Chicago Nursing Home Abuse Attorney Blog

When hunting for a place to spend their retirements, people tend to look for a degree of luxury. Consider, for example, The Park at Vernon Hills, a retirement community featuring independent and assisted living. It's not a nursing home, but concerns are similar.

Among the amenities The Park advertises as part of its carefree resort-style senior living is "the largest residential rain forest in the world - larger than a football field and more than six stories tall! It is a beautiful site to behold, maintained at a constant 72 degrees and 50 percent humidity. Residents walk along the winding quarter-mile walking path and see the spa, pool, café and more than 5,000 trees and shrubs."

We have no reason to believe The Park is anything but a responsible, caring facility, but even the best can suffer from the unexpected, reminding us again of the importance of vigilance - and the law of unintended consequences. In this case, the unintended seems to be Legionnaire's Disease.

The disease has a mysterious history but is now generally tied to bacteria that can survive in warm, moist, air-conditioning systems of large buildings, including hospitals - and apparently in artificial rain forests. It is spread by inhaling water mist, not by direct contact between individuals.

The Lake County Health Department and the Illinois Department of Public Health are investigating five cases - including two resulting in death - of the disease at The Park. The departments say that, so far, the outbreak is limited to that community. They have targeted the rain forest atrium as a possible source of the bacteria.

The Park has also hired an independent contractor to investigate - and has shut down the rain forest.

"We're taking every precaution and doing everything we can," Jane Woloson, executive director at The Park told the Lake County News Sun.

Michael Kosner, President
The Kosner Firm Chtd.

You have a dog, and you love it. It's a gentle animal, and you're not concerned that it could become vicious. But you should be, especially during the holidays with their unusual tumult and people around who your pet isn't all that familiar with.

If your dog bites someone, the consequences can be severe - especially for your pet, but for you as well. You can be held responsible for emotional as well as physical damage.

The latest issue of Highland Park's monthly newsletter, the Highlander, offers hints for keeping your pet calm and out of danger during stressful holiday visits. We'd like to pass them along.

1) Place your dog in its crate with a bone or chew toy, at least during hectic times such as when holiday guests are arriving or leaving and during dinner preparation and serving.

2) Have an adult watch the dog for signs of stress and to protect it from unwanted attention from children. (The newsletter lists as signs of stress the dog yawning or licking its chops; showing the white part of its eye in a half moon shape; turning its head away, walking away or trying to hide under furniture; growling or raising the fur along its back; becoming still with its mouth closed, staring at a bothersome person and growling.)

3) Intervene if a dog shows any signs of stress when a child approaches or is petting it. The signs suggest the dog wants to be left alone, in which case return it to a crate in a separate room, away from guests.

4) Do not allow visiting children to hug dogs. Most dogs do not like hugs and kisses. Even if they tolerate them under normal circumstances, they may not tolerate them from strangers or in a high-stress situation with additional noise and people.

Michael Kosner, President
The Kosner Firm Chtd.

It's fall - perhaps the last gasp of outdoor fun for several months - and the kids are still playing football outside, skateboarding up and down the sidewalks and riding bikes all over the neighborhood.

Is your house the place all the neighborhood kids want to hang out, even when you're not home? Perhaps the kids are on your lawn or in your backyard because you have the best Tree House. But whatever the reason, remember that kids can get hurt. They're not accountable for knowing if it's safe to play on your premises. And if something happens, you could be liable.

The best way to handle potential premises liability is to prepare your property to minimize the possibility of accidents - to make sure your house is a safe house.

Is your backyard fenced in? It's been said that good fences make good neighbors and this is certainly a case in point. Make it difficult for children to get in.

Is your outside lighting on in the evenings? Lights can prevent people from tripping or otherwise getting hurt on your land.

Then there are temporary problems. Rakes left on the ground, partially hidden in a pile of leaves -- the kind that invite children to dive in - can lead to broken noses and other injuries.

There's a lot to think about when it comes to protecting your home and yourself, and each season brings its own dangers. Get through autumn and there's winter - when shoveling daily and salt on your driveways and walkways can help keep the people who visit your home safe.

Make things safe. It's a gift both to your neighbors and yourself.

Michael Kosner, President
The Kosner Firm Chtd.

There's a caution that goes with moving a loved one into a Nursing Home. It has to do with doctors. Often, you have to pick someone new to provide care.

This is because the caring individual who has been there for years and really knows the ins and outs of a patient's problems doesn't visit nursing homes. At the same time, the patient may have become too frail to visit the doctor; of course, that's one of the reasons the patient needs the level of care provided by a good facility.

Where do you look? You can start with the home. They have lists of doctors who visit there. But that's not the place to stop. Check out the choices so you don't decide without some independent information. You might start by talking with the families of other patients the doctor visits. And talk to the doctor.

This process is especially delicate since, when your loved one needs a home, it's likely that the medical situation is complex. Make sure the doctor understands what's going on.

Nursing homes supply families with a list of physicians who visit their facilities. Families might choose from the list knowing little about the doctors. Likewise, the doctors often take on medically complex patients they have never met.

Examples from the Chicago Tribune's recent articles about misuse of anti-psychotic drugs in nursing homes illustrate the problem.

One describes a 74-year-old woman who was not psychotic but was placed on an antipsychotic drug. It happened early this year at the Fondulac Rehabilitation and Health Care Center in East Peoria. A family member told state investigators that when she was admitted, she was assigned a doctor who had never taken care of her before. She had no history of mental illness, but on her second day in the home the doctor put her on medicine for "agitation." Three weeks later, she was dead.

The inspection report says a family member complained to the nursing staff about her reaction to the medication: that she was difficult to awaken, couldn't hold her head up and was slobbering. The family member added that the doctor canceled a meeting to discuss the matter. On the woman's 20th day in the home, a nurse wrote in her notes that the woman was "lethargic, extremely limp, eyes rolled back in head." The family called the next morning to complain again about the drug, and the director of nursing pulled the woman's file. But 25 minutes later, the director called the family back to tell her the woman had just died.

Said the nursing home, we were following the doctor's orders. The state cited the nursing facility for failing to "medically justify" the administration of the drug, but nothing happened to the doctor.

Several owners told the Tribune they struggle with doctors who rarely visit patients, and the fact that doctors can also cause problems for the nursing homes adds some credibility to their recommendations.

There is, by the way, another safeguard to consider: Nursing homes are required to have pharmacists visit regularly and review prescriptions. If they discover a problem, such as a patient placed on a drug without cause, they notify the nursing staff and doctor. They can't guarantee, however, that the doctor will act.

Indeed, doctors have disagreed with the inspectors, who often are nurses. The Tribune said many argue that their patients do better on psychotropic drugs than off. Others said families demanded the medications. Some said they were puzzled that inspectors would urge patients be taken off drugs that have eliminated unwanted symptoms.

Says the Tribune, "When inspectors at a facility in central Illinois in March reported finding a woman on an antidepressant who showed no signs of depression, they cited the home for not trying to reduce her medicine. Contacted by the inspectors, the doctor pointed to his medical expertise: 'How do you assess her for depression? She doesn't talk. She has lots of things wrong with her and lots of reasons for being depressed. It is my clinical judgment, all of that would make anyone depressed. I will not go by pharmacist recommendations."

Michael Kosner, President
The Kosner Firm Chtd.

The Chicago Tribune's recent articles on the use of mind-altering drugs used unnecessarily to treat nursing home patients reported that even when the homes are cited by regulators, doctors who prescribe the medications get away free. This is despite incidents where the doctors prescribed such psychotropic drugs and increased dosage apparently without regard for the patient's true condition.

The article cites examples taken from Illinois inspection records. In one 2008 case, a woman considered "moderately impaired" by Altzheimer's disease was placed by relatives in Heritage Manor of Mount Zion, a facility southeast of Decatur, Ill. When admitted, this grandmother scored 23 out of 30 on a mental exam. Nurses found her pleasant and talkative.

However, she had crying spells and tried to wander off. Though she was not psychotic, her doctor prescribed two antipsychotic drugs, and later doubled the dosage of one of the drugs at least four times. That put her above its recommended limit.

Her family called in a neurologist who found her to be glassy-eyed and "catatonic," scoring zero on the mental test. The neurologist urged that she be weaned off the drugs. She was and became aware and responsive.

The Tribune said state regulators cited the home in November 2008 for the misuse of psychotropic drugs. Nothing happened to the doctor - the person primarily responsible for her medications. The newspaper found this pattern repeated many times when it reviewed 40,000 state and federal inspection reports filed since 2001 on 742 Illinois nursing homes: homes cited for misusing psychotropics even though the patients' doctors were responsible. Facilities must administer prescribed drugs as long as the orders meet state and federal nursing home regulations.

The Tribune noted many cases of doctors prescribing powerful drugs without sufficient reason and in doses too high. Cases also showed doctors failed to follow-up appropriately. They are required to see nursing home patients only once every 60 days, though some don't turn up that often. Nurses, who may not be trained in the drugs, are stuck monitoring side effects.

Unfortunately, as a former regulator with the Illinois Department of Public Health told the paper, "There's no downside for the physicians" who order inappropriate psychotropics. "Physicians don't have any citations against them." The Department enforces nursing home regulations but cannot discipline doctors, other than by reporting alleged wrongdoing to the Illinois Department of Financial and Professional Regulation.

Individuals can make similar complaints to Financial and Professional Regulation, though the Department can take quite a bit of time to act.

Or family members can enlist the help of an attorney to keep doctors attentive and their loved ones safe.

Michael Kosner, President
The Kosner Firm Chtd.

It happens even at the best of Illinois' nursing homes: misuse of drugs used to treat mental illness. At least that's what reporters from the Chicago Tribune have found.

Looking back through regulatory records from the last eight years, Trib reporters found that half of homes rated four or five stars by the federal government have been cited for situations involving psychotropic drugs - medications that change the way people's brains work. And some of the violations involved injury and death.

This emphasizes how hard it is for potential nursing home residents and their families to evaluate their options; problems are everywhere.

Among the citations the Tribune reported was one in 2003 of Lake Forest Place, a five-star facility, for improperly using or monitoring psychotropic drugs given to six residents. One 95-year-old was given an antipsychotic drug though he had no psychotic symptoms. Three other residents reportedly received psychotropic drugs without justification or consent - and at least one man was given such a medication and sleeping pills in larger than recommended amounts. Inspectors wrote that his private caretaker after one such dosing tried to wake him and couldn't.

Hickory Nursing Pavilion, another five-star home, was cited because a resident had her dosage of a psychotropic doubled after she complained about people smoking on the bus taking her to an outside program. The Tribune said she told inspectors, "The doctor came to see me for one minute, then left. Next thing I know, he was increasing my medication."

Staffs ignorant of the dangers of these drugs were also reported. The paper said nurses at a four-star home near Peoria were unaware of a test that can check residents for tics and tremors, and staff at another four-star facility, a few miles away, knew of the test but not how to give it.

Deaths involving psychotropics included a woman who died at the four-star Wauconda HealthCare and Rehabilitation Centre after having trouble breathing for three hours after being given an anti-anxiety drug. While it was a regular medication for her, the staff failed to recognize the severity of her reaction that day.

Then there was a man on multiple psychotropics at the four-star P.A. Peterson Center for Health in Rockford. He became lethargic and then, when staff withheld the drugs for several days without informing the patient's doctor, he worsened and died. The report said the doctor, after learning the drugs were stopped, said they couldn't do that without throwing a patient into withdrawal. Cited, the facility unsuccessfully appealed and then agreed to train staff and change policies about contacting doctors.

The facilities, which retain top ratings, all explained that things happen.

However, the lesson is that when we choose a home, we need to consider a wide range of things. Though the star ratings of the moment may be accurate, it's worth looking further back and asking questions. If nothing else, it will tell the nursing home you're watching.

Michael Kosner, President
The Kosner Firm Chtd.