Nursing Homes Abuse Blog - By Jonathan Rosenfeld

We'd like to think that beauty of our jury system is that it allows reasonable people to hear evidence about a dispute and render a rational decision based upon the evidence presented.  After all, the people on the jury are in the best position to render a fair and impartial decision--- right?  Similarly, if a jury comprised of fair and rational people can arrive at one decision, how could anyone think otherwise?

The concept of diverging views of in civil lawsuits is nothing new, but I was again reminded of the extreme disparity between the findings from a jury and those from nursing home surveyors in a recent article written by Michael Booth in The Denver Post, "Jury says man died due to Rocky Ford nursing home's negligence; state differs". 

The situation Booth contrasts is the recent situation involving a nursing home negligence lawsuit in Colorado where a jury awarded the family of a deceased resident $3.2 million due to the facilities alleged negligence in allowing a resident to develop stage 4 pressure sore.  Meanwhile, the same situation was investigated by authorities from the state's Health Department and the facility was not cited for any type of "deficient practice because the investigation did not substantiate current deficient practice."

If that mumbo-jumbo was too much for you to understand--- like myself--- it simply means that the facility was found not to be negligent in relation to the care of this patient. 

No deficient practice?  While I'm sure there are medical experts out there that opine that the development of a stage 4 pressure sore (the most advanced stage), the overwhelming medical literature suggests that a stage 4 pressure sore is a medical complication that simply should not occur.  In fact, Medicare has deemed stage 3 and state 4 pressure sores that develop during a hospitalization to be simply inexcusable that they are part of the list of 'never events'-- medical complications deemed so inexcusable that hospitals will not be reimbursed by medicare when they occur at their facilities.

Perhaps the surveyor(s) involved in the investigation of this matter were simply having an 'off day' at the time they conducted their inspection? While indeed a possibility, I'd suspect that it's more unlikely--particularly in situations such as this-- where there are relatively 'clear cut" situations involving poor nursing home care, my hunch is that there is a more drastic underlying problem that needs to be addressed when it comes to calling out poor nursing home care.

While situations such as this can be discouraging for families who wish to report episodes of poor nursing home care, I continue to suggest to families that they indeed need to report all episodes of poor nursing home care or injuries to the regulatory agencies within their states.  While the ultimate findings of the agency may lack the decisiveness that many families crave, the investigations may still turn up valuable evidence for use in civil matter.

Considering that some of these state investigative reports lack any credible findings, it may be a good thing that they are generally inadmissible in civil trials.  Thankfully, there still are some dedicated jurors who are able to use their common sense to determine right from wrong.

Related Nursing Homes Abuse Blog Entries:

Jury Awards Family Of Deceased Nursing Home Patient $3.2 Million In Response To Bed Sore Lawsuit

Nursing Home's Conduct In Wrongful Death Case Angers Jury---- To The Tune Of $200 Million

Nursing Home Lawsuits: Do they represent isolated events or are they representative of poor care?

Are Protective Agencies Doing Enough To Protect Nursing Home Patients?

Bed sores are a progressive complication that can afflict any immobile patient in a nursing home or other type of care facility.  When bed sores (also referred to as: decubitus ulcer, pressure ulcers or pressure sores) develop, the open wounds expose the patient to a risk of complications including infection of the surrounding tissue, bone and even the entire bloodstream--- which can prove far more formidable to overcome than the patient's original condition.

The good news with respect to the overwhelming number of situations involving bed sores in nursing homes is that these cases can be prevented with proper care from staff at the facility.  Paramount to the prevention of bed sores in any facility is the realization by the facility (and staff) that certain patients are predisposed to developing them based upon their physical condition--- and prevention methods must be created and implemented.

Similarly, staff need to monitor the skin integrity of each patient they are caring for to identify bed sores in their early stages.  From a treatment perspective, bed sores in their early stages are far more manageable to treat than once they progress to a more advanced level.  In addition to recording the patients skin condition in their medical chart, staff should also advise the attending physician of the situation so a timely intervention can be made.

Perhaps out of fear, shame--- or downright indifference--- the existence of bed sores in patients at some nursing homes seems to get consistently downplayed / ignored; as if the wounds will magically vanish with time. 

I was again reminded of this troubling scenario of 'bed sore denial' when I read about a recent jury verdict in a wrongful death lawsuit involving a Colorado nursing home where a patient developed advanced bed sores that became infected.  According to news reports of the verdict the the Denver Post, the family of an 88-year-old patient at Pioneer Healthcare Center alleged that the facility was both negligent in its care of their loved one and that the facility intentionally failed to disclose the extent of the wounds to family.

The existence of the bed sore wasn't disclosed to the family until a CNA at the facility advised the man's son that the wound on the man's buttocks and scrotum were infected to the extent that they began to smell. By the time the man was transferred to a hospital-- the damage had been done-- and their was little that could be done from a medical perspective.

Obviously, this fact pattern was disturbing enough to the jury hearing this case as they awarded $3.2 million in damages to the man's family.

Related:

Delay In Providing Care For Patient With Pressure Sore Results In Fines Against Facility

Bed Sore Prevention Is An Ongoing Process For All Nursing Home Patients

Mounting Evidence Suggests That Bed Sore Prevention Is Cost Effective

Are Pressure Sores Really That Hard To Prevent? Study Demonstrates Some Nursing Homes Are Successfully Reducing Rate Of Pressure Sores At Their Facilities.

The overwhelming number of hospital-acquired pressure sore cares derive from a medical system that is focused on treating a patients acute care needs as opposed to maintaining the patient's overall well-being. 

While the origins of hospital-acquired pressure sore (bed sores) cases and pressure sores that originate during a nursing home admission are quite similar with respect to the underlying factors behind their development, the cases can vary substantially when it comes to a litigation perspective. 

Despite the relatively elementary reasons for their development, hospital bed sore cases can become quite complex when the necessary legal maneuvering associated with medical malpractice cases gets involved.

Unlike nursing home negligence cases which are typically based upon a standard of care set forth in the patient's 'care plan', hospital pressure sore cases lack the relatively 'cut and dry' standard of care and require the use of a treating physician or retained expert to establish how the medical facility veered off course with respect to caring for the particular patient.

Given the hesitancy of many doctors to testify against a peer in the medical community, many hospital pressure sore cases rely upon expert testimony to establish both the applicable standard of care (how hospitals in the community are to care for patients) and causation (how the deviation in the standard of care resulted in the patient developing pressure sores).

Consequently, we for most hospital pressure sore cases, we commonly utilize the services of medical experts including both physicians and nurses to assist in proving our cases--- even during our initial case reviews.  While, the utilization of these experts can prove to be fairly time consuming and expensive, these experts can identify cases that are indeed meritorious and those where there may be problems down the road.

Further, as a lawyer who represents families in hospital acquired pressure sore cases, I find that families genuinely appreciate hearing an assessment of their situation from an expert who has no horse in the race.  Similarly, from a settlement posture, the early retention of experts (with case reports) signals a level of preparedness to hospital administrators that your case is prepared and ready to do.  

While there will never can be a guarantee of a specific outcome in any lawsuit, getting your ducks in a row at an early stage can set the stage for the timely resolution of hospital pressure sore cases.

Related Nursing Homes Abuse Blog entries:

Can a hospital be pursued for medical malpractice when a patient develops bed sores during a hospitalization?

Bed Sores Are Amongst Most Common Hospital Errors

Study Claims Hospitals Frequently Under-report Severe Bed Sores

Medical Facilities Need To Identify Pressure Sores As They Develop

The origins of pressure sores have been well documented for centuries--- the combination of unrelieved pressure and force put upon the body. However, from a technological perspective, relatively little progress has been made towards reducing the rates pressure sores in patients with heightened risk factors.

From a preventative standpoint, the most widely suggested preventative technique remains turning patients at regular intervals to encourage the bodies natural circulatory process to bring vital oxygen and nutrients to areas of the body that can be starved off from these necessities when patients remain in one position for extended periods of time.

Pressure sore prevention plans remain a fixture at many medical and care facilities that care for the elderly and immobile patients. While promising in theory, these plans require the constant work from facility staff to effectively carry out.

Given the heavy work loads typically placed upon staff in nursing homes and other care facilities, the sad reality is that pressure sore prevention plans typically are not consistently carried out. Consequently, the development of pressure sores at medical facilities remains among the most significant threats to patient well-being.

In this light, I was really encouraged to read about a new pressure sore reduction technology that holds the promise of significantly improving the lives of millions of people who are at risk for developing pressure sores. The product known as Smart-e-Pants was developed by a team of experts in the fields of medcine, engineering and physical medicine who studied different aspects of pressure sores over five year period.

The end product may be reminiscent of ordinary bicycle shorts, but really is an undergarment with embedded electrical sensors to help simulate mini-muscle movements that healthy people ordinary make when they sit in a chair or lay down in bed.

According to one of the product’s developers Dr. Ming Chan, a rehabilitation medicine specialist for Alberta Health Services at Glenrose; “[o]ur aim is to prevent pressure ulcers by bringing blood flow and oxygen to the muscles. Smart-e-pants provides an electrical current for 10 seconds every 10 minutes stimulating the nerves and muscles to replicate what we do when we ‘fidget’ in our chair.”

While it may be a while before we see smart-e-pants devices broadly used in nursing homes and hospitals, researchers are encouraged from the initials trial and at tests completed with a pilot group of patients.

As we cautiously wait for more extensive trials to run their course, I am grateful to see more attention getting placed upon what truly has become an epidemic at many facilities. Who knows? Smart-e-pants may become standard issue to patients at risk for at nursing homes and hospitals?

Related:

Pressure Sores Must Be Timely Treated In Order To Maximize Chances Of Patient Recovery

Who Said Nursing Care Was Easy? The Prevention Of Bed Sores Requires Staff To Turn & Reposition Patients On A Reqular Basis

Why do bed sores commonly develop on the buttocks?

How quickly can a bed sore develop in a nursing home or hospital patient?

If you ever need a reminder of the lingering impact nursing home neglect has on an individual, take a look at a a Post-Tribune article, "Woman who sued Northlake nursing home for malpractice dies".  As a society, we frequently forget about how victims of nursing home neglect frequently suffer long after a lawsuit is is resolved or news story is published.

The Post-Tribune article highlights how Mary Ann Jackson fought for years to live with horrible bed sore injuries she sustained during an admission Northlake Nursing and Rehabilitation Center in Merrillville, IN (now closed).  What started as an 'ordinary' admission for rehabilitation following a stroke and treatment of a small bedsore, developed into a nightmarish 11-month stay at the facility-- that billed itself as a specialized wound care facility.

According to her sister, Shlli Jackson, "[y]ou could see the muscles and ligaments down to the bone.  Her bedsores were so bad she was stuck in a fetal position with her legs glued together."

Amazingly, Ms. Jackson fought to live for almost two years following her ordeal, eventually recovering from the pressure sores and an infection known as "sepsis" that required multiple surgeries and hospitalizations.  Ms. Jackson's will to live was apparent to the director of social services and admissions at the nursing home where she was eventually transferred to, Rick Lipscomb;

She had one foot in the grave.  I don't know how she didn't die.  I've seen animal carcasses on the side of the road that looked better than when she arrived here...

Episodes such as this are an important reminder to me that every patient--- regardless of their apparent condition--- deserves an opportunity to receive the best possible care following an episode of poor care at a nursing home.  Moreover, as a personal injury lawyer, stories like this demonstrate that more attention needs to be focused on the diminishment in quality of life that many nursing home patients have following an incident involving negligent care during the litigation and trial of nursing home negligence cases.

Related Nursing Homes Abuse Blog entries:

Stiffened Joints Or Contractures Can Exacerbate A Patients Risk For Developing Bed Sores

Contractures In Nursing Home Patients Put Them At Risk For Developing Decubitus Ulcers & Other Injuries

Are Protective Agencies Doing Enough To Protect Nursing Home Patients?

Survival rates for sepsis patients is dependent on how quickly the medical facility identifies the problem and implements treatment

At some point during the processing of placing a loved one in a nursing home, families must rely on the representations made by facilities as to the type of care that they are capable of providing. 

Representations made in promotional materials and through staff at the facility are frequently a determining factor in facilities selecting one facility over another.

No doubt that inflated assurances are routinely made by personnel (salesmen) to close a sale of a product or service.  While some of the assurances may ultimately prove to be false--- and perhaps a source of frustration to the individual to which they were made---at the end of the day they really are nothing more than (expensive) annoyances--- but usually the person can simply pick-up and move along. 

Contrastingly, in the nursing home context, such assurances derive far more importance and are can frequently mean the difference between a patient thriving and significant deterioration of the patient due to the fact that the facility was not a proper place for the individual in the first place.

