California Nursing Home Abuse Lawyer Blog

Study Finds that Regular Exercise and A Hazard Free Environment Reduces the Risk of Falls in Nursing Homes

September 17, 2011 | by Yeroushalmi Law

One of the most serious health risks facing the elderly today are fall related injuries. The National Safety Council estimates that people over the age of 65 have the highest death rate from fall related injuries. In a recent research article entitled “Effectiveness of Intervention Programs in Preventing Falls: A Systematic Review of Recent 10 Years and Meta-Analysis”(available on Pubmed), the authors attempted to derive scientific evidence of the effectiveness of newly developed intervention programs and to make recommendations to health care providers on the subject of fall prevention. According to the meta-sensitivity analysis used in the study, the results revealed that randomized controlled trials of fall-prevention programs conducted within 2000-2009 are effective in overall reduction of fall rates of 9%, with a reduction of fall rates of 10% in multifactorial interventions, and 9% in community settings.

The study suggests that besides implementing intervention programs to prevent falls by the elderly, health care providers can also help reduce the rate of falling by taking various preventative measures. For instance, the care providers can identify individual’s risk factors for falls. Further, the health service providers can implement intervention programs and physical activity focusing on lower-extremity balance and strengthening. They should also beware of psychological factors such as fear of falling and classify injuries which have occurred based on the International Classification of Diseases. The study reveals that nursing homes can actually contribute in fall prevention by taking effective measures for their residents.

Indeed, nursing facilities in San Francisco and San Mateo can help reduce fall rates by removing environmental hazards and taking other proactive measures such as installing lights in bathrooms and corridors as well as avoiding wet and slippery floors. The best way to prevent a fall, according to our experience, is to answer a resident’s call light when the resident signals for help, so that the resident does not attempt to get up unassisted. Prompt response to call lights, of course, requires an adequately staffed facility.

Furthermore, by creating a safer environment, the risk of falls is greatly reduced. In addition to the environmental aspect, there should also be adequate nursing staff in the nursing home to supervise residents and assist them with daily activities and exercise, which can strengthen their muscles and reduce the risk of falls. Simple physical activities such as walking around the common areas and stretching can strengthen muscles and improve the balance of residents, thus lowering the risk of falling. Moreover, some residents who experienced a fall before may become less active since they are lacking in confidence and fear falling again. The nursing staff and their families should show support and encourage them to do some easy exercises in order to avoid this fear mentality.

The Occurrence of Falls in Nursing Homes Can be Reduced With Proper Training, Sufficient Staff, and a Safe Environment

September 16, 2011 | by Yeroushalmi Law

A recent study published by the Journal of the American Medical Directors Association on fall rates in Bavarian nursing homes provides helpful insight on preventing falls in Los Angeles Nursing Homes. The study showed, for example, that the fall rate of men was higher than that of women (2.18 and 1.49 falls per person-year respectively). Most falls occurred between 10am to 12pm and 2pm to 8pm. 75% of all falls occurred in the residents’ rooms and bathrooms while 22% were observed in common areas. Among all falls, 41% occurred during a transfer and 46% occurred while walking. Residents with less functional limitations have a higher fall rate at night, in the residents’ rooms and while walking. On the other hand, residents who have more functional limitations and need more care have higher falls during the day, in the common area and when being transferred.

Several important conclusions may be drawn from this study, which can assist the public in not only choosing a proper nursing home, but also in properly supervising the care of their loved ones once they are placed in a nursing home. First, residents who need a higher level of care have a greater risk of falling in the common areas since they are brought to the common areas without sufficient nursing staff to supervise and look after their activities. Second, the high fall rate during a transfer highlights the need for professional staff trained and experienced in taking care of residents and particularly trained in assisting with transfers. Third, most of the falls happened in residents’ rooms and bathrooms, which reveals the nursing homes studied were not equipped sufficiently and failed to provide a safe environment to their residents. All these issues reveal the problems plaguing nursing homes despite their legal responsibility to create a safe environment free of hazards and to prevent accidents.

In order to prevent falls, nursing homes must provide adequate staffing. In the state of California, nursing homes are required to provide a minimum of 3.2 nursing hours per patient, per day. Sufficient staffing is essential so that the residents can receive help and care instantly. The nurses also need to communicate efficiently and effectively during shift changes so as to ensure that residents are not neglected. Further, nursing homes should provide professional and well-trained nurses to their residents. Nurses should receive specific training on subjects such as assisting with a transfer and fall prevention. A skillful and experienced nursing staff that is provided with the necessary resources and training could definitely help reduce fall rates in nursing homes. In addition to the nursing staff, the nursing homes’ owner should also improve the physical plant by adding sufficient handrails and skid-proof mats to prevent the risk of falling, and ridding the facility of unnecessary safety hazards.

