Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Over the past several months, we have attempted to gather as many different perspectives regarding nursing homes and the care they provide from people with varying backgrounds. 

Today's interview is with Mary Nix of EldercareABC.

Q: What are some positive trends (if any) in the nursing home industry?

A: The positive trends we have noticed would be the Green House movement created by Dr. William Thomas. You can read more about it here: http://www.cga.ct.gov/2005/rpt/2005-R-0618.htm

Q: What are some negative trends (if any) in the nursing home industry?

A: I think the amount of abuse of the elderly in nursing homes that we see popping up in the news around the country and the fact that nursing homes are businesses and often the bottom line is a profit and not the care of the individuals.

Q: What correlation do you see with respect to the national trends in the nursing home industry and the impact on patient care?

A: Again-- since so much of staffing, resources and care depends on Medicare, Medicaid and other business factors, it is frightening that many individuals may be neglected simply because the funding is not what it should be. I am sure that most nursing homes are going above and beyond the call of duty to work around funding losses, but still it is the most quiet, non-verbal individual who cannot speak up that may feel the funding troubles the most.

Q: How would you compare the nursing homes of today vs. those of 20 years ago?

A: It seems that they have become more institutionalized rather than less. I hope that Green Houses might catch on and change that.

Q: What suggestions do you have for families when it comes to selecting a facility for their loved ones?

A: Visit at unexpected times, ask for references and see what the home offers. What is the staff to patient ration? What are the costs? I would suggest if a family has a complicated situation, that they consult with someone like yourself or a Geriatric Care Manger to make sure all aspects of the choice are studied and all resources utilized for your loved one.

If you were to look at just one criteria for selecting a nursing home, I'd tell you to look at the facilities staffing levels.  Sure, its nice to have a sparkly new facility and perhaps a gourmet chef, but when it comes down to patient care nothing can take the place of a sufficiently staffed facility with properly trained men and women.

In order to assure that nursing home patients are adequately cared for, some states such as California have legislated minimum hours of care provided to patients on a daily basis.  While the number is of course somewhat arbitrary and varies substantially from patient to patient, the patient care requirements do provide somewhat of a floor with respect to minimum staffing requirements for nursing homes.  

In other words, the minimum daily time requirements really translate to the number of staff nursing home owners must hire to legally operate their facilities.

A class action lawsuit filed in California against Skilled Healthcare Group, Inc., alleges that corporation failed to provide patients at their facilities with the minimum staffing levels set forth in California law.

According to Michael Thamer, a lawyer representing the nursing home patients in this case, "The message from he top is simple: state beneath the budget."  Thamer goes on to say, "This corporate greed is what has kept the defendant from adequately staffing their facilities."

A jury will soon make a determination as to the sufficiency of the allegations made by the nursing home patients and the damages they are entitled to.  In addition to compensatory damages related to Skilled Healthcare's under-staffing at their facilities, the lawyers for the nursing home patients also seek statutory damages based on the residents age and the amount of money they pay the facilities every month.

Despite the fact that Skilled Healthcare filed for bankruptcy protection in 2001, the company appears to be thriving. In the past five years, the company has acquired nursing homes in Texas, Illinois, New Mexico, Kansas, Nevada and California.

Read more about this nursing home lawsuit here.

Related Nursing Homes Abuse Blog Entries:

Less Patients, Happier Staff, Healthier Patients. Research Shows Less May Actually Be More When It Comes To Patient Loads For Nurses

Long-Term Care Hospitals: More Profit, Less Staff

Poor Nursing Home Care Subject Of Class Action Lawsuit Against National Nursing Home Chain, Extendicare

Minimum Nurse Staffing Ratios

Last month was the National Child Abuse Prevention Month, so it is an appropriate time to talk about child care: child care options, how to choose a child care facility, national and state regulations, abuse/neglect, and common injuries. Just like the elderly, children represent a vulnerable population, requiring special regulations, protections, and oversight. (See “Children in Day Care Are Susceptible to Many of the Same Problems Our Elderly Nursing Home Patients Encounter”)

Child Care Options

Child Care is the regular, supervised, and paid care of children. In the United States, there are over 335,000 licensed child care facilities (state comparison of type and number of licensed facilities). There are a variety of child care options available for families:

-        Child Care Centers – These are nonresidential facilities that provide care to children typically in classrooms of children in different age groups. Some states have licensing requirements including minimum number of children and minimum number of hours the facility operates. 