Particularly when it comes to caring for specific medical complications--- such as ventilator care, dialysis, or wound care--- families commonly need to rely on representations made by facilities because most of the common tools used in the selection of a facility fail to address ratings for the specific types of care that the patient requires.

I recently read about a situation where such inflated representations resulted in the rapid deterioration--- and ultimate death of a patient.  A recently filed nursing home lawsuit by a family in California alleges that just one month after their mother entered Petaluma Health and Rehabilitation (a skilled nursing home owned by Evergreen Healthcare) for specialized wound care, the woman’s pressure sores quickly advanced to the point that she required hospital care.

By the time the 90-year-old woman had been transferred to nearby Petaluma Valley Hospital the wounds had become so large and infected that the hospital staff reported the situation to the local ombudsman’s office for further investigation of suspected elder neglect.

According to claims made in the nursing home negligence lawsuit, the family selected Petaluma Health and Rehabilitation substantially based on documents that described the home as having experts in wound care.

While I confess to my lack of specific knowledge regarding the specifics of this particular case, I frequently request all admission paperwork and promotional materials as part of my request for production of documents in nursing home negligence lawsuits.  Particularly, when it comes to specialized care—and wound care in particular—I find such materials extremely important in the prosecution of the underlying case.  Sadly, I commonly find a substantial disconnect between these promotional representations made by the facility and the knowledge of the staff in terms to how to carry out such care.

As a caregiver, who’s family or friend may require a specific type of nursing care, you may wish to request a meeting with the supervisor in the department as for your own reassurance that the facility really is capable of providing such care.

Related:

Petaluma Nursing Facility Sued for Elder Abuse, Neglect, by Karina Loffee, Petaluma Patch October 21, 2011

Bed Sore Treatment Specialists

Medical Facilities Need To Identify Pressure Sores As They Develop

Family Blames Nursing Home For Mother's Infected Pressure Ulcers & Death

The family of a deceased woman has filed a lawsuit against a large health care company that was responsible for maintaining her health.  The lawsuit names Addus Healthcare as a defendant in two count complaint alleging that the companies negligence during a short-term stay, resulted in numerous medical complications that contributed to the patients death.  Amongst the complications alleged include:

• Failing to treat the patients decubitus ulcers
• A urinary tract infection
• Sepsis
• Medical complications that went unannounced to physicians

Read more about this recently filed lawsuit against Addus Healthcare pending in St. Clair County Circuit Court here.

The threat of sepsis

Sepsis remains a serious threat to patients in nursing homes, hospitals and other types of long term care facilities.  Sepsis is a systemic infection caused by a bacteria that can enter the body through wounds (bed sores), catheters, intravenous lines, surgical wounds, surgical drains.  Sepsis must be identified and treated quickly in order to provide the patient with the best chance of recovery.  Symptoms of sepsis may include:

• Fever
• Chills
• Confusion
• Hyperventilation
• Low urine output
• Discolored skin

Particularly when medical care is delayed for elderly patients, the sepsis can progress to a more advanced complication known as 'septic shock'.  Patients with septic shock are indeed very ill and face serious drop in blood pressure, organ failure and even death.

Addus Healthcare

Addus Healthcare is large, publicly traded company that provides a broad spectrum of healthcare services to patients acorss the country.  In particular, the company boasts a significant number of home care contracts for home-bound patients.  In addition, Addus Healthcare provides:

• Skilled nursing care
• Veteran services
• Private duty
• Adult day services
• Home & community services

Related:

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Early Detection Is The Key Element To Successful Sepsis Treatment

Study Says Older Hospital Patients Are at High Risk of Developing Sepsis

Short-term nursing home admission results in deterioration of pressure sores and sepsis

Is sepsis related to bed sores?

Suit blames Addus Healthcare for woman's death from sepsis 9/29/2011 By Kelly Holleran

A steady stream of news headlines highlighting problems at nursing homes across the county is an ongoing concern amongst families with loved ones at facilities.  After a while, I see first hand how the barrage of discouraging new stories begins to rattle the confidence of families have placed in the facilities that they have selected for their loved ones. 

While it may be easy to discount the allegations of poor care at a facility across town, what happens when the allegations are made against THE facility where your family may be living? 

Are the mere allegations enough to yank your loved one out of the facility?  Will facilities take it upon themselves to make improvements after concerning stories have surfaced?

If you have a loved one at Hamlin Place Rehabilitation Center in Boynton Beach, FL, you may have heard about a recently filed wrongful death lawsuit filed on behalf a deceased patient at the facility who was allegedly neglected to the point that she developed multiple bed sores on her head and buttocks. 

According to news reports, it was only after the patient was taken to a nearby hospital, was the family informed of the severity of her wounds.  Shortly after the wounds were detected, the woman died from complications related to the wounds.

While bed sores are indeed a problem facing nursing home patients across the country, my experience as an attorney who regularly litigated bed sore cases is that these episodes indeed tend to flare up at facilities with real underlying problems that may be more pervasive than a mere isolated event.

When--- and if--  allegations of poor care do surface at a nursing home where a loved one may be living, the allegations can either be ignored, discounted or confronted head on.  While nursing home administrators likely will decline to discuss specifics of allegations from a pending lawsuit, my experience is that by bringing concerning allegations to the forefront is indeed important as it makes the facility aware that you are tuned in the issues at the facility.  Perhaps as multiple families come forth with similar concerns, the power of unity will demonstrate to the facility that the substandard care will not be tolerated.

Related:

Family sues Boynton nursing home after finding multiple bed sores on loved one, September 13, 2011 by Rochelle Ritchie

Government Report Confirms Pressure Ulcers Harm All Nursing Home Residents; Regardless Of Race, Sex or Age

A New Low In Nursing Home Care: A Bedsore On The Head

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

Are there any federal regulations that apply to the prevention of bed sores?

On November 5, 2010, the Illinois Department of Health issued a “Type A” violation and fine of $6,520 against the Chateau Nursing and Rehab center in Willowbrook, IL. The fine was one of several recent warning signs that something at Chateau is seriously amiss.

According to an August, 2010 survey from the Illinois Department of Health, 27 residents had complaints about mistreatment. These included:

Contrary to what some medical facilities suggest, the development of pressure sores during an admission to a facility is not an inevitable part of getting older or something that simply coincides with some medical conditions.  Rather, pressure sores are overwhelmingly the result of inattentive care on the part of the facility.

After all, the prevention of pressure sores is not rocket science!  

Basic preventative measures implemented by nursing homes, hospital and other types of long-term care facilities can significantly reduce the incidence of pressure sores.  Well-known preventative measures include:

• Turning patients at regular intervals
• Keeping patients clean and dry
• Ensuring patients are kept well nourished and hydrated
• Utilizing the latest advancements in pressure reduction technologies-- cushions, mattresses ect.

Particularly in patients who may already be disabled or elderly, the development of pressure sores is an especially cruel complication that can cause pain, disability and significantly increase the chances of patients acquiring complex complications such as: sepsis, gangrene or osteomyelitis.

With years of experience representing patients and families in cases involving the development of pressure sores at medical facilities and other types of institutions, Rosenfeld Injury Lawyers understands the troubling issues as they weigh on the individual and family.  

Should the need arise to seek legal recourse in relation to the development of pressure sores, we invite you to review our expanded Pressure Sore Injury section to our firm website with pages devoted to: Pressure Sores in Nursing Homes, Pressure Sores in Hospitals, Pressure Sores in Assisted Living Facilities, Stages Of Pressure Sores and information on frequent complications such as: Sepsis, Osteomyelitis, Gangrene, Necrotizing Fasciitis and Death.

When it comes to the prevention of decubitus uclers, it very much is a collective responsibility of all parties involved. As opposed to other medical complications that can be traced to the poor care or decision making of one person, situations where a person has developed decubitus ulcers during a nursing home admission are generally reflective of an entire facility poorly doing their job.

After all, when decubitus ulcers develop and progress over time, numerous staff members were (or should be) theoretically in a position to implement changes in the patients care-- or at the very least bring the condition to the attention of other staff.

Recognizing the importance of a team approach to the care and prevention of decubitus ulcer (similarly referred to as: pressure ulcer, pressure sore or bed sore), a recently filed bed sore lawsuit seeks damages from the nursing home itself, the management company and the staff physician.  An Illinois woman's family alleges the following omissions:

Virgil Calvert Nursing and Rehabilitation Center

• Failed to supervise patient
• Failed to provide necessary care and services for patient to maintain body weight and protein levels
• Failed to provide treatment for complications such as a urinary tract infection
• Failed to maintain proper medical records for the patient

SW Management Company

• Failed to properly manage the nursing home
• Failed to provide sufficient levels of sufficient care

Dr. Basga Bernard

• Failed to provide adequate medical treatment
• Failed to send patient to the hospital
• Failed to order proper diagnostic tests to diagnose the underlying medical problems

Particularly, when we are dealing with a situation involving general neglect at a nursing home, I find it particularly important to name all of the potentially responsible parties in order to fully protect my clients.  As this nursing home lawsuit progresses through the litigation process, it certainly will be interesting to see who exactly is to blame for the the death of this patient.

Read more about this pending bed sore lawsuit against an Illinois nursing home here.

Related:

Lawsuit alleges nursing home neglect contributed to patient’s decubitus ulcers

ManorCare Named In Wrongful Death Lawsuit After Patient Developes Pressure Sores During Nursing Home Admission

What are nursing homes required to do to prevent bed sores?

A jury in Georgia has ordered the management company of a nursing home to pay $2 million in compensatory damages to the estate of a woman who died at a facility they operated.  Shortly after entering jury deliberations, the jury ordered Subacute Services, Inc., the operator of Rockmart Nursing and Rehabilitation Center to pay the award in relation to the death of 82-year-old Ruby Mae Taylor.

According to news reports, Ms. Taylor's family initiated the nursing home lawsuit, after her death related to development of decubitus ulcers that she developed during her admission to the facility.

Decubitus ulcers, also known as: pressure sores, pressure ulcers or just bed sores are a horrific problem facing nursing home patients across the country.  Generally deemed to be preventable, the prevention of decubitus ulcers falls squarely on the shoulders of the facility.

Prevention of decubiuts ulcers begins with the development of a detailed care plan for each patient to help determine what factors put the patient at risk and perhaps more importantly: what the facility needs to be doing to care for the patient. 

Despite tremendous strides in patient care with the implementation of technologies, bed sore prevention generally relies on the consistent work of staff.  Known to form when patients are left in one position over extended periods of time, prevention of decubitus ulcers generally involves:

1. Regularly shifting patients in beds or wheelchairs
2. Keeping patients clean and dry
3. Utilizing specialized mattresses to alleviate pressure build up on the bony prominences of the body
4. Ensuring patients have adequate nutrition and hydration
5. Recognizing early signs of decubitus ulcers and alerting the patient's physician

Sadly, when patients' needs go ignored over extended periods, decubitus ulcers are a likely occurrence.  Perhaps that is why the jury in the above matter held the nursing home management company responsible due to the fact that the inadequate care was a result of decisions made by the management company to inadequately staff or train the facility?

Related:

Family Blames Nursing Home For Mother's Infected Pressure Ulcers & Death

Bed Sore Verdict Against Assisted Living Facility & Home Health Care Agency

What is ‘turning’ and why is it important to prevention of bed sores?

Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?

How long do I have to file a bed sore lawsuit?

Putting aside the human toll medical errors impose on individuals, the financial impact of medical errors can be downright daunting.  According to a study commissioned by the Society of Actuaries, our country (and economy) is hobbled by a daunting $80 billion in medical errors every year!  An estimated 25% of those expenses, $19.5 billion, were determined to be avoidable.

In reconciling these figures, the actuaries determined that an estimated 1.5 million measurable and preventable medical errors in 2008 resulted in significant increases in disability, death, lost productivity and increased medical costs. 

Though preventable medical errors can occur in a number of hospital and situations, 55% errors were due to:

• Pressure ulcers
• Postoperative infections
• Mechanical complications of devices or implants
• Post-laminectomy syndrome
• Hemorrhages complicating a procedure

The actuaries arrived at their calculations based upon an insurance claims database. However, as acknowledged by the authors of the study, the actual cost of preventable medical errors may be substantially higher  as a notable number of errors go unreported.

From a dollars-and-sense analysis of cases involving medical errors, it is undeniable that these situations need to be addressed by medical facilities both in order to improve patient care and to help improve their own financial well being.

Read more about this study on preventable medical errors here.

Related:

Hospital Acquired Pressure Sores Are Devastating Source Of Patient Injury & Death

States Move To More Transparency Regarding Medical Malpractice & Hospital Errors

Medical Facilities Can Reduce The Incidence Of Infection By Taking Some Basic Precautionary Steps

Hospital Errors: Study Finds Preventable Errors Continue To Harm Patients At Alarming Rate

Sometimes I get sick of hearing about the 'good ol' days'--  when homes were affordable, people were friendlier, milk tasted like milk (as opposed to some whitish water)--- and how life may have been a little bit better?

