ruling.

In a 23-page opinion, U.S. Circuit Judge Richard L. Nygaard held that, “the language used throughout the FNHRA is explicitly and unambiguously rights-creating. These provisions make clear that nursing homes must provide a basic level of service and care for residents and Medicaid patients.”

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Every year, nursing homes throughout the state of California are fined for deficiencies found in state investigations, frequently related to nursing home care. The fines range anywhere from a Class B fine of $1,000 to an AA citation of $100,000, as was recently issued against the Encinitas nursing home Aviara Healthcare.

But California officials concede that collecting these fines can take years, if they are collected at all. Nursing homes have a right to appeal fines that are issued, and most do. In the year 2007, the state issued more than $2 million in fines and to date has collected less than 10 percent.

The California Department of Public Health is charged with the oversight of skilled nursing facilities, and is the state department that issues and collects nursing home penalties. They simply don’t have the manpower to get the job done.

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By 2050, 1 is 6 people in the world will be 65 or older, forcing the countries of the world deal with an aging population. The number of senior has jumped an astounding 23 percent in the last decade.

According to studies, the world’s population has been graying for decades due to declining birthrates and an increase in longevity. Italy, Japan, Germany and Monaco have the most senior citizens, with more than 20 percent of their respective populations over 65 years of age.

Here in the United States, residents who are 65 or older represent approximate 13 percent of the overall population, but that number is expected to double in the next 40 years. This raises serious concerns as to how we are going to be able to handle the growth.

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State investigators issued a $100,000 fine to nursing home Aviara Healthcare Center in Encinitas after finding that a resident’s death was caused by neglect. The resident died of blunt force trauma after a fall.

According to reports, the resident was at the nursing home to rehabilitate a broken hip, and suffered a fall on May 9 when trying to get out of bed. The following morning at 3 a.m., the resident got out of bed and stumbled into the hallway. A nurse saw him grab onto a large Hoyer lift (a large mechanical lift), which toppled over on top of the resident. The lift struck him in the head, causing a deep cut and a severe brain injury. He died three days later.

Investigators concluded that Aviara Healthcare was negligent for storing the large mechanical lift in the hallway outside the resident’s rooms, and received statements from several employees who stated that the lift was supposed to be stored elsewhere. As a result, a Class AA citation was issued.

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A Westlake nursing home called Lakewood Manor North was issued the state’s most severe fine after an 83-year-old resident died in January 2007.

According to reports, the patient, who was totally dependent on staff, lost his balance and fell when he was being transferred to his wheelchair, striking his head on a bed rail. Shortly after his fall, nurses noted bluish discoloration on the left side of his head. His condition continued to decline throughout the day, and the man complained of not feeling well. During the evening, after consulting with a physician, the man was transferred to a local hospital at 9:30 p.m., where he was diagnosed with severe bleeding on the brain. He died five days later.

Investigators with the California Department of Public Health faulted the nursing home for failing to take action earlier, when it was clear the resident was suffering a significant change in condition.

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A report published by the National Nursing Home Survey finds that between 1999 and 2004 the number of nursing home beds and nursing home residents declined in the United States. The number of nursing home beds dropped more than 10%, or 200,000 beds, and there are approximately 100,000 fewer nursing home residents.

The survey also found that more nursing facilities are certified for both Medicare and Medicaid, and that the vast majority of caregivers were not licensed nurses, but Certified Nursing Assistants. Also, it was found that a small fraction of nursing home residents are independent, and need no help with their activities of daily living, which a slight majority, 51.1%, needed assistance with all daily activities.

To read the entire survey, click here. (.pdf)

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The California Department of Public Health has issued fines to two Orange County nursing homes after concluding that negligent nursing care lead to the deaths of two residents. Alamitos West Health Care Center in Los Alamitos was fined $100,000.00, and Huntington Valley Healthcare in Huntington Beach was fined $80,000.00.

Investigators found that Alamitos West failed to give an 82-year-old female resident adequate fluid, causing her to suffer dehydration and kidney failure. When the woman was finally transferred to a hospital, her dehydration had caused an altered mental status. The woman died a week later, on Christmas Day.

The case against Huntington Valley involved the failure to call 911 as a patient was dying. According to reports, the caregiver thought the resident did not want resuscitation if life saving treatments was needed, but the resident had actually stated in his chart “I Do Want C.P.R.” The resident died in the nursing home.

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This list contains the issuance of citations to Southern California nursing facilities by the California Department of Public Health over the last six months. All the citations listed are issued for reasons related to patient care. For verification of the citation, please contact the local department office or Walton Law Firm LLP.

<font size='2'Facility Date Citation
Los Angeles County
Antelope Valley Healthcare 3/04/09 Class B
Arbor View Rehabilitation 3/11/09 Class B
Burbank Healthcare and Rehab 3/04/09 Class B
Casa Bonita Convalescent 3/31/09 Class AA
Chandler Convalescent 2/04/09 Class B
Country Villa Broadway 3/02/09 Class B
Emeritas at San Dimas 3/30/09 Class A
Lutheran Health Facility 3/04/09 Class B
Mid-Wilshire Health Care Center 2/02/09 Class B
Royal Oaks Convalescentr 3/13/09 Class B
Tarzana Health and Rehab 4/07/09 Class B
Windsor Terrace Healthcare 2/09/09 Class B
Orange County
Coastal Communities Hospital 03/17/09 Class B
Country Villa Laguna Hills 03/03/09 Class B
Fountain Care Center of Orange 4/07/09 Class B
Sunbridge Care and Rehabilitation 1/21/09 Class A
Riverside County
Hemet Valley Healthcare Center 2/10/09 Class A
Hemet Valley Medical Center 12/04/08 Class A
Plymouth Tower 1/13/09 Class B
San Diego County
Care With Dignity Convalescent 2/11/09 Class B
Escondido Care Center 02/25/09 Class AA
Fallbrook Hosp. Dist. Skilled Nursing 3/02/09 Class B
La Paloma Healthcare Center 3/04/09 Class B
Remington Club Heatlh Center 3/18/09 Class B
Vista Knoll Specialized Care 3/04/09 Class B
Ventura County
Brighton Gardens of Camarillo 3/09/09 Class B, WMO
Camarillo Healthcare Center 3/09/09 Class B
Country Villa Oxnard 10/30/08 Class B
Fillmore Convalescent 4/03/09. Class B
Twin Pines Healthcare 3/09/09. Class B
Santa Paula Healthcare 3/17/09 Class B, A, A, A

Class AA: The most serious violation, AA citations are issued when a resident death has occurred in such a way that it has been directly and officially attributed to the responsibility of the facility, and carry fines of $25,000 to $100,000.

Class A: Class A citations are issued when violations present imminent danger to patients or the substantial probability of death or serious harm, and carry fines from $2,000 to $20,000.

Class B: Class B citations carry fines from $100 to $1000 and are issued for violations which have a direct or immediate relationship to health, safety, or security, but do not qualify as A or AA citations.

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