-        Family Child Care or Day Care Home/Group Day Care Home – These are residential facilities where child care is usually provided in care provider’s residence. Typically, one child care provider cares for a small number of children. States have different definitions for this type of facility based on number of children. 

-        Family, Friend, and Neighbor Care – This is a situation where a relative, friend, neighbor, or other adult provides care in either the child’s home or their own home. 

-        Nanny/Au Pair – This is a setup where the family hires one person to either come to the child’s home or actually live in the child’s home. 

Early education programs can also provide an alternative to traditional child care options. They focus on school readiness and work on developing a child’s social, emotional, physical, intellectual, speech and language development with a variety of activities. Early education programs include:

-        Early Head Start (EHS) – This is a federally funded, community-based program for low-income families with infants and toddlers. It provides child development programs through EHS center-based programs, home-visit programs, or a combination of the two. (Head Start Locator)

-        Head Start – This is the same as Early Head Start Programs, but is intended for children 3-5 years old. The focus of Head Start is school readiness of young children from low-income families (family income is at or below the Federal Poverty Income Guidelines). 

-        State-funded prekindergarten programs – Some States actually fund prekindergarten programs for children 3-4 years old in order to give them the experiences they need to be ready for kindergarten. 

The Survey of Income and Program Participation (SIPP) collected information about child care arrangements for children younger than 15 years. The following table shows the percentage distribution of the primary child care arrangement. 

As you can see there are a broad array of child care arrangements available for families today based on the needs of both child and parents.  Rosenfeld Injury Lawyers is committed to the safety and well being of children in all care settings.  We welcome you to visit our Child Injury Laws Blog for the most recent developments related to child care and safety.

 Milestone-Elmwood East is a small, 12-bed nursing home located in Rockford, Illinois. Milestone, Inc. is a private, not-for-profit corporation that provides “residential, developmental, vocational, and social support services for adults and children with mental retardation, autism, epilepsy, and cerebral palsy.” This facility committed serious violations that led to the choking death of one resident. (See Nursing Homes Abuse Blog: Topic – Choking)

This nursing home committed several serious 4^th quarter violations relating to the area of policy and procedure. (See “42 Illinois Nursing Homes Cited in 4^th Quarter of 2009 for Violations Related to Patient Care”) The Illinois Department of Public Health (IDPH) fined the nursing home $25,000 on November 17, 2009. The facility provides services for persons suffering from mental retardation. These residents require more care than average residents because of reduced mental capacities. 

First, the facility failed to conduct quarterly fire drills for the 2^nd shift personnel, which endangered the lives of all residents. In the case of an emergency, including fire emergency, staff members should be trained and prepared. As evidenced by the IDPH report, this did not occur with all personnel. 

The most serious of the violations involve the choking death of a 28-year old nonverbal male resident who was ambulatory (capable of walking), mentally retarded, and also suffered from autism and cerebral palsy. This resident died after choking on food unsupervised. (See “Failure to Follow Orders Results in Death of Patient & Hefty Fine”) The facility’s failures include: 

• Failure to implement policy on neglect
• Failure to ensure that resident’s behavior program was fully documented with certain behaviors of taking food from kitchen
• Failure to ensure that enough staff were available to manage and supervise resident in accordance with his behavior plan which allowed him to eat unsupervised

The violation report completed on September 17, 2009 notes that the facility’s own policy on abuse and neglect defines abuse/neglect as to include “any willful failure to respond to an individual’s obvious needs or to provide the appropriate supervision and care that the individual served should have.” The facility’s failure to provide adequate medical or personal care or maintenance for the resident resulted in physical injury. 

Before his death, the facility’s program charts (completed on May 7, 2009) had the resident on a program to ensure that he ate at a slower pace. To support this goal, a staff member sat next to him at meals to provide verbal cues and physical prompts to slow down. In the weeks before his death, staff members noticed that he was eating even more quickly and was stealing food, which suggested increased agitation. 

