Jonathan Rosenfeld's Nursing Homes Abuse Blog : Jonathan Rosenfeld's Nursing Homes Abuse Blog | Lawyer & Attorney : Strellis & Field Law Firm | Bed Sores, Senior Neglect, Elder Abuse, Sexual Abuse: Chicago, Illinois

I guess there's probably a lot a screaming and yelling going on at the Skilled Healthcare Group (SKH) headquarters in California.  Perhaps the anger derives from the miserable looking financial chart for the company showing a whopping 75% decline in price per share in one day!

Another portion of the companies anger is probably being misdirected at the lawyers who defended the company in a class action lawsuit brought against Skilled Healthcare based on systematic under-staffing at 22 nursing homes owned by the corporate giant.  Really, the only people to blame are the managers in the company who intentionally chose to limit that staffing at their facilities.

After hearing months of evidence regarding staffing levels at the nursing homes operated by Skilled Healthcare, the jury awarded the maximum amount permissible under the California Health and Safety Code--- a whopping $671 million to the members of the class. 

The massive jury award is hardly an arbitrary number.  Rather, the compensatory damages were awarded based on a statutory violation of $500 per-patient per-day at the 22 subject facilities for not providing that state minimum staffing of 3.2 hours for each patient living at the nursing homes on a daily basis.

In addition to the compensatory damages, the lawsuit also seeks punitive damages against Skilled Healthcare.  Unlike compensatory damages, punitive damages are intended to punish the wrongdoer for their acts.  The punitive aspect of the lawsuit will move forward in the coming weeks.

I'm sure that it will take some time before any of the plaintiffs involved in this case receive any portion of the recovery, this verdict will likely force nursing home operators to re-evaluate the way they operate and the decisions they make with respect to staffing levels at their facilities. 

Sadly, when facilities are short staffed, nursing home patients suffer.  Under-staffing in nursing homes continually contributes to incidents of nursing home abuse and neglect. 

Dare I say that this verdict may improve the quality of life-- not just for patients at Skilled Healthcare facilities-- but countless other who suffer from systematic under-staffing at other facilities across the country?

Related:

Class Action Lawsuit Against Skilled Healthcare Seeks Damages For Chronic Under-staffing Of Nursing Homes

Under-staffing At Nursing Home Blamed For Pressure Ulcer, Infection & Subsequent Death

Poor Training & Under-Staffing Blamed For The Death Of A Nursing Home Patient Who Died From Injuries Sustained After She Was Dropped By A CNA In A Minnesota Facility

A Recipe For Danger: Nursing Shortage Could Reach 1M By 2020

Minimum Nurse Staffing Ratios

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In times of need, locating necessary information regarding the legal rights and resources for nursing home patients can be difficult and imposing.  In this respect, we are proud to introduce a new resource for patients, families and practitioners looking for a concise compilation of information regarding nursing home laws.  Nursing Home Injury Laws, provides every states':

• Nursing Home Laws
• Medical Malpractice Laws
• State Resources
• Applicable State Code

Additionally, we will be posting regular updates regarding important developments relevant to nursing home care within each state.  Here is a link to Nursing Home Injury Laws.

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Perhaps there is no more visual reminder of abuse or mistreatment than a bruise.  The discoloration is not only ugly in appearance, but it can also be a source of pain for the individual.  Because bruising can be a relatively common occurrence in the elderly, I think its important to learn more about this medical condition and hopefully become better at identifying a bruise due to mistreatment vs. the normal aging process.

What is a bruise?

Bruises can result after an injury, a fall, or even bumping into something. A bruise (contusion) is an injury to the soft tissue that results in broken capillaries which leak red blood cells. As the heart pumps, the blood escapes to the surrounding tissues, creating a bruise. 

Bruises can surface hours or even days after an injury and can also show up on a different part of the body than was injured. Bruises are usually reddish in color at first, turning bluish-black or purple after a couple hours, then yellow, green, or brown as they heal. Because bruises involve skin trauma, they are usually painful for at least the first few couple days. 

How bruises heal.