Certainly, I'm not one to bicker about they way things were and how tough everything is now, but I certainly have developed a respect for both traditions and learning how to do things fundamentally correctly-- without the addition of all the new gizmo's that alway's promise to improve on the way things were done yesterday.

I began having a hankering for nostalgia after I read an article a colleague emailed me from England, "Why in the 21st century, are NHS patients dying in agony from bedsores?" The article readily references a new book on the British healthcare system, by Michael Mandelstam, "How We Treat The Sick: Neglect And Abuse In Our Health Services."  

Reading though the article and book references within the article, it appears that both authors blame modern developments in our healthcare system for the systematic increases in bedsores and other medical complications that are acquired by patients during their admissions to hospitals and nursing homes.  

In particular, the writers cite the lack of continuity of care from all types of hospital staff, nurses, orderlies, and doctors as one of the main reasons we are seeing the modern day bedsore epidemic at many medical facilities.

In the good ol days, nurses and doctors were assigned particular patients whom they typically cared for during their entire admission or stay.  While caring for the same patients day-in and day-out must have help ease patient nerves, it also encouraged the staff to care for patients with a sense of pride! After all, would anyone want their professionalism questioned when a patient developed a bedsore-- due to their inattentive care?

As Dr. Matin Scurr sums up the current situation:

I've written before about the lack of continuity of care as a result of destroying the 'firm'-- a paitent used to be assisnged to one firm (or team) of medics.  The firm comprised one or two house offices (recently graduated doctors), the senior house officers, registrars and, at the top of the hierarchy, the consultant.

This firm ensured continuty of patient care.  But the firm is no more.  No patient care has become like a high-risk version of pass-the-parcel -- patients are simply handled from doctor to doctor with notes in a folder and no one following them through.

I couldn't agree more with Dr. Scurr's assessment!  Particularly as evidenced by the development of bedsores during hospitalization or nursing home stay, it is important to remember their development is really a sign of systematic neglect--- as opposed to the inadequate care of a few caregivers. 

While we may indeed see the development of other types hospital-acquired complications (medication errors, dropped patients, ect.) derive from a situation involving an individuals poor judgment, bedsores are really emblematic of systematic neglect.  Even in the most fragile patients, bedsores-- particularly advanced wounds (stage 4 bedsores) develop over periods of days and weeks.

When evaluated as a progressive condition, it usually becomes apparent that not only was the staff not doing their job in terms of bedsore prevention--- but perhaps equally importantly-- staff may not have been implementing the necessary medical treatments as the wound progressed.

I can only imagine that forcing a personal accountability issue medical staff would lead to situations where patient care would inherently improve-- both out of the staff's personal pride and perhaps-- fear over personal responsibility over their visibly inadequate care.  Indeed, perhaps its time we take a page from the past and acknowledge seemingly improved efficiencies doesn't translate to better patient care.

Related:

Simple preventative techniques can drastically reduce the rate of hospital-acquired decubitus ulcers

Families Must Educate Themselves When It Comes To Bed Sores Acquired In A Nursing Home Or Hospital

How many hospital patients suffer from bed sores?

Reducing Decubitus Ulcers In Hospitals. How One Facility Managed To Reduce Hospital-Acquired Wounds By 63%

I never served on a jury before.  So I'll have to imagine how difficult it is to serve as the decision-maker in a pending case.  Particularly when evidence is presented by skilled lawyers, I imagine there must be an element of second-guessing both the sincereity of the witnesses and lawyers involved.

In trials involving the development of bed sores at a nursing home or hospital, the frequent defense arguments center around both inevitability of the wounds and perhaps where the actual wound originated. While these arguments indeed have their place, my experience is that these arguments are brought into play for the purpose of bringing an element of confusion into many pressure sore trails.

By the significance of a recent verdict in a trial against an assisted living facility and home health care agency, I'm guessing there wasn't much second guessing on the juries end! 

After a week long trial, a Georgia jury ordered Country Crossing Assisted Living, its  individual owner and Hutcheson Home Health Care to pay more than $9.5 million to the family of a deceased patient, Charlotte Pauline Dean.

Both Hutcheson Home Health Care and Country Crossing Assisted Living were responsible for caring for Ms. Dean prior to her death in 2006.  According to evidence presented at trial, Ms. Dean's death was related to multiple infected pressure sores while the defendant's claimed that the she only required treatment for one.

By the significance of this verdict, it it apparent that not only did the jury believe the case presented by the plaintiff's (the woman's family), but perhaps more importantly, that the defendants' care was inadequate to say the least.

Related:

"Home Care Nursing" Doesn't Mean "No Care Nursing"

Home Care Nurse Has License Suspended In Connection To Death Of Disabled Boy

Are assisted living facilities responsible for the prevention of bed sores in their patients?

Jury orders health care facilities to pay $9 million in wrongful death suit, by Kristi E. Swartz, The Atlanta Journal-Constitution, March 5, 2011

Nursing Home Injury Laws: Georgia

Have you seen a bed sore?  If you haven't, advanced bed sores are truly horrific conditions that are perhaps the most gruesome example of institutional neglect. 

However, particularly when there are photographs of a gaping wound on a patient's buttocks or heels, many of these cases seem to miraculously get get resolved prior to when they get presented to a jury.  Perhaps some of the risk managers and lawyers defending these nursing homes and hospitals are providing useful advice to their clients to: settle, settle, settle?

Maybe the 'settle, settle, settle' message got confused in a recent case involving the development of bed sores during a hospital admission following a hip surgery.  The family of Alfred Gonzales, filed a medical medical malpractice lawsuit against Christus St. Vincent Regional Medical Center (New Mexico) due to the bed sores that developed on his heels during his hospitalization. 

The jury awarded Mr. Gonzalez's family $10.3 million.

Ignoring their own protocol, the hospital failed to provide Mr. Gonzalez with the appropriate care and devices to prevent the development of the bed sores (interchangeably referred to as: pressure sores, pressure ulcers or decubitus ulcers).  Tom Rhodes, the lawyer representing Mr. Gonzalez's family said it best;

Shift after shift, they didn't do what they were supposed to d.  After they know they had a problem, they charted saying that there was no problem.  It was haphazard and reckless, like they were really doing the stuff; they were just writing it down.  A lot of it had to do with the fact that he (Mr. Gonzalez) couldn't communicate well.

Obviously, the poor charting and blatant disregard for patient well being was conveyed to the jury in this matter.  The award is comprised on $595,000 in compensatory damages and a hefty $9.75 million in punitive damages.

There is no doubt that the significance of this verdict will travel to hospital administrators across the country.  Though many folks in hospital management positions may brush this case off as a freak situation, my hope is that a majority of the decision-makers take note of this case for the fact that jurors will no longer accept the fact that the development of bed sores during a hospital admission is an inevitable part of being hospitalized.

Related:

Why is it important to differentiate the type of facility where a bed sore developed?

Medical Facilities Are Not Doing Enough To Prevent Pressure Ulcers On Patients' Heels

$5 Million In Punitive Damages Awarded To Widow In Bed Sore Case Against Nursing Home & Hospital

What are some common defenses used by nursing homes and hospitals in lawsuits involving pressure sores?

Christus St. Vincent Medical Center slapped with $10.3M penalty in bed sore lawsuit by Phaedra Hayword, the New Mexican, February 18, 2011

Nursing Home Injury Laws: New Mexico

An important court decision Tennessee Supreme Court decision helps clarify what is necessary for injured parties to prove their care in a nursing home negligence lawsuit.  The case stems from the lawsuit initiated by Kimberly S. French, the daughter of Martha S. French.  Ms. French brought a wrongful death case against the Stratford House nursing home alleging:

Bed Sore FAQs

Nursing Home Injury Laws: Tennessee

Is Sepsis Related to Bed Sores?

Despite increased publicity and laws requiring nursing homes to implement preventative measures, decubitus ulcers--- also referred to as: bed sores, pressure sores or pressure ulcers remain a significant threat to the health of patients in nursing homes.  

From the time that the decubitus ulcers develop, some nursing homes begin to shift the responsibility for the development of the wounds onto the patient and family.  However, a closer look at the care-- or lack thereof--  provided to the patient during their admission to the facility generally reveals that the facilities failure to properly care for the patient was the real cause of the decubitus ulcer.

For most families, the discovery of a decubitus ulcer on a family member is a disturbing finding that leaves them with many questions about why the wound initially developed, what types of treatment options are available and what type of legal recourse is available.

At Bed Sore FAQ, we receive questions and inquiries from families across the country who are facing difficult decisions following the development of a decubitus ulcer on a loved one during an admission to a nursing home, assisted living facility or hospital.

We believe, that the more informed families become about this preventable medical condition, the better they will be able to make the important decisions that will inevitably be encountered from a medical and legal perspective.

Below are the 10 most popular questions and articles from Bed Sore FAQ over the past year by number of hits per page:

1) Photographs and diagrams related to stages and development of bed sores

Warning some of these images may be disturbing.

2) Bed Sore Treatment Specialists

We have assembled a national directory of wound care specialists which can be searched by state.

3) What is a Kennedy terminal ulcer?

A Kennedy Terminal Ulcer or Kennedy ulcer is a specific type of bed sore (also referred to as pressure sore, pressure ulcer or decubitus ulcer) that is characterized by rapid onset and rapid tissue breakdown. The ‘Kennedy Ulcer’ was named after Karen Lou Kennedy-Evans- the nurse who discovered the medical condition. Continued....

4) How does the use of the Braden Scale help in the prevention of bed sores?

The Braden Scale for Predicting Pressure Sore Risk is a universally accepted tool to help staff in nursing homes and hospitals identify individuals who may be at risk for developing bed sores (also called decubitus ulcers, pressure sores or pressures ulcers).  

The Braden Scale for Predicting Pressure Sore Risk evaluates each resident in the following areas: sensory perception, degree to which the skin is exposed to moisture, the individuals level of activity, the individuals ability to change positions, nutrition and the exposure to situations that can result in friction and shear to the skin. Continued....

5) If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

‘Damages’ refer to losses sustained due to physical or psychological injury for which you can be compensated. In cases involving the development of a bed sore (also referred to as decubitus ulcer, pressure ulcer or pressure sore), damages are assessed in terms of money compensation.

In order to recover damages, you first must establish that the nursing home or hospital was responsible for the development of the bed sore. Like all injury cases, bed sore cases require the injured person- or their estate- to prove the facilities negligent care resulted in the development of the bed sore. Continued....

6) How do medical facilities assess healing bed sores?

In order to maximize the effectiveness of bed sore treatment, medical facilities need to monitor bed sores as they heal. Most medical facilities assess how well a bed sore (also called: decubitus ulcer, pressure ulcer or pressure sore) is healing based on the size of the wound and the physical characteristics.

The size of the bed sore can be measured with a disposable ruler or with tracing paper. Increasingly, medical facilities are using technology such as ultrasound and computer guided imagery to assist in assessing bed sores during the healing process. Continued....

7) What is DuoDerm and why is it used to treat bed sores?

DuoDerm is the brand name for a commonly used hydrocolloid dressing manufactured by ConvaTec that is used to treat bed sores (or similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers).

Hydrocolloid dressings have gel-like properties to absorb excretions from the wound and protect the wound debris and potentially infection causing bacteria. Hydrocolloid dressings dressings help the wound to autolytically debride itself (the body uses its own enzymes to break down dead tissue as opposed to surgically removing it). Continued....

8) What areas of the body are prone to develop bed sores?

Bed sores can develop in any area of the body where pressure is continually applied without relief. Most frequently, we see bed sores in areas of the body that bear a majority of a person’s body weight when they sit or lay in one position for long periods of time such as:

• Buttocks
• Sacrum
• Heels
• Back

Continued....

9) What is a wound vac and how does it work?

A wound vac (also referred to negative pressure wound therapy) is a machine used to treat advanced bed sores. A wound vac uses a pump to suction fluids from bed sores or other wounds that are difficult to heal on their own.

An airtight, vacuum chamber is created by draping a polyurethane material over the entire surface area of the wound while a foam-type material is packed into the wound itself. A pump is them attached to this area to draw moisture from the wound itself. The pump acts as a vacuum to draw the excess fluids from the wound and collect them into a chamber. Continued....

10) 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. Continued....

From both a medical treatment and legal standpoint, families coping with a situation where a loved one has acquired a bed sore in a nursing home or hospital are quickly faced with difficult questions.

Let's face it, no one expects a loved one to acquire a bed sore.  When notice is received, most families are shocked to learn that they may be faced with making difficult decisions from both a medical and legal standpoint. 

