Last month, the Department of Public Health released a small Class B citation with a modest $1,000 fine against Leisure Court Nursing Center, a nursing home in Anaheim. The facility was cited for poor dementia care practices, exacerbated by a failure to monitor a resident’s fluid intake and hydration status. At first glance, the citation is unexceptional: a resident with dementia receives deficient care and the facility is given a low level citation. But upon a close review, the citation reveals how ridiculously poor dementia care, marked by clueless staff and harmful chemical restraints, remains common nearly FOUR years after California undertook a major campaign to improve dementia care.
At Leisure Court, an 82 year old female resident who had been admitted just eight days before, was observed crying out “help me!” and “hurry, hurry!” At other times, the resident was observed yelling about pain, her thirst, and her need to use a bathroom. The resident was diagnosed with dementia, arthritis, gastro-intestinal disorder, and had recently fractured her hip. The facility was supposed to monitor the resident closely for pain and gastro-intestinal distress. However, the resident’s medical records said the resident had no indications of pain and her only treatment was Tylenol. For her severe gastric pain, the resident was supposed to get antacid tablets but they were only irregularly provided.
The facility staff’s primary response to the resident’s cries of pain and distress was to call her psychiatrist and obtain an order for higher doses of Depakote, an anti-convulsant drug to restrain her “agitation” and yelling. In other words, the facility resorted to horrid chemical restraint use.
The failure of the Leisure Court staff to effectively monitor and treat the resident’s pain, despite her distressing cries, is noteworthy. The facility failed to investigate and remedy the various reasons why the resident was frequently upset, and then sought sedating drug as “treatment” to shut the resident down, with the complicity of an ignorant psychiatrist.
The use of Depakote is also interesting. Depakote is a popular drug for chemically restraining people with dementia for two reasons. One, it comes in a sprinkle form, allowing it to be concealed in a nursing home resident’s food. Two, as an anti-convulsant, it is not considered a psychotropic drug for purposes of federal reporting, is not tracked, and thus may be an increasingly popular drug for restraining residents who are having problems and express them behaviorally.
For the many people working hard to improve dementia care in California, citations liked those issued to Leisure Court remind us that our work continues to be much needed
To read the citation, click here.