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Bed Sore Articles
Jonathan Rosenfeld also publishes the Nursing Homes Abuse Blog. Summaries of related posts are available below; you can click on the links to view the full articles, or visit the website here.
Medical Journal Calls for Increased Use of Pressure Sore Assessment Scale
A recent study from the Ostomy Wound Management journal claims that the Braden Scale of assessment is extremely effective in diagnosing and preventing bed sores, or decubitus ulcers. The six-point Braden Scale, which was developed in 1987, assesses patients in the following areas: sensory perception, skin moisture, activity level, ability to change positions, nutrition and exposure to situations that can result in friction and shear to the skin.
“Overall the Braden Scale is user-friendly, and each {section} has a detailed explanation,” the study says. “Fewer severe ulcers were documented…during the time the Braden Scale was used.”
The study took a look at two groups of patients – those admitted to a Level I Trauma Center between March 1, 2007 and March 17, 2008, and those admitted between March 18, 2008 and March 31, 2009. Age didn’t factor into the study, though most patients admitted were around 60 years old. Along with the Braden Scale, an assessment technique called the Skin Scoring Tool was frequently used.
“The Skin Scoring Tool includes the following domains: sensory, mobility, continence, skin integrity, activity and function,” the study says. “Studies comparing the effects of {both} risk assessment instruments are needed.”
Of approximately 42,000 patients, about 350 developed advanced-stage pressure sores. Sores were frequently located on the sacral area, heel, hip, and buttocks. More than half of the ulcers in each population were stage II pressure ulcers. The study claims that bed sores are often best diagnosed by a team of doctors and nurses.
“Clinician judgment alone has shown inconsistent implementation of pressure ulcer prevention interventions,” the study says.
Related:
Study Finds High Incidence of Pressure Sores in Elderly Patients with Hip Injuries
Why is it common for nursing home and hospital patients to develop bed sores on their back?
Lack Of Cleanliness & Incontinence Contributes To Development Of Bed Sores In Nursing Home Patients
Under-staffing At Nursing Home Blamed For Pressure Ulcer, Infection & Subsequent Death
Proper Bed Sore Care Must Involve Dermatologists, Expert Says
Proper bed sore care often requires the expertise of many people. Doctors, nurses and family members all play a critical role in a patient’s healing. Sometimes, however, certain types of doctors might be especially well-suited to treat decubitus ulcers. In a recent report from Modernmedicine.com, an Ohio doctor argues that proper bed sore care must involve the regular supervision of a dermatologist.
“Elderly patients who have had strokes or spinal injury don’t have good [sensory abilities], so their bed sore ‘hot spot’ often goes unattended, ” says Dr. Eliot N. Mostow, a dermatologist and professor at Ohio’s Case Western Reserve University. “We need to look first at preventing bed sores, and then caring for them when they occur. ”
Mostow, a former president of the Cleveland Dermatological Society, says that dermatologists should be involved at all levels of bed sore care, from identification to healing.
“Sometimes, a dermatologist is the only one who can distinguish a pressure ulcer from something else,” Mostow says. “It’s the dermatologist who would look at the pressure spot and know whether or not it’s a decubitus ulcer, a squamous cell cercinoma, or a deep fungal infection. Clinicians might see it as just a red area, but a dermatologist might diagnose it as a stage I ulcer.”
Mostow noted that many pressure sores often form in the sacral area, an area highly vulnerable to prolonged redness and irritation.
According to Mostow, proper bed sore treatment should involve either a multidisciplinary team at a hospital, or specialists at an outside wound care clinic. Mostow advises fellow doctors to visit www.woundsource.com, a site where they can learn about the most up-to-date wound care technology.
“Too often, dermatologists forget what they already know about wound care,” says Mostow. “If there’s pressure, work with pressure release. If there are problems, we need to provide the appropriate moist wound healing and prevention, and then correct the (original) factor.”
Related:
Why is a colostomy needed for patients with severe bed sores?
What is a wound vac and how does it work?
How many calories does a patient with advanced bed sores need to consume?
Study Gives Suggestions for Treating and Preventing Bed Sores
Gangrene & Osteomyelitis Cited In Wrongful Death Lawsuit Against Nursing Home
The Journal Carrier reported on a recently filed Illinois lawsuit against Jacksonville Convalescent Center involving the death of an 87-year-old man at the facility. According to reports, the Illinois nursing home lawsuit was filed based on the poor care provided by the nursing home contributed to the patients death.
Despite having multiple medical conditions such as: prior strokes, hypertension, diabetes and dementia that put the man at an increased risk for falling, the facility allegedly failed to implement the necessary safeguards and he subsequently fell and fractured his hip which necessitated a surgery.
In addition to the fall and resulting injury, the lawsuit further alleges that the facility failed to prevent the development of a diabetic ulcer on the patient’s ankle that ultimately resulted in severe medical complications such as gangrene and osteomyelitis.
Related Bed Sore FAQ’s:
Can bed sores cause osteomyelitis?
If bed sores are not timely treated, can gangrene develop?
Bed Sore FAQ: Bed Sore Lawsuits
Nursing Home Injury Laws: Illinois
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Pressure Sores Are Needlessly Killing Nursing Home & Hospital Patients
Pressure sores (also referred to as bed sores, pressure ulcers, or decubitus ulcers) are an all too common and painful problem for nursing home residents.
Most pressure sores are preventable and are caused by faulty care where the nursing home or hospital does provide adequate care to prevent and treat bed sores. Patients vulnerable to developing pressure sores are the elderly, people who are bedridden, and people with diabetes.
Pressure sores in nursing homes can be prevented by taking simple preventative measures including:
- Turning patients
- Using pressure reducing mattresses and pads (pressure relieving devices)
- Keeping residents clean and dry
- Providing adequate nutrition and hydration
- Performing skin checks
Related:
Can dehydration contribute to the development of bed sores?
Can malnutrition cause bed sores?
What is ‘turning’ and why is it important to prevention of bed sores?
Are pressure relieving mattresses required to be used in nursing homes?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Bedsore Trial Will Test Families Allegations That Staff At Nursing Home Were Not Providing Adequate Care
A pending trial against Retama Manor Nursing Center (Texas) will put a families allegations of improper nursing care and poor medical charting—front and center before a jury.
The trial commenced by the family of Emilo Gonzalez, a patient with motile medical complications including: partial paralysis, anemia, seizure disorder, decreased appetite, dementia and Parkinson’s disease, alleges that despite a medical chart that seems to substantiate regular care—including crucial bed sore preventative measures such as turning and re-positioning, the care was never actually provided.
Lawyers for the nursing home, assert that the facility actually performed all of the care that the records demonstrate and the development of Mr. Gonzalez’s bed sore (similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers) was simply an unavoidable medical condition that developed due to the fact the Mr. Gonzalez’s body was shutting down.
Inevitability is a common defense asserted by nursing homes and hospitals in litigation involving the development of a bedsore during an admission to the facility. Despite these arguments, it usually is readily from the testimony of staff at the facility that the care indicated in the patient’s chart was not, nor could have been provided.
Related:
Why are mentally disabled patients at risk for developing bed sores?
What steps can be taken to minimize the risk of developing bed sores?
What are nursing homes required to do to prevent bed sores?
Nursing Home Injury Laws: Texas
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Are Bed Sores Inevitable For Obese Patients In Nursing Homes & Hospitals?
An article published in the Las Vegas Sun, painted an unfortunately common set of circumstances; an overweight patient goes into a hospital for a medical procedure– only to acquire pressure sores during their stay. Sure, the same scenario can (and most certainly does) occur with people of average stature, but there definitely is a disproportionate number of obese patients who enter a hospital or nursing home only to develop a lingering souvenir.
The sun article concentrates on 60-year-old Tyrone Bush, a maintenance man, who was admitted to Desert Springs Hospital for a quadruple heart bypass surgery in 2008. It was during Bush’s recovery at the hospital, that he developed multiple bed sores (or pressure sores, pressure ulcers, decubitus ulcers) on his buttocks.
More than two years later, Mr. Bush continues to be plagued from the wounds and requires extensive medical treatment for them including doctors visits and debridement procedures– where the dead skin is removed to allow the new skin to grow over the open wounds.
Not surprisingly, the hospital where the wounds developed blames the wounds on Mr. Bush himself, implying that the wounds were unpreventable given his size.
Related:
What is surgical debridement of bed sores?
Simple preventative techniques can drastically reduce the rate of hospital-acquired decubitus ulcers
Why is it important to differentiate the type of facility where a bed sore developed?
Nursing Home Injury Laws: Nevada
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Medical Facilities Are Not Doing Enough To Prevent Pressure Ulcers On Patients’ Heels
The physical make up of the foot also makes the treatment of heel pressure sores difficult for the facility and particularly disabling for the patient. The calcaneus is the largest bone in the foot, yet covered be relatively little muscle making it particularly susceptible to damage from unrelieved pressure.
Even relatively young and healthy patients in nursing homes and hospitals are at risk for developing pressure sores on their heels because many staff in nursing homes and hospitals are simply unaware of the potential risk and commonly used bed sore risk assessments may not take into consideration elements unique to heel pressure sores.
In particular, patients with suffering from hip and leg fractures are at risk, along with patients in intensive care who may have compromised blood pressure due to trauma are at an increased risk for developing pressure sores on the heels. Facilities need to be focused on these groups of patients — and any patient with limited mobility, as they remain at risk for developing heel, foot and ankle pressure ulcers.
Related:
Are bed sores on the heels common?
Why are physically disabled patients at risk for developing bed sores?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Threat Of Stiff Fines Still Fails To Reduce Rate Of Pressure Sores At Some Nursing Homes
When nursing homes take simple, preventative steps such as: turning patients, keeping them clean, and providing adequate nutrition and hydration; they can greatly decrease the incidence of pressure sores at their facilities. However, even though the preventative steps are well known, many nursing facilities simply fail to implement the necessary care that patients require to function optimally.
I was particularly disturbed when I came across an article in the Arizona Daily Star regarding a Kindred-owned nursing home that has been repeatedly failed to provide sufficient wound care for its patients. In fact, Villa Campana Health Care Center was most recently fined by state authorities $10,000 following a horrific chain of events involving a patient who was admitted to the facility last fall.
Within a month of entering Villa Campana, a patient developed a pressure sore on their buttocks. Despite the staff’s documentation of the wound, little care was provided at the wound progressed to the point that bone was involved and an infection known as osteomyelitis ensued. Eventually, the patient required multiple surgeries to treat the advanced pressure sore including a debridement surgery to remove portions of the coccyx, sacrum and surrounding tissue.
Related:
Can bed sores cause osteomyelitis?
If bed sores are not timely treated, can gangrene develop?
Nursing Home Injury Laws: Arizona
What is surgical debridement of bed sores?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Sometimes Bed Sores In A Nursing Home Patient Aren’t Discovered Until They Are Taken To A Hospital
Some of my angriest clients contact me after a loved one was transferred from a nursing home to another nursing home or hospital only to learn of serious medical problems their loved one likely acquired during their original admission.
Of course, breaking disappointing news is difficult for anyone to do. Yet, in the case of nursing homes– this is something they simply are required to do under the law. Similarly, nursing homes must notify the patients doctor if their condition deteriorates.
I see many cases where there is no doubt an intention on the part of the original facility to cover up change in condition– but also injuries related to situations involving improper care.
This situation of a dangerous condition being discovered only after the patient was transferred to a hospital was highlighted in a recent lawsuit filed against an Illinois Nursing Home, Alhambra Care Center. Part of the lawsuit alleges that the patient lived that the nursing home with multiple health problems, but the staff at the facility failed to notify the family of the conditions
Related:
Nursing Home Injury Laws: Illinois
Gangrene & Osteomyelitis Cited In Wrongful Death Lawsuit Against Nursing Home
Lawsuit Claims That Nursing Home’s Negligence Resulted In Patient’s Decubitus Ulcers
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Daughter Raises Questions After Father Dies from Bed Sore Complications
In Britain, the daughter of a man who died as a result of infected pressure sores is publicly raising questions about his death.
“To know that more could and should have been done to prevent his suffering is simply unbearable,” said 32-year-old Louise Norton, in an interview with the Reading Post. “If by speaking out we can somehow force change, I will feel in some small way justice has been done.”
According to the Post, 64-year-old Mervyn Elkington was admitted to Royal Berkshire Hospital (RBS) in March 2009, with a diagnosis of renal failure. Over the next several months, Elkington’s health deteriorated rapidly. On June 19, 2009, Elkington died as a result of sepsis - an illness caused by infected bed sores. A coroner’s report issued May 19 highlighted several missed opportunities to treat Elkington’s bed sores. The report emphasized that delays in MRI scans, as well as carrying out appropriate surgeries, strongly contributed to Elkington’s death.
“Though [Mr. Elkington] was a very ill man, the post-mortem carried out after his death suggests that he suffered from infected pressure sores,” said Norton’s lawyer, medical law expert Peter Cutler. “It is the cause of these pressure sores that the family is keen to establish.”
Louise Norton maintains that her father consistently received inadequate care while at RBS, saying specifically that nurses didn’t have knowledge of how to properly operate beds designed to help prevent bed sores.
Joe Wise, a spokesman for RBH, countered Norton’s claims.
“We are confident that we did all we could for Mr. Elkington,” he reportedly said. “He was extremely ill, with many serious health problems.”
Related:
How quickly can a bed sore develop in a nursing home or hospital patient?
Four California Hospitals Fined For Delays Related Medical Errors– Including Severe Bedsores
Two Illinois Sisters Charged With Criminal Neglect After Father Dies from Sepsis
Police found Werner "Bernie" Bernhard covered with severe bed sores.
Two women from Northbrook, Illinois are facing criminal elder abuse charges after an autopsy found that their father, Werner Bernhard, 83, died as a result of neglect.
According to a recent report in the Chicago Tribune, Mr. Bernhard’s two primary caretakers were his daughters Lisa Bernhard, 57; and Susan Bernhard, 52. Mr. Bernhard had been living at Lisa Bernhard’s residence in Northbrook at the time of his death on July 14.
Police first became alerted to Mr. Bernhard’s situation after responding to a call at Lisa Bernhard’s home on March 16. According to a Northbrook Police press release, Mr. Bernhard showed “obvious signs of neglect” at the time, including several severe bed sores. The Cook County State’s Attorney’s office reportedly said that Mr. Bernhard had been lying on the floor for at least a week when police discovered him.
“There were indications of neglect at the scene, so we started an investigation immediately,” Northbrook Detective Sgt. Dan Strickland reportedly said. “The first thing we did was make sure he was overseen by organized caregivers.”
The Tribune didn’t specify the type of care Mr. Bernhard received up until his death, though other sources report that he spent four months in nursing homes. The coroner’s report said that Mr. Bernhard died from sepsis (a severe blood infection) as a result of a fall.
According to an obituary in HuffingtonPost.com., Mr. Bernhard was remembered as a “gentle giant” who worked for more than forty years at a local high school.
“He lived the golden rule, his heart was as big as Texas, and he did things with humility and without selfishness,” said Blaine Royer, who worked as assistant principal during Bernhard’s time at Glenbrook North High School in Northbrook. “I’m hoping he’s enjoying peace, because he found peace at work.”
Related:
Family Of Neglected Nursing Home Resident Awarded $42 Million By Jury
Early Detection Is The Key Element To Successful Sepsis Treatment
Short-term nursing home admission results in deterioration of pressure sores and sepsis
Frozen-Joints Or Contractures Can Increase Patient’s Risk For Developing Bed Sores
Contractures are a medical condition where a joint is held in a fixed position due to the shortening of a muscle or tendon due to stress exerted on the muscle or spasticity (uncontrolled muscle movement). Older patients and those with limited mobility are especially prone to develop contractures. Contractures most commonly form in:
- Hands
- Feet
- Arms
- Legs
Once an individual has developed contractures, little can be done to alleviate the problem aside from aggressive orthopedic surgery. Consequently, medical facilities (hospitals and nursing homes) should provide physical and occupational therapy to people who are at risk for developing contractures and to keep the body flexible.
The rigidity that accompanies contractures generally means that many of the repositioning techniques commonly used to prevent bed sores may be unfeasible. As a general rule, the more immobile an individual is, the higher likelihood they have in developing bed sores.
Related:
If a person has contractures, are they at an increased liklihood for developing bed sores?
6 Most Common Causes Of Bed Sores & How Caregivers Can Help
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Study Says Older Hospital Patients Are at High Risk of Developing Sepsis
A recent joint study from Vanderbilt and Brown Universities found that hospital patients 65 and older have a fairly high risk of developing sepsis, or illness caused by severe blood infection. Sepsis (also called severe sepsis, sepsis infection, and septic shock) is a potentially deadly condition that’s often caused by late-stage bed sores.
