Monday, January 19, 2009

Glen Bridge Nursing and Rehab Fails to Seek Timely Emergency Care for Resident

Niles
GLEN BRIDGE NURSING AND REHABILITATION CENTRE
8333 W. Golf Road in Niles
FINED- November 14, 2001
Glen Bridge Nursing and Rehabilitation Centre WAS
fined $10,500 for failure to seek timely emergency
care for a resident with a head injury.
Responding to complaints, surveyors learned it took
nearly 2 hours from the time a resident was found with
a head injury until she arrived at the hospital for
treatment.
After the resident emerged from a room with blood
dripping from the back of her head, an ambulance was
called. When informed the ambulance could not arrive
quickly, staff suggested it come within 30 minutes.
The ambulance, however, did not arrive for about an
hour. The resident’s condition worsened, but staff did
not arrange for immediate medical assistance.
A facility nurse left a message for the resident’s
physician, but the physician did not get the message
in a timely manner. The physician indicated 9-1-1
should have been called and he should have been paged.
Interviews with staff revealed the resident complained
of a headache, her eyes started to droop and she
became increasingly sleepy and lethargic.
When the resident was admitted to the hospital, she
was comatose and placed on life support. The family
withdrew life support the following day and the
resident died. According to the coroner’s report, the
resident died of a subdural hematoma due to blunt head
trauma.
A Department-ordered plan of correction required the
facility to notify a resident’s physician in a timely
manner of any accident, injury or significant change
in condition; to have written policies and procedures
for medical emergencies and to ensure staff follows
them; and to record changes in a resident’s condition
in the resident’s medical record.
.

Resident of Manor at Lincolnwood Place Dies After Facility Fails to Monitor

MANOR AT LINCOLNWOOD PLACE
7000 N. McCormick Blvd. in Lincolnwood.
FINED- June 7, 2001
Manor at Lincolnwood Place was fined $10,000 for
failure to adequately supervise a resident with a
history of wandering.
Responding to an incident report, Department
investigators learned a resident left the facility
unnoticed about 2 a.m. and was found the next morning
face down in the snow between two vehicles in an
automobile dealership parking lot which is about 1,000
feet from the facility. The woman was transported to a
local hospital emergency department where she was
pronounced dead from hypothermia.
The resident, who had been missing for about six
hours, was dressed only in a housecoat and was not
wearing shoes. The overnight temperature was between 8
degrees and 10 degrees.
Per staff interviews, surveyors found the resident
had been wandering around the facility much of the
previous evening and had to be redirected to her room
several times. While conducting rounds, a nurse -- who
had previously guided the resident back to her room --
noticed the resident was not in her room and a search
of the facility failed to locate her.
It is assumed the resident left through an east exit
door that is also used as an entrance for the
facility's assisted living section. This door requires
a key card to enter the facility, but there is no
alarm on the door or key card required for exit.
A Department-ordered plan of correction required the
facility to ensure that supervision precautions are in
place for residents diagnosed with wandering behaviors
and that all resident-accessible exterior doors are
equipped with an alarm or are visually monitored.

Wednesday, January 14, 2009

Problems with Long Term Care Insurance

According to the U.S. Department of Health and Human Services, 70 percent of people over age 65 will require long term care services at some point during their lives. Contrary to popular belief, most of these services are not covered by Medicare. And the cost of this care is high. The average cost of a private room in a nursing home is $209/day. And in many areas, the cost is higher. It is not surprising, then, that people are interested in purchasing long term care insurance.

Unfortunately, purchasing long term care insurance may not be the answer. After reviewing 47 long term care insurance policies, Consumer Reports recently concluded that long term care insurance is too risky and too expensive for most people. A combination of fine print exclusions and unfair practices is denying benefits to thousands of seniors.

