Updated 2-28-13
Suit: Facility let woman ‘waste away’ is the title of a front page article in the Sacramento Bee, my local paper.
Updated 2-28-13 Suit: Facility let woman ‘waste away’ is the title of a front page article in the Sacramento Bee, my local paper.
Here is a brief summary of the lawsuit:
- Joan Boice was suffering from Alzheimer’s and was no longer able to live at home.
- In September 2008 she was moved into Emeritus at Emerald Hills, in Auburn (a community in the foothills outside of Sacramento)
- Three months later the community discovered pressure ulcers had formed on both of her feet, her right hip and her right elbow. Emerald Hills staff immediately began the process of having her transferred to a skilled nursing facility.
- She died 3 months after being moved the memory care building to a skilled nursing building.
Here are the charges being made by the family:
- Emeritus is only commitment is to growing their empire and making money.
- They had inadequate staffing and staff training
- They should never have admitted her to the community as frail as she was
- It is unclear if they are suggesting they should have never let the wounds develop or if the primary error was not promptly noticing and addressing them.
Here are the questions/issues (some legal, some operational):
- Should she have been admitted in the first place?
- Did she have pressure sores when she was admitted?
- When were the pressure sores first discovered? (There is conflicting evidence)
- Should the community have discovered the pressure sores sooner?
- Is this a case of being too aggressive about getting one more head in a bed?
- At what point should care givers have noticed newly formed pressure sores?
- Is this just a case of greedy lawyers taking advantage of a terrible situation or do they have a righteous cause?
- Who’s fault was this . . . if anyone’s?
- Does the family have any responsibility in all of this?
Given that she may very well have died in the same time frame, should the company have any financial obligation here? What do you think? What are the issues? Updates: February 17: http://www.sacbee.com/2013/02/16/5194796/judge-rejects-mistrial-claim-in.html#storylink=misearch#storylink=cpy February 26: http://www.sacbee.com/2013/02/26/5217160/doctor-testifies-emeritus-facility.html
Don’t miss a single issue of Senior Housing Forum, subscribe today. It is free! We do not sell or share your contact information. The posts are practical and never too long. Go to the main page of Senior Housing Forum and on the top you will see a link to our subscription sign-up page. You will receive notification when a new article is posted. You can unsubscribe at any time. Finally: If you know anyone who is looking at emergency call systems I would appreciate the opportunity to talk with them about Vigil Health Solutions.
I think your first question is the most important! Should she have been admitted in the first place. I see facilities accept residents with inappropriate placements all of the time…..but I also see the families allow this to happen! Some families are in denial and think a Memory Care area is “too much” for their loved one and allow their parent to be placed in lower levels of care. A lot of times it may be financially motivated. To really get to the bottom of this discussion, one must know what happened during the assessment and tour. Was the facility upfront and honest about their levels of care? About their assessment? Was the family honest as well? Did the family adequately describe her limitations? It is a very sad story no matter what but one that happens quite a bit!
From LinkedIn Groups
So to summarize, it is a case of an elderly woman with advanced dementia, who was very frail, not eating well and developed pressure ulcers on feet. She was transferred to skilled nursing and died 3 months later. As a house calls geriatrician who works with many elders with dementia in various forms and stages; it could be neglect or it could be a lack of advance directives clearly stated by family and doctor. I also review cases for elder abuse claims – both plaintiff and defense and have seen many problems for facilities when they try to care for an elder but the family does not want much done because they have advanced dementia, and the doctor does not specifically address the advance directives. I would STRONGLY urge any facility who is trying to do the right thing to make sure all residents have advance directives and more specifically a POLST to clarify what interventions are to be pursued and which will not. That said, other facilities I have seen do ignore warning signs of patient decline and do not act, those facilities have not fulfilled their duty to their resident.
Elizabeth Landsverk MD
From LinkedIn Groups
Hi Steve,
I’m an attorney and read the article. There are allegations, but I don’t have enough info to comment intelligently about the merits of the claim. It sounds bad, but we are not privy to the facts.
By Lorie Eber
From LinkedIn Groups
Elder care is a messy business and things go wrong all the time. Family needs to be more pro-active in managing care and moving a loved one when it is evident the facility cannot provide the needed care. I moved my Dad from a very nice CCRC to a specialized dementia care facility and his quality of life improved tremendously.
By Lorie Eber
Steve, one must be diligent and educated when it comes to seeking professional assistance in this industry. More advocacy is needed. Sharing stories like this reminds us the importance of awareness. There are wonderful people in the business of caring for seniors. I was fortunate to find someone who helped place my father-in-law in an outstanding board and care home. Would not have found it had it not been for Linda and her caring expertise. Find resources, reach out to people you trust. Thank you for sharing such a significant issue.
From LinkedIn Groups
it starts with the assessment to see if the potential resident will be able to thrive in the community. This poor lady should have been looked after, moreso if she was in the dementia specific area of the community where the staffing is higher. I don’t understand the pressure ulcers, those should have been recognized when she was bathed by the staff member.
By Jo Letwaitis; LION – Top 1% viewed profile
From LinkedIn Groups
Jo,
Assessment is the first issue. Often it is given shortshrift. Many times the family misleads the facility and the facility may be motivated to keep its census up.
By Lorie Eber
From LinkedIn Groups
I’m wondering how often the family visited? Pressure sores to happen overnight and the staff should have addressed them long before they got to the point that the resident needed to be moved to a skilled nursing facility. But family also needs to take an active part in the resident’s care. They need to visit regularly at different times and days and take note on how the resident is dressed, it they look comfortable, if they are gaining or losing weight, etc. If they family can’t do this, they need to hire someone such as a care manager to do so. People who are no longer able to express themselves need someone from outside the facility to check on them and advocate for them.
By Mindi Blanchard
Sounds like a sad story.
Like the attorney above, not nearly enough details provided here to judge the claim.
I find myself wondering if the person was quite bedbound when she was admitted (dementia and unable to live at home doesn’t equal bedbound), and what kind of care arrangement was negotiated with facility. I also don’t quite see what the advance directive would have to do with pressure sores (even completely comfort care patients shouldn’t be developing pressure sores), although I agree that all older people should be encouraged to complete an AD and a POLST.
As others have said, more information is needed before blame can be assessed. Assisted living communities in CA are not allowed to accept or retain residents with pressure ulcers greater than stage 2 unless they are on hospice. I have seen pressure ulcers develop and worsen very quickly in a patient who may have for example diabetes, poor circulation, inadequate nutrition. This poor lady did not just have one, but several, which leads me to suspect she probably would have benefitted from closer supervision.
Unless she was in independent living (which was not the case), I don’t think it’s fair to expect the family to be responsible for monitoring the care, or for adding to the cost by hiring a care manager. It’s understandable that they would trust the community to provide the care they agreed to upon admission and that they were being paid for.
Higher cost of memory care units does not always equate to better care. I have seen many people improve significantly, both mentally and physically after moving to a good licensed care home which can provide better supervision, usually also at a lower cost. Families would be advised to look at the pros and cons of all available options before making a choice.
From LinkedIn groups:
Lorie – I agree…or they have a non-clinical person go and do the assessment. Yes, as a past ED I often spoke over the phone to an adult child who says mom is independent x5 ADLs and the woman ultimately comes in and needs a wheelchair etc. Sad.
By Jo Letwaitis; LION – Top 1% viewed profile
From LinkedIn Groups
They may be trying to save money or engaging in wishful thinking. Either way, it leads to a bad outcome.
By Lorie Eber
From LinkedIn Groups
In the year 2013, we must all realize that the word “system” when applied to health care in our country is broken. We have great health care products, medications, surgeries and yes, even great communities and care facilities.But none of these takes the place of patient and patient family responsibility. We need to be aware of the treatment options we have, fully decide to participate and be conscious and observant to supervise whatever treatment we or our loved ones receive.
As the holder of my husband’s power of attorney and medical proxy I am responsible for his care at the facility I chose. Initially I chose an assisted living facility. Several months later, my husband’s Alzheimer disease progressed to a level I felt the staff at the facility could not manage given the staff to resident ratio. The facility attempted to reassure me that with the additional fees they were charging, they could indeed provide for him.
I chose to move him, although they said a change would be harmful to him. A year later, my husband is thriving in a new unit of memory care, which had its glitches in the beginning. I am there almost every day, at differing times of the day, to monitor his care, his health if I see he has a cold, his wardrobe, his cleanliness, the menus as well as the activities being offered.
The facility is providing a service to me. I am the consumer, not my husband who is the resident.
By Dr. Phyllis W Palm
From LinkedIn Groups
Phyllis,
Your experience sounds very much like mine. It seems to be a secret in the industry that most assisted living facilities cannot properly address the needs of dementia residents (which make up most of their residents). To do it right requires more trained staff. My Dad has come back to life–literally.
By Lorie Eber
Everything is someone else’s fault, isn’t it? Seems like that is the culture of today.
Combine that with the fact that some families won’t accept the end of their loved ones life (often putting them through add’l suffering) and it’s a recipe for disaster.
From LinkedIn Groups
You posed some really good questions in your article in Senior Housing Forum. Coming from the Skilled Nursing side of healthcare I can tell you the pressure to admit, admit, admit is tremendous. Should this little Alzheimer’s patient have been admitted? Many times Alzheimer’s patients in particular are misplaced due to not enough appropriate beds being available.
If an Alzheimer’s patient has other medical issues such as wounds, needing rehab for recently repaired fractures, recovery from pneumonia or UTI, a SNF may be the best short-term placement. But, in spite of those medical issues, if the patient is in their wandering stage and the SNF isn’t prepared to deal with that issue 24/7, then the SNF could be putting both the facility and the patient at risk. But, most of the ALFs that cater to Alzheimer’s aren’t qualified/licensed to take care of the other medical issues. It’s a real Catch 22.
By Mary Payne-Wehner
From Linkedin Groups
Most unfortunately, the caregivers( me included) get turned off by the memory care facilities they visit while their loved one remains at home. There is just one room where all the action–food, lounge chairs, wheelchairs, walkers and activities are. Each resident or two has a bedroom and bath, some of which are used only for twice weekly showering.
The residents wander around or nap. All are dressed, but some are not so neat. Some watch tv, but most stare at it blankly. Some folks utter nonsense sounds, some curse aloud or bang their fists or clap their hands.The spouse , son or daughter walk away saying “My loved one is not ready for this.” They want stimulating activities.
Well, at the assisted living facilities the stimulating experiences are often focussed on bingo and nail polish. The memory care folks where my husband resides are permitted to spend all or part of their weekdays in the Day Club with the assisted living folks.
Please choose wisely folks and get some help from others who have been there.
By Dr. Phyllis W Palm
From LinkedIn Groups
The problem that I see is assisted living facilities, which have lower overhead than skilled nursing facilities because they don’t have to meet regulatory requirements for Medicare and Medicaid reimbursement are offering care to residents who really should be in skilled placement and not in an ALF. Some of these facilities are charging more than a SNF would charge, and offering fewer services. Families like the ALF better because it is cleaner and brighter, and don’t realize that their loved one is not being adequately cared for.
Not all ALF’s are doing this, but some are.
By Catherine Anne Seal
We are at the prosess of creating our first ALF
We also would like to make it holistic I myself am acupuncturist
and hebalist and I would like to add Organic garden and Yoga
and make a farmers market
Hi Steve – We appreciate the discussion going on here, and are happy to see that many of your colleagues are hitting on the right points – that this article is lacking some crucial facts. This reporter attended the plaintiff’s presentation of the case and ran the story. The defendent’s presentation of the case is going on now and it obviously paints a very different story and brings to light a number of facts and testimony that were never touched on in the first part of the trial. As we told the reporter, out of respect for everyone involved in the trial and the trial process itself, Emeritus will comment only once the ruling is announced.
Hi Emeritus:
I really appreciate your responding. It feels as if the newspaper is only presenting one side of the story, perhaps even a tool for the plaintiff. I know you are in the difficult position of not being able to respond during the trial.
I would like to offer that when a verdict has been rendered I would welcome a “The other side of the story” article from you if you are interested.
Steve Moran
Yes – Absolutely. Thank you for the opportunity!
From LinkedIn Groups
I feel there is a fine line for facilities taking care of our seniors putting their clinical needs and assessments first beyond the financial rewards for the company. So many get overlooked due to inadequate staffing and communication of condition change. Be involved with each patient and deliver quality care not just look out for the bottom line to fill beds and exceed quota. Our seniors are precious and deserve dignity and the best care possible.
By Patsy L. Gruenenfelder
I agree that many valid points have been raised. However I would like to point out that some pressure wounds are unavoidable due to comorbidities. This fact is well documented and researched. I will be very interested to see “the other side of the story”.
Emeritus is a neglectful company and only cares about it’s revenue. Having dealt with this facility personally. I whole heartily believe that the Managers took a blind eye to this womens needs. The staffing in that building was ridiculously short staffed especially in the memory care. This whole company needs to be shut down.
From LinkedIn Groups
Since I work for Emeritus, I can say its not about heads in beds. It’s about patient care. There are many factors that could have caused this patient to die…..infection, poor nutrition, etc. There are always 2 sides to every story and somewhere in the middle is the correct answer….
By Joyce White