The Vanderbilt/Brown study found that 750,000 patients develop sepsis in the U.S. each year alone, and that more than 60 % of those patients are over the age of 65. Risk factors for sepsis, according to the study, include: weakened immune system, frequent hospitalizations, malnutrition, and incidences of pneumonia. Another strong risk factor is exposure to medical tubes and catheters; both of which often serve as portals for infection.
Patients with sepsis frequently display what the study calls “confusion or altered mental states,” or delirium. Other signs of sepsis include: weakness, loss of interest in food, urinary incontinence, and falls.
The study recommends that hospitals implement strong infection-control programs. It also recommends that hospitals devote more resources to observing elderly patients – yet also acknowledges the challenges in doing so.
“It may be difficult to obtain samples of blood, body fluids or tissue from patients who are cognitively impaired, debilitated, dehydrated or frail,” the study notes. “Positioning patients for high-quality chest radiography is [also] difficult.”
According to the study, sepsis accounts for close to $17 billion in U.S. hospital costs each year.
Related:
Early Detection Is The Key Element To Successful Sepsis Treatment
Lawsuit Claims Texas Facility Ignored Patient’s Pressure Sores
In Galveston, Texas, a family is suing a Texas City-based nursing home, saying it failed to properly care for their family member’s severe pressure sores. The bed sores, the family claims, resulted in Christopher Murphy’s early death.
According to court documents, Murphy was a patient at the Hearthstone at the Mainlandnursing home from May- September 2010. Hearthstone at the Mainland is one of fifteen Texas facilities run by Houston-based Hearthstone Management, Inc. The documents say that Murphy, who was 69, suffered a fall about three weeks into his residency.
At the time, the court documents say, doctors told the Murphy family “that he did not have injuries related to the fall.” However, the suit alleges that doctors diagnosed Murphy with “infected wounds to the buttocks, feet and legs,” and “acute renal (kidney) failure.”
According to Murphy’s autopsy, the cause of death was determined to be sepsis (sometimes also referred to: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia) a severe infection caused by an advanced stage bed sore on Murphy’s sacral area. The autopsy also determined that Murphy had a urinary tract infection (UTI), as well as a colon infection. The plaintiffs in the case, Peter Murphy and James Joseph Murphy III, are suing Hearthstone Management for survival damages, and are seeking a juried trial. The court documents do not state the plaintiffs’ relationship to Christopher Murphy.
Related:
Early Detection Is The Key Element To Successful Sepsis Treatment
Nursing Home Injury Laws: Texas
Is sepsis related to bed sores?
Bed Sores Continue To Plague Patients In Chicago Nursing Homes & Hospitals
Even in large metropolitan areas like Chicago, IL patients in nursing homes, hospitals and other types of senior living facilities continue to suffer from a medical complication that has been around as long as history books have been written— bed sores.
While some facilities suggest that the development of bed sores is an inevitable part of the aging process, the overwhelming majority of circumstances behind the development of bed sores at a medical facility indicate that the facility was simply not doing an adequate job caring for the patient.
The mechanics behind bed sore development
Bed sores (or otherwise referred to as: pressure sores, pressure ulcers or decubitus ulcers) are the result of basic mechanical principals: force and shear. When patients in nursing homes and hospitals are left in place for extended periods, the weight of their body on relatively hard surfaces such as hospital beds and wheelchairs gradually impairs the bodies circulatory process.
Gradually, blood flow is restricted to the areas of the body that remain with unrelieved pressure. Without a nutrient rich supply of blood, tissue and skin die— giving way to an open wound. Like most medical conditions, bed sores do not develop overnight. Most situations involving the development of bed sores during an admission to a medical facility result from patients being left in place over an extended period of time!
Prevention of bed sores requires a team effort
While the medical community has made tremendous strides in the prevention and eradication of diseases that have long troubled society, relatively little progress has been made when it comes to reducing the incidence of bed sores in patients who are infirm or elderly. Some studies on patient care have shown that patients today are more likely to develop a bed sore today than they were just ten years ago!
What may be most troubling about bed sores compared with other medical complications, is that the factors that are associated with development of bed sores remains well-understood by the medical and non-medical community. Whether it’s a small family-operated nursing home or large university hospital, bed sore prevention requires quite a bit of hands-on care. In addition to keeping patients active, other preventative measures include:
- Rotating physically disabled patients out of their beds on regular intervals
- Keeping patients clean and dry- changing incontinent patients quickly
- Encouraging adequate nutrition and hydration
- Utilizing specialized devices such as pressure relieving mattresses and cushions for patients with limited mobility
Medical complications associated with bed sores
Thankfully, when bed sores are identified in their early stages patients chances of a full recovery are quite good. Unfortunately, when facilities are slow to acknowledge the presence of a bed sore or the wound has advanced, there is a good chance of medical complications such as:
Knowing the prevalence of complications from advanced bed sores (stage 4), it is crucial that staff at medical facilities carefully document each pressure sore and keep the patients physician regularly updated as to their condition.
Legal rights for you and your loved one
Given the well known measures known to prevent the development of bed sores, the development of bed sores during an admission to a nursing home, hospital or assisted living facility is simply inexcusable. As opposed to other types of nursing home negligence or medical malpractice cases, where an individuals error can result in patient injury, most cases involving bed sores are reflective of the negligent care on the part of an entire facility.
Attorneys at Rosenfeld Injury Lawyers have successfully resolved bed sore cases involving different types of medical and non-medical facilities on behalf of families and individuals in Chicago and on a national basis. If your family member has developed a bed sore under the care of a facility, we would be honored to talk with you regarding your potential legal rights. As with all of our cases, our consultations are free and confidential and we only charge a fee when there is a recovery.
Related:
Why is it important to differentiate the type of facility where a bed sore developed?
What are the stages of bed sores?
Is an autopsy necessary when a family suspects bed sores caused the death of a family member?
Illinois Man Sues Nursing Home for Failure to Treat Mother’s Bed Sore
An Illinois man is suing the Walnut Grove Village nursing home in Grundy, Illinois, for $50,000, according to the Morris Daily Herald. The plaintiff, Dwayne Mickelson, says that the nursing home neglected and abused his mother, Ethel, on two counts.
The first count alleges that Walnut Grove Village failed to properly care for Mrs. Mickelson after a fall on Jan. 27, 2010. The fall resulted in a broken hip. According to court documents, Mickelson was unsupervised at the time of the fall, and was required to undergo surgery for the hip fracture. The lawsuit alleges that the hip injury resulted in further medical complications, which ultimately led to Mrs. Mickelson’s early death.
The second count claims that Walnut Grove failed to properly care for a bed sore, or pressure ulcer, that developed on Mickelson’s left heel. According to the Daily Herald, the bed sore become infected, and ultimately required surgery on March 18, 2010. Heels are one of the most common areas on the body where bed sores appear.
According to the Fruland Funeral Home in Morris, Illinois, Mrs. Mickelson died on April 17, 2010, at the age of 88.
Related:
Nursing Home Injury Laws: Illinois
1) Fall In Nursing Home, 2) Bed Sore In Nursing Home, 3) Lawsuit Against Nursing Home
Medical Facilities Are Not Doing Enough To Prevent Pressure Ulcers On Patients’ Heels
Minnesota Caregiver Neglects Patient’s Severe Bed Sores, Leading to Amputation
From Minnesota comes a disturbing story about a PCA (personal care assistant) whose alleged neglect of a paralyzed patient’s severe bed sores resulted in the amputation of the patient’s legs.
The Granite Falls News reports that Casandra Sannerud, 26, was charged with multiple counts of Medicaid fraud on behalf of the Minnesota Attorney General’s Office.
The charges included: three counts of theft by false representation, one count of criminal neglect, and one count of failure to report, resulting in great bodily harm. The Attorney General’s Office brought the charges against Sannerud after seeing a May 3, 2010 report on Minneapolis-based WCCO-TV, entitled “Family Blames PCA for Woman Losing Her Legs.”
According to WCCO, Sannerud was working as a personal care assistant to her friend Jennifer Darville, who was paralyzed from the waist down in an ATV accident in 2004. In late 2009, the report says, Darville developed pressure sores on the backs of her legs and her hips, which she couldn’t see or feel. The report goes on to say that Sannerud failed to report the decubitus ulcers, as required by Medicaid, and that they grew so severe that Darville required amputation of her legs.
The Attorney General’s Office says Sannerud only documented the pressure ulcers once, on January 14, 2010, after Darville had been admitted to a South Dakota hospital on December 20, 2009. State fraud investigators also discovered more than 100 overlaps between Sannerud’s daily PCA timesheets, and her work at another care center.
Sannerud countered the claims by saying she’d tried to get Darville to see a doctor, but that Darville had refused.
In a Granite Falls district court on May 25, Sannerud plead guilty to charges of theft of medical costs, and failure to report a health condition. She was sentenced to two years of probation, and was ordered to pay $7,043.30 in restitution.
Related:
A Graphic Example Of Nursing Home Negligence: Amputation Of A Leg Due To Untreated Bed Sores
Can bed sores lead to amputation of limbs?
Why are physically disabled patients at risk for developing bed sores?
South Carolina Man Charged With Elder Abuse After Mother Dies of Severe Bed Sores
A South Carolina man has been arrested and charged with elder abuse, after his mother died of complications from severe bed sores , Columbia-based WLTX-TV reports.
Eddie Williams, 57, was the primary caregiver for 75-year-old Geneva Roberson, according to WLTX. On March 25, authorities found Roberson trapped in Williams’ home in the Lincoln Park neighborhood of Columbia. Roberson had several abrasions on her upper and lower body, and appeared to be suffering from dementia, Richland County deputies said. Roberson died on May 16, after being placed in a Sumter County nursing home by social workers.
A report from the Richland County Coroner’s office indicated that Roberson’s wounds were easily preventable, had she been given proper care. The report said that, along with severe decubitus ulcers, Roberson suffered from neglect, malnourishment, and end stage dementia.
“No vulnerable person should be cared for in such a way that Williams did,” said Gary Lott, the Richland County coroner, in a report from WISTV.com.
Williams was taken into custody at his attorney’s office on June 1. A posting from JP Holley Funeral Home in Columbia indicates Williams was one of Roberson’s two grown sons.
Related:
Elder Abuse Is Widespread, Yet Only 4% of All Cases Get Reported To Authorities
Nursing Home Attorney, Jonathan Rosenfeld, Discusses Elder Abuse In News Article
Sobering Bed Sore Statistics Regarding Prevalence, Infection & Death
A recent report from Wrongdiagnosis.com gives several alarming statistics about the incidence of bed sores, or decubitus ulcers, in American hospitals. Among the Web site’s findings:
- 34,319 people die annually as a result of complications from bed sores
- 474,692 bed sores occur in hospitals every year
- 7 percent of people with bed sores die as a result of their infections
Wrongdiagnosis goes on to say that 94 people die every day as a result of severe bed sores, at a rate of three people per hour. Why isn’t more attention given to this deadly— yet preventable medical condition?
Related:
Hospital Errors: Study Finds Preventable Errors Continue To Harm Patients At Alarming Rate
Medical Errors, Such As Pressure Ulcers, Costing U.S. $20 Billion Per Year
Hospital Acquired Pressure Sores Are Devastating Source Of Patient Injury & Death
National Institute of Health (NIH) Study Lists Bed Sore Prevention Tips
Since they were first identified in Egyptian mummies, bed sores have defied doctors’ best attempts at healing. Bed sores, or decubitus ulcers, are difficult to treat, unsightly to look at, and extremely costly, for both medical communities and society at large. A study conducted by the National Institute of Health found that pressure sores cost the U.S. $3 billion annually.
However, there are definite steps an elderly patient can take to prevent bed sores, according to the study. Below are a few suggestions:
1. Avoid foam and alternating air mattresses.
Foam mattresses, according to the NIH, “produce high local pressures…and are more likely to predispose patients to pressure sores.” Alternating air mattresses, though better than foam mattresses, are much less efficient at shifting weight than fluid-based mattresses, which the study recommends. “Fluidising systems have been the most consistent at reducing pressure over the bony high points,” the study says.
2. For wheelchair-bound patients, electrical therapy might be best.
“Functional electrical stimulation has been shown to prevent pressure sores in paraplegic patients by inducing shape changes in the buttocks and improving blood flow,” the study says, adding that about a quarter of all wheelchair users will develop a bed sore at some point. The study warns that pillows are not always effective for wheelchair users, since they can actually cause compression. “Wheelchair cushions rarely result in [lower pressure readings],” the study says.
3. Keep beds flat, when possible.
According to the study, it’s best to assume a flat, supine position while resting in bed during the day. “Patients more often developed pressure sores in sacral tissues when the head of the bed was raised,” the study says. A flat bed decreases shear, or the gravitational force on more sensitive areas of the body. The study also recommends lying prone (face down) at night.
The study advises doctors and nurses to use the Braden and Norton scales of assessment whenever possible, and to also check diastolic blood pressure, temperature, and the patient’s daily protein intake. According to the study, increased education in hospitals would result in a 65% reduction in bed sores.
Related:
Are there any federal regulations that apply to the prevention of bed sores?
Pressure Relieving Devices May Help Reduce Rate Of Pressure Sores In Nursing Home & Hospital Patients
As a lawyer who sees a significant number of cases where nursing home or hospital patients have developed bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) during a short or long-term admission, I feel as though the most progress has been made with respect to new technology in the utilization of pressure relieving devices.
Special padding on wheelchairs, heel pads and pressure relieving mattresses are the most common types of pressure relieving devices used in nursing homes and hospitals. Like all medical devices however, to achieve maximum benefit from the new technology staff must receive proper training.
Occasionally, we see long delays between the implementation of the pressure relieving devices from the time that they were originally ordered by the doctor. Sometimes the delay is based on the fact that the facility may be inadequately stocked with the devices. Yet in other situations, facilities may claim that such devices are too expensive.
Unfortunately, given the alternative– having patients with advanced bed sores, the reality is that these devices are a bargain from both a cost savings standpoint in terms of bed sore treatment expenses as well as the physical and psychological toll bed sores take on patients.
Related:
Hospitals Fined For Preventable Medical Complications Such As Bed Sores
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Study Emphasizes Importance of Good Diet in Preventing Pressure Ulcers
A study from the Australian Journal of Advanced Medicine claims that a proper diet is essential to preventing advanced pressure ulcers. The study, a collaboration between European and American nurses, found that there was a direct correlation between good nutrition and fewer bed sores.
“Through nutritional supplements, the risk [of bed sores] can be reduced, and the patient’s nutritional status can then be preserved,” the study says.
Along with helping to reduce bed sores, proper nutrition can dramatically alter a patient’s daily life.
“Nutritional supplementation leads to an increased capacity to manage activities, and [helps to] reduce the patient’s sensitivity to infections,” the study says.
Though the study doesn’t give specific diet suggestions, it recommends patients consume at least 25-50 calories per kilogram of body weight. It also advises a strict regimen of multivitamins, along with lots of daily personal time with nursing staff.
“The number of ulcers decreases if nurses interact with nursing-home patients at least fifteen minutes, and with enrolled nurses for two hours a day,” the study says.
When patients are not provided with proper nutrition, organs can begin to fail and critical body functions can begin to deteriorate rapidly. According to the study, a lack of appetite can lead to rapid weight loss, dehydration and the inability to move. Signs of malnutrition include:
- diarrhea
- disorientation
- muscle twitches
- goiter (enlarged thyroid gland)
- scaling and cracking of the lips and mouth
Several groups are considered “high risk” for malnutrition, including patients with mouth problems, patients with gastro-intestinal problems, and patients with low diastolic blood pressure. The effects of malnutrition can be severe, ranging from impaired respiratory function to an overall increase in complications.
“Malnutrition..is an important indicator for the origins of pressure ulcers in patients aged between 65 and 85 years,” the study says.
The study also notes that “elderly people generally eat little, and the wrong kind of food.”
Related:
Doctor Alleges Dehydration & Malnutrition In Nursing Home Lawsuit On Behalf Of Relative
Inadequate Nutrition & The Development Of Bed Sores In Nursing Home Patients
Federal Guidelines Suggest Specific Measures for Preventing and Treating Bed Sores
A recent article in the Journal of the American Medical Directors Association takes a look at federal bed sore laws enacted in 2004, and how they can help patients today. Using the laws as guideposts, the article explains in detail what hospitals and nursing homes can do to treat and prevent bed sores, or decubitus ulcers.
Prevention
First, the guidelines emphasize that proper nutrition is essential to preventing bed sores, particularly a patient’s protein intake. Patients without enough protein in their diet aren’t usually able to heal wounds effectively.
“Nutritional goals for a resident…who has a pressure ulcer, or is at risk of developing pressure ulcers, should include a protein intake of approximately 1.2-1.5 grams per kilogram of body weight,” the study says. The USDA also recommends that elderly people consume approximately 50-60 grams of protein per day.