Given the fact that the overwhelming majority of bed sores (similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers) are the result of systematic neglect and improper care, medical facilities are frequently hesitant to supply answers to questions like:

What causes the bed sores to develop?

What types of medical treatments are available to treat this condition?

Is the facility responsible for this condition?

What is the legal recourse for a patient with bed sores?

Will my loved one survive?

You are not alone.  With more than 500,000 nursing home and hospital patients coping bed sores, there remains a shortage of complete, concise and updated sources of information.  In an effort to fill this void, we have developed a website devoted to proving the most comprehensive source of information related to bed sores on the internet-- Bed Sore FAQ. 

Bed Sore FAQ is more than a medical-legal website, it is an authoritative resource for families to gather information to assist in the decision making process.  In addition to answers to common questions, Bed Sore FAQ has an expended Bed Sore Resource Center highlighting the following topics:

• Bed Sore Glossary
• Bed Sore Treatment Specialists
• Bed Sore Articles
• Bed Sore Research Studies
• Websites Devoted To Bed Sores

For more than 30 years, attorneys at Rosenfeld Injury Lawyers have fought for injured patients and families who have been harmed due to carelessness or neglect of others.  Put our experience in the fields of nursing home negligence and medical malpractice to work for you!  We invite you to speak to our lawyers for a free case analysis today.

Surprisingly, heel pressure sores are poised to overtake the buttocks as the most common area of the body where pressure sores develop. 

While the underlying causes of heel-related pressure sores remain similar to their peers:

• mmobility
• Friction
• Shear
• Unrelieved pressure

These factors combined with the physical structure of the foot make the heel area particularly susceptible to developing pressure sores in both the acute care (hospitalization) and long-term setting (nursing homes).

As many as 1 in 3 patients in acute or long-term care setting may develop some type of pressure sore on their heel during their admission.  While heel pressure sores, certainly can very in their degree of severity, advanced pressure sores are painful, disabling and embarrassing for the patient.

Factors relating to the development of pressure sores

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.

Preventative Techniques To Reduce Heel Pressure Sores

There is no secret to reducing the incidence of heel-related pressure sores.  Rather, facilities need to be attuned to common sense precautions to reduce the amount of pressure exerted on the heels.

Common preventative techniques to reduce the development of pressure sores on the heels include:

• Using pillows and towels to prop up the patients legs, thereby eliminating or reducing the contact between the heels and the underlying surface
• Use of specially designed foam boots on patients feet
• Use of specialty mattresses

Treatment For Patients With Heel Pressure Sores

As with pressure sores that form in other areas of the body, it is far easier to prevent pressure sores on the heels than to treat them after they develop.  Treatment plans generally include keeping the wounds clean and dry to allow the tissue to heal. 

In situations involving advanced pressure sores (stage 3 or 4), the wound may need a procedure referred to as a debridement where the dead tissue is removed during a surgery. When heel pressure sores advance or become infected, there may be few options other than to amputate the leg. 

Prognosis for Patients With Heel Pressure Sores

Most medical experts remain cautious when issuing a prognosis for a patient with pressure sores on their heels.  Even after the wound on the heel is tended to, heel pressure sores are particularly disabling for people of all ages and put patients at risk for other medical complications that may arise from prolonged immobility.

Given the severity of pressure sores on the heel and foot that developed during an admission to a medical facility, a careful analysis of the care should be evaluated from a medical-legal standpoint.  If the facility failed to employ proper care, a lawsuit may be initiated by the patient or family for medical expenses, pain and disability.

Related:

If you are looking for a comprehensive article on the development of pressure sores on patients’ heels, I suggest that you take a look at: Heel Pressue Ulcers: Stand Guard, Adv Skin Wound Care. 2008 Jun;21(6):282-92; quiz 293-4. Langemo D, Thompson P, Hunter S, Hanson D, Anderson J. University of North Dakota College of Nursing, Grand Forks, ND, USA.

Are bed sores on the heels common?

Are assisted living facilities responsible for the prevention of bed sores in their patients?

Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?

'Under-staffing' and 'under-funding' are just several of the underlying reasons alleged to contribute to the development of a patient's bed sores (or decubitus ulcers, pressure ulcers or pressure sores) during an admission to a Missouri nursing home.  

The nursing home negligence lawsuit, filed by my colleague Attorney David Terry, is filed on behalf of a deceased nursing home patient and alleges the nursing home (Parkwood Skilled Nursing and Rehabilitation Center) and its various management companies operated the facility in a manner where money necessary for essential patient-care services was diverted away from the the facility to the benefit of the facility owners.

The subject of the lawsuit, Nellie Wilks, was an elderly woman who was admitted to Parkwood Skilled Nursing and Rehabilitation Center on July 7, 2008.  At the time of her admission, Ms. Wilks suffered from various medical conditions and was very much dependent on the staff at Parkwood for providing care for her daily living needs.  Despite her maladies, Ms. Wilks did not have any type of pressure sore on her body.

Also at the time of her admission, the staff at Parkwood conducted an assessment of Ms. Wilks needs and determined her to be at risk for developing bed sores, due to her limited mobility, incontinence of bowel and bladder and need for staff assistance with all of her daily living needs.

The failure on the part of the staff at Parkwood (as well as the owners' failure to provide staff with the means to do their job) to properly implement Ms. Wilks' plan of care is alleged to be responsible for the development of a stage IV pressure sore on Ms. Wilks' sacrum. The wound's advanced nature, necessitated a medical procedure known as a diverting colostomy and extensive medical care until her death on October 26, 2008.

The lawsuit against Parkwood specifically alleges the facility failed to provide adequate care to prevent the following:

• Pressure sores
• Malnourishment
• Development of a urinary tract infection
• Osteomyelitis
• Severe pain

Sadly, many nursing home patients are currently suffering horrible pain and embarrassment due to bed sores.  The overwhelming majority of bed sore cases are the result of the facilities failure to properly implement plans of care.  In cases where a bed sore developed during an admission, facilities can be held responsible for the resulting pain and loss of dignity and medical expenses.  

Our nursing home attorneys are available to discuss your situation with you and advise you of your legal rights.  All consultations are confidential and no fee is ever charged unless there is a recovery for you. (888) 424-5757

Related:

Nursing Home Resident Dies From Improperly Treated Pressure Sores During Short Rehab Stay

New York jury awards $19m to family of man who developed advanced bed sores during nursing home admission

Lawsuit Claims That Nursing Home's Negligence Resulted In Patient's Decubitus Ulcers

Angela Thompson v. Parkwood Skilled Nursing and Rehabilitation Center (pdf)

Bed Sore FAQ's

On November 24, 2009 nursing home surveyors from the Illinois Department of Health (IDPH) conducted an inspection of Edwardsville Terrace, a nursing home in Edwardsville, IL.  The inspection of the facility found numerous violations of federal and state laws applicable to nursing home care.

In particular, surveyors discovered the following alarming situations at the Southern Illinois facility:

• The facility failed to have written procedures regarding patient care (Section 350.620 Resident Care Policies)
• Edwardsville failed to provide skilled nursing services that are required to maintain each patient's health-- when the facility failed to identify signs of physical and psychological illness that were apparent in one of the patients (Section 350.1210 Health Services)
• Delaying the implementation of medical care that was necessary for patients who need the services of a physician, licensed nurse or professional nurse
• Failed to maintain adequate patient records pursuant to Section 350,1610
• Neglecting a patient in violation of Section 2-107 of Illinois' Nursing Home Care Act

The above violations came to light following an investigation of an extremely sick patient suffering from uncontrolled diabetes and severe mental illness amongst other maladies.

Nursing home surveyors focused on the fact that the patient at issue was admitted to a hospital emergency room after an extended illness Edwardsville Terrace.  The unidentified patient was admitted to the emergency room with the following diagnosis:

1. Septic shock
2. Dehydration
3. Cardiomyopathy
4. E. Coil
5. Sepsis
6. Right nephrolithiasis causing E. Coli sepsis
7. Chronic ear infection
8. Hypertriglycerdemia

The nursing home patients acute illness necessitated extensive medical treatment and extended hospitalization. While reviewing the patient's chart from Edwardsville Terrace, a gross lack of documentation lead the surveyors to believe the facility failed to provide essential medical care.

Certainly, this survey should give patients and their families cause for concern; due to the fact that this facility failed to meet the basic needs of this patient.  Hopefully, the disclosure of poor care (as well as the $20,000 fine imposed against this facility) will cause Edwardsville to improve their documentation and re-commit themselves to providing necessary care for all of their patients.

Nonetheless, I am sure that this incident is not isolated.  If you believe your loved one was mistreated, abused or neglected at Edwardsville Terrace, I would honor the opportunity to speak to you about the situation and your legal options.

Related:

Diabetic Ketoacidosis Is An Under-Appreciated Danger Facing Many Nursing Home Patients

Dehydration & The Development Of Bed Sores In Nursing Home And Hospital Patients

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Improper Transfer Leads To Broken Arm

First Quarter 2010 Illinois Nursing Home Violations Released

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 including:

• Stage III decubitus ulcer
• Multiple stage I and II decubitus ulcers on the patients feet
• Dehydration
• Urinary tract infection

None of the conditions were disclosed to the family until after the patient was admitted to a local hospital.  

In cases such as these-- perhaps more alarming than not notifying the patients family as the various problems their loved one has developed-- is the fact that the facility allowed the conditions to develop in the first place.  My guess is that the facility was so ashamed of the condition they allowed their patient to get into that they failed to document the conditions during the patients stay at the facility either.

Some of these situations may give way to a claim against the nursing home where the condition developed.  In addition to contacting an attorney to discuss your legal options, you should give serious consideration to locating another facility for your loved one following their discharge from the hospital.

Related:

Dehydration & The Development Of Bed Sores In Nursing Home And Hospital Patients

Untreated Urinary Tract Infections In Nursing Home Patients May Result In Urosepsis

Why do nursing homes describe pressure sores according to 'stages'?

Are bed sores on the heels common? Bed Sore FAQ

One of the most memorable cases I worked on involved a young man who was in a nursing home following a severe injuries he sustained in a construction accident.  Due to the nature of the man's injuries, a catheter was used to drain urine from his bladder.  Despite doctors orders to change the catheter every 30 days, months went by without any catheter change.  In fact, six months went by without a catheter change.

Finally, after six months without a catheter change, a nursing home employee recognized the obvious problems: cloudy / brownish urine and testicles extremely swollen due to infection.  The situation initially resulted in a hospitalization where the man's testicles were surgically removed.  Unfortunately, the staff's intervention was too little, too late.  Within a week of arriving at the hospital, the man died from a condition known as urosepsis.

Urinary Tract Infections

Urinary Tract Infections (UTIs) seem like a minor problem, especially in nursing homes, considering the range of common diseases, infections, and illnesses. However, UTIs can prove very dangerous, especially when nursing home facilities fail to prevent UTIs in the first place or fail to provide proper and prompt treatment.

Urosepsis

Urosepsis is basically a severe urinary-tract infection. A UTI occurs when bacteria travels up the urethra (the opening in the body through which urine passes) into the bladder. UITs account for over 30% of infections reported by acute care hospitals and are the most common type of healthcare-associated infection. 

The bacteria can stay contained in the bladder (cystitis), travel to the kidneys (pyelonephritis), or even spread into the bloodstream (urosepsis). With urosepsis, you can suffer a dangerous drop in blood pressure, which can deprive your organs of oxygen. It can even prove fatal if you do not receive prompt antibiotic therapy, with an associated problem of increased use of antibiotics and multidrug-resistant bacteria.

Symptoms of UTIs include:

• Strong, persistent urge to urinate
• Burning sensation when urinating
• Passing frequent, small amounts of urine
• Blood in urine
• Cloudy, strong-smelling urine
• Bacteria in urine

More severe UTIs can also cause the following symptoms:

• Flank (upper back and side) pain
• Lower abdomen pain
• Fever
• Shaking and chills
• Nausea
• Vomiting
• Frequent, painful urination

While most urinary infections are mild, they can progress to more serious infections. Risk factors for urosepsis include:

• Older age
• Being female
• Having an indwelling urinary catheter (Foley catheter)
• Suffering from kidney stones
• Having impaired immunity

Urosepsis and catheter usage

UTIs are a common problem for the elderly because they are more likely to suffer from common risk factors. There is a marked increase in the prevalence of UTIs in both women and men after age 65. Females are more likely to suffer from UTIs as they age because of physiology and hormone changes. 

First, women have a shorter urethra, making it easier for bacteria to travel into the bladder. Second, as women age because the tissues of the vagina, urethra, and base of the bladder become thinner and more fragile. In addition, decreased estrogen levels causes pH changes in the vagina, allowing E.coli colonization, which causes about 80% of all UTIs. Men, on the other hand, suffer more UTIs when older because of prostatic disease. 

