Class action suit against Revera Nursing Homes.

Medicare.gov, search for a NH, hospital, etc then find and read health inspection reports is an interesting read, and where I found and read the above story.

pamstegma and Churchmouse

There are good and bad (more bad) in every service sector. I just finished reading about a man who died at the hospital, from a NH. He was complaining of not being able to breathe. According to the report the only person to try to help him was a STNA. He was not trained to give the kind of aid the man needed, so the STNA asked for help, even from a phlebotomist and 2 surveyors who were at the facility. When the STNA was finally able to get the nurse, she helped the man lay down, positioned him on the bed, told the STNA to close the door and left. Long story short, EMS was called, they tried chest compressions, took him to the hospital, where he died. The facility then was retraining their staff on what to do if/when emergencies like this could happen. This facility was/is going to be sued by this man's loved ones. This is probably one of the reasons many older people don't want to go into NHs.

:(

I fear you speak the truth CM. I really doubt the law suit will go very far, not because there haven't bee real incidents of neglect but because the whole chain of evidence will be so hard to follow if any time has passed. Staff have moved on, records are incomplete, families have learned to find peace in their loved one's passing and are not willing to pursue an action that would take years. A coroner's inquest? Another public inquiry? Here is my last (?) comment on the issue, from the London Free Press 06/2016:
"Starting next week, 84 per cent of Ontario’s 630 long-term care homes will get a full inspection just once every three years, and a “light inspection” the other two years, say sources that include the Ontario Long Term Care Association, which met last Thursday with bureaucrats in Ontario’s Health Ministry."

Zytrhr, I've seen a handful of people employed in the care sector that I wouldn't leave in charge of a goldfish that I liked, many many more who were doing their best even if their best wasn't anything to cheer about (which is why I took my mother home), and a goodly number of really skilled and experienced people with a genuine vocation. There was one instance of what I would call actual abuse directed against my great aunt; and if I'd had anything more to go on that a single event that she told me about, with no evidence to back her up, no name to go on, no leads to follow, I'd have had that "caregiver" sacked and reported to the authorities, or called the police myself if it hadn't been followed up.

Keeping frail and/or mentally frail very elderly people safe, healthy and happy is a monumentally difficult, time-consuming and expensive task. They are getting to the end of their lives, their bodies and sometimes their minds are breaking down, and we have set ourselves the goal of delaying those processes for as long as possible. It's necessarily a losing battle, and if sometimes things go badly wrong - war crimes are committed, to extend the metaphor, if you like - then what we need to do is find out who did what, why that happened, and how we can avoid a repetition. Very occasionally there will be a criminal or a psychopath at the root of it; far more often, there aren't enough staff, there isn't enough money, there hasn't been adequate training, or one human error has led to another, and we need to change those things. Taking money *out* of the organisation is really not going to help.

Introduce adversarial litigation and financial incentives to the arena and it just makes things worse. Expertise, energy and resources will be diverted to fighting in the courts instead of learning, training and the real work of caring. Because big money is involved, problems are actively covered up instead of highlighted and debated. People start telling lies and making excuses, and nobody learns from mistakes - except that they learn to make dam' sure that nobody ever finds out.

The Toronto lady's thinking is that a class action will "hit them where it hurts" - this group will go out of business and the families of similarly maltreated residents will be offered compensation. Well, Pam Stegman has already broken down what actually happens with the money. And besides, how much would you consider 'compensation' for your elderly parent's pain and suffering? She would do better to demand a public enquiry based on a detailed examination of her father's case; and if her lawyer cared a flying fig about standards of care in the sector he'd be persuading her to that course of action instead.

If this group is made an example of, the rest of the sector will look to their practices and make very sure indeed that care records are fully up to date. Those records may be full of sh*t - also no pun intended - but they'll certainly be up to date. The winners at the end of this will not be the best care providers, but the shiniest, squeakiest-clean care providers. They may incidentally provide good care, but what they do best of all is: not get caught.

zythr, I have seen patients get kinder care at a nursing home than they get from their own families, who never even seem to visit. Even at an assisted living, with 80 residents, the daily sign in sheet is never even a full page.
There is always room for improvement in a nursing home, but as long as Medicaid is paying so little, it won't happen.

Churchmouse

NHs should hire you as their spokesperson, since you seem to be in their corner, just sayin' The bad ones far outnumber the good. Many nurses can be kind and caring when loved ones are around and be the exact opposite when the loved ones leave.

The lady could be telling the truth about the care of dad.

Medical records, don't know where you're at, but Cleveland Clinic, (#2 rated hospital in the country) immediately shuts down access to what is called MyChart, and sends the records to an outside source (in Wisconsin). If someone wants to see them,they submit a request and pay a fee. The daughter should "fight" to get to the bottom, no pun of what happened to her dad.

The Toronto Star article also included her description of when she undressed her father to investigate. She stated that she had never seen him unclothed before, ever: how, then, did she have any idea of what state he was in before he was admitted?