Along with protein intake, the guidelines urge doctors to pay special attention to issues of fecal incontinence, which can be ultimately more damaging than urinary incontinence.
“Some studies have found that fecal incontinence may pose a greater threat to skin integrity,” the guidelines state.
Treatment: Patient Rights
In terms of actually treating bed sores, the laws give strict measures about patients’ fundamental rights. The laws remind doctors that even the most vulnerable patients deserve proper care.
“The fact that a patient is a ‘do-not-resuscitate,’ or on hospice, cannot be used as a reason to withhold pressure ulcer care, or to explain a worsening pressure ulcer,” the laws state. “A do-not-resuscitate order alone does not mean that ulcer care can be discontinued or limited.”
The laws also state that patients have the right to refuse bed sore treatment, but that that the refusal must be documented.
Treatment: Assessment
In order for bed sores to heal properly, they must first be accurately assessed. The bed sore laws give doctors specific protocol for making an initial identification:
- Differentiate the type of ulcer (pressure-related vs. non-pressure related)
- Determine the ulcer’s “stage” (1-4 on the Braden Scale)
- Describe and monitor the ulcer’s characteristics
- Assess, treat and monitor pain
On a weekly basis, the laws say doctors should:
- Examine the size, depth and location of the bed sore; noting if any colors or odors have changed
- Monitor and manage the patient’s pain level
- Accurately describe the tissue at the edge of the wound
The AMDA article reminds readers that pressure ulcers typically don’t “reverse stage,“ or go from a high-stage ulcer (Stage 3 or 4), to a lower 1 or 2 stage.
“Wounds do not progress toward healing in a manner that is consistent with down staging,” the article says. “Rather, wounds heal by contraction and scar formation.”
The article notes that pressure ulcers should begin healing within two to four weeks of starting treatment.
Doctors Say Severe Pressure Sore Wounds Should be Kept Moist
The sight of a severe pressure sore wound can be upsetting for both doctor and patient. Stage 3 and 4 pressure sores are hard to treat, and in some cases may cause great discomfort and pain. Fortunately for patients, doctors have many sophisticated wound dressings at their disposal, several of which are relatively pain-free.
A study from the Cleveland Clinic Journal of Medicine indicates that when it comes to treating pressure sore wounds, an “occlusive dressing” might be a patient’s best option. Occlusive dressings are air- and water-tight covers that retain some of the wound’s original moisture. Unlike traditional gauze dressings, which tend to cause pain when removed, occlusive dressings rarely cause secondary trauma.
“In both acute and chronic wounds, the principal function of a wound dressing is to provide a moist healing environment,” the study says. “Removal of [wound dressings] by aggressive scrubbing or drying has been shown to be detrimental.”
The study recommends that doctors not change occlusive dressings until they leak, a period typically lasting several days to three weeks. The study also indicates that saline-soaked gauze may be an acceptable alternative to occlusive dressings, as long as the gauze is not allowed to dry.
Show Your Support For People With Bed Sores. Become A Fan Of Bed Sore FAQ On Facebook Today!
Everyday families of patients in nursing homes and hospitals across the country face a devastating discovery– that their loved one has developed a bed sore. For most, the news comes as a shock. After all, no one ever expects to contract bed sores during an admission to a medical facility?
Yet the initial discovery of a bed sore is really only the beginning in a long process of process of attempting to heal the wound and prevent it from progressing. It is frequently during the bed sore treatment process, that feelings of concern shift to stronger feelings of anger as families see the difficult and painful treatments that most bed sore patients face.
Bed sore FAQ is intended to be a resource for individuals and families seeking information regarding:
- How did a bed sore develop on my loved one?
- Why didn’t the medical facility prevent the wound from developing in the first place?
- What are the treatment options available?
- Is there any legal recourse?
Show your support for bed sore prevention, education and treatment today by becoming a fan of Bed Sore FAQ on Facebook!
Study Finds High Incidence of Pressure Sores in Elderly Patients with Hip Injuries
A study from St. Bartholomew’s Hospital in London found that elderly patients who enter hospitals with hip injuries are at a high risk of developing pressure sores, or decubitus ulcers.
The study took place at an inner-city hospital in the East End of London. Of the 283 patients included in the study, 90 (32 percent) developed bed sores during their stay. Most patients were women over the age of 70, who been admitted with hip fractures.
The most common bed sore locations were the sacrum (a triangular bone at the base of the spine), heels and buttocks. A majority of the pressure sores began soon after admission, particularly on patients’ operation days. Of the patients with pressure sores, 34 percent developed ulcers within the first week, and 24 percent developed ulcers within the second week.
The study highly recommends that elderly patients be attended to by a rotating staff surgeons and nurses. According to the study, “effective management of the elderly patient with pressure sores requires more expertise than a nurse alone can offer.”
Study Gives Suggestions for Treating and Preventing Bed Sores
A study from the Cleveland Clinic Journal of Medicine provides a far-ranging and extensive overview for treating and preventing bed sores (pressure ulcers) in elderly patients.
Among the key points of the study:
- 95 percent of pressure ulcers occur in the lower part of the body.
- The incidence of pressure ulcers is actually higher in acute care hospitals than in nursing homes.
- A great majority – 70 percent – of all pressure ulcers occur in people 70 years of age or older
- The use of catheters in incontinent patients greatly increases the risk of bed sores
- Healing occurs most rapidly when open bed sores are closed surgically
The study recommended that care staff turn patients every 1 1/2 hours, versus the usually standard two hour interval. Researchers also found that doctors should take great care in selecting preventative devices, which range pressure-relieving mattresses to manual movement from nurses and doctors. Proper preventative devices should ward off all bed sores, which vary in severity from stage 1 to stage 4.
Texas Hospital Blamed for Patient’s Severe Bed Sore
A former patient at Beaumont’s Memorial Hermann Baptist Hospital has sued two of the hospital’s doctors, claiming that they delayed treatment and caused unnecessary complications, including a stage 3 bed sore.
According to the Southeast Texas Record, Ronald Lee Phillips, Sr. was admitted to Memorial Hermann on Oct. 29, 2006, for two consecutive seizures. The Record reports that his doctors, Dr. Darella Cooper and Dr. Jeffrey Klem, were informed of his symptoms in the evening, yet delayed seeing Mr. Phillips until the next morning.
“At some point after admission, {Dr. Klem} was informed of Mr. Phillips’ condition, which indicated a potential heart attack,” the suit states. “However, Dr. Klem failed to respond in a timely manner, and delayed seeing {Mr. Phillips} for several hours.”
During the evening, Mr. Phillips suffered a heart attack, which resulted in severe physical and mental injuries, the suit states. Mr. Phillips remained a patient at Hermann Baptist until mid-November 2006. Throughout his stay, Mr. Phillips developed a stage 3 decubitus ulcer, as well as a staph infection, according to court records.
Mr. Phillips is suing Hermann Baptist for physical pain, suffering, mental anguish, physical impairment, physical disfigurement and incurred medical expenses. Mr. Phillips’ wife, Fredericka – also a plantiff in the case – is suing Hermann Baptist for mental anguish, loss of consortium,, and loss of services. The Phillips are suing for an undisclosed amount.
Texas law states that plaintiffs may sue for up to $250,000 in medical malpractice cases.
Pressure Sores Among Most Costly Post-Operative Injuries, Studies Say
Two recent studies published in Health Affairs indicate that post-operative pressure sores are among the most costly injuries caused by medical error, according to MedPageToday.com.
Of the ten costliest medical errors, pressure ulcers ranked No. 2, second only to postoperative infections. Other common errors included infection due to a central venous catheter, infection following a blood infusion, and abdominal hernia. Hospital-acquired pressure ulcers are among the Federal Government’s list of “never events,” or avoidable injuries that should never occur at U.S. hospitals.
The first Health Affairs study, authored by Milliman consultant Jill Van Den Bos, found that the total annual cost of medical errors is about $17 billion. The total “social cost” – the sum of costs to doctors, providers, and all other individuals affected by the error – is much higher, between $348 and $913 billion. Van Den Bos and her colleagues arrived at their conclusions by analyzing an 8-year sample of national medical claims data, from 2000 to 2008.
The second study, by John Goodman of the Dallas-based National Center for Policy Analysis (NCPA), produced similar findings.
“Your chances of dying from a cause other than the one you were hospitalized for are as high as one in 200,” says NCPA senior fellow and coauthor Pamela Villarreal, adding that all patients have a one in twenty chance of getting a hospital-caused infection.
Villareal advises hospitals to adopt a “no-fault” compensation system, whereby compensation for death would be set at $200,000, and injury at $20,000.
“This type of compensation system would give hospitals and providers economic incentives to reduce error rates,” says Villareal.
Goodman and Villareal estimate that as many as 6.1 million injuries occur in hospitals each year as a result of adverse medical effects.
Proper “Coding” Necessary for Hospitals Receiving Bed Sore Reimbursement
The hospital chart of an elderly loved one can be a confusing morass of letters, scribbles and numbers. Yet the numeric “codes” on each person’s chart are essential to receiving proper Medicare coverage.
In a recent interview with The Hospitalist, two “documentation specialists” gave tips for understanding your loved one’s chart:
1. First, understand that universal “codes” are used by hospitals. The codes help the hospital’s internal ”coders” submit an accurate claim to Medicare. Most codes are taken from the “ICD-9-CM,” or International Classification of Diseases. For example, even though nurses can give a “stage” (1-4) of a pressure ulcer, it must also be accompanied with the proper code in order for a patient to receive reimbursement.
2. If you’re confused about your loved one’s chart, ask to see a “Documentation Specialist.” “Documentation Specialists” are intermediaries between physicians and coders. “We’re just trying to help physicians capture the quality of care that they’re giving,” says Stephanie Jensen, RN, coordinator of the Clinical Documentation Integrity program at Omaha’s Nebraska Medical Center. “We want to make sure that, in the medical record, the documentation supports the severity of illness…and overall clinical picture.”
3. A useful acronym to know is a “DRG,” or “Diagnosis-Related Group.” “DRGs” number about 500, and are used by Medicare to determine the amount it should pay to hospitals. Patients in the same “DRG” tend to use similar amounts of hospital resources.
4. The more specific a physician can be in his or her diagnosis, the more good it will do patients. “If it’s not documented, it didn’t happen,” says Karen Bachman, BSN, director of clinical documentation at Good Samaritan Hospital in Suffern, NY.
Related:
California Nursing Home Abuse Case to go to Trial
A Sacramento, Calif. judge has decided that a civil suit alleging abuse at a local nursing home should go to trial, Patch.com reports.
The plaintiff, Dennis Lee Haney, said in a complaint that Eskaton Properties, Inc. was responsible for the early death of his mother, 78-year-old Dorris Hilton. Hilton spent three months in Eskaton’s Fair Oaks Care Center facility before passing away in November, 2006, from a urinary tract infection (UTI).
“She was neglected and without care or attention, without assistance in feeding or toileting, and was left without medication for a diagnosed urinary tract infection until she became confused and incoherent,” Haney’s complaint said. “During this time, her cries of pain for assistance prompted no response from defendants, who had allocated knowingly inadequate resources to provide proper staffing to care for [my mother].”
A spokesperson for Eskaton, which is based in Carmichael, Calif., said that the allegations were unfounded, according to Patch.com
“{We} maintain that this individual was provided the same highest level of care that each of the 3,500 people we serve each day receives,” said Stuart Greenbaum. “Because the case is still being litigated, we cannot respond further on the details. Except to add that this unique allegation is incredibly disconcerting to the 1,700 dedicated and compassionate professionals who work for Eskaton.”
Patch reports that there have been several complaints of abuse filed against Eskaton’s Sacramento properties over the past few years. Neither Haney’s attorney, Lawrence Hensley, nor Greenbaum could say whether the number of complaints was commensurate with the normal rate for the region.
According to Eskaton’s Web site, Eskaton has more twenty-nine care centers throughout Northern California, and treats more than 14,000 adults annually. With 9,025 facilities, and 289,891 beds, California has the highest number of nursing home residents in the country, according to Administration on Aging data.
Without A Prevention Plan, All Nursing Home & Hospital Patients Remain At Risk For Developing Pressure Ulcers
Pressure ulcers are indeed preventable in the overwhelming majority of circumstances. The key is to identify patients who are at risk quickly after their admission to a medical facility and timely– and effectively implement preventative measures such as regular pressure relief and ensuring patients remain clean and dry.
Medicare has determined that pressure ulcers are indeed preventable and hospitals may no longer seek reimbursement for patients who develop pressure ulcers during a hospitalization.
While Medicare’s assignment of pressure ulcers to its list of never events remains an important development for patient safety, the fact remains that pressure ulcers are indeed a significant problem for many patients and result in many families seeking answers regarding medical care and legal options.
Here is an assembly of web resources related to pressure ulcers:
Computers that monitor prisoners in a correctional facility are not a bad idea in nursing facilities to ensure that the patient in the nursing home are being well cared for and not falling and are turned appropriately. The latter is one of the most reliable ways to prevent pressure ulcers.
Jeffrey Levine, M.D. has this website and blog to discuss geriatric patient care and wound care. The recent blog posts go into detail about geriatric law and what, legally, is needed to care for the elderly patient in a residential facility.
Discussed here is elder abuse and the warning signs, prevention and who is at risk. Many times in residential facilities, pressure ulcers are a tell tale sign of elder abuse.
Lippincott’s NursingCenter.com
This is a nurse to nurse dialogue about typical nursing practices. There are many misconceptions about nursing and what is correct and incorrect modes of care.
This is a site that focuses on skin care and what to do to take care of skin during all stages of life. It discusses the care of skin during the stages of pressure ulcers.
The discussion her is on Aderma® which helps in the treatment of pressure ulcers. The training to use Aderma ® has revved up during 2010 and has high hopes as 2011 as begins.
Medicare is threatening covering pressure ulcers, therefore more and more hospitals are becoming stricter in their guidelines and precautions to prevent them.
A new technique was founded and implemented by nurses in this program and may go to hospitals’ countrywide. They technique details using music over a loudspeaker that stops when it is time for position changes.
This nursing program teaches prospective nurses how to recognize and treat symptoms of pressure ulcers. Warning signs are outlined, plus treatment regiments.
Skin is defined in detail with a picture and then the stages of pressure ulcers are outlined to assist people in recognizing them. Treatment guidelines are given to aide in the treatment.
This website demonstrates the wholistic approach to caring for the patient in the home health setting. It ranges from diet and fitness to medically caring for the patient.
What happens when you see a reddish patch of skin on a patient? The telltale signs of pressure ulcers are definitely important to be able to look at and diagnose so treatment begins immediately.
The author, Gerry, is an experienced nurse and leader in the health field. He focuses on elder care.
This is a huge reference collection of information concerning wound care and technology on wound care. Discussions include surgery, debridement, acupuncture, healthy eating and much much more.
Using ultraviolet therapy while doing wound care helps eliminate the odor associated with pressure ulcers. This can assist the patient in healing because it helps focus on taking care of the wound and not controlling the smell.
Bed Sore Prevention: Staff Must Turn & Reposition Bed-Ridden Patients At Regular Intervals
The underlying mechanics behind the development of bed sores (also called: pressure sores, pressure ulcers or decubitus ulcers) is relatively simple– unrelieved pressure on the body results in restricted blood circulation and consequential lack of nutrients and oxygen to skin and tissue. When pressure goes unrelieved for extended periods of time, tissue dies and a wound develops in the area.
Armed with a basic understanding of the mechanics behind the development of bed sores, medical professionals suggest alleviating the pressure on the body on regular intervals.
If a patient is mobile, they should be encouraged to get active on a regular basis. Obviously, for physically incapacitated patients who are unable to move on their own, staff assistance is necessary to relieve pressure.
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Tips for Ensuring Your Parent’s Proper Care & Prevent Complications Like Pressure Sores
If you’re an adult child of an elderly parent, you may already know that choosing a proper nursing home can be stressful. Carolyn L. Rosenblatt, nurse and author of the blog AgingParents.com, shares some tips on how to ensure your parent will always remain safe and healthy:
- Get to know the difference between “convalescent hospitals,” “care homes,” “retirement homes,” and other nursing home monikers. Often the main difference is how long an elderly parent is expected to stay. Also investigate the history of each facility: is it a small home, or part of a huge chain? Inquire as to whether the facility is an actual nursing home, or Residential Care Facility for the Elderly (RCFE). Be sure to get as much background information as you can.
- Pick a care facility that’s close enough to visit often. Daily visits are best. “Residents who have frequent visitors generally do much better than the ones who have no one to visit them,” Rosenblatt notes.
- Don’t be afraid to ask questions. Inquire especially about bruises, bandages and incidences of falls on your loved one’s chart. Usually an increase in falls is a clear warning that something may be wrong.
