Chicago Nursing Home Abuse Attorney Blog

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.

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.

A public meeting earlier this week took a hard look at the practice of putting younger adults with mental illnesses in Illinois nursing homes. Members of Gov. Pat Quinn's Nursing Home Task Force spent four hours listening to social workers, nursing home residents and advocates demanding that the practice stop. These undesirable residents allegedly include felons who police say assaulted, raped and even killed elderly and disabled housemates.

"A nursing home is not the place to test the rehabilitation of violent offenders. It is not the place to see if the fox can live peacefully in the henhouse," said Jamie Jimenez, an advocate with the Community Counseling Centers of Chicago, quoted in an article in the Chicago Tribune.
As well they should be, the governor's representatives were also upset by the violence in the state's facilities. "We have a situation that is not acceptable to us," said task force chairman Michael Gelder, Quinn's senior health policy adviser. He described the hearing as "a call for action," that call coming in the form of questions about, and criticism of, Illinois' long-term pattern of putting criminals with mental illness with the elderly and disabled. The shuffling of younger residents into nursing homes from jails, shelters and psychiatric facilities has put a definite strain on that industry and fails both the psychaitric patients and other nursing home patients.

"We are in crisis now," said Phyllis Mitzen, co-director of the Center for Long-Term Care Reform. "We find ourselves ... with a need to change the entire long-term care system."

Mark Heyrman, a board member of Mental Health America of Illinois, noted that psychiatric patients often receive substandard treatment in nursing homes and could be more cheaply and effectively housed in community mental health centers and assisted living arrangements. "Our long-term plan has to be to stop institutionalizing people in nursing homes who are only there because of a mental illness," he said.

The Tribune says Illinois nursing homes currently house about 15,000 people whose primary diagnosis is a mental illness, and one speaker estimated two-thirds of them could be in less institutional settings within five years if the state budgets for community rather than institutional care. Anthony Zipple of Thresholds mental health centers said Illinois has two pilot programs, though small ones "relative to need," that seek to move hundreds of mentally ill people out of nursing homes.

State law requires criminal background checks (and assessments of risk to other residents if felonies are found) of all incoming nursing home residents. However, a Tribune investigation said those screenings were inaccurate and often took longer than a year.

Other speakers called the current process farcical, and noted that nursing homes don't always report crimes that take place to the police. Moreover, police reports are generally not shared with state inspectors. They called for closer cooperation between the state and local law enforcement and prompt removal of licenses from homes with continuing patient-safety issues.

The task force will hold its next meeting next week (Oct. 29) in Springfield. We can only hope the state moves quickly to correct the kinds of conditions that led another speaker at last week's meeting to report he had been stabbed by the same person in two different nursing homes. In the meantime, be ready to question a home's policies in this area (Who do you let in?). It can keep your loved ones safer.

And if you have comments or recommendations, check out the task force's web site.

Michael Kosner, President
The Kosner Firm Chtd.

Can you expect your loved ones to get better care when you put them in a for-profit nursing home or in a not-for profit home? Intuitively, given the competitive market place, you'd expect for-profits to do a better job for your money, but a recent study of homes in the United States and Canada, done by a group of mostly Canadian doctors and published in the British Medical Journal, suggests the not-for-profits provide higher quality of care.

The study cautions, however, that it is an overview and many factors may influence quality in the case of individual institutions.

The paper's 11 authors reviewed 8827 studies that had been done of the quality of care in for-profit versus not-for-profit nursing homes between 1965 and 2003. Of these, they decided 956 should be reviewed fully and they selected 82 articles to be included in their results.

The authors looked most closely at results for the four most frequently reported quality measures and found that in 40 of the articles, all significant comparisons favored not-for-profit facilities. In three, all comparisons favored for-profits, and the rest were less consistent.

Analyzing the combined results for the articles suggested not-for-profits delivered higher quality care in the categories of more or higher quality staffing and lower incidence of bed sores. The other two quality measures - physical restraint use and problems with government inspections - tended to favor not-for-profits but not by statistically significant amounts.

The study's authors noted that nursing homes, whether for-profit or not-for-profit, vary substantially in their management styles, motivations and organizational behavior, and their study, they said, is not a blanket judgment of all institutions. "Some for-profit institutions may provide excellent quality care, whereas some not-for-profit institutions may provide inferior quality care," they wrote.

Of course, such an analysis is only a broad background factor when we're looking for a home for our loved ones. However, the findings do remind us that the amount a home costs is not a guarantee of quality, and we do have to look closely at a lot of factors if we want a good result.

Michael Kosner, President
The Kosner Firm Chtd.

