Osteomyelitis means an infection of the bone or bone marrow caused by invasive bacteria. Remember your skin is your first and one of the most important defenses that your body has against pathogens in the outside world. Once that defense is taken down you are at an increased risk for all sorts of problems. Osteomyelitis can degrade bony material to such an extent that amputation of the affected body part may be needed.

The methods of caring for bedsores and the range of time it takes for one to heal varies depending on the stage, nature and severity of the sore and the general health and co-morbidity of the patient.
Generally the first form of treatment of a bedsore that has progressed past Stage II is debridement. This is the removal of necrotic tissue contained within the wound. Debridement

The removal of necrotic tissue is an absolute must in the treatment of pressure sores. Because dead tissue is an ideal area for bacterial growth, it has the ability to greatly compromise wound healing. There are at least seven ways to excise necrotic tissue.
1. Autolytic debridement is the use of moist dressings to promote autolysis with the body's own enzymes.
2. Biological debridement using maggots is the use of medical maggots to feed on the necrotic tissue in an effort to clean the wound. This method has generally fallen out of favor however, is still considered a medically permissible option for wound care.
3. Chemical debridement, or enzymatic debridement, is the use of enzymes that promote the dissolution or removal of necrotic tissue.
4. Mechanical debridement is the use of outside force to remove dead tissue. This involves the packing of a wound with wet dressings that are allowed to dry and then are removed.
5. Sharp debridement is the removal of necrotic tissue with a scalpel or similar instrument.
6. Surgical debridement is the most popular method, as it allows a surgeon to quickly remove dead tissue with little pain to the patient.
7. Ultrasound-assisted wound therapy is the use of ultrasound waves to separate necrotic and healthy tissue.
Flap Surgery

A surgical intervention of last resort is where skin is removed from another part of the person's body and applied (transplanted or grafted) over the sore. Skin transplantation or grafting can help prevent infections and speed healing. However, it may be too risky for people who are frail or undernourished.

If all other treatments are ineffective, an area of skin next to the pressure sore is cut and folded over the sore. This procedure is called flap surgery.

Conclusion
Families need to remember that it is much easier to prevent the formation of a serious decubitus ulcer/bedsore then it is to treat one that has already formed. Once formed, a bedsore on an acutely ill patient with serious co-morbitities can be difficult to control. This is especially true where a sick patient is unable to ingest copious amounts or protein which promotes healing. Families need to be responsible and accountable to their loved one to see that they are getting the care they need and deserve. Although, it is ultimately up to the caregiver's to administer care that comports with the standard of care, it is incumbent upon the families of patients to speak up when they see something to indicate their loved one is being neglected in a nursing home.

Patients at well run facilities will be subjected to appropriate elopement precautions as a part of their care plan. Such care plans often include electronic monitoring wherein the staff is alerted via alarm when a patient leaves the threshold of the facility entrance. In order for this method to be effective requires facilities to appropriately identify true elopement risks before they escape along with vigilant adherence to protocol once an alarm is activated. If there is no one at the nurse's station when the alarm is activated then the resident attempting to exit the facility will do so without constraint. Federal regulations mandate that all nursing homes be properly equipped and staffed so that the risk of elopement is mitigated.

The Kosner Firm, Chtd. concentrates on all issues surrounding nursing home abuse and neglect and has been representing families and victims of nursing home abuse and neglect since 1998.

Michael Kosner, President

Bedsores are classified in stages. The definitions of the four pressure ulcer stages are revised periodically by the National Pressure Ulcer Advisory Panel (NPUAP) in the United States. Briefly, however, they are as follows:
•Stage I is the most superficial, indicated by non blanchable redness that does not subside after pressure is relieved. This stage is visually similar to reactive hyperemia seen in skin after prolonged application of pressure. Stage I pressure ulcers can be distinguished from reactive hyperemia in two ways: a) reactive hyperemia resolves itself within 3/4 of the time pressure was applied, and b) reactive hyperemia blanches when pressure is applied, whereas a Stage I pressure ulcer does not. The skin may be hotter or cooler than normal, have an odd texture, or perhaps be painful to the patient. Although easy to identify on a light-skinned patient, ulcers on darker-skinned individuals may show up as shades of purple or blue in comparison to lighter skin tones.
•Stage II is damage to the epidermis extending into, but no deeper than, the dermis. In this stage, the ulcer may be referred to as a blister or abrasion.
•Stage III involves the full thickness of the skin and may extend into the subcutaneous tissue layer. This layer has a relatively poor blood supply and can be difficult to heal. At this stage, there may be undermining damage that makes the wound much larger than it may seem on the surface.