Basic Organizational Changes Lead to Greater Quality of Care in Nursing Homes, Study Finds

September 15, 2011 | by Yeroushalmi Law

Although understaffing is a common denominator of most injuries sustained by residents of California nursing homes, the issue of staffing is equally one of quality as it is quantity. Labor costs naturally comprise the most significant portion of a nursing home’s expenses. But both sufficient and qualified staffing are the essential components of a safe nursing home environment that not only prevents injuries to its residents, but actually improves their quality of life.

Often times, nursing home owners and operators make the unfortunate decision to place profits over people by cutting staffing and not providing sufficient qualified staff in order to increase their bottom line. Although much has and can be written about that issue, a recent study suggests other significant interventions that can improve the quality of care without significantly increasing staffing or costs of care.

Recently, the Journal of the American Medical Directors Association conducted a comprehensive, multi-level intervention in twenty nine Missouri nursing homes in need of improving quality of care and resident outcomes. The results of the two year study, published in August 2011, revealed that skilled nursing facilities can improve the quality of care they provide and enhance the health and safety of their residents without increasing staffing or costs of care. The study, entitled “Randomized Multilevel Intervention to Improve Outcomes of Nursing Homes in Need of Improvement”, is available for purchase online.

The 29 intervention facilities underwent a 2-year multilevel intervention with monthly on-site intervention from expert nurses with graduate education in gerontological nursing. Although shorter intervals are appropriate, a two year period was chosen to ensure that both the administrative and nursing staff could adopt and maintain the improved care-delivery practices implemented by the study. The theoretical model for the multilevel intervention was “getting the basics of care done”, with organizational changes such as consistent nursing leadership, consistent administrative leadership, and an active quality improvement program. The intervention targeted three levels of staff responsible for operating a nursing home: owners, administrative staff, and direct care staff.

The study found that resident outcomes improved through the interventions, particularly in the areas of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in ADL. One of the study’s findings was that staff retention improved in the intervention facilities (as opposed to the control facilities) as the leadership learned to involve staff in decision making and improvement programs. This was significant, given the consensus that direct care staff and administrator turnover is associated with a negative effect on quality of care. The results were encouraging, as the intervention did improve the quality of care in the areas of pressure ulcers and weight loss.

From a legal standpoint, implementing the findings of this study would serve the nursing home owners’ and operators’ best interests as well, as nursing homes are required to take all steps necessary to improve the quality of care by setting up an administrative system designed to improve quality of care. Specifically, Title 42 of the Code of Federal Regulations, Subpart B, section 483.75, entitled “Administration” mandates: “A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”

Essentially, the study finds that developing a greater and consistent management team dedicated to involving direct care givers in decision making and improvement programs can lead to greater quality of care. This is consistent with the findings linking high staff turnover with low quality of care levels. Most nurses are by nature dedicated to providing the best care they can to their patients, but they must be equipped with the tools and resources necessary to do so.

Recent Study Finds Job Satisfaction Increases Quality of Nursing Care

September 14, 2011 | by Yeroushalmi Law

Over the past three decades, the importance of registered nurse (“RN”) job satisfaction has been significantly highlighted, as job dissatisfaction leads to higher turnover rates and a decrease of RN’s in the workforce. A shortage of RNs in California and particularly in San Diego nursing homes, have resulted in not only lower RN-to-resident ratios and thus unmanageable workloads, but also a decrease in the quality of nursing care. Resolving the RN shortage problem and facilitating RN job satisfaction is essential to maintaining the quality of care to which elderly residents of nursing homes are entitled.

A recent article published on August 4, 2011 by JiSun Choi, Linda Flynn and Linda H. Aiken entitled Nursing Practice Environment and Registered Nurses’ Job Satisfaction in Nursing Homes addresses the issue of nursing adequacy as an essential contributing factor to quality of nursing care. The article concludes that, to increase the quality of nursing care, an adequate nursing workforce should be guaranteed by enhancing and maintaining RN job satisfaction. The article identifies a variety of factors contributing to RN job satisfaction, such as work-related, demographic, and facility characteristics. The article concludes that best method to increasing RN job satisfaction is the construction of a supportive nursing practice environment in nursing homes.