Risk factors include:

• Atrophic urethritis
• Atrophic vaginal mucosa (atrophic vaginitis)
• Benign prostatic hyperplasia
• Prostate cancer
• Catheter use
• Chronic bacterial prostatitis
• Genitourinary abnormalities
• Genitourinary calculi
• Renal and perinephric abscess formation
• Urinary diversion procedures
• Urethral strictures

Improperly maintained catheters are one frequent cause of UTIs. Usually, the longer a catheter is in place, the more likely an infection will develop. Up to 35% of patients requiring a urinary catheter for seven days or more will develop a CAUTI. About 50,000 long-term care residents have catheters at any given time according to the CDC’s 2009 report on catheter-associated urinary tract infections (CAUTIs). 

It is recommended that catheters are used only in appropriate situations and are left in place only as long as necessary. (See “Never Event #4: Catheter Associated Urinary Tract Infections and Nursing Homes Abuse Blog: Catheter Usage)

There are steps that nursing homes can take in order to reduce the risk of CAUTIs (proper use, proper technique, and proper situations). Proper use of urinary catheters is important, including:

• Not using urinary catheters to manage incontinence
• Using urinary catheters only in patients as necessary
• Remove the catheter as soon as possible
• Not using urinary catheters as a means of obtaining urine for culture or other diagnostic tests when the resident can voluntarily void

Instead, urinary catheters should only be used when necessary. Situations where indwelling urethral catheters are appropriate include: 

• When resident has a bladder obstruction
• Critically ill patient cannot voluntarily void urine for tests or to measure urine output
• Patients undergoing urologic surgery
• To help genital or anal wounds heal
• If resident requires prolonged immobilization
• To improve comfort for end of life care

Proper technique for urinary catheter insertion can also help reduce the risk of CAUTIs including:

• Washing hands before and after inserting or touching the catheter or catheter area
• Ensuring that only properly trained professionals insert/maintain the catheter
• Only touch the catheter when necessary
• Use sterile equipment
• Ensuring that healthcare personnel who take care of catheters receive periodic in-service-training

If used properly (proper situation and proper technique), indwelling urinary catheters can be a helpful tool when caring for nursing home residents. However, when proper technique, use, and care of catheters are not achieved, serious bacterial infections can occur.  

It is frightening how quickly a simple UTI can turn into a dangerous bacteria infection (urosepsis) that could prove fatal. Bloodstream infections in the elderly are associated with a higher mortality rate compared to bloodstream infections in younger age groups. Therefore, prevention of dangerous UTIs and proper treatment is important. 

If you or a family member has an indwelling catheter, it is important to ask questions about why it is necessary, for how long it is necessary, and proper and hygienic care. 

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

Sources:

Nursing Homes Abuse Blog: Never Event #4: Catheter Associated Urinary Tract Infections

Nursing Homes Abuse Blog: Catheter Usage

CDC: Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009

The Merck Manual of Geriatrics: Urinary Tract Infections

Geriontological Nursing: Urinary Tract Infection - Guidelines to assessment, treatment, and prevention in the older adult

The American Journal of Medicine: Bloodstream infections in the elderly

International Journal of Experimental, Clinical, Behavioural, Regenerative and Technological Gerontology: Unique Aspects of Urinary Tract Infection in the Geriatric Population

Journal of the National Medical Association: Problems in diagnosing infections in the elderly

The Journal of Urology: Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection

Emerging Infectious Disease Journal: Engineering out the risk for infection with urinary catheters

Journal of the American Medical Directors Association: Complications of chronic indwelling urinary catheters

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.

Well, according to a Tennessee jury, the answer to the above question is a resounding 'yes'!  Evidence was presented to the jury regarding the circumstances that led up to the death of a resident at Celebration Way, a Tennessee assisted living facility in 2004 due to an intestinal obstruction and sepsis.

Among the claims presented by the family of the deceased was that the facility was so understaffed that they could not provide adequate care for the woman.  This claim was substantiated at the trial against the facility when it was demonstrated that despite orders for 60 doses of MiraLax, a laxative, the facility administered just 16 doses in the months leading up to the woman's death.

After a two week trial, the jury awarded substantial damages to the woman's family against: the administrator of the facility, director of nursing, Americare Systems, Inc., Shelbyville Residential LLC and Celebration Way.

Read more about this wrongful death lawsuit against an assisted living facility here.

Understaffed Nursing Homes

As lawyers who tend to see the results of things gone bad, I can attest to the problems under-staffing results in.  In some situations, staff are responsible for caring for more than 30 patients per day.  When the stresses put on nurses reach this level it is essentially impossible for them to adequately perform their job. 

Corners begin to get cut.  Not necessarily out of maliciousness or laziness-- but because there simply is not enough time in the day to perform the tasks they are responsible for.  The end result is that patients to not get the care they require and consequently get neglected or hurt.

In most situations, I point blame at the management who make a conscious decision everyday to strip staffing levels to the bare-bones in order to maximize the profitability of their facilities.  Hopefully, when courageous juries, like the one above, start sending messages in the form of large verdicts, operators will begin to change the way they do business.

Related:

Early Detection Is The Key Element To Successful Sepsis Treatment

Failure To Monitor Bowel Movements In Nursing Home Patients Can Lead To Impacted Bowels

High Staff Turnover Rates Plague Most Nursing Homes

My guess is that you'd be hard pressed to find any person-- out of all the people admitted to hospitals this very day-- who is aware of the fact that they are at an increased risk for developing  pressure sores based on the very fact that they are in the hospital.

Pressure sores acquired during a hospitalization are one of the most devastating problems facing patients in all demographics and with various types of conditions. The fact remains that thousands of hospital patients will develop a pressure sore during their hospitalization this year.  

This is not a new trend.   Rather hospital acquired pressure sores have long been a problem facing the young and old during the time they spend in hospitals.  However, unlike other medical complications that have been addressed over the past decade, pressure sores related to a hospitalization remain an untamed dragon. 

The most recent study on medical errors related to hospitalizations, the seventh annual HealthGrades Patient Study in American Hospitals should convince any skeptics out there that pressure sores (also referred to as: bed sores, pressure sores or pressure ulcers) acquired during a hospitalization are a real-- and growing problem.

In making this determination, the study evaluated medical records from 39.5 million hospitalizations at 5,000 hospitals across the country based on standards set forth by the Agency for Healthcare Research and Quality.  The studies findings indicate:

• Pressure sores are the second most common patient safety incident with a development rate of 36.05 incidents out of every 1,000 hospitalizations
• Medical treatment related to treatment of hospital-acquired pressure sores results in $2.64 billion in costs

So what does this study really tell us?

Pressure sores are not just a problem facing nursing home patients.  Hospitals must acknowledge the fact that pressure sores are a real threat to patient well-being and train staff regarding early identification and treatment.  

My hope is that by by focusing more attention on pressure sore prevention, future hospital patients can avoid the pain, embarrassment and risk associated with this ailment.

Pressure Sores Are Preventable

When high-risk patients are properly identified and preventative measure such as: regular turning, personal care, nutrition and pressure relieving mattresses are provided, the incidence of pressure sores acquired during a hospitalization can be minimized.  

It's not just me claiming this!  Medicare has placed hospital-based pressure sores on its 'never list' -- its list of medical errors that are so easily preventable that they should never happen.  No longer can hospitals seek reimbursement from Medicare for pressure sore related medical treatment if the wound developed during an admission to their facility.

Related Nursing Homes Abuse Blog Entries:

Pressure Sores In Hospitals On The Rise

Over 500,000 Adults Suffer From Bed Sores In Hospitals

Reducing Decubitus Ulcers In Hospitals. How One Facility Managed To Reduce Hospital-Acquired Wounds By 63%

Bed Sore FAQ:

How many hospital patients suffer from bed sores?

What can hospitals do to reduce the rate of bed sores in their facilities?

Are hospital patients prone to develop bed sores?

Bed Sore Resources

As a nursing home lawyer who has been involved in many cases where where 'sepsis' is listed as a cause of death, I can attest to the devastating effects this complication has on patients with bed sores (similarly called: pressure sores, pressure ulcers or decubitus ulcers) and other medical conditions. 

To those unfamiliar with sepsis, it is a severe infection that effects the complete body.

The wide-reaching effects of sepsis surprised even me.  According to statistical analysis of septic hospital patients:

• Sepsis is the 10th leading cause of death in the U.S.
• 1/3 of people who develop sepsis will die
• Sepsis results in more than $17 billion in medical expenses every year

The fight against sepsis has now begun!

The Banner Desert Medical Center (Arizona), is now the first medical center in the country to implement a sepsis detection program to help improve the survival rate of patients.  The hospital uses a scientific formula to detect warning signs that are indicative of sepsis including:

• changes in body temperature
• increases in heart rate
• changes in respiratory rate
• white blood cell count

Once the early signs of sepsis are identified, the hospital is able to administer treatment quickly-- and greatly improve the patients survival rate.  At Banner Medical Center, the hospital credits the new program with the early detection of sepsis in 60 patients within the first two-month period that traditional detection techniques were unable to spot.  Read more about this important development in sepsis detection here.

My hope is that the sepsis detection instruments used at this hospital become common practice-- not just amongst hospital patients-- but nursing home patients as well who frequently receive delayed medical treatment because nursing home staff do not have the tools to make a diagnosis of sepsis.

Related:

Is sepsis related to bed sores? BedsoreFAQ.com

Despite Their Avoidability, Bed Sores Continue To Plague Nursing Home & Hospital Patients In All Demographics

Lawsuit Alleges: One Week In The Nursing Home Results In Significant Deterioration Of Pressure Sores & Sepsis

Bed Sore Resources

Bed Sore Treatment Specialists

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 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 lawsuit against Tower Hill Healthcare Center here.

About Tower Hill Healthcare Center

Tower Hill Heathcare Center is located at 759 Kane Street in South Elgin, Illinois.  Despite the facilities relatively impressive 4-star (out of 5 stars) rating, the facility has been cited numerous times for safety violations related to patient injury.  The majority owner is of Tower Hill is Jack Rajchenbach.  Mr. Rajchenbach knows his was around Illinois nursing homes, having ownership interest in the following facilities:

• BRIDGEVIEW HEALTH CARE CENTER 
• THE CARLTON AT THE LAKE
• CLARK MANOR CNV CENTER
• SPRINGFIELD TERRACE 
• TOWER HILL HEALTHCARE CENTER 
• GLENVIEW TERRACE NURSING CENTER
• THE IMPERIAL GROVE PAVILION
• THE ARC OF JACKSONVILLE, LTD.
• GROVE LINCOLN PARK LVG & REHAB
• PETERSON PARK HEALTH CARE CTR
• EMBASSY HEALTH CARE CENTER
• GROVE NORTH LIVING & REHAB CTR
• WHITEHALL NORTH
• HARMONY NURSING & REHAB CENTER

Related:

Why is a colostomy needed for patients with severe bed sores?

What are the signs of infection for people who have bed sores?

Is sepsis related to bed sores?

What are nursing homes required to do to prevent bed sores?

Why are physically disabled patients at risk for developing bed sores?

Bed Sore Resources

Bed Sore Treatment Specialists

The son of a deceased nursing home patient blames 'under-staffing' as the primary reason why his mother fell and subsequently developed pressure ulcers.  Gary Brown filed a lawsuit against a county operated nursing home in Nebraska on behalf of his deceased mother's estate.

In addition to under-staffing, the lawsuit alleges the facility allowed his mother to develop pressure ulcers (also referred to as pressure sores, decubitus ulcers or bed sores) during her recovery from a fall at the facility. Despite the fact that the pressure ulcers progressed and became infected, the facility also allegedly failed to notify the woman's personal physician.  Lastly, it is claimed that the pressure sores contributed to the patient's death.

Read more about this lawsuit due to development of pressure ulcers here.

Nursing Homes Obligation To Prevent Pressure Ulcers

Nursing homes must develop a customized program to prevent and monitor each resident's risk for developing pressure ulcers.  Unfortunately, at facilities that are inadequately staffed, many of the preventative measures set forth in a care plan are not complied with.

Pressure ulcers may develop when a patient is left in one position for a long period of time. 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.

To minimize development of pressure ulcers, nursing home residents should be:

• Cleaned regularly with mild soap and lukewarm water
• Moisturized daily
• Kept dry and clean-- especially kept free from urine and feces
• Rotated on schedule to prevent the build up of pressure from one area of the body
• Encouraged to get proper nutrition and hydration
• Kept the bed elevation as low as possible- this reduces pressure on the sacrum and buttocks

Related Nursing Homes Abuse Blog Entries

Government Report Confirms Pressure Ulcers Harm All Nursing Home Residents; Regardless Of Race, Sex or Age

Nursing Home Visits. An Opportunity To Conduct Your Own Inspection.

