elderly

North Carolina is notorious for its wild daily temperature swings. You might start the day needing long sleeves and long pants, change to shorts by lunchtime, then put on a jacket after sunset. For most of us, this is nothing more than a minor sartorial inconvenience; but for people over age 65, temperature swings can be dangerous to their health.

According to research published in the Proceedings of the National Academy of Sciences, even seemingly small changes in summer temperature swings–changes as tiny as 2° F–may shorten life expectancy for people with chronic medical conditions. According to the lead scientist for the study, Antonella Zonobetti of the Department of Environmental Health at Harvard School of Public Health (HSPH):

“The effect of temperature patterns on long-term mortality has not been clear to this point. We found that, independent of heat waves, high day to day variability in summer temperatures shortens life expectancy. This variability can be harmful for susceptible people.”

Previous studies have confirmed the association between heat waves and higher death rates. But this new research goes a step further. Although heat waves can kill in the short term, the authors say, even minor temperature variations caused by climate change may also increase death rates over time among elderly people with diabetes, heart failure, chronic lung disease, or those who have survived a previous heart attack.

The research showed that for each 2° F increase in summer temperature change, there was a 2.8% to 4% increase in death rate for susceptible seniors. Calculations suggest that summer temperature swings could account for more than 10,000 additional deaths per year.

Why? What could that tiny temperature fluctuation do that is so dangerous?

Researchers say that older people and those with chronic health conditions have a hard time adjusting to extreme heat. As their bodies struggle to adjust, the elderly experience physiological stress, which can cause frail or sick bodies to become sicker.

Although there is not much to be done about this, Dr. Robert Glatter, interviewed for WebMD, says that friends, relatives, and neighbors should try to keep a closer eye on people with chronic health problems, not just on days with blazing heat, but also during sudden weather snaps.

“Watch for any changes in their daily vital signs and complaints,” says Glatter, [an emergency medicine specialist at Lenox Hill Hospital in New York] who was not involved in the study. “Make sure you’re listening very carefully to their complaints.”

Make sure the elderly have appropriate temperature controls in their living environments, and provide them with air conditioning and fans, if possible. And if your loved one lives in a nursing home, spend a full day there in the summer to see how well the facility controls temperature.

To read the full story on WebMD, click here:  Summer Temperature Swings

Although many studies have linked antidepressant use among the elderly and falls, new study published in the Journal of Gerontology looked at the specifics of why this happens.

According to ScienceDaily, researchers from the Institute for Aging Research of Hebrew SeniorLife (an affiliate of Harvard Medical School) found that nursing home residents have a five-fold increased risk of falling within two days of a new prescription for, or an increased dose of, a non-SSRI (selective serotonin reuptake inhibitor) antidepressant such as bupropion or venlafaxine.

“Our results,” says lead author Sarah D. Berry, M.D., M.P.H., a scientist at the Institute for Aging Research, “identify the days following a new prescription or increased dose of a non-SSRI antidepressant as a window of time associated with a particularly high risk of falling among nursing home residents.”

The medications can cause a variety of side effects that may contribute to the incidence of falls, including sedation, lightheadedness, dizziness, low blood pressure, and coordination problems. With medication changes, the side effects are new and potentially more powerful, which may contribute to the risk of falls.

In light of her findings, says Dr. Berry, an instructor in medicine at Harvard Medical School, “nursing home staff should keep a watchful eye on residents in the days following a non-SSRI antidepressant change to prevent falls and clinicians should avoid making changes on weekends or during times when unfamiliar staff is present.”

To read the full ScienceDaily article, click here:  Nursing Home Residents at Heightened Risk of Falling

To read the journal article abstract, click here:  Antidepressant Prescriptions

The Centers for Medicare and Medicaid Services compile data about nursing homes, and about nursing home residents. Yesterday, NPR News Investigations published an interactive graphic of the level of independence among U.S. nursing home residents.

This graphic is quite cool! You start by choosing an independence measure you want to examine from the residents’ ability to bathe, dress, eat, walk, or use the toilet by themselves. Then, you move your cursor over a state to see the percentage of residents in that state who can do the activity without help.