- Keep an eye on your parent’s tailbone. This is an especially susceptible spot for bedsores. Be sure to check that your parent’s skin isn’t reddened or bruised, and that it stays intact upon touch. Be extra vigilant if your parent uses a wheelchair.
- Remember that not all nursing homes are created, or managed, equally. A recent survey of nursing home citations found that 96 percent had been cited for Medicare and Medicaid rules of operation violations.
As you decide on a proper nursing home, keep in mind that you, as a family member, are often your parent’s last line of defense. Ongoing vigilance is needed to ensure that your parent lives out his or her remaining years in dignity, and with a real sense of safety. Consider your hard work and watchfulness a timeless gift to your parent.
Nursing Home Admits Fault in Woman’s Death From Pressure Sores
A nursing home in Sheffield, England has admitted it was at fault in the death of a 78-year-old female patient, according to a BBC report.
Doreen Betts, who died in May, 2009, contracted sepsis after developing severe pressure sores on her feet. Sepsis is a serious blood infection that has a mortality rate of more than 50 percent. Betts was a patient at the Kersal Mount Nursing Home in Sheffield, recently renamed the Laurels and The Limes Care Home.
“Mrs. Betts was clearly a victim of neglect,” said Sarah Rowland, a medical law specialist at British law firm Irwin Mitchell. “Any level of neglect is unacceptable, but what Mrs. Betts went through was particularly horrific. Had the nursing home acted with the proper level of care and attention, Mrs. Betts would not have died in such a painful manner.”
Three months before her death, Betts’ GP (general practitioner) had recommended that Kersal Mount refer her to a bed sores specialist. The request was ignored, according to the BBC. At Betts’ inquest, consulting pathologist Nicholas Tiffin found that Betts would not have died, had she not developed the infected pressure sores.
“We were distraught to find that the home had ignored the recommendation to refer her to see a settlement,” said Betts’ son, Stephen. “Nothing can bring her back, nor can it alleviate any of the horrendous pain and discomfort she went through in those final weeks.”
The Betts family, represented by Irwin Mitchell, has settled with Kersal Mount for an undisclosed sum.
Government Program Aims to Reduce Hospital Re-admissions From Complications Such As Pressure Ulcers
A new government program unveiled on Wednesday, April 27, will aim to reduce hospital readmissions by 20 percent, according to NorthJersey.com. The initiative, an extension of the Patient Protection and Affordable Care Act passed March 23, will allot more than $1 billion to help fund “demonstration projects” over the next three years. (“Demonstration projects” are government-funded studies that test and measure potential changes to services and payment plans.)
“The ultimate goal is to eliminate preventable errors,” said Rima Cohen, counselor to Health and Human Services Secretary Kathleen Sebelius. “We want to make the best care, normal care, for all patients.”
According to Cohen, one in seven hospitalized Medicare beneficiaries is harmed during the course of his or her care. Re-admitted nursing home patients are a particularly vulnerable group.
Dr. Jaime Torres, a regional Health and Human Services director in New York City, says hospitals must pay special attention to the “handoff” period, or the time when patients are discharged from hospitals to nursing homes. Torres says many readmissions could be avoided if doctors adhered to stricter follow-up procedures. Torres advises hospitals to place a follow-up phone call within a patient’s first 24 hours in a nursing home, and to check up on patients’ prescriptions during each call.
New programs similar to what Torres envisions are already underway in some parts of the country. In New Jersey, a collaborative effort among 150 hospitals and nursing homes has already reduced the rate of pressure ulcers, or bed sores, by 70 percent. Though federal law requires nursing homes to have bedsore prevention programs, bed sores can often go undetected. In many cases, bedsores can develop rapidly, sometimes within hours.
Along with bedsore prevention programs, Kelly also noted that there have been successful efforts to monitor bloodstream infections, which are often caused by contaminated catheters. Catheter-associated urinary tract infections are on the government’s list of “never events” that should never occur at a properly-run hospital.
West Virginia Nursing Home Sued for Negligence After Patient Develops Decubitus Ulcers
The wife of a former Charleston, WV nursing home patient is suing Genesis Healthcare Corporation for an undisclosed amount, according to The West Virginia Record.
Garnet Phillips claims that her husband, George, suffered from several worsening conditions during his 13-month stay at the Valley Center Nursing Home , including dehydration, urinary tract infections, and sepsis. Sepsis is a deadly blood infection that commonly occurs as a result of advanced decubitus ulcers (bedsores) or other infection sites. Mrs. Phillips claims that Valley Center staff failed to monitor her husband’s skin breakdown, and failed to develop an adequate care plan for treating and preventing bedsores. Valley Center is one of more than 200 care centers operated by Genesis.
Mr. Phillips was at Valley Center from Sept. 20, 2009 to Oct. 18 2009, according to a complaint filed March 25 in Kanawha Circuit Court. The case will be tried in front of Circuit Judge James C. Stucky.
West Virginia law states that plaintiffs may seek up to $500,000 in compensatory damages.
ManorCare Named In Wrongful Death Lawsuit After Patient Developes Pressure Sores During Nursing Home Admission
With more than 500 locations in 33 states, ManorCare remains of the largest nursing home chains in the country. From a financial standpoint, ManorCare is clearly a very profitable operation. In 2006, the last year its profits were disclosed, ManorCare earned $167 million from $3.6 million in sales. In 2007, financial titan, the Carlyle Group purchased the company for a record breaking acquisition of HCR ManorCare in a reported $4.9 billion deal.
Sadly, despite its largess and financial profitability, nursing home patients in HCR ManorCare facilities are subject to many of the same stubborn problems encountered by patients at lesser known facilities. In particular, many patients in ManorCare skilled nursing facilities are at risk for development of pressure sores, also referred to as bed sores, decubitus ulcers or pressure ulcers.
While multiple factors may be at play when a patient develops decubitus ulcers, one of more common underlying problems is that many facilities do not have adequate numbers of staff to help care and re-position patients who may be disabled or unable to move on their own. Medical studies have demonstrated that when nursing home patients remain in one position for extended periods of time, they are at heightened risk for developing pressure sores.
Along these lines, the family of a deceased woman has filed a wrongful death lawsuit against a ManorCare nursing home in West Virginia after their family member developed multiple health problems including: dehydration, malnutrition and pressure sores during an admission.
According to the nursing home lawsuit, the woman’s conditions developed and progressed during the three year period she was a patient at ManorCare. In addition to seeking compensatory damages for medical expenses, pain and emotional trauma– the lawsuit further seeks punitive damages against HCR ManorCare and other related entities.
Related:
Family Awarded $546,000 In ManorCare Lawsuit
Chicagoland Manor Care Facility Named In Wrongful Death Lawsuit
Will Music Sound The Farewell Tune To Bedsores Acquired At Nursing Homes?
Bedsores are truly a horrific condition impacting nursing home patients in all demographics. As a lawyer on the front lines of these cases, I am continually dumbfounded by the lack of basic precautions in place at many facilities to prevent these potentially deadly wounds from developing in the first place.
After all, it’s not like bed sores develop due to a medical complication or error. Rather, bedsores (or interchangeably used with the terms: pressure sores, pressure ulcers or decubitus ulcers) are almost always indicative of a facility that has grossly neglected their patients by failing to tend to basic needs like regularly moving the patient or keeping them clean and dry.
A new study conducted by the University of Cincinnati College of Nursing (Ohio) is looking to see if the implementation of a reminder-system for the staff to move and re-position patients on a regular basis can help in the reducing the number of patients who acquire pressure sores during their admission.
Under the year-long pilot program, music plays for one or two minutes every two-hours for a 12-hour period. All staff at the facilities– from maintenance workers to administrators get involved to assist in moving immobile patient s or remind relatively able-bodied patients to get up and move around.
Through the course of the pilot program, none of the patients at the facilities involved have developed bedsores.
When I read stories such as this, I am reminded how a little effort on the part of nursing homes can go a long way towards preventing this painful and potentially life-threatening medical condition.
Related:
Music could help prevent bedsores, By Cindy Kranz January 5, 2011
What steps can be taken to minimize the risk of developing bed sores?
What is ‘turning’ and why is it important to prevention of bed sores?
Why are physically disabled patients at risk for developing bed sores?
As Prevalence Of Decubitus Ulcers Continues To Rise, Caregivers Seek Information From Leaders Regarding Decubitus Ulcer Research & Treatment
Originating from latin word “decumbere” meaning “to lie down”, ducubitus ulcers may develop in patients who have limited mobility and spend much of their time laying or sitting in one position for an extended period of time. Knowing the possibility of decubitus ulcers patients in nursing homes, hospitals and assisted living facilities, staff need to make prevention of decubitus ulcers a priority and implement preventative measures to curtail them from forming in the first place.
Here are some useful web resources for caregivers seeking more information about decubitus ulcers:
The focus is on abuse that occurs in nursing home and assisted living facilities. The most current trends on abuse and neglect in nursing homes are discussed.
The risk of being hospitalized is countered with the threat of developing infections in the hospital environment. Here is discussed the prevalence of hospitalization for the elderly for most medical problems encountered and the increased risks of developing decubitus ulcers in this kind of environment.
This is the sight that leads all others with information on infection prevention in medical settings. The blog is focusing on treating each decubitus ulcer individually based on what each person suffering from the ulcer needs.
The author describes what causes decubitus ulcers, symptoms, prevention and treatment for individuals who have for and treat ulcers.
Decubitus ulcers are considered a “never event” and this serious infection is losing Medicare/Medicaid reimbursement. This details the thoughts on whether or not these ulcers are preventable and treatable.
Even though there are preventative measures in place, decubitus ulcers are a significant problem in the nursing home environment.
Outlined here is a new study that will be starting in the treatment of decubitus ulcers in diabetic patients.
According to this website, there are natural herbal solutions to help in the treatment of decubitus ulcers. Treatments from honey to massage are discussed here.
This article and video shows that a main form of treatment for decubitus ulcers can be a treatment of using ultra violet rays to help kill germs in the wound.
The author discusses that one way to see signs of neglect in a loved one who resides in a nursing home, is to do a visit while the loved one is being cared for by a nurse. At that time, you can do a physical check and see if there are any deubitus ulcers on the body.
The focus here is what the skin looks like when a decubitus ulcer starts to develop. The ulcers are due to prolonged pressure, and they are easier to prevent than treat.
Good nutrition and what you feed your body helps your body remain in a state of health. While in bed, for one reason or another, good nutrition is extra important so your body stays well and helps in the prevention of many problems that can occur while in bed, most commonly decubitus ulcers.
Decubitus ulcers are the result of a being in a prolonged position for a long amount of time which leads to skin breakdown.
Author of this blog deems that good nutrition is the main factor in helping treat a decubitus ulcer. Nourishing the body appropriately is what aides in healing.
This is a new wheelchair seating system that helps reduce the chance of developing decubitus ulcers by decreasing friction while in the wheelchair.
Family Of Disabled Man File Lawsuit Against Chicago Nursing Home After He Develops Pressure Sores During Admission
The family of a man with a spina bifida has filed a lawsuit against Tower Hill Healthcare Center, alleging the facilities neglect resulted in the man’s physical injury and deterioration since he was admitted to the facility.
According to the lawsuit, the man was admitted to Sherman Hospital (a Chicagoland hospital) on July 5, 2008 for an elevated body temperature. However, when staff at the hospital examined the man they noticed other problems such as: poor oral hygiene, bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) covered with feces and an exploded colostomy bag.
Consequently, the hospital staff reported the suspected mistreatment to the Illinois Department of Health to investigate further.
The man died on July 31, 2008 due to a staph infection and pneumonia. This nursing home negligence lawsuit is pending in Kane County, Illinois. Read more about this Illinois Nursing Home Lawsuit against Tower Hill Healthcare Center here.
Related:
Problems persist in Chicago nursing home with track record of providing poor nursing care
How much money does it cost to pursue a claim or lawsuit for bed sores?
Family Of Disabled Man File Nursing Home Neglect Lawsuit Against Chicagoland Facility
Chicago Nursing Homes Not Making The Grade
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Jury Punishes Nursing Home Where Man Develops More Than 20 Decubitus Ulcers
When people actually see the gruesome photos of rotting flesh on a person’s backside hear about the ongoing medical procedures that are necessary to heal the wound, they begin to understand the real impact of this medical condition.
Along these lines, an obviously compassionate jury in New York awarded the family of a man who
succumbed to infection following the development of bed sores almost $19 million. The New York Post reported that the Brooklyn jury’s award was comprised of $3.75 for the man’s pain and suffering and a hefty $15 million in punitive damages.
According to the man’s daughter’s Margaret Whitehurst, the man rapidly declined during his nine month admission to Brooklyn Queens Nursing Home. ”He walked in on two legs and a cane. He was 237 pounds. When we got him back, he was 148 pounds and had holes all over his body.”
In addition to hearing testimony regarding severe bed sores (also called: decubitus ulcers, pressure ulcers or pressure sores), the jury also heard from an expert witness who testified about how the nursing home altered the man’s medical records to make it appear as though he entered the facility with bed sores.
Bed Sores: Not Just A Pain In The Butt– More Like An Uncontrollable Killer
Nursing Home Injury Laws: New York
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Bed Sores Continue To Plague Nursing Home & Hospital Patients In All Demographics
Although the news regarding the horrific physical and emotional impact of bed sores (also called decubitus ulcers, pressures sores or pressure ulcers) surely is on all respectable medical professionals radar screens, bed sores in nursing homes and hospitals continue to plague individuals in all demographics. In order to improve patient care, bed sore prevention must be a priority at all nursing homes and hospitals.
Should a bed sore develop, staff must be diligent in identifying the wound as quickly as possible an implement the use of medical equipment such as pressure relieving mattresses and other pressure relief devices such as heel protectors to prevent the wounds from advancing.
Related:
Nursing Homes With Higher Percentage Of Hispanic Residents Have Higher Rate Of Bed Sores
Hospital Acquired Pressure Sores Are Devastating Source Of Patient Injury & Death
Are there any federal regulations that apply to the prevention of bed sores?
Rosenfeld Injury Lawyers: Pressure Sore Injury
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Pressure Sores Must Be Timely Treated In Order To Maximize Chances Of Patient Recovery
Pressure sores (also known as pressure ulcers, decubitus ulcers, and bed sores) are a common problem for residents of long-term care facilities. Residents with limited mobility and other co-morbidities are at increased risk for bed sores.
In most cases, pressure sores are a preventable problem. Pressure ulcers are a very painful and embarrassing condition, and all efforts should be taken to reduce the potential for developing sores.
These areas depend on whether you are bed-bound or use a wheelchair. If you use a wheelchair, these areas include the buttocks, should blades, and backs of arms/legs.
If you are bed-bound these areas include your buttocks, back of your head, back of your ears, shoulders, backs of knees, ankles, and heels. Any areas where there is a thin layer of tissue covering bone are more susceptible to bed sores. Any time prolonged pressure prevented adequate blood flow to the tissue, a patient is at risk.
There are many factors that lead to the development of bed sores. Some easy steps that can help prevent decubitus ulcers include:
- Ensuring adequate hydration and nutrition
- Keeping residents dry and clean (this is especially important for patients without bladder/bowel control)
- Turning / repositioning patients
- Performing skin checks (especially for patients with decreased sensation or mental awareness)
- Using pressure relieving devices
Pressure relieving devices include pressure relieving mattresses (air alternating mattresses, cushions), joint protectors heel pads, and wheelchair cushions. These devices help redistribute pressure from places that are more susceptible to developing pressure sores. Mattresses can inflate/deflated to reduce pressure on different areas of the body. It is important that long-term care providers are adequately trained in using these devices, so they can take advantage of their full benefits.
Attention should be given to distribution of weight, posture, alignment, stability, and relief. Pressure relieving devices are a helpful tool for long-term care providers, especially for residents who would otherwise require frequent turning, but they are not a substitute for quality care.
If you do develop a pressure sore, it is important to continue using pressure relieving devices, maintain a healthy diet, keep the wound clean to prevent infection, properly dress the wound, remove damaged tissue if the pressure ulcer is severe, and take antibiotics if the wound is infected. If the pressure sore is severe enough, it might even require surgery.
Early detection is the most important step in treating pressure ulcers. It is important to remember that each and every resident requires an individualized care plan that can determine what prevention treatment, if any, should be used. The hope is that with adequate care, pressure sores can be prevented.
Sources:
AHRQ: Pressure Ulcers in the Long-Term Care Setting
Blogs & Other Web Resources For Families Seeking Information Regarding Bedsores
Bedsores have established themselves as one of the most symbolic signs of systemic neglect of patients in nursing homes, hospitals and other medical facilities. Once thought to be an unpreventable condition that was just part of getting old, today we now see that bed sores generally be prevented with proper care and nutrition.
