Three Assisted Living Workers Charged in Death of Resident

Three assisted living facility workers are being prosecuted in the death of 86-year-old, Hazel Place, a resident who suffered from Alzheimer’s disease.  Authorities alleged the three left Ms. Place outside in sweltering weather for six hours.

Jamie Johnston, 30, Jenny Logan, 50, and Letticia Martinez, 27, employees of  Cappella Assisted Living and Memory in Grand Junction, Colorado, were charged with negligent death of an at risk person and criminally negligent homicide, both felonies.  

Johnston and Martinez were also charged with a misdemeanor for allegedly forging patient records, according to court documents describing the charges.

National Weather Service data shows that the high temperature in Grand Junction that day was 102 degrees Fahrenheit (38.9 Celsius).

The court documents detailing the evidence gathered against the workers have been sealed.

Place could walk and did so frequently in a routine that was familiar to caregivers, but was supposed to be checked on every hour because she was at risk of falling, her daughter, Donna Golden, told The Daily Sentinel in Grand Junction.

“What it boils down to, as the caregivers that day and probably on other days, none of them were doing their job. Not a one of them checked her,” she said.

Cappella Assisted Living and Memory said in a statement that it reported the circumstances surrounding Place’s death to regulators and conducted an internal investigation which led to the dismissal of two of the workers. The third worker was placed on “investigatory leave,” the statement said.

“We are very saddened by the passing of this beloved resident, and we continue to send our sincerest sympathy to this resident’s family and friends,” the statement said.

At Death's Door- Shedding Light on How to Live

Kaiser Health News recently published a story about Ronni Bennett, a  popular blogger who writes about aging, a blog aptly entitled "Time Goes By- What its Really Like to Get Old."   The story highlight's Ms. Bennet's decision to write openly about living with her own recent terminal diagnosis.

At Death’s Door, Shedding Light On How To Live explores the impact of a terminal diagnosis on how one person decides to live the rest of her life and how she is coping with the diagnosis. Her blog posts are illuminating, poignant, and of course, heart wrenching.  She lists the things she no longer does, like regularly exercising, or finds concerning:

All kinds of things... fall away at just about the exact moment the doctor says, “there is no treatment” (which is their common expression for “you're terminal.)”At least, that is true for me and one of those things that fell away is any concern at all about what any person thinks about me in any regard. How others identify me is not my concern.

She continues in another post:

"I live in a different country now – the land of the terminally ill.  

 Isn't that a horrible phrase, “terminally ill.” It's too clinical, even industrial. It ignores the humanity of the life that will be extinguished and it sounds so imminent, as if I am already on the first bus out of here - a bus being driven, of course, by the grim reaper, hood in place and scythe in hand.

But that's not true of me. For awhile anyway, I've got some time. None of the doctors and nurses knows exactly how long in my case but, given some chemotherapy, six to eight months before symptoms begin to kick in has been mentioned.

Me? I take the prediction with some caution. The time could be shorter or it could be longer and since there is nothing I can do to affect the timing, the only rational choice for me is to carry on living.

Without, however, losing sight of the impending exit date. To ignore it would be absurd.

On the day I learned of my new status, some decisions came to me immediately. I've mentioned giving up the daily workout I've always despised, and now I get to eat all the ice cream and cheeses – my two favorite foods – as I want."

Bennet's posts have found positive responses from readers.  Still, the Kaiser article acknowledges that others may not prefer to share their lives with strangers:

"Other people may have very different perspectives as they take stock of their lives upon learning they have a terminal illness. Some may not want to share their innermost thoughts and feelings; others may do so willingly or if they feel other people really want to listen."

The blog is insightful and compelling.  