In our state, North Carolina, the percentages are:

• 3.1% can bathe alone
• 7.1% can dress themselves alone
• 42.2% can eat by themselves
• 5.8% can walk independently
• 10.5% can use the toilet without assistance

These statistics tell the story of the level of care most nursing home residents require. This is why the difficult decision of whether to place a loved one in a nursing home is more a question of how to choose a good and caring nursing home–this extreme level of round-the-clock care is impossible for most families.

To see the full, interactive graphic by NPR, click here: Independence Graphic

And if you find yourself needing to choose a nursing home, please do your homework. Quality care exists, but it can be difficult to find…and life in a poor-quality nursing home can be horrific. We have created a few videos to help your nursing home decision. Click here: the HensonFuerst YouTube Channel

These types of

There are many different living options for people who are no longer able to live independently, or who require more care than the average family can give. About 70 percent of people over age 65 will require some type of long-term care services during their lifetime. The process of choosing can be overwhelming.

To begin, it’s important to know the differences among various terms. Each type of facility offers different benefits and levels of care, and often must follow different rules and government guidelines in order to maintain its certification and/or funding. The quality of individual facilities varies, as well. Some are wonderful, but many (way too many) are horrific. (On the HensonFuerst website, we provide guidance about how to choose the best-rated care in your area, and we’ll also discuss these topics in detail in future blogs.)

To help ease the confusion, here are some definitions of commonly used terms:

Long-Term Care

“Long-term care” is an overarching term used to describe any service (including many of the services listed below) designed to help people who have chronic illness, disability, dementia, or other condition that requires on-going help. Long-term care services can be provided anywhere, including in the individual’s home or in a residential facility.

Continuing Care Retirement Communities (CCRCs)

CCRCs offer multiple levels of care–Independent Living, Assisted Living, Skilled Nursing Care—housed in different areas of the same community or campus. As the personal and medical needs of residents change, they have the opportunity to move to a different care facility while remaining in the same community—social connections remain in place, friends can stay friends. CCRCs provide residential services (including meals, housekeeping, and laundry), social and recreational services, health care services, personal care, and nursing care.

If you are considering a CCRC, be sure to check the associated nursing home, in person and on the Nursing Home Compare page on www.Medicare.gov. A CCRC contract usually requires you to use the CCRC’s nursing home if you need nursing home care. And some CCRC’s will only admit people into their nursing home if they have previously lived in another section of the retirement community, such as their assisted living or an independent area. CCRCs usually require a large lump-sum entrance fee, and residents must pay a monthly fee. (Licensed as nursing homes/residential care facilities or as homes for the aging.)

Independent Living Community

Independent living communities typically provide meals in a restaurant setting, housekeeping, transportation and various social activities. While there may be wellness programs, care services may or may not be available for an additional charge. These communities are often part of a Continuing Care Retirement Community. (Not licensed.)

Assisted Living Facility

These communities promote independence in a private residence setting, a kind of “home with services” for people who are generally well but still need help with everyday tasks. There is an emphasis on privacy and choice. Residents typically have private locking rooms (unless shared by choice) and private bathrooms. Personal care services are available on a 24-hour-a-day basis. Residents have access to assistance with meals, bathing, dressing and/or medication as needed. In addition, transportation and social activities may be available (not all facilities offer all services, so ask for a list of services in writing). Assisted Living facilities may stand alone, or they may be part of a Continuing Care Retirement Community. There is usually a monthly fee, plus additional fees for added services. (Licensed as residential care facilities or as rest homes.)

Skilled Nursing Facility

Skilled nursing facilities are nursing homes that are certified by Medicare to provide 24-hour nursing care and rehabilitation services, in addition to other services. Many of these communities offer short term, comprehensive rehabilitation programs on an inpatient and outpatient basis. They may be stand-alone facilities, or part of a Continuing Care Retirement Community. (Licensed and regulated by state public health departments.)

Nursing Home

A nursing home is a facility licensed by the state to offer 24-hour skilled nursing care and personal assistance. For people who don’t need to be in a hospital but still require round-the-clock care, a nursing home provides nursing care, personal care, room and board, supervision, medication, therapies and rehabilitation. Rooms are often shared, and communal dining is common. Some nursing homes have special care units for people with Alzheimer’s disease or other serious memory disorders. (Licensed as nursing homes, county homes, or nursing homes/residential care facilities.)

