The Culture Change Coalition of Peoria brought attorney Steven M. Levin, of Levin & Perconti (Chicago) for an enlightening presentation on Thursday. Perconti has been involved locally with the East Peoria Gardens lawsuit where a business decision to mix the elderly with a younger, more vibrant population turned disastrous.
Perconti is one of the country’s top litigators in the highly-specialized area of nursing home abuse and neglect, as well as being a vigorous advocate of nursing home reform. Throughout his presentation he called for the need to have owners more directly involved in the daily care of residents.
Perconti said that’s obvious when direct care staff get burned out while owners don’t. Studies show that nursing homes with a religious affiliation and homes with permanent staff are far less likely to be sued. Unfortunately, understaffing and the rigors of the seven-day week commitment take their toll on staff.
When he asked for a show of hands, he found a variety of staff present in the Arbor Hall Auditorium at ICC-North. “There are no owners present,” Perconti said, seeming to have anticipated such. “The owners ultimately make the decision and probably need to attend (a meeting like this).”
Perconti shared that, in depositions against nursing homes, there is frequently a lack of communication of the care plan to direct care staff. “In fact, the direct care staff have often never seen the care plan,” he noted.
Culture Change Steps In
In 1987, the OBRA '87: Nursing Home Quality, Staffing And Enforcement Issues was passed by the senate. But Perconti admits that extensive change is still needed.
The change needs to come from the owners. Several direct care staff present cited creative solutions they have tried. Yet fear of incrimination was cleared a shared value among the audience, some of whom had been told not to document patient conditions in order to avoid self-incrimination.
Perconti recommended photographing a stage 3 pressure sore on the day of admission, for example, proving that the patient arrived with the sore. The direct care staff in the room voiced objection, saying that the business owners and their defense attorneys discouraged the practice.
While Perconti noted that society has moved from a purely consumer model, more changes are in order. Losing sight of goals is the number one oversight that currently leads to nursing home care lawsuits. Documentation, Perconti proposes, is the remedy.
When direct staff objects to how time-consuming documentation is, he reminds them that hospitals do extensive documentation. Nursing homes need to commit to a business model that is just as consistent.
Evidence of unavoidability is the best argument any nursing home owner can site in defense. If document does not exist proving unavoidability, the charges will stick.
Perconti also proposed “self-staffing” as a business practice. He pointed out that many direct care givers don’t really know exactly what their job is. When put on the stand during trial, 90% of direct staff cannot remember the residents they worked with. There is also a lack of complete charting, the one thing that would be most evidential in court.
With self-staffing, direct care workers chose when their hours and their residents. One audience member said her nursing home does partial self-staffing.
“It sounds scary,” Perconti said. “Giving staff greater decision-making responsibility. But we know you are unlikely to use someone you know.” Translated, a nursing home resident is less likely to sue a caregiver they see regularly and who knows their wants, needs, and abilities.
For more information or to become involved with the Culture Change Coalition of Peoria, visit their website at www.cccofpeoria.com.
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