Given the fact that bedsores impact more than 500,000 patients every year and result in billions of dollars in resulting medical treatment, it is easy to see why bed sores have become such an important topic amongst websites and blogs. Here are some valuable websites and articles related to bedsores that I have found particularly useful for families seeking information or simply looking for a place to vent frustrations.
This is describing how to care for bedsores through healthy eating and herbal treatments. The blog talks about home remedies for the bed sores and future prevention.
Discussed here is elderly care and the prevalence of bedsores in nursing homes and assisted living facilities.
Garrett discusses the elderly in the United States and how our society views the elderly and the fact that nursing homes and assisted living facilities exist to help care for seniors around the clock. He outlines the seniors legal rights.
Medical Malpractice Nursing Home Abuse Neglect Injury Lawyer
Through the eyes of the study described, music is used in nursing homes to prompt staff to change the positions of the residents. They are using 10 nursing homes in the study to see if it helps the staff remember to more promptly change the residents’ positions.
A Texas family won their lawsuit against a nursing home due to a family member dying from complications of a bedsore. The nursing home was also found delinquent in hydrating and providing adequate nutrition for the deceased.
This blog talks about all the current news that is affecting the nursing home industry. It discusses litigations, current vaccinations and trends.
This is a discussion and account of nursing homes and the dangers that are posed due to the population that are served in nursing homes across the country. The residents can be in decreased physical health and mental capacity putting them at higher risk for abuse and development of bedsores.
According to the data collected, bedsores are high on the list when it comes to problems in hospitals. Developing bedsores after hospital admission is a major problem that needs to be addressed due to the growing problem.
This blog goes into bringing up the argument that repositioning to help care for and prevent bedsores may not help with treatment and prevention. The argument is that the bedsores are still developing despite the care plan that includes a repositioning schedule. Hmmm…
Build Muscle Mass 101 Articles
Bedsores are prevented by a healthy diet that builds muscle in the body. Nutrition fuels the body and helps the body stay healthy and prevent breakdown which can lead to bedsores.
Discussions about preventing bedsores, or pressure sores, teach people about pressure release and changing positions. It is of utmost importance to do these preventative measures to keep the skin safe for people who have limited mobility.
Bedsores are defined by the author. Then the articles go into symptoms, causes and treatment of the bedsore.
Paralyzed people all over the world, especially developing countries, have major problems after their injuries are sustained due to the inability of help to care for the person, physically. Surviving the initial injury is important enough, but there is usually no one there to help relieve pressure and bedsores develop and can be life threatening.
McKnight’s Long Term Care News & Assisted Living
This blog focuses on bed sores and noticing the difference between bedsores and other sores. The treatment for these sores are different depending on where they stem from.
This blog depicts home remedies that help treat bedsores. It ranges from using Vitamin E oil to Lysol spray to Aloe Vera.
Have a website that you find particularly useful? Please share! Use the contact form and send it over and we will be sure to include it in our upcoming posts.
15 Websites As A Reference Tool For Patients & Families Coping With Pressure Sores
Pressure sores may impact patients in nursing homes, hospitals, assisted living facilities or even people with limited mobility who are living at home. Because pressure sores remain such a common problem impacting patients in all demographics, it is important to learn about pressure sore prevention, treatment and resources. Therefore, we have assembled a variety of pressure sore web-based resources authored by a diverse group of authors to gain various perspectives on treating and preventing the development of pressure sores.
This blog touches on nursing practice, all types of clinical research, community discussions and debates among nursing practices.
2. Nurse. Com
Overall nursing spectrum guide to educate and help the nursing community understand nursing issues throughout the country.
3. Elderly Abuse in Nursing Homes
This blog encompasses all aspects of abuse in nursing homes. They touch on the topic of pressure sore treatment in nursing homes.
This blog helps the community learn about and find skilled nursing homes for the people looking for placement. The blog discusses pertinent aspects of care in nursing facilities.
Providing pertinent information about Indiana Nursing Homes, the blog provides information about the nursing home services and care in Indiana.
The blog describes what the elder laws are and which are frequently broken due to abuses, pressure sores, etc. It is updates as frequently as new information arises.
All things aging discusses all aspects of elderly life as people age. Day to day living, self-care, home placement plus much more is discussed.
Craig Hospital specializes in bringing the holidays to people who cannot be home to celebrate due to hospitalization for mainly spinal cord injury and traumatic brain injury. The blog discusses conditions that people face who are seen by members from Craig Hospital.
Focusing on rehabilitation, this blog discusses the fact that pressure sores have been a historic problem for those in the rehabilitation process and it is still a problem today. The pressure sore can impede recovery and cause further complications to the patient.
Bringing together a spectrum of health topics among the wheelchair community. Pressure sores can be common and prevented by doing frequent pressure releases during the day.
11. Penawar Penyakit
This accurately describes pressure sores, stages, and treatment. It has a lot of photographic depictions of pressure sores and what they look like and how to find them.
This sight and blog focuses on people with spinal cord injury and the prevalence of pressure sore development. There are people with spinal cord injury who blog and brings up topics.
13. Public School
The blog discusses who is at high risk for developing pressure sores and signs to look for. It also goes through the stages of bedsores and describes each stage.
This focus is on wound care products and treatment for pressure sores. It touches on the lengthy process of caring for and healing a pressure sore in the body.
This blogspot discusses in detail what a pressure sore is, how people can get pressure sores and different treatment options for the people. It also goes into detail on ways to prevent pressure sores.
Bed Sore Prevention May Require Nursing Homes To Obtain Pressure Relieving Devices For Their Patients
As a lawyer who sees a significant number of cases where nursing home or hospital patients have developed bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) during a short or long-term admission, I feel as though the most progress has been made with respect to new technology in the utilization of pressure relieving devices.
Occasionally, we see long delays between the implementation of the pressure relieving devices from the time that they were originally ordered by the doctor. Sometimes the delay is based on the fact that the facility may be inadequately stocked with the devices. Yet in other situations, facilities may claim that such devices are too expensive.
Related:
Medical Facilities Are Not Doing Enough To Prevent Pressure Ulcers On Patients’ Heels
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Sometimes Medical Complications, Such As Bedsores, Are Not Disclosed Until The Patient Is Seen At A Hospital
Some of my angriest clients contact me after a loved one was transferred from a nursing home to another nursing home or hospital only to learn of serious medical problems their loved one likely acquired during their original admission.
Of course, breaking disappointing news is difficult for anyone to do. Yet, in the case of nursing homes– this is something they simply are required to do under the law. Similarly, nursing homes must notify the patients doctor if their condition deteriorates.
Related:
Nursing Homes Abuse Blog: Hospital Bed Sores
Medical Facilities Are Not Doing Enough To Prevent Pressure Ulcers On Patients’ Heels
Pressure Sores In Hospitals On The Rise
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Four California Hospitals Fined For Delays Related Medical Errors– Including Severe Bedsores
California enacted a state law in July 2007 requiring hospitals to report “never events” (events that are never supposed to be allowed to happen). Never events include s
evere bedsores (stage 3 or 4), foreign objects left inside surgical patients, surgery performed on the wrong body part, surgery performed on the wrong patient, air embolism, blood incompatibility, and CATIs (catheter-associated urinary tract infections).
Hospitals are required to report these “never events” to the California Department of Public Health. If a hospital fails to report these events they face $100 fine for each day the event goes unreported. State officials hoped that the law would help hospitals identify and address problem areas to improve patient treatment. (See “What can hospitals do to reduce the rate of bed sores in their facilities?”) Unlike hospitals, long-term care facilities and nursing homes are not required to report never events.
Other states, such as Illinois, have similar reporting programs with, such as the Illinois Hospital Report Card and Consumer Guide to Health Care. (See “States Move to More Transparency Regarding Medical Malpractice & Hospital Errors”) This program also only requires hospitals to report medical errors, infections, and other issues. Improved reporting systems will help educate medical professionals about common mistakes in their own hospitals.
An American Medical News article states that hospital error-reporting systems are falling short. This is because many hospital reporting systems do not allow doctors, nurses, and other hospital staff members report mistakes anonymously. This means that many errors and problems go unreported, which does nothing to help reduce errors and improve patient safety.
Between 2007 and 2009, 106 facilities were fined almost $1 million for failure to report or delays in reporting never events. This list included four Riverside County hospitals (Parkview Community Hospital Medical Center in Riverside, Kaiser Permanente’s Riverside Medical Center, Riverside Community Hospital, and Desert Regional Medical Center in Palm Springs) for delays in reporting never events. Most of these events were severe bed sores.
Bed sores (otherwise known as pressure sores, pressure ulcers, or decubitus ulcers) are a common but preventable problem. (See “Is It True That Bed Sores Are Preventable?”) If left untreated, pressure sores can grow and become infected, requiring drastic and painful treatment.
Prevention is key because decubitus ulcers are easier to prevent than to treat, and it avoid putting the patient in unnecessary pain and discomfort in addition to being put at risk for serious health complications such as sepsis and even death. Bed sores can be prevented by conducting daily skin inspections (especially for at risk patients), using pressure reducing mattresses, pressure-release wheelchairs, frequent position changes, minimizing friction, and healthy diet. (See “Simple preventative techniques can drastically reduce the rate of hospital-acquired decubitus ulcers”)
Sources:
Bed Sore FAQs: What can hospitals do to reduce the rate of bed sores in their facilities?
The Press-Enterprise: 4 Riverside County Hospitals Fined for Error Report Delays
American Medical News: Hospital error-reporting systems falling short
Associated Content: Hospital Error Reporting Causes Increase in Patient Safety
Illinois Hospital Report Card and consumer guide to health care
Who Said Nursing Care Was Easy? The Prevention Of Bed Sores Requires Staff To Turn & Reposition Patients On A Reqular Basis
The underlying mechanics behind the development of bed sores (also called: pressure sores, pressure ulcers or decubitus ulcers) is relatively simple– unrelieved pressure on the body results in restricted blood circulation and consequential lack of nutrients and oxygen to skin and tissue.
When pressure goes unrelieved for extended periods of time, tissue dies and a wound develops in the area.
Armed with a basic understanding of the mechanics behind the development of bed sores, medical professionals suggest alleviating the pressure on the body on regular intervals.
Related:
Why is ‘turning’ so important to prevention of bed sores?
What steps can be taken to minimize the risk of developing bed sores?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Avoidable Medical Errors, Such As Decubitus Ulcers, Continue To Rise In Hospitals Despite Reduction Methods
The term “never event” earned its name simply due to the fact the government determined that that the events should never happen in properly functioning hospitals. As an added incentive for hospitals to prevent these situations from occurring, the government will not reimburse hospitals for these medical errors. These events include:
- leaving foreign objects inside surgical patients;
- surgical site infections;
- air embolisms;
- transfusions using the wrong blood type;
- Inadequate glycemic control;
- severe pressure sores; (See “Simple Preventative Techniques Can Drastically Reduce The Rate of Hospital-Acquired Decubitus Ulcers”)
- post operative pneumonia;
- MRSA infection (methicillin-resistant Staphylococcus aureus);
- falls and trauma; and
- catheter-associated urinary tract infections (UTIs).
All too many of us, especially those of us with family members in nursing home facilities, know someone who has suffered from one of these “never events.” In the month of July, medication-error deaths are 10% higher than any other month because medical school graduates are just beginning their residencies. (See “Avoid Hospitals in July”) Apparently, the most common foreign object left inside a surgical patient is a surgical sponge.
In 2008, the Centers on Medicare and Medicaid decided to stop reimbursing hospitals for these “never events.” This is so hospitals are not paid for the procedure that caused the never event and the follow-up treatment to treat the error.
In California, 14% of preventable errors over the last two years were caused by “retained foreign objects.” In response, the state plans to use some of the money collected from hospital fines to research how to reduce these preventable hospital mistakes.
Illinois is taking steps to reduce hospitals errors with its website, the Illinois Hospital Report Card and Consumer Guide to Health Care. This site provides hospital information to consumers and includes a report card including staffing, infection prevention, and quality care. (See “States Move to More Transparency Regarding Medical Malpractice & Hospital Errors”)
However, “never events” are not always preventable. Some patients, because of poor condition (malnutrition, kidney failure, etc) prior to surgery, are more likely to suffer from certain surgical complications, including “never events.” For example, patients requiring colon resection are more at risk for post-surgical infections and pressure ulcers. This might deter physicians from working with patients with certain risk factors because if something goes wrong and a never event occurs, the hospital might not get paid by Medicare or insurers who adopted similar payment policies.
In addition, no matter how many new policies and improvements are put in place, humans practice medicine and human-error can still occur. Hopefully, additional oversight and transparency will help reduce dangerous and preventable hospital errors.
Sources:
SF Gate: Avoidable Mistakes Rise Despite Hospital Efforts
Medical News Today: In Hospital Deaths from Medical Errors at 195,000 per Year USA
The Washington Post: Hospitals Tally Their Avoidable Mistakes
Illinois Hospital Report Card and Consumer Guide to Health Care
Nursing Homes Abuse Blog: Avoid Hospitals in July
Even Stiff Fines Can’t Force Nursing Homes To Take Necessary Steps To Prevent Pressure Ulcers
When nursing homes take simple, preventative steps such as: turning patients, keeping them clean, and providing adequate nutrition and hydration; they can greatly decrease the incidence of pressure sores (also called: bed sores, decubitus ulcers or pressure ulcers) at their facilities. However, even though the preventative steps are well known, many nursing facilities simply fail to implement the necessary care that patients require to function optimally.
Related:
Can malnutrition cause bed sores?
Can dehydration contribute to the development of bed sores?
What is ‘turning’ and why is it important to prevention of bed sores?
Are incontinent patients at an increased risk for developing bed sores?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Wireless Patient Monitoring Holds The Key To Better Patient Care & Possibly The Prevention Of Pressure Ulcers
Many hospitals and nursing homes suffer from understaffing. These understaffed facilities are unable to provide the best possible care to its patients and residents. This leads to an increased number of preventable deaths and injuries. One possible tool to help combat this problem is the use of remote monitoring devices. Inadequate supervision and staffing at nursing homes is no excuse for poor patient care. (See “Are assisted living facilities responsible for the prevention of bed sores in their patients”)
Remote monitoring devices allow for wireless patient monitoring. The monitors typically track temperature, pulse, blood pressure, glucose, and personal data (weight, pain, drugs). The system can record and transmit data to doctors. In the case of patients who do not live near medical support, it can transmit vital information to doctors to alert them of any change in patient status. For nursing home residents, remote monitoring can help staff better monitor residents and focus their attention on the patients who need medical assistance. The system is particularly helpful for monitoring patients with chronic diseases including diabetes, heart failure, and patients recovering from strokes. In addition, remote monitoring prevents unnecessary trips to the doctor and hospital, which can reduce costs.
As new technologies are incorporated into patient care, there must also be standards set on how to monitor data and how often. Even though doctors and nurses do not need to physically take a patient’s vital signs, they still need to review the data. However, overall, this will free up a lot of time for doctors and nurses because of reduced need for office visits.
The FCC (Federal Trade Commission) delivered its National Broadband Plan to Congress in March. The FCC promotes broadband to save money in healthcare with the use of remote monitoring of health records and patients’ vital signs. Together, remote monitoring and electronic health records could save as much as $700 billion over 15-25 years. (See “Is It Time For Nursing Homes To Embrace Electronic Medical Records?”)
Remote monitoring offers one option to improve patient care and safety, while also reducing costs. But, it is unclear how likely the use of remote monitoring will be in nursing homes in the near future. Until then, it is critically important that nursing homes are properly staffed, so that residents receive the proper care and supervision to achieve or maintain the best possible health and prevent medical conditions such as pressure ulcers.
Sources:
Broadband.gov: Broadband & Health Care
Med Health World: Patient Monitoring Without the Wires-Is Ultra Wideband Frequency the Future?
Nursing Homes Abuse Blog: Is It Time For Nursing Homes To Embrace Electronic Medical Records?
Medical News Today: Remote healthcare monitoring not so distant
Who’s To Blame For Bed Sores In The Obese? Or Are They An Inevitable Part Of Being Fat?
An article published in the Las Vegas Sun, painted an unfortunately common set of circumstances; an overweight patient goes into a hospital for a medical procedure– only to acquire pressure sores during their stay.
Sure, the same scenario can (and most certainly does) occur with people of average stature, but there definitely is a disproportionate number of obese patients who enter a hospital or nursing home only to develop a lingering souvenir.
The sun article concentrates on 60-year-old Tyrone Bush, a maintenance man, who was admitted to Desert Springs Hospital for a quadruple heart bypass surgery in 2008. It was during Bush’s recovery at the hospital, that he developed multiple bed sores (or pressure sores, pressure ulcers, decubitus ulcers) on his buttocks.
Related:
Nursing Home Injury Laws: Nevada
What can hospitals do to reduce the rate of bed sores in their facilities?