I have never before mentioned in this blog another of my favorites, The Blog, by Rory Feek.  Rory's blog, too, concerns life, and coping with a terminal illness, but more profoundly, it is about love.  My  wife and I were fans of husband and wife country music artists Joey and Rory Feek from the first time we watched them on the CMT talent show "Can You Duet."  We have purchased every CD, and I have combed over every line of prose and poetry germinated and nurtured by their love- love of life, love for each other, love for their children, love for their family and friends, and love of God.  Like millions we wept when Joey lost her battle with cervical  cancer. 

My eyes still well with tears when I see the song, "When I'm Gone," in my playlist, and am reminded of Rory's testimony of the song's impact on his life in the blog post entitled, aptly, "when I'm gone:"  

Our ‘make-believe‘ song and video seems to be coming true.
Some call it ‘life imitating art’.  I don’t.
I call it God.
He knew I would need her to tell me goodbye… not just once, but a thousand times.  And I’d need to know that no matter how much time passes, that she loves me still.  And He made it so that if I needed to be reminded of her beautiful life and heart and voice… she would only be a ‘click’ away.

While there are likely no words uttered from human lips, or written by human hands, that can guide entirely any individual in his or her own meeting with mortality, it is both comforting and inspiring that others share their insights and wisdom.  The rest of the great mystery is perhaps the province of the divine. 

Nursing Home Involvement in Patient's Death Object Lesson on Aging-in-Place Planning

An effective Aging-in-Place strategy will include, as a last resort, identification, consideration and communication of standards used in selecting institutional care.  So many folks assume they have an effective Aging-in-Place plan, but never consider the likelihood of short or long-term institutional care, which may, regardless of an underlying plan, be inevitable. 

This oversight can have tragic consequences if short-term institutional care becomes inevitable!  If decision-makers cannot effectively evaluate competing institutional care options, a choice of care may be uninformed.  Mistakes can be  severe and permanent. Consider the case of a Massachusetts nursing home.  

Massachusetts officials announced this week that they are maintaining a freeze on admissions at a South Yarmouth nursing home as a federal investigator’s report reveals details about the death of a patient that collapsed during physical therapy, and later died.

According to a Centers for Medicare & Medicaid Services (CMS) report, Windsor staff failed to perform chest compressions or use an automated external defibrillator (AED) on a patient who became unresponsive while doing light hand and wrist exercises in his wheelchair in the rehabilitation gym.  The CMS report describes a chaotic scene, with precious and possibly life-saving moments lost while staffers scrambled to respond.  Reading the report of the event one might conclude that there was no consideration by the management or staff of the possibility of such an event, and there appears to have been no knowledge of, reference to, or implementation of a concerted emergency life saving plan.  

CMS criticized the institution  for going three years without mock trials of code blue emergency drills, which include notifying the entire nursing home staff of an emergency and making the facility accessible to rescue personnel. 

The result was horrific.  A physical therapy assistant said she couldn’t get an outside line on a nursing home phone while dialing 911 emergency services and after numerous attempts resorted to using her personal cell phone to call 911.  Other staff  struggled put the patient, who wore a nasal cannula for oxygen, in an oxygen mask, but it was not applied properly.  By the time emergency rescue crews arrived and started performing CPR, the resident had no cardiac activity or signs of life. When a second rescue crew arrived about three minutes later with additional emergency equipment, access to the patient was delayed by locked doors as many of the staff were unaware of the emergency.

The American Heart Association says that after 10 minutes few attempts at resuscitation succeed.

The patient was transferred to Cape Cod Hospital and put on a ventilator, but family members decided to withdraw life support March 6, and the patient died one hour later.

 CMS fined Windsor Skilled Nursing and Rehabilitation Center $90,000 following the death of the 54-year-old resident in March.  The sanction works out to approximately $3000 for each of the almost 30 years of the patient's life expectancy.  The sanctions took place after investigators determined that Windsor staff failed to do CPR on the patient after he went into respiratory and cardiac arrest.