AT 7:00 AM, the Director of Nursing found the resident in the living room on his back with chewed up food next to him. The director of nursing called paramedics and performed CPR (cardio pulmonary resuscitation) until they arrived. Despite these measures, the resident died. The cause of death was asphyxiation caused by a sausage found lodged in his throat. It turns out that the resident had stolen a sausage wrap from the food that had been prepared for breakfast. A tray of food covered with foil was left on the kitchen counter. 

One of the direct service providers (DSP) even saw the resident walking out of the kitchen and noticed that the foil on the food had been disturbed. Even though the resident had no documented history of stealing food from the kitchen, he did have a history of stealing food from other residents. However, the facility personnel did not put together his presence near the kitchen, the disturbed food, and the history of stealing food. 

The facility’s assessment for the resident stated that he required 24-hour supervision including assistance with diet, portion control, and eating rate. The DSP who saw the resident coming from the kitchen admitted that it was not unusual to catch residents in the kitchen area. The DSP also stated that the resident had stolen food from the kitchen before but she failed to document this. 

The resident’s Individual Habilitation Plan states that the staff should report all issues of concern to their supervisor and/or the nurse. However, the DSP never reported seeing the resident stealing food from the kitchen. This failure resulted in the resident’s care plan not being updated to include measures to prevent him from stealing food, especially in light of his problems controlling how quickly he consumes food. The DSP also admitted that mornings at the facility were “hectic,” and the facility could benefit from additional staff. In addition, on the morning in question, the kitchen was left unsupervised even though there was food left out on the counter.

The facility’s failure to properly monitor the resident and update his care plan allowed him to steal food from the kitchen unsupervised and ultimately choke to death. Unfortunately, the fines assessed will do nothing to benefit this resident. However, hopefully, it will do something to change the behavior and procedures of the facility in the future in order to protect the other residents. 

Stories like this highlight the fact that there are problems with small nursing homes as well as large nursing homes. Even with fewer residents to care for, oversights and mistakes can occur, and these mistakes can be deadly. In this situation, Milestone-Elmwood East did not properly monitor and care for a young, 28 year-old resident. If you or a loved one have suffered injury at the hands of Milestone, Inc, you may be entitled to compensation. 

Sources:

Illinois Department of Public Health (IDPH); Milestone-Elmwood East

IDPH: Milestone-Elmwood East – 4^th Quarter Violations

IDPH: Nursing Homes in Illinois – Quarterly Report (October-December 2009)

Nursing Homes Abuse Blog: Failure to Follow Orders Results in Death of Patient & Hefty Fine

Nursing Homes Abuse Blog: Topic – Choking

Nursing Homes Abuse Blog: 42 Illinois Nursing Homes Cited in 4th Quarter of 2009 for Violations Related to Patient Care

Too often in my world as a lawyer for the injured in nursing homes and other long-term care facilities, I see a disconnect between the type of injury a client sustained versus the explanation provided by a facility.  In other words, I've seen many facilities claim an injury, such as a complex leg or arm fracture is due simply to a patients 'old age' when in reality such injuries rarely occur absent trauma.

Sure, its nice to think that as a diligent lawyer, I may be able to dig through the rubble (or medical records as is usually the case) and begin to piece together the real reason my client sustained the injuries they did-- and in some cases this really does happen.  Yet in other cases there really is no way of connecting the dots between the actual injury and the likely source of it.

As a realist I know that the success of the case is very much dependent on thoughtful employees or other witnesses decision to report the situation to authorities and their investigative efforts.  Without someone stepping forward to report a suspicious situation or an injury to authorities, many cases involving abusive conduct simply remain hopelessly difficult to prove.

In this sense of an obviously suspicious situation getting vetted to authorities, I came across a news report involving a disabled man who suffered a fractured shoulder and severe bruising at a Florida Group Home.  According to the report, the facility contacted authorities following the incident, claiming that his caregivers at the group home were just trying to restrain him after he had gotten 'upset' before bedtime.

Of course-- especially in situations involving the disabled, sometimes staff are faced with the unpleasant task of restraining a person against their will in order to prevent them from harming themselves or others.  However, in this case, the this young-man who suffered from cerebral palsy and paralysis in his body-- except for use of his left hand-- essentially making him completely dependent on the staff for everything which makes me question such a seemingly innocent explanation. 