In For Rehab. Out With Bedsores.

Bed Sore Resources

Bed Sore Treatment Specialists

Autonomic dysreflexia (or hyperreflexia) is a dangerous condition that can occur with bed sore patients or patients with spinal cord injuries above the middle of the chest (usually above T-5).  Autonomic dysreflexia occurs when an irritation or pain below the level of the spinal cord injury sends a signal that fails to reach the brain.  

Over time, the bodies a delayed pain response results in changes to the sympathetic portion of the autonomic Nervous System (helps people adapt to changes in the environment and is associated with the “flight-or-fight” response), resulting in muscle spasms and a narrowing of the blood vessels.  This in turn can cause blood pressure to rise and heart rate to drop, which can lead to stroke, seizure, or even death. 

Signs autonomic dysreflexia may include:

• Pounding headache
• Goose bumps
• Red blotches on the skin, above the level of the spinal cord injury
• Sweating, above the level of injury
• Cold, clammy skin, below the injury
• Nasal congestion
• Slow pulse (< 60 beats/minute)
• Restlessness
• Hypertension (blood pressure greater than 200/100)
• Nausea

Autonomic dysreflexia can be prevented.  Specific precautions include:

• Frequent pressure relief in bed / chair (turning the patient to change positions)
• Avoidance of sunburn and scalding from hot water
• Maintain a regular bowel program
• Proper nutrition and fluid intake
• Compliance with medications
• Proper maintenance of indwelling catheter (keep tube free of kinks, keep drainage bags empty, check catheter daily for deposits)
• Perform routine skin assessments

Treatment of autonomic dysreflexia can be as easy as changing positions or removing the cause of irritation.  However, treatment must be initiated quickly in order to prevent further complications.  Many stimuli can cause autonomic dysreflexia including anything that would have been painful, uncomfortable, or physically irritating before the injury.  

The most common causes are:

• Overfill bladder – this can be due to a blockage in urinary drainage device, bladder infection, inadequate bladder emptying, bladder spasms, or bladder stones
• Bowel full of stool or gas – due to constipation, hemorrhoids or anal fissures, or infection and irritation
• Skin irritations – due to wounds below the injury, pressure sores, ingrown toenails, burns, or tight/restrictive clothing
• Broken bones

If the trigger cannot be identified and removed or if problems persist, medications can be used to treat the autonomic dysreflexia. 

People suffering from spinal cord injuries are particularly susceptible to pressure sores because of sitting or lying in the same position for an extended period of time.  In addition, spinal cord injuries can reduce or eliminate sensations, making it more difficult for the person to know when a pressure sore is developing.  These pressure sores can cause a dangerous condition known as autonomic dysreflexia in patients with spinal cord injuries.  

Autonomic dysreflexia is a potentially life threatening condition resulting from over activity in the Autonomic Nervous System, which can cause high blood pressure leading to seizures, stroke, and even death.  

Therefore, it is important that nursing home staff pay special attention to residents suffering from spinal cord injuries.  This includes frequently turning the resident to relieve pressure, regulating bladder and bowel output, properly maintaining catheters, and regularly checking for skin irritations.  Prevention of pressure sores is key to maintaining the physical health of residents with spinal cord injuries. 

Related:

Are bed sore patients at risk for amyloidosis?

Can bed sores cause osteomyelitis?

Is necrotizing fasciitis related to bed sores?

If bed sores are not timely treated, can gangrene develop?

Bed Sore Resources

Bed Sore Treatment Specialists

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.

When bed sore are not timely treated, the wounds may progress and become an advanced stage bed sore. A stage 3 or 4 bed sore typically requires more aggressive interventional medical treatment may be required such as surgical debridement, flap reconstruction or a diverting colostomy may be necessary.

By the time significant medical treatment his utilized, many patients are already suffering from complications such as: osteomyelitis, amyloidosis, gangrene or sepsis. 

In addition to the pain that accompanies bed sores, the medical complications may claim the life of the person.  In my practice, we commonly represent families in wrongful death lawsuits for people who have developed bed sore during an admission to a hospital or nursing home.

Many of these commonly encountered situations are discussed at BedSoreFAQ.com, where we receive thousands of visits every month from concerned family members and care givers. If you have a question, not discussed, feel free to contact me for a no-obligation consultation. (888) 424-5757. Toll-free. Anywhere

After a one week stay at Caseyville Nursing and Rehabilitation (IL), Theresa Mary Steiner's pressure sores significantly deteriorated to the point that she had become 'septic' according to a recently filed lawsuit. 

The lawsuit claims that on December 12, 2008 Ms. Steiner was admitted to the facility with stage II pressure sores on her buttocks and early stage pressure sores on her heels.  Five days later, when Ms. Steiner was discharged, the pressure sores (also known as pressure ulcer, decubitus ulcer or bed sore) had advanced to stage IV and Ms. Steiner had become known as septic.  As a result of the sepsis (also referred to as: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia), Ms. Steiner died.

The lawsuit further alleges that Caseyville Nursing and Rehabilitation was negligent in the following ways:

• Failing to screen Ms. Steiner on admission to the facility
• Failed to have adequate staff to treat Ms. Steiner's wounds
• Never developed a care plan for Ms. Steiner
• Never notifying Ms. Steiner's physician as to her condition

My take:

With the obvious disclaimer (I don't know anything about the case other from what is in the newspaper), it would appear as though the Ms. Steiner's family may have a difficult time winning their case. 

As the plaintiff in this matter, Ms. Steiner's family has the burden to prove their case.   Given the fact that Ms. Steiner enter the nursing homes with clearly form pressure sores and the wounds worsened in such a brief period of time, perhaps the damages was done by the time she had entered the facility?

Sepsis and Pressure Sores

With open wounds from pressure sores, bacteria can easily enter the bloodstream and cause and infection in the body.  When the infection progresses, it may cause sepsis.

In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Symptoms of sepsis include:

• Fever
• Low body temperature (hypothermia)
• Loss of ability to appreciate surroundings
• Cool hands and feet
• Anxiety
• Shaking
• Organ dysfunction

In order to provide patients with the best chance of recovery, facilities should identify and treat patients as quickly as feasible. If not treated properly, many patients with sepsis die shortly after the condition develops.

Resources:

Is sepsis related to bed sores? Bed Sore FAQ

Nursing home blamed for resident's sepsis St. Clair Record, December 7, 2009

Sepsis Nursing Homes Abuse Blog August 7, 2008

Nursing Home Injury Laws

Bed Sore Resources

"What do nursing homes describe pressure sores according to stages?"

-Edith Phoenix, AZ

Nursing homes and hospitals use a four stage scale to describe, monitor and treat pressure sores (also called bed sores, pressure ulcers or decubitus ulcers).  By categorizing pressure sores, according to standardized characteristics, a sense of uniformity can be established amongst all medical facilities that treat people with pressure sores.

Bed sores are categorized based on their severity (stage 1, stage 2, stage 3 or stage 4). The National Pressure Ulcer Advisory Panel, a professional organization dedicated to the prevention and treatment of bed sores, has set forth specific characteristics to help medical professionals objectively categorize a wound.

Stage I- 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 II- 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 III- 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 IV- 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.

Occasionally, a bed sore may be categorized as ‘unstageable‘. Unstageable bed sores are usually referred to as an extremely advanced wound where there is involvement of skin, muscle and bone.

Bed-bound patients commonly develop pressure sores in the following areas: back or sides of your head, rims of ears, shoulders, hip bones, lower back or tailbone, knees, heels, ankles and toes.

 Resource:

Bed Sore FAQ

National Pressure Ulcer Advisory Panel

Stages Of Bed Sores

Bed Sore Resources

A home-care nurse has been charged with criminal mistreatment after she failed to seek medical attention for an elderly woman with severe bed sores that ultimately claimed her life.  Prosecutors filed the charges against, Virginia Munger after an investigation revealed that although Munger was aware of advanced bed sores (also referred to as: decubitus ulcers, pressure ulcers or pressure sores) for six months, she took no medical intervention.  Munger was employed as a CNA by Homewell Senior Care, a home-care nursing company.

Read more about this case of senior neglect here.

Home Care Services

Many seniors are turning to home-care services as a way of living independently for longer.  Many of these companies offer senior a variety of medical and non-medical services and provide staffing on as 'as needed' basis.  Unlike nursing homes, home-care services are loosely regulated by federal and state officials. 

Officials at home care service companies should conduct an assessment to determine what the patient's needs are and determine if the company can indeed provide those services.  Once the needs are assessed and services are provided, the company should provide supervision of its employees to make sure those services are properly provided and the patient's needs are continually met.

In the case above, the elderly woman's family may have a cause of action against the home service company-- not necessarily for the criminal conduct of its CNA, but for failing to provide adequate supervision.  Additionally, if the company was made aware of the woman's bed sores-- yet failed to take any action they may similarly be liable for her treatment and death.

Related Nursing Homes Abuse Blog Entries

Home Care Nurse Gets Probation For Ignoring Bedsores On Child

Home Care Nurse Has License Suspended In Connection To Death Of Disabled Boy

Bed Sore Resources

In addition to monitoring food and liquid intake of nursing home patients, staff need to pay attention to the elimination of the wastes.   When urine and feces are not produced on a regular basis, nursing home staff must bring these problems to the attention of physicians.

One of the more obvious cases of nursing home neglect my office is working on involves a patient who went at least 10 days without a bowel movement.  Shift after shift of nursing home staff tended to our client-- yet no one cared enough to look at his medical chart to see when the last bowel movement occurred.  It was not until the man was taken to a local hospital, was it determined that the man's bowel had become impacted with feces.  Within 24-hours of his admission to the hospital, the man died from complications related to sepsis.

What is an impacted bowel?

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence. 

One of the most common symptoms is lack of appetite, caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness; diarrhea; hardened feces; cramping and pain; vomiting; constipation; bad breathe; and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis (also referred to as: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia) or death. 

The most common cause of impacted bowel symptoms is Crohn’s disease.  In a nursing home setting, causes of impacted bowel include: not drinking enough water; not eating a diet with adequate fiber; lack of activity; certain prescription medications and generally unhealthy diet with high fat and processed foods.

When timely identified, impacted bowels can be treated with a higher fiber diet, increased hydration, exercise, laxatives, enemas, suppositories, or manually removing the hardened feces.

Unfortunately, many nursing home patients are highly susceptible to impacted bowels due to a combination of inattentive staff and an unhealthy lifestyle.  In order to minimize the chances of impacted bowels among patients, nursing homes should:  

• Provide the residents with proper nutrition (sufficient fiber, water, and healthy foods), the residents can suffer from painful constipation. 
• Provide as much physical activity as feasible for patients.
• Monitor each patients bowel movements (time, quantity, consistency)  
• Pay special attention to patients complaining of stomach pain or cramping

Resources:

Article Click - Fecal Impaction vs. Constipation

The association of fecal impaction and urinary retention in elderly nursing home patients

Annals of Internal Medicine – Incontinence in the Nursing Home

One of the trends in nursing home litigation has been the inclusion of mandatory arbitration agreements in admission paperwork.  By signing an arbitration agreement (usually unknowingly), nursing home patients may surrender their opportunity to recover money for an injury via a traditional jury trial.  Alternatively, injured parties must present their grievances before an individual or group of arbitrators.    

The arbitration agreements set forth the terms of the arbitration and how many arbitrators will hear the matter.  Generally, in the case of a single arbitrator, the individual is selected by the nursing home.  In the case of an arbitration panel (usually three people) both the nursing home and the injured party may choose an arbitrator, with a third arbitrator selected by the appointed arbitrators.

Because the ability to award money for an injury or wrongful death is taken out of the hands of jurors and into the power of individuals who may be influenced by industry power-- mandatory arbitrations are usually vigorously fought by injured parties. 

Until recently, it was universally believed that an injured person stood little chance of receiving a fair recovery in an arbitration setting because many of the arbitrators had allegiance to large nursing home operators and other appointed arbitrators may be unfamiliar with issues that frequently arise in nursing home injury matters.

That was then, this is now.

Recently, a three-person arbitration panel recently awarded over $2.7 million in damages to the family of Voncil Sherrod who died in March, 2005 from complications related to gangrene and advanced pressure sores that developed during her admission to High Point Health Care and Rehabilitation Center in Tennessee.

In addition to High Point, damages were also sought from Mariner Health Care (the parent company), Mariner Health Care Management (the management company) and National Heritage Realty Company (the licensee).  Ms. Sherrod's estate claimed that all entities were guilty of: negligence, violation of the Tennessee Adult Protection Act (TAPA) and medical malpractice.