Alzheimer’s/Memory Care

Alzheimer’s or Memory Care communities are a type of service, not particular facility. They provide specialized services to meet the needs of individuals with dementia, brain injury, or Alzheimer’s disease. These services may be provided by an Assisted Living, Skilled Nursing or Residential Community.

Rest Home

These facilities offer 24-hour supervision and supportive services for people who don’t need on-going medical or nursing care. They provide housing, meals, activities, and medication administration.

Hospice Care

Hospice provides care for individuals who are terminally ill, including health services, volunteer support, grief counseling, and pain management. Although most hospice programs are only allowed to offer services to people who are thought to have less than six months to live, some hospitals are providing hospice to people with a documented terminal illness who need palliative care. These services can be provided in a person’s home, a hospital, or a long-term care facility.

Adult Day Care

Even though the name sounds a bit condescending, Adult Day Care can be very helpful for adults who are functionally impaired, but who want or need an alternative to live-in care. These programs run during the day (much like child day care), and provide variety of health and wellness, social, and related support services in a safe, protective setting.

For More Information…click the links below:

HensonFuerst Attorneys Nursing Home Abuse webpage

National Clearinghouse for Long-Term Care Information

Medicare.gov

The North Carolina Board of Nursing has issued a new statements designed to clarify the scope of practice for nurses.

These position paper provide guidelines about what the standards for competent care are for LPNs and RNs. Topics include what to do when assessing a patient, planning for a client’s needs, implementing the plan, evaluating outcomes, recording data, collaborating with others, and counseling the client and/or the client’s family.

Click the links to read the papers:

Position statement for RN practice.

Position statement for LPN practice.

While these papers are intended for nurses, everyone with a loved one being cared for by nurses should review them to make sure that competent care is being delivered. If you wonder how your nurse is following through on the guidelines, ask. Good care starts with good communication.

On the other hand, if it becomes clear that your nurse is not competent, or if you suspect that your loved one is being abused, talk with someone further up the chain of command–the head nurse or facility coordinator. If you believe that your loved one is in immediate danger, it is better to be safe than sorry:  call 911.

And finally, if your loved one has been injured by abuse by a long-term care facility and you want to explore your legal options, call the HensonFuerst Nursing Home Abuse team–we’re here 24 hours a day, 7 days a week. You can reach us at 1-800-4LAW-MED. If you have questions, HensonFuerst has answers.

Today, June 15, is the 5th annual World Elder Abuse Awareness Day.

Sponsored by the International Network for the Prevention of Elder Abuse (INPEA), the first Awareness Day in 2006 involved several hundred organizations and governmental bodies throughout the world, on all seven continents. Their core message is this:  Never ignore elder abuse.

Throughout the world, abuse and neglect of older persons is largely under-recognized. It is an unspoken problem. Unfortunately, no community or country in the world is immune from this costly public health and human rights crisis.

Elder Abuse Facts

According to the World Health Organization, the elderly are especially at risk of abuse in institutions such as hospitals, nursing homes, and other long- term care facilities. In a survey in the United States, for example, 36% of nursing home staff reported having witnessed at least one incident of physical abuse of an elderly patient in the previous year, 10% admitted having committed at least one act of physical abuse themselves, and 40% said that they had psychologically abused patients.

Abusive acts include physically restraining patients, depriving them of dignity and choice over daily affairs, and providing insufficient care (for example, allowing them to develop pressure sores).

Signs and symptoms of abuse include:

• delays between injuries or illness and seeking medical attention;
• implausible or vague explanations for injuries or ill-health, from either patient or caregiver;
• differing injury accounts or case histories from patient and caregiver;
• frequent visits to emergency departments because a chronic condition has worsened, despite a care plan;
• laboratory findings that are inconsistent with reported treatment.

The HensonFuerst nursing home abuse team has seen first-hand the abuses that can be heaped on the elderly. Just a few months ago, six residents of the Britthaven of Chapel Hill nursing home were given overdoses of morphine, and one resident died. They were all in the Alzheimer’s unit, which means that they were helpless to know what was going on… helpless to fight back.

Stories like that are what keep HensonFuerst fighting against elder abuse every day of the year.

New Haven, Connecticut–home to Ivy League Yale University–is also the location of the latest example of how disgusting and neglectful a nursing home can get. According to a story by a Connecticut NBC affiliate, the Department of Public Health held a surprise inspection of The West Rock Health Care Center. Everyone was surprised when inspectors found:

“Linens that were worn thin and brown; boxes of medical records soaked in pooling water; and a nurse who cleaned an open ulcer with the same ‘fecal smeared washcloth’ used to clean the patient.”