Inherent Problems

All insurance policies offer to pay for some “losses” and not others. This is not necessarily unfair, as long as the limitations of the policy are properly explained. Here are some common limitations of current long term care insurance policies:

Your premiums can increase

…and they probably will. Most LTC policies do not contain a restriction on premium increases. This is a problem because, you must keep your long term care insurance in force continuously in order to collect the benefits. Many seniors pay the premiums for many years, but eventually have to drop the coverage because the premiums become too high. If you stop the coverage, you have simply lost that money.

Your benefits may not increase

…but the cost of medical care will. Policies that do not provide increased coverage based upon the rate of inflation can leave you without adequate coverage. A policy which guarantees to pay $200 a day may be sufficient now, but it won’t be in 2020.

They won’t start paying immediately.

Many policies have an elimination period of 30, 60 or 90 days before they will pay any benefits. Most policies will only pay if you can prove a certain level of disability. Some even have provisions that they will only pay if you are transferred to a nursing home after a hospital stay. This can be important because, according to the government, 57% of people go to a nursing home without a prior hospitalization.

They won’t pay forever

Most LTC policies do not pay for nursing care indefinitely. Many policies limit coverage to 4 years. There are also policies that cover less. It is important to know how long they will pay.
They won’t pay for everything

In addition to limiting total payments, there are many services that are not covered. Some plans will not cover home care, even though they would cover the same treatment in a nursing home. Some will only cover “skilled care” and exclude many necessary routine functions that a nursing home would ordinarily provide.

What would cause me to forfeit the policy

Do you forfeit the policy if you miss one payment? Are you required to make payments even when you are collecting benefits? Does the insurance company have to notify somebody else of a potential forfeiture if I develop dementia? These are all important questions to ask.

Is the policy renewable?

This has become less of a problem in recent years. In some early policies, however, the insurance company could simply decide not to renew the coverage. If they fail to renew the policy when you are ill or over 70, (for example), it may not be possible to get other coverage.

All of problems described above are considered “fair” practices for insurance companies. The difficulty is that many consumers don’t know these limitations when they buy the policy. Inquiring about these potential limitations can help you to ensure that you are getting what you paid for.


Unfair Tactics

Unfortunately, there are also some unfair tactics that insurance companies use to deny coverage. If you are a victim of one of these tactics, you should contact the state insurance commissioner. If you cannot resolve the dispute, you may even need to contact a lawyer. Here are a few common tactics:

Agent Overselling

Long term care insurance agents make a substantial commission on each sale. Unethical agents will paint a rosy picture of all of the benefits the policy offers, and downplay any limitations. Remember that the written insurance policy and NOT the agents promises will govern your coverage. It is almost impossible to prove that the agent lied to you about what you would receive. You should assume that if it is not in writing, it doesn’t exist. Given the length of time you will pay for the policy, you should get a copy of the policy and review it before you buy it.

They say I don’t need nursing home care

Insurance companies have a long history of denying medical treatments that they believe are unnecessary. It is not uncommon for them to require a policyholder to visit a doctor chosen by the insurance company for an exam. These doctors are likely to be more concerned about pleasing the insurance company than the patient.

They rescinded my policy for “misrepresentations” on my insurance application

A common practice by unethical insurance companies is to rescind coverage long after the policy was issued. Here’s how it works. The policy application asks you to list any medical conditions that you have. The insurance agent encourages you to only list the “important” conditions. You write down the major stuff, but forget a minor back injury that has mostly resolved. The policy is issued and you pay the premiums for a year or so. A problem arises and you need the coverage. You submit a claim. Instead of paying, the insurance company orders all of your medical records, going back ten years. They discover the back injury and claim that you “misrepresented” your health condition. As a result, they rescind the policy, return your premiums and deny the claim. To get the coverage, you have to fight them in court. This can be difficult when you are near the end of life and in a nursing home.

One way to avoid this problem is to disclose everything on your insurance application. Do not trust an agent who suggests that you don’t have to list everything.


Deliberate bureaucratic hassles

Several long term care insurance companies have become notorious for making it so difficult to make a claim that their policy holders simply give up. The New York Times recently reported that “some long-term-care insurers have developed procedures that make it difficult – if not impossible – for policyholders to get paid.”[1] For example, in 2003, a subsidiary of Conseco insurance sent an 85 year old woman suffering from dementia the wrong form to fill out, according to a lawsuit, then denied her claim because of improper paperwork. In California alone, nearly one in every four long-term-care claims was denied in 2005.

