However, on October 14, 2012, Mr. Relton finished his own meal and then took a cheese roll that belonged to another resident. He placed it in his mouth. A support worker at the home says that he took Mr. Relton out of the dining room and brought him into the lounge, this was done to ensure that Mr. Relton was unable to take any more food from other residents. Despite the fact that Mr. Relton did not appear to have anything in his mouth or appear to be in distress at the time, the support worker admits that he did not check whether Mr. Relton swallowed the cheese roll that he took a second ago.
Cases of negligence at assisted living centers have gone up considerably in the past years. While previously family members used to be at peace after leaving their loved ones at these facilities, today choosing such a caring home is not only a hard decision; it has also become a matter of life and death.
Hundreds of stories swamp national news every few days narrating horrific negligence cases at the hands of caregivers who are entrusted with the most vulnerable faction of people in our societies. What is more? After a wrongful death because of negligence, there is no one to take the blame. With court rulings and weekly trials, the death of a loved one becomes a blame game as the culprits seek refuge in flimsy claims and disregard the sheer importance of a human life- as crippled as it may have been.
Anyone who reads the horror stories that are sprinkled through out the country about care provided to patients in nursing homes has to ask himself or herself “What is wrong with these people?” How can any human being treat an aging or disabled person with so little compassion? Unfortunately, as these horrendous acts keep occurring in nursing homes, it is obvious that there are many facilities that have both administrations and staff that just do not have empathy for their residents.
Another Sad Story
Recently at a nursing home in Iowa, a 64-year old woman was allowed to die while her two daughters could only watch. Barbara Logsdon was a resident at the Golden Age Nursing and Rehabilitation Center in Centerville. Two of her daughters worked at the facility, which should have made her feel safe as well as put their minds at ease that they could keep an eye on her care. Unfortunately, in the end, there was nothing they could do except watch while their mother died. Barbara was supposed to have her airway cleared for mucus blockages regularly according to the medical records. When her daughter arrived at the facility on June 22nd, she found her mother in distress and alerted a nurse. The nurse dismissed the situation as she said she had other people to attend to. The second daughter then arrived and eventually they got a nurse to come and start clearing Barbara’s airway, but by then, it was too late. The nursing home was fined $8,000 for this basic omission. Stories like Barbara’s should be few and far apart but that just is not the case in the nursing home industry. There seems to be many facilities and staff members that have little compassion for their charges. Somewhere along the line, the human connection has been lost and these poor patients are treated with disregard and in some cases, even disdain.
Perhaps its because many of us have grown up associating mealtime with a sense of relaxation and enjoyment, there seems to be an overriding sense of complacency at many nursing homes when it comes feeding patients. Many facilities just dish out dispense the plastic trays of food without much regard to how– or if the meal actually gets eaten. This complacency with meal times in nursing homes is commonly responsible for situations such as malnourishment, dehydration or choking.
I began to consider the everyday complications associated with eating and drinking in nursing homes when I read about a New York Nursing Home that was sanctioned following the choking death of a patient at the facility. According to news reports, the New York Health Department issued an ‘immediate jeopardy’ sanction against Cunningham nursing home in Syracuse, NY after the agency conducted an investigation into the incident. While the specifics of the incident were not released, the conduct of the facility was obviously of concern enough for the agency to issue its most severe sanction.
Dietary Restrictions Based Upon Each Person’s Care Needs
Many patients in nursing homes have do-not-resuscitate (DNR) orders on file to keep staff aware of their end of life wishes. While such decisions are indeed quite personal and should be respected by the facility, my guess is that these DNR orders were intended to encompass situations where a patient was theoretically suffering from an illness or similar situation that was brought about the inherent aging process— as opposed to an injury inflicted by a staff member at a nursing home.
It is particularly disturbing when nursing home staff members take it upon themselves to make such a vital decision– whether or not to intervene– in the moments following an acute injury. The delay in providing medical attention for an acute decision is not only disingenuous, but frequently made for selfish reasons– mainly because it could theoretically conceal an erroneous or abusive act.
Recently filed lawsuit
A sizable contingent of the nursing home population has difficulty swallowing due to a variety of medical conditions including stroke, muscle weakness and Alzheimer’s. Diagnosing patients with swallowing problems is part of the nursing homes overall responsibility when it comes to patient care. While a series of sophisticated swallowing are now available to assist in the diagnosis of swallowing problems — such as an X-ray with a contrast material (barium X-ray) or A visual examination of your esophagus (endoscopy), most facilities rely upon an exam conducted by a physician or speech therapist with specific training regarding swallowing. After the patient has been assessed, the patient’s physician will assign restrictions based upon the patient’s abilities. A doctor will write an order for the type of diet– and food consistency that a patient requires: whole, chopped, pureed, liquid or even the use of a feeding tube in some cases. Just like any other order from a doctor in a patient’s chart, the nursing home staff are to adhere to the order until otherwise instructed. However, just as with any medical complication, nursing home staff need to be present to monitor patients and provide assistance when needed. Primarily when staff fail to abide by standing orders or when staff fail to monitor patients during meals, patients with swallowing problems are at risk for serious life threatening complications due to choking. I was reminded just how serious choking episodes in nursing homes can be when I read about how three nursing home patients in Connecticut nursing homes have choked to death over the course of the last three months! These terrifying incidents include:
- On April 29th, a developmentally disabled patient at Meridian Manor nursing home choked to death on ziti procured from a take-out restaurant that actually delivered the food directly to the patient’s room without any intervention from facility staff.
- On March 6th, an 82-year-old patient at Aurora Senior Living Center in Cromwell choked to death on marshmallows.
At their most basic level, fines imposed against nursing homes for negligent care of patients serve to both punish facilities for situations that may have developed in the past and to serve as a way of prodding facilities to improve the care they dispense— or else they will face similar sanctions again if the problems persist.
If all goes according to plan, facilities that receive a fine will stop, pause– and think about the type of care that they provide to patients because the fine imposed against them remains enough of a sting for the facility to improve its patient care.
The trouble that I continually see with the overwhelming number of monetary fines imposed against nursing homes is that the fines are rarely commensurate with the degree of inadequate care provided. Moreover, when the fines imposed against offending nursing homes are evaluated in the context of a facilities business operations, they amount to little more than the cost of doing business.
I’ve come to accept that the physical responsibilities placed upon nursing home staff are completely unrealistic. The desire of management and administrators to maximize the individual productivity of nursing home workers may appear to be an admirable proposition on paper— yet, fails when it comes to providing quality care for patients.
While an assembly line approach to staffing can yield increased productivity in an industrial setting, the technique is inappropriate in situations where— heaven forbid, more individualized care is required. While I regularly hear from nursing home staff how overwhelming their superiors expectations are of them, it frankly can be difficult to accurately quantify how such working conditions impact the patients.
A recent episode of blatant nursing home neglect, reported by WCCO in Minneapolis caught my attention, for both the tragic outcome of the situation, but also because a closer review of the circumstances highlights the dangers situations of under-staffing at nursing homes.
A recently-released Minnesota State Health Department report revealed new information about a questionable choking death in a Mahnomen nursing home. According to the report, 82-year-old Keith H. Johnson was a resident of the Mahnomen Health Center, when he was served a deadly meal of solid foods on Dec. 13, 2010. The decision to serve solid foods clearly violated Johnson’s doctor’s orders, which said he was only to eat pureed meals. Johnson, who suffered from Alzheimer’s, had a documented history of eating too fast and choking. Shortly after being served a sandwich, Johnson began to cough When two attempts at the Heimlich maneuver failed, Johnson was hospitalized, and died six days later from cardiac arrest.
“We regret the tragic incident that occurred,” said Mahnomen’s director of nursing, Rachel Tuenge, who declined to discuss specifics with reporters. “We investigated the incident fully on the day it happened, and made the necessary changes to our policies.”
A nurse who was involved with incident said she’d seen Johnson eating other types of food – namely cookies and bread – so she “thought that the resident could eat regular consistency food.”
Officials from the Illinois Department of Public Health have imposed a $2,200 fine against North Church Nursing & Rehab after the facility failed to properly supervise a patient at the facility at mealtime and the patient choked to death on her food. The State Journal-Register reported that the investigation into the choking death was triggered by the Morgan County Coroner who was conducting an examination of the patient’s body. Nearly two years before this incident, the same facility (then known as Golden Moments Senior Care Center) a similar incident occurred at the facility when a patient who was to be on a pureed food diet, choked to death on a pieces of ham that were intentionally cut for him by staff at the facility. That incident resulted in an original fine of $50,000 that was subsequently reduced to $32,500 after the facility appealed the sanction. My take: I can appreciate the different levels of facility culpability involved in the two choking incidents— and hence the significantly different fines imposed. Nonetheless, I find the similarities between these incidents occurring at the same facility within a relatively short period of time— to be extremely concerning. As a lawyer who has representing families in nursing home lawsuits involving patients who have choked on food, I seriously question why a facility should seemingly be let off the hook when they failed to learn their lessons just a short while before. If nursing home fines are going have their intended effect of improving patient care, I would hope that regulators look at episodes such at this, with a more critical eye— the second time around.
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