The nursing home submitted a plan of correction with public health officials that is under the process of review.  If the 120-bed nursing home is not brought into “substantial compliance” with regulations by Aug. 27, the government will no longer reimburse Windsor for services delivered to Medicare and Medicaid patients.The federal agency threatened to rescind Windsor’s Medicare and Medicaid contract by June 19, but that deadline has now been extended to Nov. 27.  The sanctions and warnings started after state Department of Public Health officials took the rare move of finding that Windsor was in “immediate jeopardy” May 27.  "Immediate jeopardy" was changed to “non-immediate jeopardy” June 7, but a CMS letter to Windsor dated June 8 said “substantial compliance, however, had not been achieved.”  Meanwhile, the institution to cares for patients.

Windsor spokesperson Ernie Corrigan said earlier this month that the nursing home staff has gone through “hundreds of hours of training” since the May 27 jeopardy finding.  He said in an email that the staff had followed proper protocol as far as life-saving measures were concerned:

The response staff was continuously at his side, detected and continued to detect a pulse, and followed the protocols outlined by emergency medical trainers and the American Heart Association that dictate that you do not provide CPR or AED assistance when a patient continues to have a pulse. It is our view that everyone involved did their very best and performed admirably during a rapidly deteriorating medical emergency that eventually led to this patient’s death.  

State health inspectors will conduct an unannounced follow-up inspection once the nursing home submits an acceptable plan of correction, according to an official with the state Department of Public Health.  If DPH finds the nursing home to be in compliance with regulations, it will lift the freeze on admissions, the DPH official said.

In addition, CMS will not terminate its contract with Windsor if the nursing home comes into compliance with state and federal regulations, a CMS spokesperson said.

Findings of jeopardy and nursing home terminations in Massachusetts are not common. Last year, five Massachusetts nursing homes were placed in jeopardy, a DPH spokesman said.  Only one nursing nursing home in Massachusetts has had its Medicare provider agreement involuntarily terminated since June 2015.

For more information, please go here.

Religious Music Aids the Dying

Listening to religious music helps seniors increase their life satisfaction and self-esteem, and decreases anxiety around death, according to new analysis published in the Journal of Gerontology.  Music also helped seniors appreciate a sense of control, according to researchers at Baylor University, University of Texas- San Antonio, Bowling Green State University and Duke University. The research suggests that long-term care residents may benefit from listening to religious music. Responses were collected among more than 1,000 adults, all over age 65, who were either practicing Christians, identified as Christian in their past, or who were unaffiliated with a specific faith.

"Given that religious music is available to most individuals — even those with health problems or physical limitations that might preclude participation in more formal aspects of religious life — it might be a valuable resource for promoting mental health later in the life course,” the authors concluded. Results appeared in The Journal of Gerontology.  

According to McNights Long-term Care News, a  2013 study, also published in the Journal of Gerontology, considering the use of religious songs in helping older African Americans cope with stressful life events, also found that songs evoking themes of thanksgiving, communication with God, and life after death improved the mental health of those studied.  These join a growing amount of research literature that associates various religious factors with positive mental and physical health, and even suggests that aspects of religious involvement may reduce mortality risk. 

Go here for an article discussing the broader Family and Psycho-Social Dimensions of Death and Dying in African Americans.

Ohio Ranked One of the Worst States in which to Die

Only Two States Were Ranked Lower

Ohio is one of the states where the dying are less likely to receive the best all-around care and legal protection, according to state-by-state rankings by Forbes magazine. In only Illinois and Washington, D.C., are the dying less likely to receive proper treatment, the Forbes analysis suggests.

Utah is the state where the dying are most likely receive the best treatment, according to the ranking. Rounding out the top five states to die are Oregon, Delaware Colorado, and Hawaii. Following the District of Columbia at the bottom of the Forbes list are, in ascending order, Illinois, Ohio, Louisiana and Mississippi. For the complete list, click here.

To create its rankings of “Best Places To Die,” Forbes looked at five criteria that measure the care and legal protection states provide to the dying, as well as the amount of money heirs may inherit. Here are the criteria, along with the weight Forbes assigned to each: