Author Archives: Adam Peck

Long-term care residents also are often highly functionally impaired. Many are incontinent, immobile, and confused or demented. The worse the functional status, the greater the likelihood of infection or colonization with resistant microorganisms

For example, incontinence and impaired mental status have consistently been associated with asymptomatic urinary tract infection. MRSA colonization is more likely to be identified in residents with pressure ulcers or fecal incontinence or who are bed bound or require feeding tubes or urinary catheters. In most cases, impaired functional status is a determinant of admission to long-term care and is not modifiable. If the major predictors of infection in long-term care facilities are poor functional status and co-existing chronic illness, and these conditions cannot be altered, to what extent is it realistic to anticipate that endemic infections can be prevented in such residents? In addition, with the number and severity of existing conditions, how much illness or death is attributable to infections per se, rather than to underlying chronic disease? Assessing the impact of infection on patient outcome in evaluating interventions to prevent infection is, thus, often problematic. An example is a decision to provide comfort care but not to treat pneumonia with antibiotics in severely impaired patients.

County prosecutors and senior citizen advocates introduced a new law as the best hope of defending the aged and infirm from violence, neglect and fraud committed by criminals in the guise of caregivers.

On July 1,2011, Napa County will begin enforcing California’s first law requiring government permits for in-home caregivers.

“In-home care is one of the five hottest jobs” said Kristi Lesnewich of the Napa County Commission on Aging said at a news conference. “But there’s no oversight, and convicted felons can do it — except not in Napa County anymore.”

“Why is there oversight for people who provide massage and pedicures, but none for those who care for the elderly?” Lesnewich told 75 people at the Napa Valley Hospice and Adult Day Services.

Last year, Napa County and its five cities ratified the ordinance, which requires those seeking to provide in-home personal or domestic services to pass a criminal background check and pay for an annual permit.

Background check fees are paid to the Area Agency on Aging Serving Napa and Solano. They cost $90 in the first year, $79 for the second year and $67 annually thereafter. The permit costs $20 annually, paid to the county Clerk-Recorder’s Office.

The local law requires the permit for anyone seeking money, room or board for caregiving, including relatives. Registered nurses and other licensed health-care workers are exempt because they already submit to background checks to receive their licenses.

County-issued permit cards will be light green, laminated and bear the holder’s photograph, permit number and expiration date.

Crimes such as a recent Contra Costa County murder make the need for new protections plain, said Napa County District Attorney Gary Lieberstein, referring to Diane Warrick’s recent sentencing for fatally stabbing a 70-year-old woman in her care.

Warrick, now 57, was arrested in April 1997 after taking hostages at Napa State Hospital and demanding to be taken to the pharmacy. Released after three and a half years in a state hospital, she was sentenced this April to 31 years to life in prison for murdering Mary Jane Scanlon and stealing her cash, car and passport.

Warrick had answered a Craigslist ad seeking a caregiver for Scanlon, a paraplegic, according to Contra Costa authorities.

“We believe and hope the rest of the state is watching,” said Lieberstein, who called in-home care a common destination for parolees needing employment to retain their freedom. “We believe this should be a state law. We don’t think this protection should only be in Napa County.”

With the state on the sidelines, officials in Sonoma, Santa Cruz, Humboldt and San Luis Obispo counties have discussed with Napa County possible versions of the law, according to Jane Hinshaw, the Napa DA’s investigator for elder abuse cases and financial crime.

“We weren’t willing to wait,” she said. “We could be getting really good at (enforcing) this law by the time the state gets to it, and that’s fine.”

At least 1 million, and as many as 2 million Americans 65 and older have been abused, neglected or exploited, and only one in 14 cases is reported to law enforcement or social services, according to the National Center on Elder Abuse.

A federal agency has released health quality data that show troubling statistics about nursing home care in California. The data show almost one in 10 long-term nursing home patients was physically restrained in 2008.

The state snapshot also said that some 27 percent of short-stay nursing home residents had bed sores that same year. In these areas, California ranked last among the states.

Bill Freeman of the Agency for Healthcare Research and Quality said he hopes the numbers are useful to lawmakers. The agency found the state was ‘average’ in overall quality of care.