If you, or a family member, are a victim of one of these practices, you may need to fight for your rights. If you are unsuccessful on your own, you may consider calling the Illinois Department of Insurance to make a complaint. The Illinois Attorney General is another option. If none of these are successful, it may be necessary to consult a lawyer.

[1] “Aged, Frail and Denied Care by Their Insurers” New York Times, March 26, 2007

Monday, January 12, 2009

LaGrange Rehab Center Fails to Follow Procedures Following Accident

LaGrange
LAGRANGE REHAB CENTER
339 S. Ninth Ave. in LaGrange
FINED- April 9, 2001
LaGrange Rehab Center was fined $10,000 for failing
to ensure its staff was properly trained to provide
emergency care services for residents involved in
accidents.
Responding to an incident report, Department
investigators learned that a resident, who had a
history of pacing and wandering, became entangled in
his gown and a privacy curtain and was found by staff
sitting on the floor next to his bed. The material was
wrapped around his neck, and he was not breathing. The
resident died due to strangulation.
Per record review and staff interviews, surveyors
were unable to determine what, if any, life-sustaining
measures were taken by facility staff.
Staff removed the material from the resident's neck
and checked for a pulse, but made no other assessment
of his condition. Two staff members then moved the
resident into his bed, while a third employee reported
the resident's death to a facility supervisor. One of
the employees indicated no attempt was made to
resuscitate the resident because he had a Do Not
Resuscitate (DNR) order. None of the employees
involved in this incident had cardiopulmonary
resuscitation (CPR) certification.
Facility policies and procedures for accidents and
emergency care instruct employees not to move a
resident, but to assess his condition by checking for
pulse, airway, breathing and circulation and, if the
resident is viable, to begin emergency services.
Policies also address the application of DNR orders
for residents when the incident is an unnatural
accident.
Investigators determined the three employees involved
in the incident did not follow applicable policies and
procedures.
A Department-ordered plan of correction required the
facility to ensure that policies and procedures are in
place for handling medical emergencies and that staff
are properly trained to provide emergency services.

Mercy Nursing in Homewood Fails to Perform CPR

Homewood

MERCY NURSING HEALTHCARE AND REHABILITATION CENTER
19000 Halsted St. in Homewood
FINED- 2002
Mercy Nursing Healthcare and Rehabilitation Center
was fined $10,000 for failure to provide adequate and
emergency nursing care to prevent a resident death.
Responding to a complaint, Department investigators
learned facility staff did not immediately notify a
resident's physician of her deteriorating condition
and, when the woman became unresponsive, did not
perform cardiopulmonary resuscitation (CPR),
incorrectly believing the woman had a "Do Not
Resuscitate" order. The resident expired.
A review of the resident's record found family
members noticed she was not eating and had become
increasingly lethargic. The family requested a
physician evaluate her condition and she was to be
seen the next time a doctor was at the facility.
Records indicate facility staff did not notify the
resident's physician of her declining condition for
more than 17 hours and did not send her to the
hospital after her doctor did not immediately respond
to a page.
The facility failed to follow its policy to contact
the resident's physician or the facility's medical
director or to send the resident to the hospital when
a significant change in a resident's condition occurs.
A Department ordered plan of correction required the
facility to train its staff on proper resident
monitoring and procedures to immediately notify a
physician when there is a significant change in a
resident's condition.

Friday, January 9, 2009

Hickory Nursing Pavilion cited for Failure to Supervise Confused Patient

Hickory Hills
HICKORY NURSING PAVILION
9246 S. Roberts Road
FINED- 2006
Hickory Nursing Pavilion was fined $15,000 for
failure to provide adequate supervision to a confused
resident identified as at risk for leaving the
facility. The resident left the facility without staff
knowledge and was found walking in traffic by police.

