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Southern California legislators are supporting a proposal that would require nursing homes to post their ratings on the front door, much like health grades are posted at restaurants. Yesterday, Assembly Bill 215 was introduced in the California legislature to require that any nursing home that receive federal money to prominently display the rating it received under the federal government’s recently unveiled five-star rating system.

“Posting nursing home grades is crucial to ensuring our loved ones receive the high quality of care they deserve,” State Representative Mike Feuer (D-Los Angeles) said in a statement. “This legislation will give families valuable information and provide an additional incentive to facilities to achieve the highest standards.”

Last month, Los Angeles County supervisors voted unanimously to require that any nursing facility that receives Medicare and Medi-Cal funding to post their ratings, and inform all new residents of the rating. The ratings are based on federal inspections, using three years worth of data.

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San Dimas nursing home Casa Bonita Convalescent Hospital was fined $121,000 by the Department of Public Health after the death of 88-year-old resident Rita Twomey. State regulators issued three citations after finding that caregivers turned off the alarm of a ventilator keeping the resident alive. When the ventilator malfunctioned, no alarm was sounded and the resident died.

According to reports, Twomey’s daughter found her mother in bed with her lips and fingers blue. Tragically, the daughter tried to keep her 91-year-old father, whom she had brought for a visit, from going into the room. “They didn’t even get to say goodbye,” the daughter said. “That’s the heartache.”

The 106-bed Casa Bonita disputes the allegations made by the state, and intends on appealing the fines in Superior Court.

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Nursing Home Compare, a five-star rating system used to rate nursing homes nationwide, has been updated and upgraded by the Centers for Medicare and Medicaid Services. The updated website (click here) is intended to make choosing a nursing home easier for searching, and will hopefully have the effect of “outing” those poor nursing facilities that continually under-perform.

This is good news for consumers and nursing home advocates, and elder abuse lawyers. It is also sorely needed. U.S. Census figures project that the number of Americans over 65 will double by 2030, and two-thirds of those will require some period of nursing home care.

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Bed rail entrapment is not a rare occurrence in the hospital and nursing home setting. Despite repeated warnings from consumer groups and the FDA, nursing facilities across the country are using hospital beds that violate well known FDA dimensional guideline addressing safe hospital beds and bed rails, creating in increased risk of suffocation and asphyxia.

The FDA has identified seven zones of entrapment, and made recommendations as to the acceptable dimensions of those zones to avoid entrapment hazards. Walton Law Firm LLP recently handled the case of an elderly woman who was found dead sitting on the floor next to her bed with her head wedged between the bars of her bed rail. She was literally hanging from the bed rail. The firm brought a lawsuit against the facility and the bed rail manufacturer for violations of FDA guidelines and other acts of negligence.

For those interested in learning more about the bedrail entrapment, and the identified zones, click here to see a diagram of the zones of entrapment. The video below is also an excellent instructional aid on the various ways a person can become entrapped in a hospital bed.

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The New York Times has a story today about the dramatic increase in hospital patients with bedsores over the last 14 years. A report from the Agency for Healthcare Research and Quality finds that over 500,000 patients admitted to U.S. hospitals in 2006 suffered from a bedsore that was developed either before or during their hospital stay. That represents a whopping 78.9 percent increase over a previous study performed in 1993.

The failure to prevent or treat bedsores has been the basis of several cases here at Walton Law Firm LLP. Most legal claims arising from bedsores (frequently called “pressure ulcers” or “decubitus ulcers”) occur in the nursing home or hospital setting, and involve a bed sore that became a Stage III or Stage IV before appropriate treatment was obtained. Sores that severe can often lead to secondary problems such as infection, and usually require painful treatment.

“Bedsores are preventable, but it’s not easy,” said William Spector, an agency researcher. “It’s not like you just get a prescription and one physician can take care of it. It’s a major team effort that requires a multidisciplinary team of dietary aides, nurses aides, physical therapists and physicians all playing a role.”

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The County of San Diego paid $1.6 million to settle a case filed by Ruth Lomeo against Edgemoor Geriatric Hospital, a county-run nursing home.

According to the lawsuit, Lomeo, who was only 44, was given an overdose of fentanyl pain medication by nursing staff at Edgemoor and began to have trouble breathing. It took over 20 minutes for 911 to be called and for emergency help to arrive. It was alleged that the lack of oxygen caused brain damage, and that Lomeo now communicates like a five year old, and cannot care for herself.

The County of San Diego denies all the allegations, and states its decision to settle the case was a business decision to avoid a jury verdict.

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The Des Moines Register reviewed 81 bonus payment programs in over 30 states and found that numerous nursing homes with a below-average care giving rating were receiving quality-of-care bonuses. The newspaper looked at eight federal bonus programs in states where regulatory violations by a nursing home do not automatically disqualify a nursing facility from receiving a bonus. The eight programs analyzed are costing taxpayers $313 million per year.

By way of example, the Grace Living Center in Oklahoma earned approximately $96,000 in bonuses during the last year despite federal records that show the home has been cite for more violations than the state or national averages. Toby Edelman of the nonprofit Center for Medicaid Advocacy called the bonuses “preposterous,” and pointed out the incongruity of the government taking money from bad facilities by issuing fines, then returning the money in the form of a bonus. “It just doesn’t make any sense,” Edelman said, “it’s totally confusing to consumers.”

Legislation approved earlier this year says the bonuses will continue at least through June 2009.

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It is hoped that a new California law which will go into effect January 1, 2009 will cause increased reporting of thefts from elderly residents of nursing homes.

The new law will require police and facility ombudsmen to immediately report cases of known or suspected elder abuse, specifically including theft, to the local District Attorney’s office.

Elder theft in nursing homes frequently goes unreported. Nursing home administrators/owners claim that most thefts result from the elder “misplacing” their property. The reality is that most thefts do not get reported because it makes the facility look bad. It is hoped that the new law, which specifically requires facilities to report theft, will result in increased reporting of elder theft.

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The California Long-Term Care Ombudsman Program is the state program responsible to investigate and resolve complaints made by individuals (or their representatives) residing in long-term care facilities such as nursing homes. Last week, when the California budget was signed by Governor Schwarzenegger, he cut state funding for the ombudsman program.

The decision has not gone over well with elder care advocates. The governor’s cuts removes roughly 15% of the budget for the program, which translates into a loss of 1.25 of every 3.7 positions.

To contact your local ombudsman’s office call the appropriate telephone number in the geographical area the incident leading to the complaint occurred.

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A study just released by the Inspector General of the Department of Health and Human Services reports that 94% of all nursing homes nationwide were cited for violations of federal health and safety standards during 2007. Approximately 17% received deficiencies or citations for issues which caused “actual harm or immediate jeopardy” to residents. These deficiencies were for such things as bedsores, medication errors, lack of nutrition/dehydration, abuse and neglect of residents.

In total, inspectors received 37,150 complaints nationwide. Surprsingly, only one-fifth of the verified complaints involved the abuse or neglect of patients. The remainder were for adminsitrative issues or those related to the physical premises.

Another telling statistic is that 94% of for-profit nursing homes were cited whereas only 88% of non-profit nursing homes were cited. For-profit also received an average of 7.6 deficiencies per home whereas non-profits averaged 5.7 per home.

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