According to Medicare.gov, Oklahoma has 297 nursing homes. Of these skilled nursing facilities, 156 (52%) rank at or above the national average for their care. The remaining 141 (48%) nursing homes are ranked below average and much below average in the ratings allowed by Medicare and Medicaid federal and state regulators.
Many families use this information to find skilled nursing care in their local community before placing their loved one in a nursing home or rehabilitation center.
Many nursing home residents with Alzheimer's, dementia, and other cognitive issues require the highest memory loss care in nursing homes in Oklahoma. Other patients with mobility issues require around-the-clock assistance due to aging, paralysis, or other condition.
Unfortunately, mistreatment, neglect, and abuse among the disabled elderly still occur in nursing homes in Oklahoma. Numerous skilled nursing facilities fail to provide every resident's necessities, including medical care, shelter, water, food, and hygiene assistance.
The United States federal government and the state of Oklahoma routinely inspect every skilled nursing facility, assisted living community, hospital, independent living home, and rehabilitation Center providing nursing and hospice care. These inspectors can identify violations of established regulations, enforce compliance, and impose monetary fines.
Below is just a small sampling of the serious problems in skilled nursing homes in Oklahoma.
Failure to Protect Residents from Accident Hazards
If staff members in nursing homes fail to take appropriate action, the residents may be subject to risks and dangers which could lead to serious health issues, injuries, or even deaths, including:
- Failure to ensure the process for falls was in place to prevent recurring falls after a resident had recurring falls requiring two different hospital stays due to multiple rib fractures and a collapsed lung (pneumothorax). (Golden Oaks Village)
Failure to Report and Investigate Any Act or Reports of Abuse, Neglect, or Mistreatment
Anyone who sees or hears anything concerning allegations of mistreatment in skilled nursing homes must promptly investigate them. Failure to do so may result in serious consequences for the facility.
- Failure to ensure residents were free from physical abuse and neglect after a resident receiving assistance from a Certified Nursing Assistant when rising from a shower chair began leaning over, fell, and was sent to the emergency room for a fracture to the right femoral neck. (Cimmaron Nursing and Rehabilitation Center)
- Failure to ensure residents were free from verbal abuse led to an immediate jeopardy situation after a Certified Nursing Assistant had been verbally disrespectful to the residents. (Country Club Care Nursing and Rehabilitation Center)
- Failure to ensure agency staff was knowledgeable on the policy and procedures using mechanical whirlpool lifts resulted in immediate jeopardy when a resident fell from the lift, sustaining a head injury, fractured ribs, and a right femur fracture had expired in the hospital from a brain bleed. (Golden Oaks Village)
- Failure to ensure residents were free from mental abuse after a staff member photographed the resident following an incontinence episode and posted the photograph on social media. (Heritage Skilled Nursing and Rehabilitation)
- Failure to ensure a dependent resident was not transported and left at home alone, unable to care for himself. (Noble Health Care Center)
- Failure to protect residents from inappropriate touching by another patient. (Tuscany Village Nursing Center) (Epworth Villa Health Services, Oklahoma City, OK)
- Failure to protect patients from resident-to-resident altercations and notify proper authorities to prevent further altercations. (South Pointe Rehabilitation Center)
- Failure to ensure a resident was free from abuse after a resident reported an issue with the specific staff member making fun of another patient's speech. (Warr Acres Nursing Center)
Failure to Implement and Follow Infection Protection Protocols
Infectious diseases can spread easily through healthcare facilities and nursing homes if proper procedures aren't followed. If the nursing staff and workers don't follow appropriate safety precautions, they may risk exposing patients to dangerous bacteria and viruses. Some examples include:
- Failure to ensure staff used appropriate Personal Protective Equipment according to the Centers for Medicare and Medicaid Services (CMS) to prevent the spread of Covid-19. (Cimmaron Nursing and Rehabilitation Center)
- Failure to ensure cross-contamination did not occur during incontinent care after a Certified Nursing Assistant failed to clean the area and did not remove her gloves or wash her hands while providing incontinent care. (Forrest Manor Health and Nursing Center)
- Failure to ensure the resident was free from abuse. The administrator was observed holding the resident to the bed by their arms in an attempt to remove personal items from the patient's possession. (Forrest Manor Health and Nursing Care)
Failure to Ensure Residents Receive Proper Treatment to Prevent Bedsores
Nursing staff must adhere to strict protocol to avoid developing bed sore infections in Oklahoma nursing facilities.