Why is it important to differentiate the type of facility where a bed sore developed?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Pressure Mapping System Can Help Identify Areas Of The Body Prone To Develop Pressure Sores
Pressure sores are a very serious– yet preventable problem that plagues many nursing home and hospital patients. Now, new technology in the form of a Pressure Mapping System can help identify areas on a patient’s body that may form pressure sores. The new technology would assist doctors in preventing bedsores before they start to form.
Pressure sores (also known as decubitus ulcers, bedsores, and pressure ulcers) are areas of skin and tissue that have been damaged by inadequate blood flow because of sustained pressure. Nursing home residents and hospital patients are at increased risk for pressure ulcers because of decreased mobility, wheelchairs, and bed confinement.
Common areas to suffer from decubitus ulcers are the:
- Buttocks
- Heels
- Lower back
- Shoulders
- Hips
- Knees
- Ankles
Pressure mapping is a useful tool for doctors to help assess patients who are susceptible to developing pressure sores and making an early diagnosis in patients with existing pressure sores. A pressure map helps reveal what is happening underneath a patient’s skin. It allows doctors to see areas of pressure under a patient’s skin that are not yet apparent on the skin’s surface.
The mapping device is actually a thin mat that has sensors attached to it. The mat is placed between the patient and the bed, wheelchair, or other seating surfaces. These sensors, which are attached to a computer, read the amount of pressure exerted on them, creating a color-coded map of the pressure distribution. This image can help a caregiver determine high-pressure areas.
Then, the caregiver can implement preventative measures so pressure sores do not occur. Pressure-reducing measures include changing positions more often, changing body position, changes in equipment, using special cushions, pads, mattresses, and beds that relieve pressure, and using foam, air, or water-filled devices to cushion a wheelchair seat and foot rests.
Pressure mapping systems are not without their problems. There are some concerns with the lack of standardization in how different devices report pressure readings. In addition, some devices simply report an average pressure reading over a larger area, which might under-report the pressure in small bony areas surrounded by lower pressure areas. Therefore, pressure maps should be used as just one tool in effectively diagnosing and preventing pressure sores. It is important that doctors and caregivers still perform detailed skin inspections for signs of pressure sores.
Pressure mapping systems can help prevent dangerous and painful pressure sores, which improves quality of life and reduces the cost of treating pressure ulcers. However, some facilities might not be able to afford the high cost of such a system. Ridge Meadows Home Care Team was able to purchase a $17,000 Pressure Mapping System because of a $10,000 donation. When choosing a nursing home facility, it is important to ask about preventative measures such as a pressure mapping system, especially if you are at increased risk for pressure sores.
Sources:
Maple Ridge News: Pressure Mapping System to Treat, Prevent Bed Sores
Lippincott’s Nursing Center: Wound and Skin Care – Can pressure mapping prevent ulcers?
Optimal Positioning: Wheelchair Seating Comfort and Pressure Mapping
Is $28 Million In Punitive Damages Enough To Punish A Nursing Home That Allowed Patient To Develop Infected Pressure Sores?
Well according to a California jury, the answer is ‘yes’. $28 million is the amount of punitive damages the jury awarded in the elder abuse and wrongful death case (Sacramento Superior Court) against Colonial Healthcare of Auburn and its parent company Horizon West of Rocklin.
This case revolved around the abuse and death of Ms. Frances Tanner, a 79-year-old resident, who died from an infected bedsore. Punitive damages were awarded because the jury determined that the nursing home was “malicious, oppressive, or fraudulent.” In addition, the jury awarded Ms. Turner’s daughter, Elizabeth Pao, $1.1 million for loss of companionship and her mother’s pain and suffering.
Ms. Frances Tanner was admitted to Colonial Healthcare of Auburn in March 2005 with a diagnosis of dementia. Then, in September 2005, Ms. Tanner fell and broke her hip. The nursing home did not conduct a timely assessment of her injury, which resulted in a delay in treatment.
It took eight days after Ms. Tanner’s fall for the nursing home to diagnose her with a hip fracture. It was at this point that staff members also discovered a bedsore (also known as a pressure sore, decubitus ulcer, or pressure ulcer). A few weeks after undergoing hip surgery, Ms. Tanner died from an infected bedsore. (See “Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?”)
Bedsores are a very serious and dangerous problem for nursing home residents, especially those who have limited mobility. When Ms. Tanner suffered a fall, the nursing home should have first conducted a thorough examination, with special attention given to a possible hip fracture. Hip fractures are a very common injury in elderly nursing home residents because of weak bones. Second, nursing home staff should have implemented measures to prevent bedsores during her recovery because of Ms. Tanner’s reduced mobility.
It is unthinkable that it took the nursing home eight days to discover the hip fracture and bedsore. Then, what is even worse is that the nursing home facility allowed Ms. Tanner’s bedsore to progress to such a level that the resulting infection actually killed her. (See “Are the development of bed sores during a nursing home admission an indication of nursing home neglect?”) Decubitus ulcers are incredibly painful, and it is likely that Ms. Tanner spent her final days in pain from her hip fracture and infected bedsore.
Bedsores are a preventable injury. When a nursing home resident suffers an injury that leads to reduced mobility, the nursing home should implement special preventative measures to ensure that no bedsores occur. In fact, nursing homes must do this. They must take steps to prevent bedsores. Then, if a resident does suffer from a bedsore, the facility must provide proper care and treatment to ensure that the bedsore heals and does not worsen.
Healthcare of Auburn directly contributed to the death of Ms. Tanner. The elder abuse and wrongful death charges are important to hold the facility responsible, and the punitive damages help to further punish the nursing home and prevent future tragedies. However, they do nothing to bring Ms. Elizabeth Pao’s mother back.
Resources:
The Sacramento Bee: Jury Hits Auburn Nursing Home with $28 Million in Punitive Damages
The Washington Examiner: Jury Awards $29.1 million in nursing home death
Simple preventative techniques can drastically reduce the rate of hospital-acquired decubitus ulcers
Though surely an unanticipated complication, hospital-acquired decubitus ulcers (also referred to as: pressure ulcers, pressure sores or bed sores) remain a tremendous problem for patients and the hospital itself. Acknowledging the negative impact of decubitus ulcers, Texas Arlington Memorial Hospital set out to create a program to reduce the rate of hospital-acquired decubitus ulcers. Though hardly high-tech, the hospital cut the rate of decubitus ulcers by 63% utilizing the following techniques:
- Screening all new admission for decubitus ulcers
- Encouraging patients who are physically able to use the toilet as opposed to diapers
- Empowering all hospital staff: physicians, CNA’s, RN’s and others to identify and document all signs of early stage decubitus ulcers when caring for patients
- Implementing extra skin checks for physically disabled patients or those who constantly use medical equipment like oxygen masks or tubing
- Analyzing all patient records on a quarterly basis to determine which preventative techniques are working and those that are not
Related:
Bed Sore FAQ: Bed Sore In Hospital
Nursing Homes Abuse Blog: Hospital Bed Sores
Nursing Home Injury Laws: Texas
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Nursing Home Resident Dies From Improperly Treated Pressure Sores During Short Rehab Stay
Mr. Newton K. McManus Jr. died on May 31, 2008, less than one month after being admitted to Caseyville Nursing and Rehabilitation Center, an Illinois nursing home, on May 8, 2008. Mr. McManus spent his final days in pain, suffering from pressure sores, leg ischemia (inadequate blood flow, resulting in pain and non-healing wounds), and a urinary tract infection. Ms. Shirley McManus filed a wrongful death lawsuit against the facility in St. Clair County Circuit Court, seeking$150,000.
Caseyville Nursing and Rehabilitation Center is a 150-bed facility located in Caseyville, Illinois has a one-star rating from Medicare Nursing Home Compare, which is a much below average rating. Not unsurprising considering the poor treatment Mr. McManus received, Caseyville had twelve health deficiencies between January 2009 and March 2010, which is four more than the Illinois average and the U.S. average.
Mr. McManus seems to be the victim of neglect. In the final month of his life, he suffered from a series of health problems including:
- Bed sores
- Urinary tract infection (See “Untreated Urinary Tract Infections in Nursing Home Patients May Result in Urosepsis”)
- Malnutrition (See “Can malnutrition cause bed sores?” and “Inadequate Nutrition & The Development of Bed Sores in Nursing Home Patients”)
- Dehydration (See “Can dehydration contribute to the development of pressure sores?”)
Bedsores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) are a very serious and preventable problem that affects many nursing home residents. Nursing homes are required to ensure that residents do not develop pressure sores and provide treatment and services to promote healing and prevent infection for residents with existing pressure sores.
Oftentimes, these victims do not receive adequate care and services that would prevent these painful and dangerous injuries. If not properly treated, decubitus ulcers can progress rapidly, damaging tissue and bones and cause sepsis or even death. It is saddening that this is how Mr. McManus spent the final days of his life, in pain and agony. Coupled with the horrible physical pain was the victim’s deteriorating mental state and distress.
Ms. Shirley McManus is now suing the nursing home facility for wrongful death, alleging that the facility committed several negligent acts that resulted in his death. Her lawsuit alleges that the nursing home failed to provide adequate care, failed to protect Mr. McManus from abuse and neglect, failed to notify his doctor of a change in physical condition, failed to create a care plan that addressed his pressure sores, and also failed to maintain his body weight.
Situations like this should not occur in nursing homes. Residents are entitled to receive necessary care and services in order to attain or maintain the best possible physical, mental, and psychosocial well-being. If you or a loved one are not receiving this minimum level of care and have suffered injury, you may be entitled to compensation
Sources:
Madison St. Clair Record: Woman Sues Caseyville Nursing Home Over Man’s Death
Illinois Department of Public Health: Caseville Nursing & Rehab Ctr
Medicare Nursing Home Compare: Caseyville Nursing & Rehab Ctr
Untreated Urinary Tract Infections in Nursing Home Patients May Result in Urosepsis
Can malnutrition cause bed sores?
Inadequate Nutrition & The Development of Bed Sores in Nursing Home Patients
Can dehydration contribute to the development of pressure sores?
Survival rates for sepsis patients is dependent on how quickly the medical facility identifies the problem and implements treatment
Many of our nursing home negligence and medical malpractice cases involve patients who may have developed a pressure sore only to be confronted with another medical problem– sepsis. Sepsis is a severe infection that effects the complete body. Due to the open wounds that accompany advanced pressure sores (also called bed sores, decubitus ulcers or pressure ulcers), provide the perfect entry way for infection to enter the body.
Sepsis (sometimes also referred to as: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia) is a deadly, yet surprisingly common medical condition. According to a recent sampling of hospital patients:
- Sepsis is the 10th leading cause of death in the U.S.
- 33% of people who contract sepsis will die from the disease
- Medical expenses to treat sepsis cost approximately $17 billion per year
The Banner Desert Medical Center in California recognized the substantial problems associated with sepsis and has begun to implement a prevention and treatment program. Believed to be the first of its kind, the California hospital uses a scientific formula to detect warning signs that indicate a patient is at risk for contracting sepsis. The diagnostic program evaluates:
- changes in body temperature
- increases in heart rate
- changes in respiratory rate
- decreases in white blood cell count
After the early symptoms of sepsis are identified, the hospital is able to rapidly administer medical treatment and greatly improve the patients survival rate. In the first two months of its use at Banner Medical Center, the hospital credits the new program with the early detection of sepsis in 60 patients and likely a substantial number of lives as well. Read more about this important development in sepsis prevention here.
Hopefully this sepsis detection tool can be applied to patients in a nursing home setting as well. Too often the implementation of medical treatment for nursing home patients is delayed due to inadequate training of staff and insufficient medical equipment.
Related Bed Sore FAQ’s:
Is sepsis related to bed sores?
Are bed sore patients at risk for amyloidosis?
Why is a colostomy needed for patients with severe bed sores?
Why are physically disabled patients at risk for developing bed sores?
Nursing Homes Abuse Blog: Sepsis
Nursing Home Injury Laws: California
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Nursing home neglect and medical malpractice alleged in wrongful death case involving the development and advancement of decubitus ulcers during admission to nursing home and hospital
Philadelphia jurors have spoken in a case involving the development of decubitus ulcers during a hospitalization and deterioration during a subsequent stay at a nursing home. Not only did they speak up, but the jurors stood up in a loud way, slapping $5 million in punitive damages on top of a $1 million compensatory award against the Jeanes Hospital and Hillcrest Convalescent Home (Pennsylvania).
In the case believed to be the first of its kind decided by a Philadelphia jury, the punitive damages were allocated: $1.5 million against the hospital and $3.5 million against the nursing home.
According to the lawyer for the man’s family, Steven R. Maher, Jeans Hospital failed to diagnose the man’s urinary tract infection that contributed to the development of bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) and then the man was transferred to Hillcrest Nursing Home where the bed sores worsened. After a courageous battle attempting to heal the decubitus ulcers at home for more than two years, the man succumbed to complications related to the decubitus ulcers.
Jeanes Hospital is part of the Temple University Health System and Hillcrest is owned by Genesis HealthCare Corporation, a large nursing home operator in the Northeast.
Unlike compensatory damages that are intended to compensate an injured party for their loss, punitive damages are only awarded in situations where a court determines the conduct to be outrageously negligent or reckless. In cases involving decubitus ulcers, punitive damages may be appropriate when staff repeatedly fail to tend to their duties over extended periods. No doubt that the plaintiff’s lawyers were persuasive, but my guess is that the testimony and photographs (if any) really incited feelings of rage.
Additionally, this case is important because too often we see different medical facilities point their fingers at the other facility. Here we see that even when a patient arrives at a nursing home in a less that ideal condition, facilities still have an obligation to provide the patient with quality care to prevent further deterioration.
Related Bed Sore FAQ’s:
What can hospitals do to reduce the rate of bed sores in their facilities?
After I become aware of a bed sore, should I photograph it?
Nursing Home Injury Laws: Pennsylvania
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Son blames under-staffing at nursing home for development of mother’s pressure ulcers and infection
Without a doubt, staffing is the number one predictor of the the type of care patients in nursing homes, hospitals and assisted living facilities will receive. High-tech medical equipment and expansive medical facilities mean nothing without a team of properly trained personnel to tend to patient needs.
In this sense, the son of a deceased nursing home patient blames ‘under-staffing’ as the reason why his mother fell and subsequently developed pressure ulcers at the facility. As the special administrator of his mother’s estate, Gary Brown filed a nursing home negligence lawsuit against a county operated nursing home in Nebraska alleging that his mother’s injuries and death could have been prevented had the facility had adequate staff.
As is frequently the case in with injuries occurring in the nursing home setting– one error leads to the development of another. In the case of this lawsuit, it is alleged that after the facility failure to supervise the woman resulted in a fall and hip fracture. After the hip was surgically repaired, the facility failed to acknowledge the fact that the woman’s immobility that accompanied put her at risk for developing pressure ulcers (also referred to as pressure sores, decubitus ulcers or bed sores) during her recovery at the facility.
The facilities negligence continued even after the pressure ulcers developed as the pressure ulcers advanced and became infected. Further complicating the situation is the fact that the the facility failed to notify the woman’s son or personal physician of her pressure ulcers. Finally, Mr. Brown claims that the pressure sores contributed to his mother’s death.
Read more about this nursing home negligence lawsuit involving the development of pressure ulcers here.
Nursing Homes Obligation To Prevent & Treat Pressure Ulcers
Every patient coming into a nursing home must be assessed to determine their risk for developing pressure ulcer and a care plan must be developed to meet the patients needs. When facilities are inadequately staffed or staff never receives proper training, many of the preventative measures set forth in a care plan never get done and patient injury frequently ensues.
Pressure ulcers are a known problem facing patients in nursing homes and hospitals with limited mobility. Pressure ulcers may develop when patients are left in one position for extended periods of time. Patients who remain in one position for extended periods are at risk for developing pressure ulcers as limited blood flow to the area results in the gradual decay of tissue.
Consequently, many nursing home patients need to be ‘turned’ on a regular basis. Many facilities have charts to help staff keep track of the re-positioning schedule for each resident.
In order to reduce the incidence of pressure ulcers, nursing home residents should be:
- Kept clean and dry, particularly those patients who may be incontinent
- Moisturized daily
- Washed regularly with mild soap and water
- Changed positions on a regular basis to chances of unrelieved pressure
- Kept well fed and hydrated
- Kept the bed elevation as low as possible- this reduces pressure on the sacrum and buttocks– areas where pressure ulcers frequently develop
Related Bed Sore FAQ’s:
What are the signs of infection for people who have bed sores?
What should I do if my family member develops bed sores during an admission to a nursing home?
What areas of the body are prone to develop bed sores?
What type of legal recourse does a person with bed sores have?