Imperial of Hazel Crest Fined for Failing to Supervise Resident

Hazel Crest
IMPERIAL OF HAZEL CREST
3300 W. 175th St. in Hazel Crest

FINED- 2006
Imperial of Hazel Crest was fined $20,000 for
neglecting a resident by failing to provide specific
supervision, monitoring, treatment and care. The staff
had not checked on the resident for approximately
14-hours due to the resident's aggressive behavior
toward staff. The resident was found behind a
barricaded room door, dead on the floor.
Hickory Hills

Tuesday, January 6, 2009

Alden Heather Fails to Prevent Patient from Wandering

FINED- 2003
Alden Heather Rehab and Health Care Center was fined
$50,000 for failure to take necessary precautions to
prevent a resident from leaving the facility
unsupervised.
Responding to a complaint, Department surveyors
learned a resident, who had a history of wandering,
left the facility unnoticed and froze to death before
staff found her in an alley behind the nursing home.
When staff realized the resident was missing, the
building and grounds were searched and the resident
was found in the snow, wearing only a T-shirt, sweat
pants and slippers. Her body temperature was 84
degrees.
A review of the nurse's notes revealed that the
resident would wander during the night and had
previously attempted to leave the facility. Because of
this behavior, her whereabouts were to be monitored
every two hours. However, there was no evidence that
this was done.
During the Department's investigation, surveyors
observed that the facility's front doors did not have
an alarm. The administrator told surveyors that the
doors were monitored between 8 a.m. and 8 p.m. There
was no supervision of the doors during the time the
resident left the facility.
The Department-ordered plan of correction required
the facility to provide residents with adequate
supervision and to ensure all resident-accessible exit
doors are equipped with functional alarms or are
constantly monitored.

Alden Harvey Fined for Failing to Investigate and Report Sexual Assault of Resident

Harvey

ALDEN HEATHER REHABILITATION AND HEALTH CARE CENTER
15600 S. Honore St. in Harvey
FINED- May 21, 2002
Alden Heather Rehabilitation and Health Care Center
was fined $10,000 for failure to properly investigate
or to report the sexual assault of a resident by
another resident.
Responding to a complaint, Department surveyors
learned the facility administrator, after being
informed a resident had sexually assaulted another
resident, instructed staff not to notify the
resident's physician or call police, as required by
the facility's abuse policy. The administrator also
told staff to write an incident report, but not to
include it in the residents' files.
According to staff interviews, the man led a
confused, non-verbal woman resident into his room and
barricaded the door with a night stand while he
assaulted her. Fifteen minutes prior to this incident,
an aide stopped the man from taking the same resident
into his room, redirected the woman back to her room,
which was about 50 feet away, and left her alone.
Family members contacted police about 18 hours after
the attack and asked facility staff to send the
resident to the hospital to be examined by a
physician. The resident's doctor told surveyors he was
notified when the woman was taken to the hospital, but
only told a male resident had been found in her room.
Following the assault, facility staff did not
re-evaluate the man's care plan or take steps to
protect other residents. The man was arrested for
rape, but his physician was not notified until about
12 hours after he was taken into custody.
A Department-ordered plan of correction required
facility administration to initiate a complete and
thorough investigation into allegations of abuse, to
notify the appropriate authorities of suspected abuse,
to conduct an immediate evaluation of the alleged
perpetrator and to protect its residents from harm.

Clearbrook-Wright Nursing Home Fined for Failure to Detect and Treat Bed Sore

Gurnee
CLEARBROOK-WRIGHT HOME
34377 N. Almond Road in Gurnee.
FINED- September 5, 2003
Clearbrook was fined $10,000 after a resident
developed a pressure sore behind his left knee that
went unnoticed and untreated for about a month. By the
time the sore was discovered, the resident’s tendon
was exposed. The pressure sore may have been caused by
a protective device that was left on the resident’s
knee for an extended period of time. Staff did not
notice the pressure sore because they did not
completely remove the device or look at the back of
the resident’s knee while giving him a bath.