In making this substantial award, the arbitration panel obviously sent a message to the various nursing entities that they can no longer assume that taking a nursing home negligence matter away from a jury will protect them from liability.  Also, notable was the large award for punitive damages against the facilities especially in light of the more modest awards for other claims.

The 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 Nursing Homes Abuse Blog Entries:

A Legal Victory For Nursing Home Residents. State Laws Can Supersede Federal Arbitration Act

AARP Joins Fight To Preserve Right To Jury Trial

Are Trials Really That Important? 

A Call To Abolish Arbitration Clauses 

Bed Sore Resources

Thousands of people visit Bed Sore FAQ each month to get information related to the care of bed sores (also referred to as decubitus ulcers, pressure ulcers or pressure sores) and to learn their legal rights after a bed sore develops during an admission to a nursing home, hospital, group home, assisted living facility, or residential care facility for the elderly.

Below are the 10 most popular Bed Sore FAQ's according to reader-generated traffic.  If you have a question related to bed sores or are interested in discussing legal options, please fill out the contact form, and I will respond to your inquiry personally.

1. What does a bed sore look like?
2. What are the stages of bed sores?
3. Are there limits on the financial recovery for a person who developed bed sores due to the negligence of a facility?
4. How does the use of the Braden Scale help in the prevention of bed sores?
5. What does a patients albumin level have to do with bed sores?
6. Is it possible to hire a lawyer to prosecute a bed sore case if I don’t have much money
7. What are nursing homes required to do to prevent bed sores?
8. Why is a colostomy needed for patients with severe bed sores?
9. What is a wound vac and how does it work?
10. What is surgical debridement of bed sores?

Still looking for more information?  Bed Sore FAQ is updated frequently and we have many new entries in the works. Also, please check out our new sections including a Bed Sore Resource Section with comprehensive information on the following:

• Bed Sore Glossary
• Bed Sore Treatment Specialists
• Bed Sore Articles
• Bed Sore Research
• Links To Bed Sore Web Sites

A nursing home negligence lawsuit has been filed against Highland Health Care Center and its parent company  Covenant Care Midwest for their negligent care of a patient.  The lawsuit alleges that the patient was admitted to Highland Health Care Center on November 5, 2008 for physical therapy, following a total knee replacement surgery.

During the course of the prescribed physical therapy, the patient developed decubitus ulcers on his back and heel.  The decubitus ulcers became so severe that, surgery was required to help heal the wounds.

The nursing home negligence lawsuit claims Highland Health Care Center made numerous mistakes related to the patient's care and subsequent decubitus uclers, including:

• Failing to notify physicians of the patient's change in medical condition
• Failing to administer treatments prescribed by the physician
• Failing to make observations related to the patient's change in medical condition
• Failing to implement a pressure sore prevention program

The lawsuit is pending in Madison County Circuit Court.  Read more about this nursing home lawsuit here.

In with one problem, out with another...

While I certainly have no way of verifying the facts surrounding this nursing home lawsuit, the facts sound all too familiar.  In cases were nursing homes, hospitals rehabilitation facilities are hyper focused on a specific task, such as physical therapy, other patient needs can often fall to the wayside.  

Nonetheless, skilled nursing facilities have a non-delegable duty to take all feasible measure to prevent development of decubitus ulcers.  In this case, I have a hard time believing that if the facility was indeed performing the specified physical therapy on this patient.  If so, how did the decubitus ulcers develop?

Covenant Care

Covenant Care operates 50 facilities (skilled nursing, assisted living and select therapies) in California, Illinois, Indiana, Iowa, Nevada, Nebraska and Ohio. 

Related:

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

What steps should I take before meeting with an attorney to discuss a case involving bed sores?

How long does it take for a lawsuit involving development of bed sores at a medical facility to be resolved?

What type of legal recourse does a person with bed sores have?

Resource:

Nursing Home Injury Laws

Bed Sore Resources

Harriman Care and Rehabilitation Center is under investigation after the grandson of a resident claims the facility provided such extraordinarily poor care that his grandfather developed advanced bed sores so big, 'you could stick your fist in'.  The grandson, William Brummitt claims the care Harriman provided to residents was so poor that it resulted in harm to both his grandfather, William Williams and his grandfather's roommate, Larry Waldo.

Brummitt claims the facility mistreated Waldo so severely that  he 'had laid in bed for seven days without a sheet being changed.'  'Flies were swarming around his left leg stump, where the femur was exposed," Brummitt added referring to Waldo's amputated legs.

Waldo died on June 25th, from "years of neglect to his health" according to a memo from the Roane County District Attorney. Nonetheless, the complaints from Brummitt prompted an autopsy to be performed on Waldo to help determine if the gangrene and subsequent leg amputations were necessitated by poor nursing care or an inevitable medical necessity.

Interestingly, Mr. Brummitt's mother, Bonnie Brummitt, is the power of attorney for William Williams and has attempted to block her son's contact with the nursing home.  Are William Brummitt's allegations accurate or are they nothing more than an unfair portrayal of care at this Tennessee nursing home?  

Read more about the allegations made against Harriman Nursing Home here.

Signature HealthCARE LLC

Signature HealthCARE is a Florida-based health care company, operating 21 skilled nursing facilities in Tennessee.  Harriman Nursing Home is a 180-bed facility in eastern Tennessee, that concentrates in both rehabilitation and long-term care.

Related Nursing Homes Abuse Blog Entries

Nursing Home Visits. An Opportunity To Conduct Your Own Inspection.

Bedsores: Are You At Risk?

A New Resource For Bed Sores: BedSoreFAQ.com

In cases involving advanced bed sores (also called: pressure sores, pressure ulcers or decubitus ulcers), a wound vac or negative pressure wound therapy can be used to heal the bed sore.  A plastic bandage is used to cover the wound and a tube attached to a vacuum machine draws out moisture. The process can be painful, but the use of wound vacs drastically shorten the healing process and reduce risk of infection.  This is a useful video demonstrating wound vac process.

Nursing Homes Abuse Blog Posts On Bed Sores

Government Report Confirms Pressure Ulcers Harm All Nursing Home Residents; Regardless Of Race, Sex or Age

Pressure Sores In Hospitals On The Rise

Bedsores. Completely Preventable? Absolutely.

"The Nursing Home Says My Dad's Bedsores Were Unpreventable..."

A research study concluded by researchers at Brown University concluded nursing homes with a higher Hispanic populations have higher rates of bed sores (also known as: pressure sores, pressure ulcers, decubitus ulcers) than facilities with less minorities.  The results are detailed in the Journal of the American Medical Association.

The researchers gathered information from the National Repository of the Minimum Data Set, a federally mandated assessment of all nursing home residents and from the Oscar Database System, a survey of all nursing home residents from the Centers for Medicaid and Medicare Services.  Additionally, the Brown study evaluated all nursing home residents over 65 who live in nursing homes in California, New Mexico, Texas, Arizona and Colorado.

The lead researcher of the Brown survey, Vincent Mor, chair of the Department of Community Health, conducted a similar survey in 2007 that concluded African Americans are more likely than whites to live in poor-quality nursing homes.  That study found the disparity of care received in predominately African American nursing homes to be worst in the Midwest.

Read more about the results of this nursing home survey here.

Bed Sores Are A Problem Facing All Nursing Home Residents

A bed sore is an area of skin that breaks down when you stay in one position for too long without shifting your weight. This often happens if you use a wheelchair or you are bedridden-- even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.

A bed sore starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony areas like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.

Despite claims from the health care industry, bed sores are preventable with competent medical care.  Staff in nursing homes and hospitals must to an assessment of those individuals who are at heightened risk for development of bed sores and create a plan for their prevention.  Frequently, a care plan will include: frequent rotation to discourage sitting in one area for long periods, pressure relieving air mattresses and special enhanced nutrition diets.

Our Commitment To Minority Communities

One of the reasons there are higher rates of poor nursing home care amongst minorities is due to barriers in communication.  Nursing homes housing individuals should have staff to help communicate both physician orders to the residents and to communicate resident needs to physicians.  When there is a breakdown in communication, resident safety is jeopardized.

At Rosenfeld Injury Lawyers, we pride ourselves on our commitment to all minorities.  For more than 35 years, we have been honored to represent individuals and families of all races and ethnicity's.  We maintain a Spanish speaking staff and frequently work with translators to zealously represent individuals in the Polish, German, Italian, Japanese, Chinese, Korean and Vietnamese communities. 

We believe all people, regardless of their ethnic background, deserve the finest legal representation available.

Nursing Homes Abuse Blog Entries On Bed Sores:

Government Report Confirms Pressure Ulcers Harm All Nursing Home Residents; Regardless Of Race, Sex or Age

Incontinence Amongst The Nursing Home Population

Over 500,000 Adults Suffer From Bed Sores In Hospitals

A report released by the Centers for Disease Control and Prevention confirmed what many nursing home residents and employees already know-- pressure ulcers are a tremendous problem encountered be nursing home residents of all races, sexes and ages.  The report,"Pressure Ulcers Among Nursing Home Resident: United States, 2004" analyzes information from the National Nursing Home Survey which is comprised of more than 14,000 nursing home residents from across the country.

In 2004, more than one in 10 nursing home residents had some form of pressure ulcer within the year.  Based on the total number of nursing home residents, that translates to more than 159,000 nursing home residents with pressure ulcers (otherwise known as bed sores, decubitus ulcers, or pressure sores).  Stage II pressure ulcers were the most common according to the survey.  Over 35% of the nursing home residents with pressure ulcers had more advanced-- stage III or stage IV ulcers that required special wound treatment.  Even younger nursing home residents, those commonly thought to be somewhat removed from the problem, are at risk according to the report.

The study demonstrates that while it is important to identify nursing home residents who are at risk for development of pressure ulcers and implement preventative techniques, no nursing home resident is immune from risk of developing pressure ulcers and the nursing home staff need to be tuned in to the factors related to pressure ulcer development and treatment.

About Pressure Ulcers

A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.

A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony areas like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.

Despite claims from the health care industry, pressure ulcers are preventable with competent medical care.  Staff in nursing homes and hospitals must to an assessment of those individuals who are at heightened risk for development of pressure ulcers and development a plan for their care.  Frequently, a care plan will include: frequent rotation to discourage sitting in one area for long periods, pressure relieving air mattresses and special high nutrition diets.

Factors increasing the risk for development of pressure ulcers:

• Being bedridden or in a wheelchair
• Fragile skin
• Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow
• Inability to move certain parts of your body without assistance, such as after spinal or brain injury or if you have a neuromuscular disease (like multiple sclerosis)
• Malnourishment
• Mental disability from conditions such as Alzheimer's disease -- the patient may not be able to properly prevent or treat pressure ulcers
• Older age
• Urinary incontinence or bowel incontinence

Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst):

• Stage I: A reddened area on the skin that, when pressed, is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.
• Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
• Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.
• Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

Web Resources For Information On Pressure Ulcers:

Pressure Ulcer, Medline Plus

National Pressure Ulcer Advisory Panel

Staging Pressure Ulcers, Wound Care Information Network

Bed Sore FAQ

My office was recently retained by the family of a woman who developed pressure sores on her buttocks and vagina in a Chicago nursing home.  When asked, the family was unsure if their loved one was technically 'incontinent'.  After reviewing the woman's chart, it was obvious that the woman was incontinent and the nursing home failed to provide properly adequate cleaning and timely changes for this elderly nursing home resident. 

By some accounts, more that 50% of the people living in nursing homes or assisted living facilities may have some type of bladder or bowl control problems.  Although widely used, incontinence can be defined as the uncontrolled elimination of urine or fecal material from the body. 

Incontinence Is Not A Normal Part Of Aging

Despite its prevalence, incontinence is often treatable.  Any resident who has been deemed incontinent should be evaluated by a physician to determine if the cause of the incontinence is physical or psychological.  Once the cause is identified a combination of behavior modification and staff assistance may be of some help.  In other cases, medication or surgery may also help alleviate the incontinence issues.  Diapers or similar undergarments should only be used as a last resort.

Incontinent nursing home residents have an increased vulnerability for developing pressure sores (also called: pressure ulcers, bed sores or decubitus ulcers) for several reasons:

Nursing Home Residents In Denial Of Their Incontinence

Let's face it, there is perhaps nothing more humiliating to a senior than to admit to nursing home worker, whom he or she may not know, that they have lost their ability to control their bladder or bowels.  Consequently, some nursing home residents are hesitant to notify the staff to their situation and may wind up literally sitting in their own waste.

Inadequate Staffing To Properly Monitor And Change Incontinent Residents

All too frequently, nursing home staff try to implement a 'one size fits all' program for incontinent nursing home residents.  This approach is simply not acceptable.  Nursing homes must have a program in effect to monitor each residents changing needs and have staff available to change soiled residents.  Additionally, adequate levels of staffing should be in place to encourage residents who are able to use the toilet.