In addition, residents were not given medications on time, and slept on beds that were “unmade and with an accumulation of soiled sheets.”  In all, there were 37 pages worth of violations.

The nursing home was shut down.

Reaction of the owner, Anthony Pinto? “This is a travesty,” he said, referring to the closing. He believed everything “was correctable.”

Except you can never correct for the pain and indignity already suffered by the residents, or the extra infections that might have already occurred due to such unclean conditions. HensonFuerst believes that our senior citizens deserve the highest of care, not the lowest. We fight everyday to keep nursing home residents from becoming victims of this type of abuse and neglect.

If you have a loved one in a nursing home, visit often… talk with staff about concerns you might have… and make facilities take responsibility for proper treatment of your relative. If you believe abuse has already taken place and have questions about what additional action you can take, call us. At HensonFuerst, if you have questions, we have answers. (HensonFuerst: www.lawmed.com; 1-800-4-LAW-MED)

The SmartMoney Magazine website published an eye-opening list of “10 Things Nursing Homes Won’t Tell You,” which was adapted from a book by Jonathan Dahl and the editors of SmartMoney.  Everyone related to a nursing home resident should visit the site, read the list, print it, study it, and post it somewhere visible.

So I don’t give everything away, I’ll include 5 items here (with our own commentary).

1. “We’re careless about the drugs we give out.” Some nursing homes have been cited for unnecessary drug use, use of antipsychotic medications among residents who are not psychotic, and overdosing residents so that they are easier to care for. We have seen this locally, when Britthaven of Chapel Hill nursing home was reported to be the subject of investigation when residents were given narcotic medications without a prescription, leading to the death of one patient.
2. “If it’s not in the care plan, we’re not gonna do it.” The federal government requires a care plan for each resident, which outlines how the resident should be cared for. Even if something is on the care plan, nursing homes can neglect the promised duties… but if a particular aspect of care is not on the plan, forget about it. Don’t assume anything.
3. “‘Neglect’ is our middle name.” When nursing home residents are neglected, they can suffer from dehydration, pressure sores, malnutrition, disease, and sometimes death.
4. “We use physical restraints on your loved ones.” Restraints are allowed as a method of last resort to keep a loved one safe or protect others. But that doesn’t mean that use of restraints isn’t abused, and can lead to depression, agitation, bruising, and other physical problems.
5. “Fines? Go ahead–give us your best shot.” When a nursing home doesn’t meet standards, it can be fined… but that doesn’t mean that the money will ever be collected. The facility can appeal the the citation and fine, or find other ways to avoid paying. Plus, corporations that own and operate nursing homes at the highest levels (because there are often shell companies that are the “face” of each facility) are usually so flush with cash that a little fine is barely noticed.

Want to read the rest of the list? Check out the original article here: SmartMoney Magazine.

HensonFuerst is an avid supporter of nursing home residents and their families. Our lawyers have been involved in some groundbreaking litigation that have made residents safer, and we continue to work for the benefit of the “little guy” against corporations who abuse and neglect senior citizens. If you think your loved one is being abused in a nursing home and you don’t know what to do, contact HensonFuerst. If you have questions, we have answers.

There is a very moving story in the April issue of The Atlantic magazine, written by a man who found himself utterly unprepared for the aging and decline of his father. Like millions of middle-aged Americans, he had to find a way to cope with the crisis. This article strives to give a voice to this silent family struggle.

It really is a must-read… read the whole article here:  “Letting Go of My Father,” by Jonathan Rauch.

According to Erdman B. Palmore, a professor emeritus of gerontology at Duke University, “The way our society devalues older people could contribute to their neglect and abuse on some occasions.” One Alzheimer’s patient cried out for water before going to the hospital with dehydration. Another broke an eye socket when a wheelchair rolled down a ramp and crashed. A patient at a third nursing home died when workers adjusted a breathing tube. Two at yet another home weighed less than 80 pounds each. Those cases and more were drawn from a Tribune-Review analysis of state surveys conducted at 118 nursing homes in Western Pennsylvania over the past three years.

Click to read “Care for Elderly Lacking” by Andrew Conte and Mike Cronin