Does she have her father's complete medical records? Does she have his care records?

By the time she got there, he had pneumonia and sepsis. He was delirious. I don't mean he wasn't in pain, just that he wasn't in control of how he expressed it. If he hadn't been delirious, he might have kept up a brave face and she'd have been too embarrassed to ask about the smell.

I'm not saying he didn't suffer (obviously he did, and I'm very sorry for that); and I'm not unsympathetic to her having had a heck of a shock; but we know there could be all kinds of interconnected reasons, other than or as well as neglect or cruelty, that could have caused this failure.

Copied from the CBC website:

"During a news conference at Queen's Park on Thursday, DeKervor said she was told about her father's falls but was assured by staff that they were minor. She then got a call saying that he had pneumonia. She flew in from San Diego and found her dad in pain.

"He would be screaming and moaning," DeKervor said. "Sometimes he would say, 'stop the suffering.' And I just didn't feel that pneumonia would cause that kind of agony."

She also noticed a bad odour in her father's room. She stripped him of his clothes and found the oozing wound on his backside. She asked the doctor what it was, and she was told it was a sacral ulcer.

"I had never been made aware that this wound existed," she said. "And I was shocked."

After DeKervor returned home she reviewed her father's medical records. She found that the only pain medication that had been ordered for him was Tylenol. Oakley said there is no evidence he ever received it."

While I agree falls happen even with the best of care and pressure ulcers happen quickly when end of life nears, if the case presented here is even partially credible somebody somewhere needs to take ownership of the terrible torment this poor man was allowed to suffer. People saw what was going on, the women changing his diapers can't have failed to make note of a 9" stage 4 ulcer so where did the system fail, and why?
I think the lawsuit is focused on any negligence, not necessarily pressure sores, and if it takes a threat to the wallets of corporate head office to get some answers then I am all for it.

They will not be isolated examples, CW, I'm sure of it. There must be hundreds if not thousands of examples of frail elderly people suffering horrific pressure sores, the sort that make your head swim just to think about them.

The gentleman in the article.

How long, do you suppose, had he spent dozing contentedly in his own armchair at home in the days before everything went belly up? How good was his skin integrity at the time when he started falling?

How would the reporter recommend that the NH restrain the gentleman and prevent him from falling?

Would the reporter approve of NH staff leaving a patient they were in the middle of washing in order to attend more promptly to our gentleman when he wanted to go to the bathroom?

In an incontinent patient, who wears pads, how surprised would you be to discover fecal matter in a 9cm bedsore? How would you go about cleaning him after a bowel movement?

If your competent patient tells you to leave him alone, what should you do?

Would the reporter like to share with us the secret of preventing all pressure sores?

At current prices, there cannot be enough staff to ensure that no patient - be he never so uncooperative, so diabetic, so obese, so loose of bowel - is ever kept waiting to go to the bathroom or left in a soiled or wet diaper for longer than we'd like.

We do know how fast pressure sores develop, and we do know how hard they are to treat and slow to heal, and how terrifyingly difficult it is to keep a pressure sore clean in an incontinent patient.

Now prove the NH staff were negligent.

Class Action Law in Canada first requires an order of certification. So if the plaintiff fails to find others willing to join the suit, it dies. Canadian law requires a "large number" of similar complainants. They don't say how many a large number constitutes.
Here in the US, if you win a million dollar settlement against a nursing home the first person paid is the lawyer, who gets half. The next payee is MERP who recovers all the money paid out, along with the insurance companies who paid for care. You'll be lucky to end up with $10K to take home.

The fact that they are bringing a class action suit seems to point to them having a belief that this is not isolated (the claim points to evidence of 82 incidents), we Canadians aren't generally a litigious society like out neighbours to the south are reputed to be.
Of course as with all such stories it has been picked up by other news sources and there are links that send you off to other horrendous examples.

Veronica, I believe the daughter lived in California and her father in Toronto, one would like to believe our parents are well cared for even if we are not able to constantly supervise.

As an Ombudsman, I met with a woman who had a stage 1 (early) pressure sore. Her daughter agreed to keep an eye on it and take pictures to keep track of it. A month later I asked her how it looked. She never checked it, not even once.

Veronica I signed on nearly a year ago to help feed patients on the stroke ward where my mother was so well cared-for in spite of their terrifyingly high bed occupancy rate.

I have my security clearance. I have had my induction training. I am still waiting to be taught how to thicken fluids, check food and drink temperatures, read the dietitians' notes and assist the patient with eating.

I just wonder how much hands-on experience of those things the person who teaches me will have. Going by the induction, probably a lot less than I've got.

Sigh. Maybe they'll get round to it before Christmas..?