It's always disheartening to see the images of a person suffering, but hopefully the attention focused on this incident by the news station will lead to a witness coming forward or perhaps more scrutiny heaped on this facility.  Hopefully, the increased attention will result in an explanation for  this man's injuries.  Perhaps at some point we will lean if the injuries are indeed related to staffs' attempt to subdue or-- dare I say-- another abusive situation attempted to be covered up by a facility?

Reporting Abuse In Long-Term Care Settings

I am a huge proponent of getting authorities from law enforcement as well as state regulatory agencies involved as soon as feasible after any suspicious incident occurring during an admission to a long-term care facility.  While many situations of suspected poor care may go explained indefinitely, I can vouch for the fact that there most definitely is a correlation between getting real explanations and getting the incident investigated quickly. 

Simply put, as a caregiver when you suspect something isn't right, you should get it checked out.

When a family member or loved one goes to the hospital for medical treatment, we expect them to get better, not worse. However, hospital infections are a very real and very dangerous problem. Illinois recently published information showing infection rates at Illinois hospitals in an attempt to increase transparency about safety and also hold medical institutions accountable. 

You can check your hospital’s infection rate at the Safe Patient Project website, or the Illinois Hospital Report Card. (See “States Move to More Transparency Regarding Medical Malpractice & Hospital Errors”) Many of the same infections that pose serious problems at hospitals are also problems at nursing homes. 

Research is showing that many hospital infections can be prevented through proper procedures. Dangerous germs and pathogens can be transferred from many sources (patient’s skin, doctor’s hands, clothing, scrubs, coats, the medical equipment itself) to the patients or to medical equipment including catheters. This research is spurring hospitals to make improvements, with the rates of some common hospital infections being cut in half. 

Infections involving central lines (a catheter or tube that is placed in blood vessels to deliver medication and fluids) are one common hospital infection. These infections can be fatal. In the United States, about 80,000 hospital patients suffer infections involving their catheters every year, and about 30,000 of these patients actually die. (See “Never Event #2: Infection in Central Venous Catheters”) 

Despite these numbers, there is some hope. The Johns Hopkins Hospital published research in 2005 showing that over 100 ICUs in Michigan almost eliminated CLABSIs by following a list of simple procedures. These procedures included: focusing on patient safety, medical staff working closely together, washing hands, using gloves, masks, and gowns, draping patients with coverings, and cleaning sites where catheters were inserted. 

Simple steps such as fully draping the patient as opposed to only draping the area where the catheter would be inserted decrease the infection rate. The culture at hospitals also needs to change so nurses and other staff members feel able to speak up if the checklist is not being followed. This is a dramatic change for many hospitals where nurses fall much lower in the hierarchy. 

The Illinois Hospital Report Card and Consumer Guide to Health Care provides information on hospital infections, including central line-associated bloodstream infections (CLABSIs). Last year in Illinois, 44 hospitals list zero CLABSIs in their ICUs, while some hospitals still listed high infection rates (see Table showing central-line infections). The state tracks the number of bloodstream infections associated with central lines or catheters used in medical, surgical, or combined medical/surgical intensive care units (ICUs). 

In Illinois, nine hospitals displayed high infection rates in 2009, which calls into doubt whether patients at these hospitals are receiving adequate care. Thorek Memorial Hospital in Chicago had 22 CLABSIs, which is the highest of all medical centers in Illinois, with an infection rate 13 times higher than the U.S. average. The hospital’s administration said that the hospital is conducting an independent review and has taken steps to reduce infections. 

• Swedish American Hospital in Rockford had 15 infections
• Norwegian American Hospital in Chicago had 12 infections
• Roseland Community Hospital in Chicago’s South Side had 10 medical/surgical ICU infections
• St. Bernard Hospital & Health Care Center in Chicago’s Englewood neighborhood, also had 10 infections
• Mercy Hospital & Medical Center in Chicago had 9 infections
• St. James Hospital and Health Centers had 7 ICU medical/surgical ICU infections
• Skokie Hospital had 5 infections in 2009.  

Many of these hospitals are increasing training and taking steps to reduce infections. However, we will have to wait until next year to see whether these steps result in fewer infections. 

On the other end of the spectrum, are several Chicago-area hospitals that have reduced their number of central line infections to almost zero. These numbers show that some area hospitals are doing something right. However, it also raises more questions about what are the other hospitals doing wrong? The following hospitals had zero ICU infections in 2009: 

• Adventist Bolingbrook Hospital
• Adventist GlenOaks Hospital
• Adventist Hinsdale Hospital
• Centegra Hospital-Woodstock
• Trinity Regional Health System. 

While several other hospitals had very low infection rates:

• Central DuPage Hospital in Winfield had 1 infection in one of their ICUs and 0 in their other ICU
• Loyola University Medical Center in Maywood had 2 infections
• Northwestern Memorial Hospital had 1 surgical infections and 6 medical infections
• Adventist La Grange Memorial Hospital had 3 medical/surgical ICU infections. 

Nursing home residents are also susceptible to many of the same infections that are common in hospitals. (See “MRSA in Nursing Homes on the Rise Amongst Residents and Staff” and “Nursing Homes – The Perfect Breeding Grounds for MRSA”) Nursing home residents might even be at higher risk for infections, especially central line infections because they require more frequent and longer-term use of central lines because of the high incidence of serious health problems. Still, there are steps that you can take to reduce the risk of infection at a hospital or nursing home:

• Require that caregivers wash their hands or wear sterile gloves before touching catheters or the area around catheters
• Ask how long the catheter or central line needs to be in place, then ensure that they are removed when no longer necessary
• Notify a nurse or doctor if bandages come off or get dirty
• Tell a nurse or doctor if the skin around your catheter becomes sore or red
• Do not let anyone touch your catheter or central line unless medically necessary
• Ask questions
• Use hand sanitizer when entering and leaving a facility

Hospitals and Nursing Homes with high infection rates raise questions about the quality of care. Hopefully, with increased reporting of infections and accountability, these numbers will go down. Nursing homes should take the same steps to reduce infections as hospitals have done in order to protect the health and safety of their residents. If you or a loved one suffered from a preventable infection at a hospital or nursing home, you may be entitled to compensation. 

Thanks to Heather Kiel, J.D. for her assistance with this Nursing Homes Abuse Blog Entry.

Sources:

Illinois Hospital Report Card and Consumer Guide to Health Care

Chicago Tribune: Tracking Hospital Infections
Chicago Tribune: What you can do to protect yourself from hospital infections

Chicago Tribune: Central Line Infections in Illinois Hospitals

Chicago Tribune: Illinois Hospitals Achieve Low Infection Rates

Chicago Tribune: Illinois Hospitals Address High Infection Rates

Nursing Homes Abuse Blog: Never Event #2: Infection in Central Venous Catheters

Nursing Homes Abuse Blog: States Move to More Transparency Regarding Medical Malpractice & Hospital Errors

Nursing Homes Abuse Blog: MRSA in Nursing Homes on the Rise Amongst Residents and Staff”

Nursing Homes Abuse Blog: Nursing Homes – The Perfect Breeding Grounds for MRSA

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. 

In today's series on causes of bed sores and how caregivers can prevent them in conjunction with David Terry, I am going to discuss the most widely accepted method of preventing bed sores -- turning.

What is turning and why is it necessary?

'Turning’ refers to exactly what it sounds like– turning the patient to prevent the build-up of pressure on the skin that can result in the development of bed sores. Turning is universally considered to be the most important factor in bed sore prevention. Yet, despite its universal acceptance, many facilities (hospitals and nursing homes) fail to properly implement turning techniques– it is hard, labor-intensive work.

Turning should be completed at intervals set forth by a physician. However, turning of patients at least every two hours is usually considered to be the minimally accepted interval. In bed-bound residents, the staff should rotate the patient to their sides. In residents who spend most of their time in wheelchairs, staff need to lift the residents out of their chairs.

Caregiver tip:

Caregivers need to recognize the importance of relieving pressure on a regular basis and be on the look-out for facilities that make rotating patients a priority.  Many nursing homes that incorporate facility-wide turning programs have:

• Charts in all patient rooms to help staff keep track of patient positioning in bed
• Have regularly scheduled music to remind patients and staff to change position
• Provide additional staff for assistance with rotating patients
• Dim lights on regular basis to remind staff and patients of turning interval

Similarly, if you don't see any of the above indications that the nursing home your loved one is ask, don't be afraid to ask the staff or administrators about the facilities bed sore prevention program.  As I see over and over again, patients tend to receive better care when they have an advocate looking out for their best interest.

Today's portion of my ongoing series with attorney David Terry regarding bed sore causes and how caregivers can prevent them, deals with an embarrassing-- yet commonly encountered condition amongst nursing home patients-- incontinence.

Like many other medical complications facing nursing home patients, the source of the problem typically stems from staffing.  Improperly trained staff or simply inadequate man power are usually the underlying reasons why patients sit in soiled clothing or diapers for extended periods of time.  

Incontinence and developing bed sores

There are a variety of psysical and psychological reasons why a patient may be unable to control their bladder or bowel.  Despite the underlying reasons for fecal or urinary incontinence, the fact remains that incontinent nursing home patients are at a heightened risk for developing bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) compared with their continent peers.

When urine and fecal matter remain in contact with the delicate skin on the buttocks and genitalia, the caustic nature of the waste exacerbates the skin-breakdown.  When urine or feces is left uncleaned for extended periods, it results in rapid breakdown of the skin especially in bed-bound patients who sit in bed for extended periods.

Incontinence and exacerbation of existing bed sores

Should a bed sore develop in an incontinent patient, staff must be extra diligent to keep the patient clean and dry. In cases where a patient has an open wound (stage 3 or 4), the wound provides easy-access for bacteria to enter the body.  Bacteria in feces can enter the wounds causing serious infections such as sepsis-- a systematic infection that can enter the body through and open wound and spread though the blood.

In some cases involving incontinent patients with severe bed sores on the buttocks or sacrum, a physician may recommend a surgical procedure to prevent fecal material getting into the wounds and causing further complications.  A surgical procedure known as a ‘colostomy’ or ’diverting colostomy’ to divert fecal waste into a pouch as opposed to passing through the rectum.

During a colostomy procedure, surgeons cutting the colon into a shorter piece and bringing it through the wall of the abdomen. A colostomy bag is attached to the end of the colon exiting the abdomen where fecal material is collected. The end of the colon that leads to the rectum is closed off and becomes dormant.  After the wound has healed and the colostomy bag is no longer needed, the procedure may be reversed.

Caregiver tips for incontinent patients:

As a caregiver, knowing the potential risks that accompany many medical conditions is perhaps the most important aspect of preventing further complications.  Keep in the mind the following when caring for an incontinent patient.

• If you know your patient is wet, demand the facility clean and change them immediately
• Encourage patients who are capable of using the toilet to do so
• Keep call buttons within reach of patients so they may notify staff when they require attention
• As soon a pressure sore becomes noticeable (stage 1) apply barrier gels and bring the condition to the attention of the patients physician

Sad but true, many nursing home patients are suffering from malnutrition.  While we often associate malnutrition amongst the homeless or people living in a third-world country, some studies suggest that between 35% and 85% of nursing home patients are malnourished.

As attorney David Terry points out in his blog post, "How Does Poor Nutrition Affect the Development of Bed Sores in Nursing Homes?" the rampant malnutrition can be associated with an increased risk of developing bed sores.

Poor nutrition results in a deterioration of body functioning.  Over extended period of time, patients without adequate nutrition tend to have organs that begin to fail and critical body functions begin to deteriorate and lose effectiveness.

As the largest organ of the body, your skin is one of the first places where the consequences of inadequate nutrition may be visible.  Malnutrition can result in the deminished effectiveness of the skin's natural resiliance to pressure and other factions that contribute to the development of bed sores (similarly described as pressure sores, pressure ulcers, or decubitus ulcers).

In addition to malnutritions reduction in the effectiveness in the skins natural resilancy, malnourishment of nursing home patients may also lead to other medical problems that contribute to the development of bed sores:

Reduction in Energy Levels: Malnourished people have less energy and consequently are unable to move on their own– resulting in a more time spent in one position.

Reduction in the bodies natural cushioning: A long-term consequence of malnourishment is loss of fat, muscle and tissue– that provide necessary padding particularly in bed-bound patients, the less padding the more pressure that is put directly on the body– thereby resulting in increased rate of bed sores.

Inadequate Nutrition & Hinderance of The Bodies Natural Healing Properties

David makes a great point regarding the important role nutrition plays in not just bed sore prevention, but also healing bed sores.  One of the most overlooked aspects of bed sore treatment is assuring that facilities provide additional calories and protiien for patients with advanced bed sores.