Each state inspects its nursing homes to make sure they comply with state and local laws. In Illinois, each home is inspected, on average, once a year. But once the inspection is made, what happens to the results? One thing we know, they are not sent automatically to the residents or the families of residents at a home.

MemberoftheFamily.net puts it this way: "Federal Regulations do not require State inspectors or the nursing home to notify patients and their families that a particular patient's care has been the subject of a survey violation. Even a finding of substandard care or actual harm does not require notification."

Illinois law doesn't require such notification, either.

Here's part of what the Illinois Department of Public Health says about the inspection process: "The Illinois Department of Public Health is responsible for ensuring nursing homes comply fully with mandatory state regulations. (U)nder a cooperative agreement with U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS), (IDPH) is also responsible for ensuring that facilities accepting Medicare and Medicaid payment for services rendered to program beneficiaries meet federal regulations and certification rules. Each year, (IDPH) conducts approximately 1,300 full, on-site licensure inspections of nursing homes and responds to approximately 6,000 complaints."

By the way, if you want to file a complaint about an Illinois nursing home, you can call the IDPH toll-free hotline at 1-800-252-4343.

IDPH notes that licensure inspections evaluate the fitness and adequacy of a nursing home, its equipment, staff, policies, procedures and finances. Illinois has some 200 surveyors employed in teams that each consist of a registered nurse, a nutritionist and an environmental health practitioner. These experts may be joined by life safety code experts and other professionals.

Complaint surveys are conducted by experts in the areas involved in charges lodged.

IDPH notes, "Illinois' licensure surveys are generally conducted on-site over a three- to four-day period during which the ... teams evaluate all aspects of resident care and nursing home procedures and practices, assessing facility compliance with more than 1,500 specific state and federal standards. (Some areas of care reviewed include resident rights, access to care, activities, assessment and care plans, health care and dietary services, housekeeping, staffing, quality of care and quality assurance.)

"The Department's evaluation may include an inspection of medical records, observation of resident care, inspection of all areas of the nursing home and interviews of residents, family members, staff or other individuals. (IDPH) also may (analyze) statistical data reported by nursing homes or (review) reportable event information or other notices filed with IDPH. Reportable events include administrator or director of nursing personnel changes; interruptions of three or more hours of services essential to the health and safety of residents; alleged or suspected crimes investigated at the facility by police; and all fires, disasters, deaths or other risks to resident life or health resulting form accidents or incidents at the facility. ...

"Nursing homes are inspected at least once every six to 15 months. The state average is once every 12 months."

Facilities are not told in advance about inspections.

IDPH shares its findings with nursing home administrative staff in an exit interview at the end of each inspection. The findings are also included in a survey report sent to the facility. If IDPH finds the nursing home failed to comply with licensure standards, it is cited for deficiencies, which it has to correct.

So, information is available but, since the home where our loved one may be staying isn't required to let you or the patient know about inspection results, we have to act to keep up with what's going on. Find out the home's policy on releasing reports. Talk to your loved one's doctor and to the person in charge of the home. If you don't get a satisfactory answer, an attorney can help.

Information on reports and a home's status are important. You have to know what you're dealing with to make sure a nursing home is giving proper care. You should be able to get inspection reports and the nursing home's response from the home or IDPH. You can ask IDPH for an inspection file by writing the Illinois Department of Public Health Freedom of Information Officer at 535 W. Jefferson St. Springfield, IL 62761 (Attn: Division of Communications)

In addition, federal inspection surveys are at www.medicare.gov/NHCompare/home.asp.

Michael Kosner, President
The Kosner Firm Chtd.

The mother of a friend of ours is in a nursing home in a northern Chicago suburb. She's 95, and she doesn't always remember very well. She's reverted to her native Eastern European language for conversation but, all things considered, she's doing pretty well. Plus, she is blessed with caring and attentive sons who visit her regularly and look out for her well-being.

And that's a very good thing. It keeps her doctor and the nursing home alert.

While nothing serious is wrong, there are little problems and these offer some cautions about what to look for if you have a loved one in a nursing home.

Currently, this woman (let's call her Hannah) can't hear. The problem is ear wax, something easy enough to cure.

Hannah's son (let's call him Sam) says the problem has been building up for several weeks. He and his brother have asked the doctor several times to remove the wax. She's been reluctant, saying there wasn't a problem. She even told him recently that there's no problem. "I saw her yesterday and she heard me fine," Sam quotes the doctor as saying, "She even responded in English."

That would be fine, but Hannah hasn't responded to anything in English for more than a year.

And the day after the doctor says she talked with Hannah, Sam's brother called him to say her hearing was worse. "She can't hear at all," Sam's brother said. Perhaps the wax massed up overnight.

Finally, the doctor said she would remove the wax and set a date more than two weeks off for the sons to bring Hannah to her office. The brothers decided this was unacceptable and made arrangements with another doctor who would take care of the problem much sooner.

They're doing a good job of watching out for their mother.

As to the doctor, she was caring for Hannah before she went into the nursing home. In fact, though she is not employed by the home, she recommended it to the family and makes weekly rounds there to see her patients.

Now, however, she seems to have lost interest. In fact, Sam now realizes, there were signs of potential problems more than a year ago - red flags that might have suggested looking for a new doctor then.

Hannah developed bed sores - one on her heel and one on her back - and was hospitalized so they could be treated. They were relatively minor, healed and Hannah went back to the home.

The doctor, however, had a different idea; she suggested hospice.

"What was that all about?" Sam wonders. "Sure, my mom is 95, but the bed sores weren't serious. She wasn't ready to die, and here we are a year later and she's doing fine. The doctor is a nice woman, but she was willing to give up on her."

And now, over a simple matter of removing ear wax, the doctor still seems to be saying, "Why bother?"

That's not something we want to hear when it comes to someone we care about.

Michael Kosner, President
The Kosner Firm Chtd.

"We checked out the home and the rating on it when we put her in," Peggy Kennedy reportedly said after her mother, Sarah Wentworth, froze to death in February in the courtyard of her nursing home, The Arbor, in Itasca.

When the family originally checked, however, The Arbor didn't have the 22 violations uncovered in its last annual inspection by Illinois' Department of Public Health. It didn't have the two-star overall rating (five is the best, one the worst) rating that Medicare inspectors now give it. (There are private websites, like Member of the Family , which compile rankings for nursing homes across the country.)

Sarah's tragic story underlines the need to keep checking, but it doesn't solve the dilemma of what to do if a nursing home's conditions deteriorate. As the daughter of another Arbor resident noted in talking with the media, "It's difficult because at this stage my mom's 89 years old. It's very hard. It's hard to move them."

Hard but certainly not impossible - and sometimes necessary. IDPH regulates, licenses and - at least once a year - inspects the 1,200 long-term care facilities it's responsible for in the state. It reports conducting some 10,000 surveys annually, for licensing, complaints and reinspection. It also helps the U.S. Centers for Medicare and Medicaid Services certify the facilities for government payments. Every facility must meet the standards in the Illinois Nursing Home Care Act.

If a nursing home doesn't measure up, you can certainly find out.

Plus you can help improve a nursing home where your loved one lives by keeping track of conditions when you visit. Medicare's website provides a four-page checklist you can use to evaluate a nursing home - and to keep evaluating it. It guides you to be aware of the appearance of residents, their rooms and common spaces, how residents and staff get along with each other, the quality of food and activities, and the safeguards and medical care the home provides.

If the nursing home falls short, and won't listen to you when you raise issues, you can call the Department of Public Health's 24/7 Nursing Home Hotline (800-252-4343). It receives nearly 19,000 calls a year leading to more than 5,000 complaints

And then, if no-one listens, you can contact an attorney who specializes in nursing home law. We can go to bat for you with the nursing home. After all, preventing neglect and abuse is more important than punishing someone after it's too late to help your loved one.

Michael Kosner, President
The Kosner Firm Chtd.

Nursing homes. As the number of seniors grows, so does the need for reliable, caring places where they can get the care they need to live with dignity and comfort when their bodies no longer are able.

Certainly, there are competent nursing homes - and the website for my Chicago nursing home abuse law practice includes information on what to look for when you're choosing one. But there are plenty of nursing homes that cut corners and hire aides at minimum wage just so there are bodies around. There are plenty of homes where caregivers don't care. There are plenty where there is abuse, both physical and mental. And that is not right. That is not fair to the residents in the homes, to you - their families - or to God.

When we place a loved one in a nursing home, it is often because we have no other choice. We try to make sure they have responsive care; that the homes fulfill the guidelines in the Illinois and federal laws that set out requirements for such facilities. But our responsibility doesn't stop there. After they are in a home, we need to know what to do to make sure they are comfortable. We must actively participate to keep care at an appropriate level. And, sometimes, we need legal help to keep a nursing home honest or to punish them for failing.

I believe in keeping caregivers honest, and that information and the courts are the way to enforce our reasonable expectations that they care. That's why I've chosen to develop this blog. Other representatives of The Kosner Firm and I will be writing regularly about nursing home abuse - about cases that serve as examples of things to look for and about what you can do to safeguard your loved ones and maintain your own peace of mind.

This will provide information, and you can go to the frequently asked questions at KosnerLaw.com or use this site if you have questions. And if you think you need the courts, we can help with that, too.

Michael Kosner, President
The Kosner Firm Chtd.