When urine or fecal material is held against the skin the damp, acidic nature of the wastes cause the skin to become weakened and susceptible to cracking and peeling--literally eroding the bodies natural defenses.  Proper maintenance of the skin, requires the skin to be kept dray and sanitized.  To minimize development of pressure sores, incontinent nursing home residents should:

• Be cleaned regularly with mild soap and lukewarm water
• Be moisturized daily
• Encourage the use of barrier products lotions
• Use proper turning techniques to minimize time spent in one location
• Use positioning devices to alive pressure from bony areas
• Keep the bed elevation as low as possible- this reduces pressure on the sacrum
• Keep residents clean and dry

For more information on incontinence and pressure sores in the nursing home setting:

Overview of Pressure Ulcer Management: An Expert Interview With Carol A. White MS, RN, ANPC, GNPC, DNP(c)

Incontinence in the Elderly: What a Caregiver Should Know

On the heels of the Nursing Homes Abuse Blog's recent discussion regarding an increase in hospital-related pressure sore cases, the Agency for Healthcare Research and Quality released a report further confirming the problem.  Perhaps most the most startling finding from the agency's report is that hospitalizations for bed sores (also called decubitus ulcers, pressure ulcers, pressure sores) have increased by more than 80% from 1993 to 2006.  This increase includes people who were admitted to the hospital because of pressure sores or developed them while being treated for another condition in the hospital.

Among the more disturbing 'highlights' in the report are:

• In 2006, there were 503,300 hospital stays with pressure ulcers noted as a diagnosis--an increase of nearly 80% since 1993.  The pressure ulcer stays totaled $11 billion in hospital costs.
• More than 90% of the pressure ulcer-related hospitalizations were intended to be for medical conditions unrelated to pressure ulcer treatment.
• Compared to stays for all other medical conditions, hospital stays related to pressure ulcers were more often discharged to and long-term care facility and more likely to result in death.
• 72% of adults hospitalized with a secondary pressure sore diagnosis were 65 or older.  In comparison 56.5% of adult patients had a principal diagnosis of pressure ulcers were 65 or older.
• Medicare was the biggest payer for hospital stays related to pressure ulcers- Medicare paid the bills for 3 out of 4 pressure ulcer stays.
• Paralysis and spinal cord injury were common co-existing conditions among younger adults hospitalized principally for pressure ulcers.

Don't let hospitals continue to provide inadequate treatment. Prevention of pressure sores needs to be a priority for hospitals.  If you or a family member developed a bed sore during a hospitalization, we can help.  Rosenfeld Injury Lawyers has successfully prosecuted bed sore cases for more than 30 years.

A lawsuit was recently filed against the Virgil Calvert Nursing and Rehabilitation Center by a former resident.  The lawsuit alleges the Illinois Nursing Home's neglect caused decubitus ulcers to develop a formers resident's body.  The female resident claims the ulcers have caused her to suffer severe pain, disability and extensive medical expenses related to their treatment.  Multiple violations of the Nursing Home Care Act, including failing to administer proper medication and providing the resident with necessary treatment to prevent the development of the decubitus ulcers are alleged

The lawsuit also names SW Management Company, the parent company of the nursing home. According to the lawsuit, SW Management Company was negligent because they failed to operate the home in a way that provided the plaintiff with adequate care.   Specifically, SW failed to properly supervise its staff and failed to terminate employees who were known to be careless, incompetent and unable to comply with the home's policies, the suit states.

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 nurisng home residents, already in a weakened physical state, a small decubitus ulcer may quickly advance to a large wound in a matter of days.

Read more about this nursing home lawsuit filed in St. Clair County Circuit Court here.

A blog reader recently wrote, "The nursing home says my dad's bedsores were unpreventable. Is this the case, or are some bedsores an unavoidable part of living in a nursing home?"

No!  The nursing home is lying to your face is is probably trying to cover their own.  Bedsores, also called pressure sores or decubitus ulcers, are preventable--with proper screening, early detection, and staff involvement.   Bedsores are a widespread problem in nursing homes and hospitals. The development of of bedsores in nursing home patients is really a reflection of poor nursing care than an inevitable part of of the aging process.

A client emailed me this disturbing You Tube video on pressure sores.  The video is graphic, but demonstrates the horrific pressure sores that may develop without proper nursing care.  The video has photos of:

• Pressure sores on hips
• Pressure sores on buttocks
• Pressure sores on feet
• Pressure sores on heels
• Pressure sores on elbows
• Pressure sores on head
• Pressure sores on back
• Pressure sores on neck

As the narrator says, if you have a pressure sore, it is likely the result of neglect.  If this pressure sore developed in a nursing home, long-term care facility or hospital, you likely have a case against them for improper care and are entitled to damages for the resulting medical treatment and pain and suffering amongst other legal rights.

Bed Sore FAQ

Nursing Home Injury Laws: Bed Sores, Pressure Sores, Decubitus Ulcers, Pressure Ulcers

This is not a word association game.  This summarizes my day yesterday.  A world of extremes.

I began my day yesterday going to Whole Foods to pick up a sandwich to propel me on trip to see a client (I hate eating fast food--long before I saw the above movie).  The store had just opened and as I walked to the back of the store where they keep the prepared sandwiches, I was blown away quantity and quality of the meat, chicken and fish behind the glass cases.  The different products were looking fresh and inviting as they sat lined up in perfect rows.  I guess it really stood out yesterday because there were so few other people in the store to distract me.  Everything was pristine.

I then got on a plane to meet with a client and her family.  My client, Nellie, an 82-year-old woman had developed a stage 4 pressure sore on her coccyx within three weeks of her admission to a nursing home. The pressure sore had gotten so bad that she had gangrene in the wound and was transferred to a special wound care wing of the hospital.  

Two to a small room, laid the mostly elderly patients, on their sides faced towards the windows as the staff tried take pressure off of pressure sores on their backside.  The smell of waste and rotting flesh was obvious despite the facilities attempt to cover up the scent with room sanitizers.  Most were incontinent and laid in soiled beds while the hospital tried to get by with an abbreviated weekend staff.  Even with an involved family such as my client's, the people sit and wait for the staff to tend to their needs.  A priest darted around the hall into and out of rooms--it was obvious by the speed at which her worked many of these people were could not spare more than a few seconds.   This was no Whole Foods.

I then got back on the plane and went home and turned on the television.  "Fast food nation' was on. 'Fast food nation' describes how a fast food restaurant chain's desire for bigger, cheaper hamburgers leads a meat packing plant to cut corners and allow fecal material into the hamburger meat.  The restaurant begin to panic when they consider how the public may react if they learn of the contaminated meat.

Why do we insist upon clean well presented food in restaurants and stores yet allow many in our elderly population to sit in facilities where livestock gets treated better?  Can you imagine what would happen to Whole Foods sales if they replaced the richly colored meat with rotting carcasses?

Development of a pressure sore can be devastating for both the individual and his or her family. Frequently, there are questions as to how to properly treat the wound. Before an adequate treatment plan can be developed, it is important to conduct a thorough assessment of the wounds. Below is an assessment compiled by Donna Sardina, RN, MHA, WCC President, Wound Care Education Institute that appeared recently on the McKnight's website:

What should be included in wound documentation to support appropriate caregiving measures?

Assessment and documentation should be carried out at least weekly. The exception is when there is evidence of deterioration, in which case both the wound and the patient's overall management must be reassessed immediately.

When wound complications or changes in wound characteristics are noted, documentation should be completed daily until the wound is stable. Documentation should include at a minimum:

Assessment findings–Type of wound, staging, correct anatomical location, measurements; presence of tunneling/undermining; drainage (amount, color, consistency, odor); wound base tissue (slough, eschar, granulation, epithelialization); wound edges (curled, callused, macerated, detached);  periwound (intact, scaly, induration, edema, redness, warmth, color).

Symptoms of infection–Fever, increased white count, hypotension, general malaise, redness, swelling, induration, streaking, purulent drainage, temperature of surrounding tissue.

Pain–Intensity, location, quality/patterns of radiation and character, duration, variations, patterns, alleviating and aggravating factors, current and past pain management plan, effects of pain, pain goal, physical exam of pain.

If a review of your family member's medical chart does not properly address the above documentation, it is unlikely they are receiving the care necessary to heal from the pressure sore or wound.

New Medicare and Medicaid guidelines will soon put pressure on nursing homes and other long-term care facilities to provide better wound-care for their residents.  Under the revised pressure ulcer regulations (F-314), facilities will be unable to receive reimbursement from Medicare or Medicaid if the agencies deem the pressure ulcer to be avoidable.

According to McKnight's Long Term Care News, up to 28% of all residents in long-term care facilities suffer from pressure ulcer's.  The cost for treatment of pressure ulcers is estimated to be more than $1.3 billion.

Under the current system, nursing homes and long-term care facilities may submit charges for pressure ulcer care to Medicare and Medicaid.  Essentially, there is no economic incentive to provide preventative pressure ulcer care for most facilities.  The new guidelines will put pressure on nursing home owners and administrators to readdress the way they provide care, or they their bottom lines will suffer.

Most facilities wound management guidelines are not adequate.  'Most of the standards are below what is necessary to decrease the incidence of wounds and manage current wounds," according to wound care expert, Margaret Bryant, PT.

The first step in providing better wound care is for facilities to provide better training for their staff.  '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.

Even the most basic pressure ulcer prevention techniques are ignored or done improperly.  In order to prevent pressure sores on heels, off-loading boots are the best choice.  However, the boots must be properly sized and adjusted in order to successfully keep the heel in the air as the boots are intended.  Improperly used boots are ineffective.

Related:

Are bed sores on the heels common?

Bed Sores Continue To Plague Nursing Home & Hospital Patients In All Demographics

Why are patients recovering from a hip fracture susceptible to develop pressure ulcers?

Continue Reading

A client's daughter forwarded this link to me regarding pressure sores (or similarly called pressure ulcer, decubitus ulcer or bed sore). This is a thorough discussion of the subject and is useful to all who have pressure sores or who may be at high risk for developing them. This article appeared on the CNN website.

Bedsores (Pressure sores)
From MayoClinic.com
Special to CNN.com

Bedsores, more accurately called pressure sores or pressure ulcers, are areas of damaged skin and tissue that develop when sustained pressure -- usually from a bed or wheelchair -- cuts off circulation to vulnerable parts of your body, especially the skin on your buttocks, hips and heels. Without adequate blood flow, the affected tissue dies.

Although people living with paralysis are especially at risk, anyone who is bedridden, uses a wheelchair or is unable to change positions without help can develop pressure sores. Pressure sores can develop quickly, progress rapidly and are often difficult to heal. Yet health experts say many of these wounds don't have to occur. Key preventive measures can maintain the skin's integrity and encourage healing. Signs and symptoms

Pressure sores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization dedicated to the prevention and treatment of pressure sores, has defined each stage as follows:

Stage I. 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 II. 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 III. 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 IV. 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.

Causes of Bed Sores

You shift in your chair during meetings, fiddle with the radio when driving, turn a dozen times in your sleep. Every day, without thinking, you make hundreds of subtle postural adjustments that help stave off problems arising from inactivity. But for people immobilized by paralysis, injury or illness, those problems -- including pressure sores -- are a constant threat. Pressure sores usually result from sustained pressure on your body. They're especially common in areas that aren't well padded with muscle or fat and that lie just over a bone, such as your spine, tailbone (coccyx), shoulder blades, hips, heels and elbows.

Because your skin and the underlying tissues are trapped between bone and a surface such as a wheelchair or bed, blood flow is restricted. This deprives tissue of oxygen and other nutrients, and irreversible damage and tissue death can occur. Though the affected tissue may die in as little as 12 hours, the injury may not be apparent for days or even weeks. In some cases, the pressure that cuts off circulation comes from unlikely sources: the rivets and thick seams in jeans, crumbs in your bed, wrinkled clothing or sheets, a chair whose tilt is slightly off -- even perspiration, which can soften skin, making it more vulnerable to injury.

Other causes of pressure sores include: Friction. Frequent shifts in position are the key to preventing pressure sores. Yet the friction that occurs when you simply turn from side to side can damage your skin, making it more susceptible to pressure sores. Shear. This occurs when your skin moves in one direction, and the underlying bone moves in another. Sliding down in a bed or chair or raising the head of your bed more than 30 degrees is especially likely to cause shearing, which stretches and tears cell walls and tiny blood vessels. Especially affected are areas such as your tailbone where skin is already thin and fragile.

Resource:

Bed Sore FAQ

Nursing Home Injury Laws: Bed Sores, Pressure Sores, Decubitus Ulcers, Pressure Ulcers

Continue Reading