Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Too we look to environmental causes of falls....cluttered hallways...improperly footwear...yet in many fall-related situations the real 'cause' of the fall lies within the person herself...

Hypotension (low blood pressure) is a problem for many nursing home residents, causing dizziness and fainting. Blood pressure readings measure the pressure in arteries - systolic pressure (the top number in a reading) measures the pressure the heart generates when pumping blood out to the rest of the body and diastolic pressure (the bottom number in a reading) measures the amount of pressure between heartbeats. A systolic blood pressure of 90 millimeters of mercury or less or a diastolic blood pressure of 60 millimeters of mercury or less is considered low.

Orthostatic hypotension, also known as postural hypotension, occurs when a person’s blood pressure drops after changing position from lying down or sitting to standing as blood pools in the legs leaving less blood to circulate back to the heart. In the elderly, orthostatic hypotension can be caused by changes in blood pressure regulation due to aging, dehydration, and certain medications.

Common causes of orthostatic hypotension include dehydration, medications, heart problems, diabetes, and nervous system disorders; all of which are common in the elderly. Dehydration can occur easily in nursing homes because of sickness or inadequate care. Also, many drugs commonly prescribed to the elderly including diuretics, high blood pressure medication, heart medication, and drugs to treat Parkinson’s disease can all cause orthostatic hypotension.

Orthostatic hypotension is more common in older adults, with over 15% of persons 65 and older suffering from it. In addition, about 50% of elderly nursing home residents suffer from orthostatic hypotension. Elderly patients, especially those who are heavily medicated or have prolonged bed rest, are especially at risk. Nursing home patients are also at risk for dehydration if they do not receive adequate care.

Orthostatic hypotension can cause dizziness, light-headedness, blurry vision, nausea, and fainting, which can cause dangerous falls. Elderly persons are particularly vulnerable to falls because of weak bones and complications from other health problems. Orthostatic hypotension can also cause strokes due to the changes in blood pressure and mental impairment because of brain damage.

Elderly nursing home patients should be properly diagnosed by a physician because not all dizziness is caused by orthostatic hypotension. If properly diagnosed, extra care can be taken with patients to prevent dangerous falls. Nursing home staff should take added precautions in the morning, when residents are first getting out of bed because that is when they are most at risk for a drop in blood pressure. The staff should also ensure that elderly residents are adequately hydrated, avoid hot weather, stand slowly, increase salt intake, and even apply compression stockings to help reduce symptoms. These simple steps can make the difference between a healthy and safe nursing home resident and one injured by a severe fall.

If your loved one suffered a nursing-home-related-fall and are looking for an explanation, one of the fist areas that should be analyzed is to see what medications the individual was taking.  Nursing home staff has a duty to do an assessment of all residents-- including a medication review--- to determine their 'risk' of falling.  A failure to do such an assessment-- or if it was improperly conducted opens the facility to potential fall-related liability.

Sources:
MayoClinic.com – Hypotension
MayoClinic.com – Orthostatic hypotension
Merck – Orthostatic Hypotension

Thanks to Heather Keil, J.D. for her assistance with this article.

 "How long do I have to bring a case against a negligent nursing home?"

The answer depends on where the incident took place.  The time to bring a lawsuit against the a nursing home is governed by the statute of limitations where the incident occurred.  Most states have specific statute of limitations for personal injury and nursing home cases.  The statute of limitations can vary tremendously by jurisdiction.  Some states have statute of limitations as short as one year from the date of the injury and other states permit a cause of action to be brought up to eight years from the date of the injury.  Statute of limitations are strictly interpreted.  If you fail to bring a lawsuit within the statute of limitations you will be forever barred from recovery.

This underlies the importance of contacting an experienced nursing home attorney shortly after an incident occurs.  Further, in many situations it is important to file a lawsuit far earlier than the statute of limitations allow in order to determine all of potentially responsible parties.

Resource:

Nursing Home Injury Laws

Most people use Power of Attorney and Power of Attorney for Healthcare interchangeably.  A Power of Attorney delegates who you wish to make healthcare decisions should you become unable to do so.  You may specify what life extending procedures, if any, you desire.  You may further specify the dates which the Power of Attorney is to become effective or terminate.  Many hospitals and nursing homes require a Power in order to obtain medical records for a disabled family member.

Here is an Illinois Power of Attorney.  This form must be witnessed and notarized.

End of life decisions are a difficult and often awkward decision for people to make.  However, an open discussion on the subject will provide immediate family members with the ability to make informed decisions when they need to.

A DNR order does not give a nursing home the right to withhold medical treatment.  Similarly, if no DNR order is on file, a nursing home must provide CPR to a resident in cardiac arrest.   With or without a DNR order in place, nursing home residents have a right to proper treatment that meets their daily living needs.

A 'Do-Not-Resuscitate Order'  (most commonly referred to as a 'DNR' order) is a medical treatment order stating that cardiopulmonary resuscitation (CPR) will not be attempted if your heart and/or breathing stops.

Before a DNR order may be entered into your medical record, either you or another person (your legal guardian, health care power of attorney or surrogate decision maker) must consent to the DNR order. This consent must be witnessed by two people who are 18 years or older. If a DNR order is entered into your medical record, appropriate medical treatment other than CPR will be given to you.

In addition to properly executing the legal document, it is also important to let your family, physicians, and your attorney aware of your decision to make one or more advance directives or a DNR order. If your family is aware of your advance directives / DNR orders, it will be easier for them to follow your wishes at a time when you may be unable to communicate them. If you cancel or change an advance directive or a DNR order in the future, remember to tell these same people about the change or cancellation.

All hospitals, long-term care facilities and nursing homes must follow your advance directive decisions.  It is entirely your decision. If a health-care facility, health-care professional or insurer objects to following your advance directive or DNR order then they must tell you or the individual responsible for making your health-care decisions. They must continue to provide care until you or your decision maker can transfer you to another health-care provider who will follow your advance directive or DNR order.

A form DNR order is here.

Definition: A traumatic brain injury (TBI) is a blow to the head that results in a disruption of the normal brain functioning. TBI's may range from a brief change in cognitive functioning to an extended period of unconsciousness. (Source: National Center for Injury Prevention and Control) TBI's are some of the more common injuries sustained by nursing home residents.  TBI's are most common in the elderly population. 

Facts: How common are TBI's:

• 1.4 million American have a TBI each year
• 52,000 deaths per year
• 235,000 hospitalizations
• 1.1 million emergency room treatments

It is a surprise to most people that people 75 and older compose the largest group of TBI patients.  Further, most TBI's result from falls or physical abuse.  (Falls and nursing home abuse)

Consequences:  It is very difficult to measure the consequence / fallout from TBI's.  TBI's have very different symptoms in every person.  While some people who may have a TBI and be able to function, other may suffer from significant cognitive and psychological impairment.  A TBI may effect sensory motor, and automatic functions.  While most of the effects of a TBI may be apparent within a day or two from the initial trauma, many long-term effect do not become apparent until long after the traumatic event.

Treatment: Many elderly who suffer from TBI's require extensive rehabilitation and physical therapy.  The cost of the rehab is significant-- some treatments costs are projected to exceed a million dollar.  The most important treatment is diagnosis.  All treatments are most affective if implemented soon after the initial injury.  In addition to physical therapists and physicians, neuropsychologists are very important in developing a care plan for TBI patients.

For additional information on TBI's look here.