A surveyor observed a nurse had an abrasive tone that increased a resident’s agitation. The resident had requested that someone take him to the office in order to withdraw $40. The nurse told him that she was busy, but would take him in 10 minutes. In 8 minutes, the resident again requested to be assisted to the office, and the nurse used a forceful tone of voice in responding. The resident then raised his fist to the nurse, and a nurse aide intervened. The resident was then assisted to the office to withdraw his money. The same surveyor heard an unidentified aide state that “If he didn’t give his money away, he would not be broke.” The fact that this was reported by a surveyor and not a staff member indicates that the culture may allow for verbally abusive behaviors by the staff towards residents.
By ShirleyAnn Janulewicz RN, BSN, PHN
As a home health nurse, I believe that home health nurses should address the psychosocial needs of their patients, not just should see the patient, complete her assessment, perform the skills that were needed based on the plan of care, and then leave. All of those skills are necessary physical skills, but the patient is a whole person, and we need to treat the patient holistically, including addressing any routine psychosocial issues that the patient might be experiencing. A social worker would address a major psychological need and also assist with the application process for In Home Supportive Services, Meals on Wheels, and access transportation to assist them to get to appointments. However, at each and every visit, the home health nurse should address the routine psychosocial needs, such as verifying their status as important members of society despite their present illness, addressing their concerns that they were burdens to their caretakers, or just listening to them talk about their problems or concerns.
By: ShirleyAnn Janulewicz RN, BSN, PHN
When working in home health, personal safety should be first and foremost on your mind. Patients come from all socioeconomic backgrounds and live run-down homes in decaying sections of the city or in fancy homes in the affluent section of town. Home health workers must be totally focused and aware of their surroundings at all times.
It is a good idea for the home health agency to talk with the police servicing the areas its personnel will visit. The police know first-hand the safe and not-so-safe areas. They can identify those troubled areas that are safest to visit either with 2 coworkers, or possibly a police presence. They also should know what type of clothing is best to wear in the different areas. For example, in some areas a white lab coat is considered almost sacred, and a home health worker would be respected and watched out for. In other areas, the white-coat may represent an opportunity to obtain needles or medications that the worker may be carrying. Wearing a stethoscope around the neck signifies a health-care person, and again, an opportunity to obtain drugs or drug paraphernalia and medications. The key then is to dress nondescriptly in order to fit in with the neighborhood and not stand out.
By: Jeannine LeCompte
EpiPen manufacturer Mylan has been accused by the chairman of the Judiciary Committee, Senator Chuck Grassley, of deliberately overcharging Medicare and Medicaid by up to $1.27 billion through the use of incorrect classification of their auto-injector devices.
At the core of the scandal is the fact that, by law, pharmaceutical companies have to reimburse 13 percent of the total cost of a drug classed as “generic” when used by Medicaid or Medicare. Name brand drugs have to reimburse 23.1 percent of the total cost—and Mylan classified the EpiPen as generic for years even after being told repeatedly by the authorities that because it had no competitors, the product was not “generic.” EpiPens went from costing $57 in 2007 to costing around $600 in 2016, an indication of the profiteering which the product’s uniqueness could allow.
By: Jeannine LeCompte
An injury caused by a dropped ice cube in a Nebraska long-term care facility has highlighted the need for facilities to adhere to legal compliance guidelines. The incident occurred when a visitor—a granddaughter of one of the residents—slipped and fell in water located in the hall of the facility. It is believed that the water originated with a water pass during which ice cubes were dropped—and were not immediately cleaned up. This was not the first time there had been a water spillage of this nature in the facility, and the staff had failed on a number of previous occasions to address such lapses.
By: Jo Ann Halberstadter, Esq. and Jeannine LeCompte
New Jersey's existing "Safe Cam" hidden camera monitoring of private home healthcare givers is being expanded for use in nursing homes and other institutional care facilities, the state's Attorney General's Office has announced. Previously, New Jersey's "hidden-camera loan program" was only available to persons wishing to use the micro-surveillance equipment in private homes to keep an eye on the treatment given to their loved ones by visiting staff. Originally launched in December 2016, the program allows members of the public to borrow the mini-cameras-valued at $300 each-and then surreptitiously install the equipment to monitor healthcare staff.
By: David Barmak, Esq.
A recent news headline in Grand Rapids, Michigan announced that two care givers working in an assisted living facility would stand trial in the death of an 85-year-old Alzheimer's resident who was in their care. The natural response to such news is, what did they do or not do? In this case, an elderly woman was able to leave the facility in the middle of the night and wander away without being missed, and when she was found, she had died from exposure. One of the two aides was charged with providing misleading or inaccurate information on the resident's medical chart after the aide claimed the woman had been checked on during regular half-hour bed checks. The other aide initially lied about not hearing the door alarm go off and then later admitted she heard it when she was with another resident, but she did not check to see if anyone had left the facility; instead, she just reset the alarm. If convicted, the two aides could each face up to four years in prison and/or a $5,000 fine.
A resident spilled coffee on his lap and left the dining room to go change his pants. The nurse thought the coffee was cold so did not think there was an injury; however, the next day during the resident’s shower, the certified nursing assistant noticed a blister on his right hip that was raised and discolored. At the time of discovery of the blister, the physician was notified to obtain a treatment order for the blister.
By: Betty Frandsen and Jeannine LeCompte
A newly-developed nursing staff training program on catheter use has been shown to reduce urinary tract infections by more than half—a development which will dramatically reduce institutional liability and operating costs. Catheter-associated urinary tract infections (UTIs) in nursing home residents are a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. Currently, a catheter-associated UTI results in at least 20 percent of all nursing home residents being sent to the hospital for infections each year, costing the healthcare system $4 billion.
A second “whistleblower” lawsuit which alleges that one of the nation’s largest Medicare Advantage suppliers overcharged by millions, has raised fears that an April 2017 warning by Judiciary Committee Chairman Senator Charles Grassley about widespread “risk score fraud, waste, and abuse” in the system may be accurate even beyond his predictions.
All contributions are made by members of our interdisciplinary team, which is made up of various healthcare specialists, licensed nursing administrators, directors of nursing, former Deportment of Health surveyors, and lawyers.