Nursing Home Injury Laws: Nebraska
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
New York jury awards $19m to family of man who developed advanced bed sores during nursing home admission
If you ask most people what a ‘bed sore’ is, you may get a lot of blank stares and shrugs. Truth is, most people probably have never seen a severe bed sore. However, when people actually see the gruesome photos of rotting flesh on a person’s backside that expose underlying layer of skin and bone they probably will next forget the image.
Similarly when people hear of the ongoing medical procedures that are necessary to heal the wound, and the pain experienced by the individual, they really begin to understand the real impact of this medical condition. The reality is that bed sores kill patients in nursing homes and hospital– needlessly.
The visual impact and physical devastation to the man that was caused by the bed sores is likely what caused a New York jury to make their substantial award in a lawsuit filed by the family of a deceased man who developed bed sores in a nursing home.
The man’s daughter’s Margaret Whitehurst, said her father’s medical condition quickly declined during his nine month admission to Brooklyn, NY facility. “He walked in on two legs and a cane. He was 237 pounds. When we got him back, he was 148 pounds and had holes all over his body.”
During the trial, the jury heard testimony from the man’s family and physicians regarding the severity of his bed sores (also called: decubitus ulcers, pressure ulcers or pressure sores), and also from a handwriting expert who testified about how the man’s nursing chart was altered. According to the handwriting expert’s testimony, the admission paperwork was altered to look as though the man entered the facility with bed sores, although his family and physicians strictly denied that fact.
Certainly, hearing that the nursing home records were altered in this matter must have swayed the jury to make such a large award for punitive damages. Punitive damages are usually awarded after a judge has given the plaintiff leave to file a prayer for such. Unlike compensatory damages intended to compensate an injured party, punitive damages are intended to punish the wrongdoer.
Related Bed Sore FAQ’s:
Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?
What are the causes of bed sores?
Nursing Home Injury Laws: New York
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Problems persist in Chicago nursing home with track record of providing poor nursing care
If you’ve ever wondered just how bad life in a poorly rated nursing home is, take a look at a recent investigative article by Sam Roe of the Chicago Tribune. Mr. Roe’s article chronicles life at Berwyn Rehabilitation Center, a Chicago, Illinois nursing home that received one-star in all major categories by the Medicare rating system. The article illustrates what living conditions are like for patients in a poorly rated facility. Sadly, despite the poor ratings and dangerous living conditions, facilities such as Berwyn Rehabilitation continue to receive federal funding.
The star-ratings of nursing home is a recent feature on Medicare’s Nursing Home Compare website that has information on the more than 16,000 nursing homes in the United States. Nursing homes are rated on a one to five- star system in categories important to patient care based on information contained in: staffing levels, nursing home surveys and overall quality measures.
Surely, the Medicare ratings assigned to facilities such as Berwyn Rehabilitation can only tip-off patients as to what may lay behind the doors of the facility, but the details of the living conditions chronicled during inspections at Berwyn Rehabilitation certainly indicate the the low ratings may be well founded.
According to Illinois Department of Health (IDPH) surveys conducted at Berwyn Rehabilitation Center, the regulatory agency noted 29 violations of patient safety and care regulation. IDPH inspectors noted the serious violations:
- Decubitus ulcers (bedsores, pressure ulcers, pressure sores) on the buttocks on incontinent patients
- Bruises of unknown origin on the legs and arms of patients who were primarily confined to bed
- Incontinent and non-incontinent patients sitting in urine and feces for extended periods
- Patients suffering from chronic pain who were never administered any pain relieving medication despite physician orders for such
- Dirty urinary catheter tubing
- Dirty dressings covering pressure sores and inadequate documentation as to when the dressings had been changed
- Dangerous bed rail usage– improperly fitted bed rails used on beds allowing patients to potentially become entrapped between the rails and bed mattress
In response to the poor Medicare ratings and survey findings, a new nursing director was recently installed at Berwyn Rehabilitation. “This nursing home was really bad,” according to Anjanette Miller, the recently appointed director of nursing. Not surprisingly, Ms. Miller attributes staffing problems as the major culprit behind the facilities poor reputation. Nursing home staff “were punching in and doing nothing,” she added.
Despite a recent shake-up with the appointment of a new director of nursing and implementation of new management team, problems at Berwyn Rehabilitation Center persist. After these new measures were put into place an inspection of the nursing home confirmed patient safety violations remain. For example, a resident became entrapped between an inflatable mattress and the bed rails on his bed even after earlier inspections had brought this problem to the attention of the facility.
An autopsy conducted by the Cook County Medical Examiner determined that the patients death was due to the suffocation related to the entrapment. An investigation into his death revealed the facility was using improperly fitted rails that were arbitrarily replaced by a nursing home employee shortly before his death.
Certainly, as we can see in situations such as this, sometimes a meager Medicare rating is well deserved.
Related Bed Sore FAQ’s
How should medical professionals document a healing bed sore?
What types of wound dressing can be used on bed sores?
What are the signs of infection for people who have bed sores?
Nursing Home Injury Laws: Illinois
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Short-term nursing home admission results in deterioration of pressure sores and sepsis
The family of a former nursing home patient at Caseyville Nursing and Rehabilitation (Illinois) has filed a wrongful death lawsuit against the facility in connection to the death of their family member. The nursing home negligence lawsuit claims that the within a week of admission to the nursing home, the woman’s pressure sore on her heel and buttocks had become an open wound (stage 4 pressure sore) and the woman become septic.
In particular, the Illinois nursing home lawsuit claims that Caseyville Nursing and Rehabilitation was negligent in the following manners:
- Failing to conduct a skin assessment when the woman entered the facility
- Inadequately staffed their facility
- Failed to develop a comprehensive ‘care plan’ for the patient
- Failed to notify a physician regarding the deterioration in the woman’s medical condition
Short-term or ‘respite care’ admissions to nursing homes are a common service that many facilities provide. When patients are admitted to nursing homes for a period of days or weeks, the facility still has the same responsibilities to care for them as they do for their longer-term patients. Even for short-term admissions, nursing homes should conduct an assessment of the patients needs and create a care plan with the assistance of the patients family and physician to assure all of the patients needs are met.
Read more about this nursing home lawsuit involving a septic patient here.
Related Bed Sore FAQ’s
Why do bed sores commonly develop on the buttocks?
What are the stages of bed sores?
Is sepsis related to bed sores?
Nursing Home Injury Laws: Illinois
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Significant award made in nursing home arbitration case involving the development of advanced pressure sores and gangrene
Unlike most personal injury cases where a determination regarding the monetary damages an individual or family is entitled to receive is determined by a judge or jury, damages in an increasing number of nursing home negligence cases is now being made via an individual arbitrator or panel of arbitrators.
Many nursing home patients may unknowingly consent to mandatory arbitration agreements in admission paperwork. Under the terms of an arbitration agreement, an individuals right to a jury trial is forfeit and settled via an out-of- court arbitration system. Proponents of arbitration agreements tend to be nursing homes, who believe a dispute resolved via arbitration will be more favorable to them than before a jury.
Arbitration agreements created by a nursing home will set forth the arbitration procedure. In cases involving the use of a single arbitrator, the arbitrator is pre-determined by the nursing home. Some arbitration agreements set forth that disputes are to be determined via an ‘arbitration panel’ (usually three people) where both the nursing home and the patient choose an arbitrator, and a third arbitrator selected by agreement of the arbitrators.
For the most part, nursing home negligence disputes resolved via arbitration tend to have lower values than similar disputes tried before juries. Because some arbitrators receive ongoing business from nursing homes, it has been suggested that their willingness to award significant damages may be limited. Consequently, nursing home arbitration agreements tend to be vigorously fought by plaintiffs (injured parties, initiating a lawsuit) as unfair and in violation of personal rights granted under the Constitution.
In a break from traditionally conservative awards in wrongful death matters, a three-person arbitration panel awarded over $2.7 million in damages to the family of a nursing home patient who died in March, 2005 from complications related to gangrene and advanced pressure sores that developed during an admission to High Point Health Care and Rehabilitation Center in Tennessee.
The significant arbitration award was made against the nursing home itself and its parent company (Mariner Health Care), the nursing home management company (Mariner Health Care Management) and the nursing home licensee (National Heritage Realty Company). At the arbitration, the nursing home patients estate claimed that all entities were guilty of: negligence, violation of the Tennessee Adult Protection Act (TAPA) and medical malpractice.
For victims of nursing home abuse and neglect, this arbitration decision is very significant as it sends a message to nursing homes that they can no longer be assured of conservative awards by arbitrators. Although rarely awarded in arbitration matters, this arbitration panel made an award for punitive damages (an award made to punish the wrongdoer as opposed to compensate) against the nursing home as well.
The $2.7 million nursing home arbitration award is comprised of the following:
- $250,000 for TAPA violations
- $400,000 in attorneys fees for intentional, malicious or fraudulent misconduct resulting in TAPA violations
- $626,396.32 for medical malpractice
- $1,500,000 punitive damages
Related Bed Sore FAQ’s
If bed sores are not timely treated, can gangrene develop?
What are the signs of infection for people who have bed sores?
Is sepsis related to bed sores?
Nursing Home Injury Laws: Tennessee
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Hospital patients are more likely to develop decubitus ulcers today than they were 10 years ago
The Agency for Healthcare Research and Quality released a report on hospital-acquired decubitus ulcers that has conclusively determined that hospital patients today are more likely to develop a decubitus ulcer during their admission than their counterparts 10 years ago. In fact, the rate of decubitus ulcers (pressure ulcers, pressure sores or bed sores) acquired during a hospitalization has increased by more than 80% from 1993 to 2006! 
In addition to higher overall rate of decubitus ulcers, the study also revealed the following information regarding the development of hospital-acquired decubitus ulcers:
- In 2006, there were 503,300 hospital patients were admitted with a primary diagnosis of ‘decubitus ulcer’ — this marks an increase of approximately 80% since 1993.
- The cost of treating decubitus ulcers at hospitals was approximately $11 billion annually.
- The overwhelming majority of cases (>90%) involving decubitus ulcer care involved patients who were admitted for unrelated medical care.
- Patients discharged from a hospital following treatment for a decubitus ulcer generally fared worse than other types of patients with a lower survival rate within the first year of hospital discharge.
- Patients who developed decubitus ulcers during a hospitalization tended to be older. 72% of decubitus ulcer patients over 65-years old had a secondary diagnosis of decubitus ulcers and 56.5% of elderly hospital patients who received decubitus ulcer treatment was due to a primary diagnosis of decubitus ulcers that had developed during their hospital stay.
- Medicare was the largest payer of for care of patients with decubitus ulcers– paying approximately 75% of all charges related to decubitus ulcer care.
- Younger patients who received treatment for decubitus ulcers tended to be paralyzed or have spinal cord injuries.
Most cases involving the development of decubitus ulcers during a hospitalization result from the hospitals failure to monitor at-risk patients and implement interventions on a timely basis. Consequently, patients who develop a decubitus ulcer during a hospital admission may be entitled to pursue against the hospital based on medical negligence.
Related Bed Sore FAQ’s
Why are physically disabled patients at risk for developing bed sores?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Nurse faces criminal charges after she fails to obtain medical treatment for bedsore patient
Criminal charges are expected to be filed against Virginia Munger, a CNA employed by Homewell Senior Care (Seattle, WA), after prosecutors concluded that Munger failed provide any medical intervention for an elderly patient she was responsible for caring for.
The criminal investigation followed the bedsore-related death of an elderly home-based patient. In the course of the investigation, prosecutors learned that Munger deliberately ignored bedsores (also referred to as: decubitus ulcers, pressure ulcers or pressure sores) on the patient for at least six months prior to her death.
Home Care Nursing Services
In recent years, a new trend has emerged in the senior care industry with the increase in home-based nursing services. Many seniors today, seek home-care services as a way of living in the comforts of their home for longer periods. Home-care senior services companies provide a broad range of services including: skilled nursing care, medication management, cooking, homemaking services, senior sitting services and transportation services.
Home care services for seniors can be a great alternative to nursing homes, group homes or assisted living facilities, but it is important for the patient and their family to realistically assess their true needs and confirm that the agency can meet those needs from the start.
Similarly, staff at home care service companies should conduct an assessment of each perspective patient to determine what the patients real needs are and make a determination if the company can indeed meet those expectations. A plan of care should be prepared by the home care agency to assure the needs of their clients are regularly met. The care needs of each client should be re-assessed on a regular basis to ensure the that the patients needs can be met on an ongoing basis.
In the case above, fault surely lies on the shoulders of the CNA responsible for caring for the elderly woman. Nonetheless, I also believe the senior care company who employed the CNA should shoulder some of the responsibility as well. If in fact the company allowed the CNA to essentially work in isolation– without the oversight of supervisors, the company would likely be found negligent for failing to supervise its employees.
On the other hand, if the senior company did in fact send a supervisor to periodically check-in on this woman– yet failed to observe the bedsores or take any invention– I think similar criminal charges would be deserving.
Related Bed Sore FAQ’s
Is an autopsy necessary when a family suspects bed sores caused the death of a family member?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Lawsuit ensues after patient develops decubitus ulcers on back and heels during rehab stint in nursing home
An orthopedic rehabilitation patient who developed multiple decubitus ulcers on his back and heels has filed a lawsuit against the nursing home where the wounds developed.
The lawsuit alleges that Highland Health Care Center (Illinois) and its parent company Covenant Care Midwest failed to implement preventative measures to avoid the development of decubitus ulcers during a short-term admission. The nursing home patient was admitted to the facility for physical therapy and nursing care following a complete knee replacement surgery.
Despite the facilities knowledge that the man had limited mobility due to his recent surgery, the facility failed to mobilize the man and get him out of bed– and perform the physical therapy he was at the facility for in the first place.
In addition to the role the nursing home played in the the development of the patients decubitus ulcers (similarly called: pressure ulcers, pressure sores or decubitus ulcers), the lawsuit alleges that the facility exacerbated the severity of the wounds when they delayed obtaining medical treatment. As a result of the severity of the decubitus ulcers, the dead skin needed to be removed surgically by a process known as surgical debridement.
The lawsuit specifically alleged the following negligent acts on the part of the nursing home resulted in the patients decubitus ulcers:
- Failing to notify a physician of the change in the man’s medical condition
- Failing to implement medical treatments ordered by the man’s physician
- Failing to note changes in the man’s medical condition in the man’s chart
- Failing to implement a decubitus ulcer prevention program
The lawsuit is pending in Madison County Circuit Court in Southern Illinois.
Rehabilitation Patients In Nursing Home
In our nursing home litigation practice, we see a significant number of cases where a rehab patient has developed a decubitus ulcer during a short-term admission to a nursing home. The underlying reasons may be varied, but I suspect that because many rehab patients tend to be younger and have an outward appearance that they are healthy, staff in nursing homes may be less likely to encourage them to engage in activity.
Similarly, short-term stays may result in abbreviated or incomplete ‘care plans’ which set forth with specificity what facilities must do to prevent wounds from developing in the first place. Clearly, by accepting a patient– even for a short term stay– nursing homes must take the necessary steps to ensure their well-being. As we see in the above matter, when facilities ignore this obligation significant problems may result.
Related Bed Sore FAQ’s
Why is it common for nursing home and hospital patients to develop bed sores on their back?
Are bed sores on the heels common?
What is surgical debridement of bed sores?
Nursing Home Injury Laws: Illinois
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Research study concludes pressure ulcers continue to plague patients during hospitalizations
In the past, pressure ulcers were primarily associated with poor nursing home care. Times have changed. Today, pressure ulcers acquired during a hospitalization are a growing problem. In our medical negligence group, we continue to see clients who enter a hospital for acute care, only to wind up with an acquisition of a pressure ulcer during their hospitalization.
Hospitals, like nursing homes, should conduct an assessment of all new patients and determine who may be at risk for developing pressure sores and implement prevention techniques. In the case of patients who may be in a hospital for an extended period, facilities should perform ongoing monitoring of skin integrity and change care as needed.
Unlike nursing homes or assisted living facilities that tend to care for patients over extended periods of time, hospital-care tends to be for shorter duration and focused more on the providing medical treatment as opposed to more generalized care.
Perhaps the hospital-based focus on providing acute care is the core reason why pressure ulcers acquired during a hospitalization have been increasing recently. A study sponsored by the Agency for Healthcare Research and Quality (AHRQ), revealed the number of hospital patients who develop pressure ulcers during their hospitalization (also known as pressure sores, bed sores or decubitus ulcers) has increased by 63% since 1996.
The AHRQ study further calculated that the hospital stay for treatment of pressure ulcers was 13 days and cost $37,500.
While a number of factors may increase the likelihood that patients may develop pressure ulcers, the underlying mechanics of pressure ulcers is premised on the scenario of unrelieved pressure on areas of the body for extended periods. When pressure goes unrelieved on the body, blood circulation to the area is reduced and the tissue in the area dies.