Stage IV pressure ulcer

•Stage IV is the deepest, extending into the muscle, tendon or even bone. • Unstageable pressure ulcers are covered with dead cells, or eschar and wound exudate, so the depth cannot be determined. .

Suspected Deep tissue injury: Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Further description: Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

With higher stages, healing time is prolonged. While about 75% of Stage II ulcers heal within eight weeks, only 62% of Stage IV pressure ulcers ever heal, and only 52% heal within one year It is important to note that pressure ulcers do not regress in stage as they heal. A pressure ulcer that is becoming shallower with healing is described in terms of its original deepest depth (e.g., healing Stage II pressure ulcer).

Unfortunately, once a bedsore proceeds past stage II the likelihood that the sore will ever heal diminishes substantially with only 62% of all stage IV ulcers ever fully healing. Once a bedsore forms that open area of the body if more susceptible to infections, such as MRSA which is resistant to modern antibiotics. Many times these infections lead to sepsis and death.

Often time's families and patients are lulled into a false sense of security because of the international reputation of the hospital or clinic in question. This is a critical mistake. A bedsore can literally form within hours and once there it can be very difficult to control. People with peripheral vascular disease and diabetes are particularly susceptible to the formation of these ulcers and often have a more difficult time with the healing process. High protein intake is crucial in order to facilitate the healing process. People who are weal and sick tend to eat less. This makes them ideal candidates for the formation and aggressive evolution of these bedsores.

Patients and families should be aware of the bedsore prevention protocols in place when a loved one is admitted to the hospital and should make sure they are being followed. This includes regular baths and timely changing of diapers should the patient be incontinent.
Michael Kosner, Esq. President, The Kosner Firm, Chtd.

And the consequences? The chances of dying go up. Other studies say elderly victims of abuse, neglect and exploitation have twice the risk of dying of those who aren't victims.

There are many stories that point out the extent of the problem: cases of home aides giving lethal doses of drugs and of people using positions of trust to permanently "borrow" money from seniors,

All of this would seem to make enhancing the rights of the elderly an obvious choice for legislators - particularly since the number of people over 55 is the most rapidly growing demographic and seniors vote in larger numbers than other age groups.

But there are opponents to the legislation. They talk about skyrocketing federal spending, state's rights and creating more government bureaucracy. Some question provisions designed to check the backgrounds of people hired to be involved with older citizens, since most abusers are known to their victims.

Backers of the Senate's Elder Justice Act and similar House proposals are now linking the cause to healthcare reform. They say this makes sense because elder abuse increases healthcare costs and financial exploitation leaves many victims to rely on public aid. Prevention would therefore be good policy, saving money in the long run.

"This is prevention, which is a healthcare issue," Robert Blancato, who heads the Elder Justice Coalition, an umbrella group for more than 500 groups that support the legislation, told Kaiser. Coalition members include AARP, the American Bar Association and industry groups representing nursing homes and long-term providers.

And why should the federal government get involved? Because studies show state and local licensing agencies. long-term-care ombudsmen and adult protective service workers don't have the resources to handle the problems.

Researchers at Texas A&M University, in a report to the U.S. Justice Department, concluded that "the universal lack of resources, the enormous variation across jurisdictions and the low priority given to elder abuse and neglect make it difficult to see how significant progress can be made without federal standards and financial support."

The current healthcare bills would require states to conduct comprehensive screening of people working with the elderly. This includes those doing home-based care, an group which almost one-quarter of the states don't regulate at all. Additional states only do background checks on medical workers. The bills would also set criteria for hiring - and firing - persons who have committed or commit violent crimes, including an appeals process.

Michael Kosner, President
The Kosner Firm Chtd.

Nursing homes provide the public face since, as Marsha Greenfield of the American Association of Homes & Services for the Aging recently said in an article written by Kaiser Health News, seniors are a more invisible population.

"Adult abuse is a lot harder (than abuse of other vulnerable populations) to get your arms around," she told Kaiser, an independent health news service. She added that this is because, while there are a growing number in community and group living arrangements, so many of the elderly are in their own homes.

The article added that other populations have become more visible as celebrities speak out on their problems. It noted that Nicole Kidman recently spoke at a congressional hearing on violence against women and that stars of "Law & Order: Special Victims Unit" appeared at a Washington rally about child abuse.

