Monthly Archives: July 2016

Nursing Homes Find a Way to Reduce Falls

Good news, but . . . Is this really news? Nursing homes have found a better way to reduce falls.

An AP article reports that nursing homes are moving away from physical items such as alarms, rails and mats to reduce falls and instead focusing on personal assistance. “What we really need to do is understand why that individual is wanting to get up in the first place,” said Joan Devine, director of education at the Pioneer Network, which is pushing for national changes.

This trend is good news, but I’m sorry everybody knows that when a sick elders gets out of bed they need to do something. Many of my clients in nursing homes have falls in the middle of the night. They are often trying to go to the bathroom rather than wait hours before an aide is scheduled to take the resident to the bathroom.

Knowing what the resident wants or needs is an oft repeated guide to good care for any condition. For example many difficult behaviors of advanced Alzheimer’s patients are attempts at communicating or doing some familiar activity. E.g. pacing is looking for something, acting out is a reaction to pain or a negative stimulus, and so on.

The immediate moral is for the patient advocate to be sure that the staff learns what a resident needs or is communicating and educate staff about those items, then be sure to monitor that care.

A broader lesson may be extended to home care. Falls happen for a reason. What is the person trying to do and how can we make that safer? Falls at night? Maybe wall rails in the bedroom and a clear path to the bathroom would make a big difference.  Maybe having an aide in the evening adjust fluids, e.g. avoiding caffeine, or diet will make a big difference. Some elders drink juice late at night because they are hungry and that gives them temporary relief from hunger but will create the need to toilet later.

Learning a person’s needs and giving needed personal attention makes for a healthier elder. “Who’da thunk it?”

Read the article here:

“20 Common Nursing Home Problems – and How To Resolve Them”

I would like to share a simply EXCELLENT guide for good care in a nursing home. It is “20 Common Nursing Home Problems – and How To Resolve Them” by one of the nations’s premiere legal advocates for nursing home residents, Eric Carlson. It is free and available through

Being a lawyer I cannot give a blanket recommendation but must, as does the 20 Common Guide, advise you to use your judgment and seek professional counsel if the Guide seems to steer you on a dangerous or futile path.   The Guide is only a guide. You must use your judgment.

Here are my comment on some on some of the points.

Some few points envision an ideal nursing home

Number 3 says the nursing home must accommodate a resident’s preferences and gives an example of everybody being awakened at 6 a.m. The explanation offered is inadequate staffing. So, If the resident does not want to be gotten out of bed at 6 a.m. the patient advocate may find the resident still in bed hours later because the aides are now taking care of other patients. The Guide suggests the patient advocate come up with an alternate plan for “sleeping in” and getting dressed and breakfast after other residents.

Number 4 points out that the law says each nursing home must provide care to enable the resident to reach “the highest practicable level of functioning.” Most patient advocates would find these words are other worldly goals that may not be met on this earth. Under-staffing is a chronic problem in nursing homes.

You must use your judgment on patient care

Number 5 deals with improper use of physical restraints and notes their use has decreased dramatically in the past decades. Everybody agrees that is good.  And I have observed that it seems like all nursing home residents are put in wheel chairs.  Could some walk with walkers? Are they in wheelchairs because they are easier to manage and there is less fall risk?  The answers depend on the particular case.  However, I must add falls are extremely dangerous for the sick elderly. They can lead to death through complications from surgery or hospital stays.

Number 5 gives bed rails as an example of a physical restraint. These rails prevent residents from falling out of bed. The Guide suggest that a bed can be lowered to the floor and a pad on the floor. This will take care of falls out of the bed. But they do not address the problem of the resident who gets out of bed and then falls when trying to walk.

Some seem out of date.

Number 11 cites refusal to bill Medicare. Medicare has changed. Gone are the days when the patient’s doctor wrote a prescription and it was followed. Now Medicare controls the provider.  The doctor does not. The provider must be able to put every service into a proper billing code while fearing charges of Medicare fraud if the billing is denied. Patients are offered a “rubber stamp” appeal system where KPRO, the Medicare “QIO,” denies almost all appeals.  Billing Medicare does not produce the results it used to just 10 years ago.

Some address non-problems.

Number 8 says a nursing home may not impose visiting hours. I have not heard from clients that nursing homes had visiting hours.

Number 17 says the nursing home may not charge residents extra for medical care. In today’s medical environment the issue of co-pays and deductibles, prescription formularies and limitations on coverage is well known. If an item is not paid it is usually a matter of insurance.

Number 18 says the nursing home must support resident and family councils. This may have been a big issue when nursing homes were homes for the frail elderly. Now these residents are in assisted lving apartments, not nursing homes. The nursing homes are taking care of a much sicker population now.

Some guide the resident into futile battles

Number 14 offers very useful advice about dealing with the problem of the alleged “short term stay” facility explanation. That is, after post-hospital skilled care ends, e.g. rehab, the nursing home tells the resident they have to move because they are now “long term care.” That is untrue because all “nursing homes” are long term care facilities by virtue of their licensing.
However, the Guide sends a patient advocate into futile court battles when it advises that a nursing home can get a bed certified by Medicaid for the resident. Michigan restricts the number of Medicaid beds it approves. One local attorney took a well financed nursing home to court on the issue and lost.

Number 20 advises that a resident may refuse medical treatment. It is all to often true that the guide for medication in a nursing home is administrative convenience. However, the patient advocate may find it impossible to be consulted on each medication change before it happens. Some have waited all day to see a doctor to explain a change, only to have the nursing home doctor never show up.
Nevertheless, a patient advocate must advocate for good care and sometimes that means moving the resident out of a sub-standard nursing home.

In closing,

Believe me, the above comments do not take away the immense value the Guide offers to Patient Advocates. If you have somebody in a nursing home, get it now. You will not regret it and you will find you will be sharing it as am I.