Elderly hospital patients are particularly susceptible to development of pressure ulcers because we tend to lose muscle mass as we age. Similarly, older hospital patients tend to have limited mobility– increasing the chances they stay in one position for longer periods of time.
Although pressure ulcers can develop in any area of the body– including unlikely areas like the back of the head, ears and fingers; the majority of pressure ulcers develop over bony prominences of the body such as: buttocks, heels, ankles and back.
With attentive staff, the overwhelming number of hospital-based pressure ulcers are preventable. Acknowledging that pressure ulcers are a real and potentially life threatening problem is the first step that hospitals need to take in order to reduce the incidence of pressure ulcers at their facilities. Additionally, implementing well-accepted preventative techniques is critical.
Widely accepted pressure ulcer prevention includes:
- Use pressure relieving air mattresses
- Rotate patients positioning bed or wheelchairs every two hours
- Keep patients clean and dry
- Make sure patients are receiving proper nutrition and hydration
Hospital negligence
In order to determine if the negligence a hospital is responsible for the development of a pressure ulcer, it is important to gather all hospital records and take photos of the wounds. In our medical negligence practice, we commonly see that poor communication amongst staff is a major culprit for hospital-acquired pressure ulcers. The poor communication is frequently found in medical charts where physician orders are not documented and patient condition goes undocumented for extended periods.
Related Bed Sore FAQ’s
Why is it important to differentiate the type of facility where a bed sore developed?
What can hospitals do to reduce the rate of bed sores in their facilities?
After I become aware of a bed sore, should I photograph it?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
MS patient settles pressure sore lawsuit against home health agency for $600,000
A woman with multiple sclerosis (MS) who was reliant on a home health care agency for medical assistance settled a lawsuit against the City of Seattle and Millennia home health care agency (Washington) for $600,000. The basis for the lawsuit was that a home health agency employee was negligent when they failed to follow the medical protocols set forth in the woman’s ‘care plan’ that was uniquely tailored to her needs. It was alleged that the home health agencies failure to follow the care plan resulted in the formation of the pressure sores (similarly called: pressure ulcers, decubitus ulcers or bed sores).
In addition to the home health agencies failure to prevent the pressure sores from developing, an employee of the agency failed notify managers at the agency of the wounds, thereby delaying medical treatment and exacerbating the severity of the wounds. Due to the stage 4 pressure sores, the woman required admission to Providence Hospital in Washington for two months of wound care.
During the hospitalization, doctors performed two surgeries to treat the pressure sores that had progressed so far that an infection had developed and spread to the bone (osteomyelitis). In addition to the osteomyelitis, the pressure sores were also infected with MRSA, a bacteria that is difficult to treat.
This sad incident demonstrates what can happen when staff at home health agencies, nursing homes and hospitals fail to follow ‘care plans’. Care plans are uniquely developed programs that are developed by physicians and other medical professionals to address the needs of each patient.
Should a home care nurse agency ignore the protocols set forth in a care plan or fail to provide accurate feedback of the patients medical condition monitor they expose themselves to liability for a resulting injury.
Related Bed Sore FAQ’s:
How much money does it cost to pursue a claim or lawsuit for bed sores?
Nursing Home Injury Laws: Washington
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Lawsuit alleges nursing home neglect contributed to patient’s decubitus ulcers
A former resident of the Virgil Calvert Nursing and Rehabilitation Center filed a nursing home negligence lawsuit against the Illinois nursing home after she developed multiple decubitus ulcers during her admission. The Illinois nursing home lawsuit alleges that decubitus ulcers she developed during her admission resulted in severe pain, disability and extensive medical expenses related to their treatment.
The nursing home lawsuit alleges that the Virgil Calvert violated provisions of the Nursing Home Care Act, an Illinois law that was created to protect nursing home patients. The lawsuit also alleges that the facility failed to administer proper medication and provide the resident with necessary treatment to prevent the development of the decubitus ulcers.
In addition to suing the actual nursing home itself, the lawsuit also names the facilities parent company, SW Management Company. The lawsuit claims that SW Management was negligent when they failed to supervise and train their employees with respect to the prevention and treatment of decubitus ulcers. The suit similarly alleges that the management company was negligent when it failed to terminate nursing home employees who were repeatedly incompetent, careless and unable to follow the policies set forth by the facility.
Decubitus ulcers are a common problem facing nursing home residents. Nursing homes have a duty to create and implement a care plan to address prevention of decubitus ulcers. Careful adherence by the entire nursing home staff is essential to proper skin care. For many nursing home residents, already in a weakened physical state, a small decubitus ulcer may quickly advance to a large wound in a matter of days if a facility fails to timely implement necessary medical treatment.
Related Bed Sore FAQ’s
What type of legal recourse does a person with bed sores have?
Why are physically disabled patients at risk for developing bed sores?
Nursing Home Injury Laws: Illinois
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Use visits of loved ones in nursing homes for more than social interactions—conduct your own assessment.
Visits to a loved one in a nursing home can— and should be fun and enjoyable for both the patient at the visitors. The social interaction and stimulation provided by nursing home visitors is crucial for patients’ emotional well-being and can be a welcome diversion to mundane living situations.
However, don’t forget to take a few moments during your visit to do your own mini-assessment of your loved ones physical condition and the condition of the overall facility as well.
Take a step back and use your common sense and reasoning and really look at how your loved one looks. Take a look at their skin—is it pale and ashen? Are they having difficulty opening their eyes? Have they lost a significant amount of weight?
While some observations may not be cause for immediate alarm, others should be brought to the attention of the staff. If you observe any indication of injury or abuse, these should be immediately brought to the attention of the staff.
In patients who are bed-bound, pull back the sheets peek under the robe. Is everything clean? Are their any dry or cracked areas of skin? Is there any unpleasant smell? Does everything look ok?
As we age, our sensory perception begins to decline and as a result many elderly simply lack the ability to perceive potential problems with their body—particularly in areas that may not be visible.
If you suspect something does not look right with your loved one — it probably isn’t. In many situations an early diagnosis of medical conditions, such as pressure sores (also referred to as pressure ulcers, pressure sores or decubitus ulcers) can drastically help improve the chances for a complete recovery– and may actually be a life saving intervention down the road.
Similarly, with respect the facility itself, take a careful look at the patient’s room itself, but also the common areas such as the recreation room and cafeteria. Is this a place that you would be comfortable living in?
If not, why? If there are problems, specifically identify each problem and bring it to the attention of a supervisor. Giving constructive criticisms to the staff alerts them to conditions, which may not be readily apparent to those at the facility on a daily basis and will help improve the living arrangements for all patients at the facility.
Remember, you’re not being a pest when bringing your observations to the attention of nursing home staff! In caring for a friend or family member you, can and should be an advocate. If you don’t look out for your loved one’s best interest, who will?
Related Bed Sore FAQ’s
What information should a facility document in individuals with bed sores?
What are the risk factors for developing bed sores?
Where are bed sores most likely to form?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Hispanic nursing home patients are more likely to suffer from pressure ulcers
Researchers at Brown University have concluded that nursing homes with a higher percentage of Hispanic residents have higher rates of pressure ulcers than similar facilities with a predominately Caucasian population.
The studies’ results were based on data sourced from the National Repository of the Minimum Data Set (MDS), a mandatory assessment of all nursing home patients, and surveys of all nursing home residents sourced at the Oscar Database System. The findings of the Brown University study are detailed in the Journal of the American Medical Association.
In addition the national databases, the Brown study analyzed data from all nursing home residents over 65-year-old living in: California, New Mexico, Texas, Arizona and Colorado.
Vincent Mor, Chair of the Department of Community Health and head of the Brown study, headed a similar study in 2007 when he confirmed that African American nursing home patients had higher rates of complications than their peers. That study determined that the problems amongst the African American nursing home patients was the worst in the Midwest.
Read more about the results of this nursing home survey here.
Pressure Ulcers Are Not An Isolated Problem Facing Minorities
A bed sore (similarly referred to as: pressure sore, pressure ulcer or decubitus ulcer) is an area of skin that dies when pressure on the area goes unrelieved for an extended period of time. Frequently found in disabled or bedridden patients (even in younger patients), the steady pressure against the skin cuts off the blood supply to that area– resulting in death of skin, muscle and tissue. If the wound progresses, the wound may ‘open’ exposing the underlying layers of muscle and– even bone.
The most common areas for pressure ulcers to form are on areas of the body where increased pressure is put on the body as a person lays down or where there is a limited amount of flesh covering the underlying bone. Pressure ulcers are commonly found in the following areas:
- Elbow
- Heels
- Hips
- Ankles
- Shoulders
- Back
- Back of the head
Pressure ulcers are preventable in the overwhelming majority of situations. The first step in pressure ulcer prevention is to complete an initial assessment of all new patients– and to re-assess patients on a regular basis. After the medical facilities have determined which patients are at a heightened risk for developing bed sores, a customized care plan should be developed. Most care plans include: frequent rotation (every two hours) of patients to discourage sitting in one area for long periods, pressure relieving air mattresses and special enhanced nutrition diets.
Minorities In Nursing Homes
Communication barriers are a primary reason why we tend to see higher rates of pressure ulcers in nursing homes with large percentages of minority patients. Nursing homes should take necessary efforts to hire bilingual staff to assist patients both in communicating their needs to the staff and advising doctors as the patients needs. Simple breakdown in communication, can result in serious threats to patient safety or even episodes of patient injury.
My office has zealously represented people with diverse backgrounds including: Hispanics, Japanese, Chinese, Israeli, Vietnamese, Russian and Italian. When it comes to representation of the injured, I believe in justice for all.
Read more about minorities in nursing homes here.
Related Bed Sore FAQ’s:
Has any research been done regarding the prevalence of bed sores in nursing homes?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
The development of decubitus ulcers during a hospitalization is not just dangerous for the patient, it is simply bad business
Decubitus ulcer treatment is a big business! An estimated $1.3 billion is spent every year on wound care in the United States. In the past, hospitals were able to recover much of the expense related to pressure ulcer treatment directly from Medicare — even if the wound developed during a hospitalization at their facility.
New governmental regulations will make these reimbursements a thing of the past when the Centers for Medicare & Medicaid Services (CMS) deems the pressure ulcer to be avoidable. The result of this new regulation is that facilities now have an incentive to prevent pressure ulcers from developing in patients at their facilities or the facility pays for the treatment out of their own pocket.
“Preventing and managing pressure ulcers takes a very aggressive approach–one that requires facility wide buy-in and multi-disciplinary involvement,’ says Heather Hettrick, PT, PhD, a director at American Medical Technologies Inc.
Under the new CMS guidelines, facilities should begin the process of re-educating staff on common bed sore prevention measures such as: using off-loading boots, application of ointments, dressing changes and proper techniques to rotating patients to prevent them from laying in one position for too long.
Some facilities such as Regency Hospital, a long-term care facility in Minneapolis, have already taken steps to make pressure ulcer prevention a priority. Every suspicious area on residents skin is photographed on a regular basis to keep track of the wound over time and as it heals. Wounds are also regularly checked for surface temperature and skin color – the early signs of skin impairment.
Some of the pressure ulcer preventative techniques used at Regency Hospital are basic and can easily be applied at other facilities. For example , staff is instructed to use hourly rounds look for the ‘Three P’s' positioning, pottying, and pain.
As a friendly reminder to staff and patients to re-position themselves, music is played every two hours to remind residents and staff they need to change positions. Other basic—yet effective devices such as ‘turning wheel’s’ are used in each resident’s room to demonstrate to all caregivers what position to change the resident to next. Would care nurse, Kathy Irons, says it best, “we take a very proactive approach where everyone is held accountable.”
Related Bed Sore FAQ’s:
Are hospital patients prone to develop bed sores?
What can hospitals do to reduce the rate of bed sores in their facilities?
How many hospital patients suffer from bed sores?
Why is it important to differentiate the type of facility where a bed sore developed?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
In order to prevent pressure sores, it is important to analyze the factors that make a person susceptible to developing them.
Unfortunately, many patients in nursing homes, hospitals and assisted living facilities will develop a bed sore (similarly called: pressure sore, pressure ulcer or decubitus ulcer) at some point during their admission. When it comes to bed sore prevention, the first order of business is to determine who is at risk for developing the condition and implement preventative measures. Studies have revealed that patients with one or more of the following conditions are at a heightened risk for developing bed sores compared with the general population.
However, when it comes to bed sore prevention, the first order of business is to determine who is at risk for developing the condition and implement preventative measures. Studies have revealed that patients with one or more of the following conditions are at a heightened risk for developing bed sores compared with the general population:
Age: As we age our skin becomes thinner and we lose muscle mass. The reduction in skin and muscle mass translates to less natural cushioning on the bony parts of our body— those areas particularly susceptible to bed sore development. Poor nutrition is another culprit that can make older people more likely to develop bed sores than their peers. Studies have shown that patients over 70 have the highest incidence of bed sores than any other demographic.
Living In A Nursing Home: Compared with patients in hospitals and other living situations, nursing home residents the higher rates of bed sores. Statistically speaking, part of the reason that bed sores are more common in nursing home patients is due to the fact that many of the patients are in weakened condition. Other reasons that nursing home patients remain more likely to develop bed sores include:
- Immobilization, such as people who are recovering from a hip fracture or who are in a coma.
- Lack of pain perception, a loss of sensation may be due to a spinal cord injuries or disease. An inability to perceive pain means the patient is not aware when they’re uncomfortable and need to change positions or that a bedsore is forming.
- Incontinence, the caustic nature of urine and feces makes the skin more susceptible to breakdown and speeds the development of bed sores.
Malnutrition: A poor diet does more than contribute to weight loss. Inadequate intake of vital nutrients such as: protein, zinc and vitamin C can contribute to skin breakdown and also hinder the bodies ability to heal existing pressure sores. Compared with patients who have a healthy diet, patients suffering from malnutrition frequently experience recurrent pressure sores, more severe infections and slower healing wounds.
Diabetes: Diabetes and vascular disease affects blood circulation and consequently areas of the body may not receive adequate blood flow and nutrients, increasing the chance of damage to tissue.
Contractures: Frozen or contracted joints make movement to reduce pressure difficult and put added stress on the body resulting in increases in friction and shear forces—that can add to the development of pressure sores.
Smoking: In addition to higher incidence of pressure sores, smokers have more severe wounds and delayed healing due to the fact that nicotine impairs circulation and reduces the amount of oxygen in your blood. Patients who are life-long smokers are particularly slow to heal from wounds related to pressure ulcers.
Even after the risk factors for developing pressure sores is identified, nursing home staff must be vigilant with their prevention techniques in order to assure the highest quality of life for all patients.
Related Bed Sore FAQ’s:
Can malnutrition cause bed sores?
Why are physically disabled patients at risk for developing bed sores?
If a person has contractures, are they at an increased likelihood for developing bed sores?
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Are bedsores completely preventable? Extremely likely.
Despite the fact that most families are reliant upon medical facilities for the care of their loved ones, I’ve noticed a stigma surrounding the development of bedsores during an admission to a nursing home or hospital. Sure, there can be a sense of guilt when it comes to any illness affecting a loved one, but when families learn the relatively simple preventative measures that facilities can implement to prevent bedsores, they usually are angry and embarrassed— simply because they feel as though they could have prevented the development of the bedsores has they know the simple preventative techniques.
As was the case with a family I met with today, who’s mother recently died from sepsis after a month stay at a Chicago-area hospital. The family confided in me that their mother had a gaping hole on her buttocks at the time of her death that went unattended to by the hospital for weeks.
Bedsores have a reputation of being associated with the poor and unwanted. Yet, in reality they are frequently found at many hospitals and skilled nursing facilities—even those with excellent reputations. The toll bed sores take on patients and families crosses all backgrounds and ethnicities.
With proper nursing care, bed sores should be preventable. In order to minimize the incidence of bed sores, nursing homes should do an assessment of each patient on their admission to their facility to determine which patients are at a heightened risk for developing this condition.
In order to reduce the incidence of bed sores amongst their patient’s nursing homes and hospitals need to develop a team approach to prevention. A recent New York Times article discussed the team-oriented approach necessary to reduce the development of bed sores in nursing homes.
Perhaps the most telling part of bed sore prevention is that all staff should be aware of how to prevent bed sores and who is at risk for developing them. Empowering all employees in a medical facility to take it upon them to prevent and take necessary interventional techniques is one of the most important factors to improving patient care.
Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »
Bed Sore
Resource Center
Information and medical contact resources for bed sore education and treatment.
- Bed Sore Glossary - definitions of common bed sore terms and phrases.
- Bed Sore Treatment Specialists - national compilation of wound care specialists, state-by-state, treating bedsores.
- Bed Sore Articles - articles and links to blog posts about bed sores.
- Bed Sore Research Studies - links to recent studies on prevention and treatment.
- Additional Bed Sore Resources
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