Whatever lawyers say there are times when pressure sores are inevitable and can appear literally anywhere on the body in the very sick and/or thin. I have seen them on the nose and ears!. In my case I received excellent care in that area even in what I considered the worst hospital in the country. Now mouth care was another matter. My teeth felt like they were wearing sweaters and the reply was that I had said I could brush my own teeth. They were somewhat annoyed when I told them checking that i still could should be part of their plan of care. They did immediately address the problem.
All I can say is that relatives need to visit often and if they notice something out of place to rectify it immediately. Offer to help out the staff with routine care if that is safe, help with bathing so you know how to do it if you are able. make visits at meal time and feed your loved one. Bring food if they don't fancy what they are being served. Don't just complain make suggestions and help where you are able. Above all volunteer at a nursing home they will e very grateful. you may need a health test ut there are multitude of things you can do to both ease the nurses load and improve the quality of life. How about pushing a wheelchair round the grounds on a nice day, sitting quietly just listening to the birds. rating the paper sitting with someone holding their hand till tey fall asleep. there is always some thing you can do even if you are old and sick or even in a wheel chair yourself. Save the criticism for genuinely bad situations.

FF it is a good and important point. I just slightly wish you hadn't said it in public - you might be putting ideas into people's heads :P

Hm. Well, they don't hold back on the details, do they?

One of the allegations is that he was not assessed for pressure sore risk on his return from the hospital following falls. Well, the home employed a wound care nurse - that doesn't sound like a place that isn't aware of the correct skin integrity procedures. But wouldn't it be ironic if they'd employed a specialist nurse, and precisely for that reason the personal care aides were no longer doing daily inspections? That is exactly the kind of complication that non-holistic meddling can lead to.

I can remember doing the hair-pulling dance in A&E when my great aunt had been kept on an observation ward for 48 hours and I discovered no one had looked at her lower leg ulcer dressing. "We don't do wound dressings," said the Staff Nurse, "Ms S is here for observation following her fall." I was young and green back then and just said: "that's inSANE!" Got me nowhere.

Whether the nursing home was at fault or not bring a question to my mind. If this wasn't a nursing home but a relative who was caring for a patient, would the other family members sue the relative caregiver? Makes me wonder how many elders living at home aren't getting the correct care. Those cases we rarely, if ever, hear about.

Don't get me wrong, I am not sticking up for the nursing home as there are two sides to every story, just putting out food for through.

I need to read the article, to be fair.

But the usual results are:

Older people read it in horror and become even more resistant to the thought of "going into a home."
Hands-on caregivers read it, wonder what the facts of the case were, wonder what the regulators thought they were doing, wonder what's *wrong* with people, and then scurry off to the bedroom or the ALF or NH and check up on our loved ones.
Absent caregivers wonder if their loved ones are being looked after properly. But don't have time to visit, not this weekend, maybe next...
Cross caregivers and family members wonder if they can sue their facility. The bastards.
Lawyers who missed out this time wonder what other kites might be worth flying
The Great and Good congratulate themselves on forming more committees to address the complex challenges of an aging demographic and learn lessons and make sure this Never Happens Again. Again.

Sorry, did I say I was getting cynical? Moi?

I suppose I hope that such headlines will encourage others to be more vigilant as well as encourage others whose loved ones have suffered neglect to rise up in righteous indignation and demand change, at the very least better government oversight. The unfortunate reality is that no one who is satisfied with their loved ones care or those who haven't yet needed to place a loved one in an nursing home will even read the article let alone push for change.

CW I'm afraid this is where I reveal myself as a true cynic and ask "cui bono?"

Who is bringing the suit, to whom will damages be paid if it's successful, and... oh here we go: let's see if we can all guess who will be making lots and lots and lots of lovely money from it without suffering so much as the trouble or discomfort of a sore bottom or the distress of seeing anyone they care about in pain.

Will the outcome be a single pressure sore healed? Will it improve the staff:resident ratio one jot? Will it pay for better training?

Of course not. The argument is that by making an example of one brand, the others will be forced to up their game. But that's not what happens. What happens is that the market is forced to ring fence money against the risk of litigation and increased insurance costs, and there is even less available for staffing and training.

The lawyers concerned are not remotely interested in holding the industry accountable. They are taking half page advertisements in national papers trawling for complainants. There's a particularly revolting one that I saw again last weekend, illustrated by an image of a bruised, rotting apple, that I was minded to complain to the advertising standards authority about last time the same campaign ran, last year.

So thank you for the reminder, I'll get on to it.

Improving standards requires strong regulators, good training and education, good employers interested in continuous development of best practice, and - as with liberty - eternal vigilance on the part of elders' advocates. I.e. thee and me. Class actions in pursuit of undisputed goals - in this case, the avoidance of pressure sores - benefit nobody but the lawyers and aggrieved relatives; and, what's more, generally the sort of relatives who don't visit often enough to help highlight a problem before it's become a disaster. I.e. the ones who do vox pop's on telly saying "I went on Thursday and there was dried food on her pillowcase and it was still there on Sunday night I think it's disgusting there ought to be a law..." And the interviewer *never* says "well why the f**k didn't you change the pillowcase then you useless tosser?"

A propos, somebody on the whine thread was asking where all the money goes and that got me thinking about this, too. Let's NOT make any more go to law than absolutely has to, please!