Neglect and a death
With home caregivers asked to perform more complex and risky tasks, the absence of training and supervision has sometimes led to fatal results.
Lisa Lassen is still haunted by the pained cries of her father, as an infection from a foot wound spread through his body, consuming his organs. “I will never forget his moaning and yelling for as long as I live,” Lassen said.
The worst part, said Lassen, is living with the belief that his death two years ago was “completely avoidable.’’
Her father, Kenneth Ell, a retired railroad worker with diabetes and early dementia, developed a foot infection soon after entering St. John Home Care, a small group home that employed personal care attendants. The Ell family chose the home, in a neighborhood of Minnetonka, in part because it seemed more intimate than a nursing facility and advertised “specialized diabetic care” and “wound and foot care” on its website.
In sworn testimony, a former personal care attendant at the home described a chaotic atmosphere. The caregiver, Jessica Crawford, said she watched as a staff member reused hypodermic needles for injecting insulin into diabetic residents, and said her training consisted of being told to watch some videos. The group home’s owner, a nurse, visited “maybe once in a blue moon,” she said.
“Most of the employees didn’t know what they were doing or didn’t carry through with their jobs correctly,” Crawford, who no longer works at the home, said in sworn testimony.
Lassen said staff failed to detect obvious signs that her father had a serious infection. He had difficulty walking, complained of foot pain and became increasingly lethargic, Lassen said. When a laboratory report revealed that Ell had an elevated white blood cell count, indicating an infection, she said three-and-a-half days passed before the staff sent the lab report to a physician’s clinic.
By the time Ell was admitted to a hospital, it was too late. The infection had spread so rapidly that, after his lower right leg was amputated, he died of multi-system organ failure. His 89-year-old mother was so overcome with grief that she threw herself on his lifeless body as it lay sprawled on the hospital bed.
The Minnesota Department of Health investigated Ell’s death last year and found that the group home had failed to appropriately treat the client’s diabetes and follow up on the lab report. The facility was cited for neglect.
“It makes me so incredibly mad,” said Lassen, who lives in Grand Rapids, Minn., and coordinates a day program for children with developmental disabilities. “I believe 100 percent that my father would still be alive today had he been treated by licensed and trained professionals.”
Mopelola Akinloye, owner of St. John Home, did not return repeated calls from the Star Tribune seeking comment on the case and the state’s findings about it. However, in court documents, Akinloye and the group home referred to the allegation that Ell received care from incompetent staff as “baseless.”
It argued that, during Ell’s stay, St. John Home employed two nurses and several nurses’ aides, and that all of the staff were trained. Akinloye, a registered nurse, said in sworn testimony that she looked at Ell’s foot every day and notified his physician when he complained of foot pain. A nurse at the facility also denied in sworn testimony that she reused needles to administer insulin to Ell or any other patient at the home. In court documents, Akinloye and the home also argue that Ell’s death may have been caused by conditions predating his foot infection. At the time of Ell’s admission to the home, he was diagnosed with chronic heart failure and kidney disease, among other ailments. A day before Ell’s death, a doctor who cared for Ell wrote on medical notes that he could not determine the cause of his infection.
Workload more demanding
The type of work demanded of home caregivers has changed dramatically in the past two decades.
Hospitals, under pressure from insurance companies to reduce costs, are releasing more patients while they are still sick or recovering, effectively shifting the burden of medical care to the home. Caregivers have had to master the operation of respiratory ventilators, intravenous feeding tubes and home dialysis, while responding to medical complications such as wound infections and low oxygen levels.
More than 80 percent of home caregivers provide nursing care, while more than 50 percent provide help with highly complex medical tasks, according to a survey of 1,926 home care workers who cared for adult Medicaid recipients in three states.
“The burdens placed on [home caregivers] have never been greater,” said Dr. Kevin Mahoney, director of the National Resource Center for Participant-Directed Services at Boston College.