Meanwhile, a coalition of elder abuse groups could only muster ordinary seniors telling their painful stories of physical and emotional abuse and financial exploitation. It's too bad that fewer people - and publications - take time to listen when a celebrity isn't speaking.

The lack of support that comes with a lack of spotlight may be changing as federal lawmakers consider establishing federal law to support the fight against elder abuse.

The House's healthcare bill would provide for national background checks for people who care for the elderly. This would override a mixture of state laws that have let known offenders end up in positions of trust where they can do additional harm.

The Senate is considering a broader Elder Justice Act that would provide federal dollars to identify and investigate elder abuse locally, require long-term care providers to report possible crimes to federal authorities and create new oversight within the Department of Health and Human Services. These provisions have been approved by the Senate Finance Committee and are part of health legislation headed for floor debate.

These provisions would help, but only up to a point since studies show up to 90 percent of elder abuse cases involve family or trusted advisors and happen in private homes. And this will get harder to control as more elderly people are at home or in community and group living arrangements without the kinds of oversight mechanisms available when, for example, child abuse is suspected. There, professionals (teachers, doctors, etc.) outside the home are required to report suspected abuse to authorities.

We'll see how the legislation develops. After all, money, as with all things, remains an issue. The Senate Act has an estimated cost of $757 million over four years. Even though this is negligible compared to the cost of healthcare reform as a whole, and despite broad support that includes more than 500 advocacy groups, this could mean passage problems.

For more information on the legislation, click here or here.

Michael Kosner, President
The Kosner Firm Chtd.

Take a case where an animal bites you. If you provoked the attack, you may not have any claim at all.

And let's suppose you get attacked in a bar. That could get complicated. When the bouncers tried to throw you out, did you fight back, leading them to use extra force? Or did that extra force get excessive to the point of increasing the liability of the bar and its employees? And what did you do when the burly drunk got out of hand? We've all seen video of the woman bartender being kicked repeatedly. The attack may have been excessive but did the bartender do something that caused it?

In cases of shared blame, the jury can assign partial responsibility to each party. If it decides, for example, that the plaintiff was 25 percent responsible, it can cut down the potential claim by that percentage diminishing a claim for, say, $1,000,000 to an award of $750,000.

So even if you contributed in some way to your injury, don't let self-blame get in the way of getting justice you deserve. When in doubt, consult with an attorney. Their experience will help them tell you whether your personal injury claim is worth pursuing.

Michael Kosner, President
The Kosner Firm Chtd.

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.

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.

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.

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 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.

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.

But one nursing home situation led to an even spookier situation at the Lake County, Ill., coroner's office -- or so it seems. The Chicago Tribune tells the story.

The eerie things that have startled people in the coroner's office started in the late 1990s when the body of a woman was inadvertently left in the cooler at the morgue for several months, the Tribune said in its Oct. 30 editions. Workers at the office suggest strange knocking sounds, sudden movements and glimpses of people walking around what should be an empty autopsy room are because of a spirit angry at being forgotten.

She was a woman named Anna who died in a nursing home. Whether she was a lonely person there isn't clear, though you can infer that she was. She became truly lost after a deputy coroner picked up her body but forgot about her in a rush of other cases. Several months went by before someone got around to caring for her body. Then, when another deputy took her to a funeral home, weirdness began. The doors of the car locked and unlocked, windows went up and down by themselves, and when the deputy reached the home and went to take her out of the car, all the doors locked and the engine turned off.

Ever since, employees have reported odd noises in the morgue, things that one senior deputy, who thinks of himself as a scientist immune to ghost stories and a skeptic when it comes to the supernatural, says he can't explain. Employees say they have heard knocking from inside the cooler where bodies are kept. They say a body's hand will fall and that they've seen persons walking in the autopsy room when a worker is the only ones around. They report doors staying open that are supposed to close automatically when they walk through them. They have heard loud whistling, sounding like a woman screaming, and attributed it to the wind.

Deputies have also reported receiving shocks from touching bodies when there were no electrical connections around, and seeing people at accident scenes walking around who were later found to have already been killed.

The deputies admit it's spooky, but say they don't feel it's dangerous.

True or not? These men of science say it happens and they can't explain it. Still, after all, it is the season for ghost stories.

It's just interesting that this one starts with a nursing home.

Michael Kosner, President
The Kosner Firm Chtd.

"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.

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.