PA Veterans' Home Cited for Abuse, Neglect

By Walter F. Roche Jr.

Just two months after a similar finding, a state run nursing home for veterans has been cited for abuse and neglect in the care provided to two of its residents.
The August inspection of the Southwest Veterans Center in Pittsburgh concluded that the facility "failed to ensure two residents were free from physical abuse and neglect," according to the state Health Department report. In both cases an employee caused the patient injuries.
The incidents, the report continues, "caused actual harm."
Nursing home officials filed a plan of correction in which they reported that one of the employees had been terminated and that staff had been retrained on abuse and neglect issues. The state Department of Military and Veterans Affairs, which runs the state veterans homes, did not respond to questions about the two incidents.
The 236-bed facility was cited in July for failure to proprly investigate a case of resident- on-resident abuse.
The report, the result of an Aug. 4 complaint investigation, found that in one instance a patient who suffered from dementia and behavioral disturbances, was also known to wander.
A goal of his care plan was to ensure that he would not physically abuse other residents, staff or visitors."
On June 11 the resident was observed grabbing another patient's wrist then striking the employee in the upper left arm when the employee tried to separate them.
On June 18 the patient fell face down on a bed and was sent to a hospital for treatment of a facial laceration, requiring sutures, and a skin tear on the knee.
Though an employee claimed to have learned of the patient's injury only after the fall, video surveillance showed the employee forcibly pushed the patient into his room and then left to attend to another patient. Only then did he call a nurse reporting the patient was lying face down.
In addition the patient, who also suffered from dementia, was subsequently diagnosed with a mild stroke.
The employee was suspended once the videotape was reviewed and subsequently terminated. The patient, at the family's request, was discharged on June 23, according to the facility Plan of Correction.
In the second case cited in the report, a female patient suffered lacerations when the wheelchair overturned, apparently as a result of an employee mishandling the wheelchair. The worker also failed to place a helmet on the patient, state surveyors reported.
That employee, the report states, was retrained on wheelchair and helmet procedures and not suspended or terminated. The patient had the sutures removed and recovered.
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