A nutritional consultation should be brought in for patients with open wounds (stage 3 or 4 bed sores) so the specific nutritional needs can be tailored to the patient need. 

Caregiver tip:

As family and caregivers it is important to recognize the severity of the medical complications that accompany malnutrtion.  As with many medical conditions, it is far easier to prevent malnutrition than to teat the accompanying medical complications that tend to develop over time.

Caregivers should be on the lookout for the following: 

• Look out for physical signs of malnutrition: diarrhea, disorientation, drastic weight loss, reduced urine output or cracking skin
• Request a speech tharapist consult if your patient has difficulty swallowing 
• For bed bound patients, make sure meals are within reach of the patient and there is staff present to assist
• Ask about nutritional supplements for patients who are weak or have exhisting bed sores

Related Bed Sore FAQ's:

Can malnutrition cause bed sores?

Are the development of bed sores during a nursing home admission an indication of nursing home neglect?

Extra Calories Essential For Pressure Sore Patients To Heal Wounds

Next week attorney David Terry and I will be exchanging blog-posts on perhaps the most common-- yet under-appreciated medical condition effecting patients in nursing homes and hospital-- Bed Sores.

Used interchangeably with the terms: pressure sore, pressure ulcer or decubitus ulcer, most people have little appreciation of the real devastation that bed sores cause until they see one first hand. Few medical conditions are as graphically disturbing as an advanced bed sore on a human being.

To assist medical professionals in the assessment and treatment of wounds, a standardized 'staging system' has been developed. 

• Stage 1- Initially, a pressure sore appears as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.

• Stage 2- At this point, some skin loss has already occurred — either in the epidermis, the outermost layer of skin, in the dermis, the skin’s deeper layer, or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration. If treated promptly, stage II sores usually heal fairly quickly.

• Stage 3- By the time a pressure ulcer reaches this stage, it has extended through all the skin layers down to the muscle, damaging or destroying the affected tissue and creating a deep, crater-like wound.

• Stage 4- In the most serious and advanced stage, a large-scale loss of skin occurs, along with damage to muscle, bone, and even supporting structures such as tendons and joints. Stage IV wounds are extremely difficult to heal and can lead to lethal infections. If you use a wheelchair, you’re most likely to develop a pressure sore on: Your tailbone or buttocks Your shoulder blades and spine The backs of your arms and legs where they rest against the chair When you’re bed-bound, pressure sores can occur in any of these areas: The back or sides of your head The rims of your ears Your shoulders or shoulder blades Your hip bones, lower back or tailbone The backs or sides of your knees, heels, ankles and toes.

• Unstageable- Is a term that generally refers to an extremely advanced wound where there is involvement of skin, muscle and bone.

Though commonly associated with the elderly, a bed sore can develop in patients of any age who are not properly cared for.  Put simply, bed sores are not a normal part of the aging process nor are they an inevitable part of life for patients in a long-term care setting.

Unlike many medical conditions that benefit from technological advances with respect to their prevention, bed sore prevention is low-tech and labor-intensive.  To minimize the development of bed sores, medical facility staff must pay attention to patient needs, utilize patience when caring for the patient and remain diligent when implementing care.  David and I will focus our attention on the most common contributing factors to the development of bed sores:

• Dehydration
• Nutrition
• Lack of pressure relieving devices
• Turning and repositioning of patients
• Contractures
• Incontinence / cleanliness

I look forward to this exchange and particularly to David's insights on these topics.  Follow our exchange on my Nursing Homes Abuse Blog or on David's Terry Law Firm Nursing Home Abuse Blog.

I am thrilled to announce the unveiling of the latest addition to the Bed Sore FAQ site, the Bed Sore Resource Center.  The Bed Sore Resource Center promises to become an essential tool for patients dealing with the multifaceted problems that accompany bed sores. 

Currently, the Bed Sore Resource Center has a: bed sore glossary, articles regarding bed sores, web resources providing medical and legal information pertaining to bed sores. 

Perhaps the most useful aspect of the Bed Sore Resource Center is a national directory of wound care specialists organized by state.  Currently, we have the largest centralized wound care database on the web, with more than 700 wound care professionals listed.

Check back in the upcoming months as we add even more sections to the Bed Sore Resource Center.