The first factor to constructing a supportive nursing practice environment is enhancing RN’s participation in facility affairs, in which nurses are able to get involved in making decisions on clinical and facility-level matters. Therefore, in order to improve the RN’s job satisfaction, nursing home administrators are encouraged to implement a self-governance model for their nurses, such as enabling nurses to develop their own schedules and assignments, making hiring decisions, and contributing to enhancing nursing home policies.

The second factor the article addressed is empowering a supportive manager. Managers of nursing homes can play a significant role in promoting job satisfaction and are urged to facilitate a supportive environment for practicing nursing care, promoting RN teamwork and enhancing RN’s self-recognition.

The last factor associated with RN job satisfaction is providing adequate resources for RNs. RNs are more satisfied with their jobs when there’s adequate staff to accomplish their work with a high level of quality. Implementing this recommendation allows nursing homes to fall in line with federal requirements related to nursing services. In particular, Title 42 of the Code of Federal Regulations, Subpart B, section 483.30, entitled “Nursing Services” specifically mandates: “The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.”

In fact, the Code of Federal Regulations go even further in that respect by mandating a minimum number of hours that RN’s must be on duty per week. 42 CFR § 483.30(b), entitled “Registered Nurse” mandates: “(1) Except when waived under paragraph (c) or (d) of this section, the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week.”

The issue of RN’s job satisfaction is closely associated with the quality of care that RNs are willing and able to provide. Maintaining and enhancing job satisfaction for RNs can significantly decrease the possibility of instances of elder abuse in San Diego nursing homes and in nursing homes throughout California.

Cognitively Impaired Patients Require Comprehensive Assessment and Specifically Tailored Rehabilitation Programs

September 13, 2011 | by Yeroushalmi Law

Often times, what begins as an estimated two week visit to a Skilled Nursing Facility for rehabilitative services after a serious injury or surgery turns into an extended stay. Post-injury patients with cognitive disabilities face the greatest risk for lengthy stays at nursing homes. According to a recent study, specifically tailored rehabilitation programs play a crucial role in the post injury recovery of such patients.

According to an article published in the July 2011 edition of the Journal of the American Medical Directors Association efforts towards research in rehabilitating cognitively impaired elders are minimal, despite the rise in the elderly popultion.

The report investigates the differences in functional recovery for cognitively impaired patients and cognitively unimpaired patients. The article, entitled “Postacute Rehabilitation in Cognitively Impaired Patients: Comprehensive Assessment and Tailored Interventions,” is available for purchase online. The authors, Francesco Landi MD, PhD, Rosa Liperoti MD, MPH and Roberto Barnabei MD, highlight the crucial role that tailored rehabilitation programs play in aiding those with cognitive disabilities as they recover from acute injuries.

Malnutrition In Nursing Homes Is Easily Preventable, According to Recent Study

September 9, 2011 | by Yeroushalmi Law

As of late, our nation has concerned itself with the widespread nature of obesity; however, this has resulted in inadequate attention to the problem of malnutrition or under-nutrition. Unfortunately, protein under-nutrition and malnutrition is regularly plaguing elderly residents of nursing facilities in California. A recent article by John E. Morley MB, BCh’s entitled “Undernutrition: A Major Problem in Nursing Homes,” in the May 2011 issue of Journal of the American Medical Directors Association, addresses this often neglected issue, describing in detail the various causes of and solutions to under-nutrition.

According to Morley, for every form of malnutrition, there are proven steps that nursing homes can take toward countering such grave and life threatening injuries. For example, Anorexia, as a form of under-nutrition, causes elderly individuals to be more susceptible to losing weight when illness strikes. Morley found that by improving food quality and environments, nursing homes can help prevent depression, which is a major cause of this form of weight loss. Cachexia can also result from anorexia, but exercise, creatine, and vitamin D can aid in the fight against this form of malnutrition. Additionally, poor cognition can arise from under-nutrition, but a well balanced diet can easily combat this tendency.

Morley’s research indicates that nursing homes have the solutions for further under- nutrition deficiencies, including low Vitamin D, Vitamin B12, and zinc levels, as well as dehydration. To increase Vitamin D levels, nursing homes simply need to ensure that their residents are exposed to more sunlight. For those with Vitamin B12 deficiencies, basic injections or inhalations of Vitamin B12 can bring their levels to a healthy state. Zinc replacement is the proven method for treating patients with low zinc levels. Finally, dehydration is common for elderly people because they do not know when they are thirsty, but nurses making “fluid rounds” consistently can make sure that patients are staying hydrated.