- Failure to complete the assessment/weekly pressure ulcer assessment and provide physician-ordered pressure ulcer treatments for three residents who had staged and unstageable pressure ulcers. (Noble Health and Skilled Nursing Care Center)
Failure to Provide an Environment Free of Unnecessary Physical Restraints
Nursing homes cannot use a restraint without following established laws and regulations. When using a restraint without authorization, serious concerns may arise, including:
- Failure to ensure an assessment was completed to ensure a resident's bed/chair alarms were not restraints or did not cause agitation. (Forrest Manor Nursing Care Center)
- Failure to ensure residents were free from restraint after a resident who had fallen was observed in her wheelchair with a lap buddy positioned on the wheelchair without authorization. (Share Medical Care Center)
How Federal Regulations Protect Patients in Skilled Nursing Facilities from Physical and Chemical Restraints
State and federal laws regulate physical and chemical restraints in nursing homes in Oklahoma to protect patients. Historically, staff members have resorted to using physical and chemical restraints on residents without following proper federal guidelines, leading to devastating consequences.
Federal Regulations on Physical and Chemical Restraints in Skilled Nursing Facilities
The use of physical restraints (e.g., seat belts, bed rails) and chemical restraints (e.g., drugs used to control behavior) in nursing homes are regulated by the Centers for Medicare and Medicaid Services (CMS). under 42 CFR 488.430 - 488.432.
These regulations prohibit physical restraints in nursing care homes for the purpose of discipline or convenience and limit chemical restraints to cases where they are necessary to treat a medical condition and are authorized by a physician's order.
In addition, CMS requires skilled nursing facilities to have a policy for using physical and chemical restraints. This policy must be made available to all staff members, patients, and their families upon request.
Even with federal regulations, staff members will violate protocols and procedures and use unauthorized restraints to control patients. Some methods of restraint in nursing homes include:
- Oversedation: Staff members sometimes over-medicate unruly or restless residents as a matter of convenience to avoid dealing with their behavior. Overmedicating can lead to serious health problems for the resident and, in some cases, death.
- Restraint belts: Skilled nursing staff may use restraint belts to physically restrain residents attempting to leave their beds or chairs. These restraints can cause bruising, skin tears, and even blood clots.
- Side rails are often used to keep nursing home residents in their beds and can be very dangerous if the resident tries to get out of bed. If the resident falls out of bed while the side rails are up, they can seriously injure themselves.
- Room confinement: Staff may confine residents to their rooms as a restraint, especially if the resident is agitated or non-compliant. Confinement in a nursing center can lead to feelings of isolation and depression in the resident.
- Monitors: Nursing home staff may use monitors to track the movement of residents, especially those who are considered a flight risk. It can be very restrictive and cause anxiety in the resident.
- Seclusion: Staff may seclude residents in a room by themselves as a form of discipline or punishment in nursing homes. It can be extremely distressing for the resident and may lead to psychological problems.
- Chemicals: Skilled nursing staff may use chemical restraints such as sedatives or antipsychotic drugs to control the behavior of residents. These drugs can have serious side effects and should only be used as a last resort.
- Physical force: Staff members may use physical force to restrain residents who are being violent or destructive. It can include holding down residents, using straps or handcuffs, or forcing them into seclusion rooms.
- Isolation: Staff members may isolate residents from other people to control them. It can lead to feelings of loneliness and isolation in the resident.
- Food deprivation: Skilled nursing facility staff may withhold food from residents as a way of controlling their behavior It can lead to malnourishment and other health problems for the patient.
- Bed rest: Staff members may require residents to stay in bed for long periods of time as a form of restraint. It can lead to boredom and frustration for the resident and may cause them to become less mobile over time.
- Verbal abuse: Skilled nursing staff members may verbally abuse residents to control them, which can be very damaging to the resident's mental health.
These regulations help protect patients in skilled nursing facilities by ensuring that physical and chemical restraints are only used when necessary and that all staff members are aware of the facility's policy on their use.
In addition, these regulations help to ensure that patients and their families are informed about the use of physical and chemical restraints in the facility.
The Importance of Monitoring Aggressive Patients in Skilled Nursing Facilities
Patients in skilled nursing facilities are among the most vulnerable members of our society and are often elderly, suffering from dementia or other cognitive impairments, and reliant on staff for their care. As a result, skilled nursing staff must be trained to handle aggressive patients to avoid altercations between residents and also violence against staff.
Skilled nursing staff can use several strategies to avoid or diffuse aggressive behavior from patients after identifying what triggers the aggression. Is the patient angry or frustrated because they can't communicate what they need? Once the trigger is identified, staff can work to address the underlying issue.
Medication may sometimes be necessary to manage a patient's aggression. However, it's important to note that many medications have side effects that can further impair a patient's cognitive function. As such, medication should only be used as a last resort after all other options have been exhausted.
Many nursing homes in Oklahoma failed to develop effective policies to control aggressive behavior among residents and staff members. Some of those failures include:
- Failing to supervise: Many cognitively impaired residents have violent behavior patterns that can lead to severe injuries if the staff fails to monitor them.
- Allowing patients to wander off the premises puts them at risk for physical harm and dehydration.
- Not providing adequate food or hydration can lead to malnutrition and dehydration.
- Not providing proper medical care can result in untreated infections, bed sores, and other health complications.
- Failing to provide appropriate assistance with activities of daily living in a nursing home can result in residents becoming injured or ill.
- Allowing residents to use unsafe equipment or furniture can lead to falls and other serious injuries.
- Ignoring resident complaints of pain can delay necessary treatment and lead to worsening conditions.
- Failing to properly clean and sanitize living areas and medical equipment can lead to the spread of infection.
- Allowing unsupervised access to prescription drugs and other medications can lead to abuse and overdose.
- Releasing residents before they are medically cleared can lead to serious health complications and death.
- Physical abuse, verbal abuse, and emotional neglect can have long-lasting negative effects on residents' mental health.
- Financial exploitation can leave residents penniless and vulnerable to further abuse.
Implementing Infection Prevention and Control Protocols in Nursing Staff
Nursing staff must take infection control seriously to prevent the spread of diseases and implement an infection prevention and control protocol. By taking this step, nursing staff can help ensure that they protect their patients from potential harm.
Infection prevention and control protocols are a set of guidelines that nursing staff can follow to ensure that they are preventing the spread of infection. These protocols can help to ensure that nurses are using proper hygiene practices, wearing protective clothing, and disposing of contaminated materials properly.
By following these protocols, nursing staff can help to protect their patients from potential harm. Contributing factors that lead to the spread of infection in a skilled nursing facility include:
- Failing to use Personal Protective Equipment: Not wearing gowns and gloves when providing care to patients in isolation due to communicable diseases or Covid-19 can spread the infection among patients, staff members, visitors, and employees.
- Failing to Disinfect High-Touch Surfaces: Germs can live on surfaces for hours or days, so it's important to disinfect frequently touched areas such as door knobs, light switches, bed rails, and call buttons.
- Allowing Unauthorized Visitors: Visitors who are not authorized can bring in germs and increase the risk of infection spreading.
- Poor Hand Hygiene: Not washing hands often enough or properly can lead to the spread of infection.
- Not Cleaning Patient Rooms Properly: Leaving blood or other bodily fluids on the floor, furniture, or bedding can create an environment where bacteria can thrive and infect other patients.
- Staff shortages: Not having enough staff on duty means that there may not be enough people to properly clean patient rooms and equipment, which can lead to the spread of infection.
- Poor Infection Control Practices: Failing to follow proper procedures for handling infectious materials can spread infection.
- Allowing Pets in Patient Areas: Pets can carry germs; if allowed in patient areas, they can easily spread the infection to vulnerable patients.
- Allowing Food in Patient Areas: Bringing food into patient areas increases the risk of contamination and can spread infection.
- Not Disposing of Linen Properly: Dirty linen not disposed of properly can create an environment where bacteria can grow and infect other patients.
- Failing to Test Water Samples Regularly: If water isn't properly tested and treated, it can become a breeding ground for bacteria that can cause infection outbreaks.
- Failing to Train Staff Members Appropriately: Staff members who aren't properly trained in handling infectious materials are more likely to cause an infection outbreak.
Resources:
Skilled nursing homes in Oklahoma that accept Medicare funding:
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