Bruises fade gradually as your body reabsorbs the blood that leaked from your blood vessels. After an injury, you can take steps to prevent or minimize bruising. This includes applying a cold compress to the injured area, elevating the injured area, and avoiding blood thinning medications if possible. During the healing process, a bruise will fade in color, from bluish-black or purple to a yellowish green to a lighter brown before disappearing. This color change occurs as the body’s white blood cells remove the decayed blood products little by little. In most cases, bruises heal in one to two weeks, but deeper, more severe bruises can last longer. 

Bruising in the Elderly.

Older adults bruise more easily and heal more slowly than younger adults because they have fragile capillaries and thinner skin. This is because as you age, your skin becomes thinner and you lose some of the protective fatty layer that helps cushion your blood vessels. In addition, bruises in older adults can last longer than the usual 1-2 weeks, sometimes lasting for months. 

Certain drugs can also make you more susceptible to bruises, many of which are common medications for older adults. Many older adults take non-steroidal anti-inflammatory medication for arthritis including ibuprofen (Advil, Nuprin) and naproxen (Aleve), which can interfere with blood clotting. Blood-thinning medication such as aspirin, Coumadin (warfarin), and Plavix (clopidogrel) reduce your body’s ability to clot, which can cause increased bruising. In addition, corticosteroids can make your skin thinner, making you more susceptible to bruises. 

Signs of abuse?

Bruises are one of the most common indicators of nursing home abuse and neglect. This is important to note because elder abuse, including physical abuse, is on the rise. Elderly nursing home residents are vulnerable to injuries and abuse because of weakness, illness, and decreased mental cognition. 

Many times the elderly residents who are victims of abuse are unable to alert family or staff of the abuse. They might be too scared to report the abuse or too embarrassed, or even unable to remember the abuse that they were forced to endure because of a cognitive impairment. 

Residents with moderate or severe dementia may be unable to give an accurate description of abuse or neglect. Oftentimes, the context in which an injury occurs is just as important as the injury itself in screening for elder abuse and mistreatment. Because of the serious risks associated with elder abuse, nursing home staff must be properly trained to recognize signs of abuse and closely monitor residents for common signs of injury or abuse, such as bruising. 

In Illinois, if a nursing home suspects that a resident’s injury might have been caused by abuse, the facility must report the matter to the Illinois Department of Public Health, investigate the alleged abuse, and provide a copy of the investigation to the Department. (Illinois Administrative Code: Long-term care facilities – 77 Administrative Code 300.3240 Abuse and Neglect). Nursing home facilities must take all injuries seriously, especially bruises that might indicate abuse (because of bruise location, size, or re-occurrence). 

Oftentimes, it is difficult to determine if bruising is normal, accidental bruising or something worse. In order for facilities to better be able to recognize abuse, the literature must be improved by documenting normal bruising in the geriatric population. This could then provide a point of comparison for nursing home facilities and caregivers when they encounter suspicious bruises. Until then, nursing homes must err on the side of caution, investigating all injuries that seem even slightly suspicious in order to protect our elderly population. 

Although older adults bruise more easily, staff should still be concerned when residents have bruises, especially if they are in patterns or clusters, or the bruises reappear.  The pattern or shape of the bruise can sometimes provide clues as to the cause of an injury (bruises can occur in the shape of knuckles or fingers). Bruises in patterns can indicate the use of restraints (bruises on hips and arms can indicate the use of bed rails, and bruises on the wrists can indicate the use of cuffs). Frequent or serious falls are another common cause of bruising, and can indicate improper supervision of a resident. In order to provide the best possible care, nursing homes must have care plans in place to prevent residents from suffering from accidents and abuse. 

The location of the bruising may also indicate abuse. The most common locations for non-accidental injury are the face, neck, chest wall, abdomen, and the buttocks. A study in the Journal of American Geriatrics Society, Bruising as a Marker of Physical Elder Abuse, reported that bruises occurring as a result of physical elder mistreatment are often large (> 5 cm) and occur on the face, lateral right arm, and back of the torso. 

In another study published in the same Journal, The Life Cycle of Bruises in Older Adults, the study revealed that almost 90% of accidentally acquired bruises in adults aged 65 or older occur on the extremities. In a sample of one hundred adults aged 65 and older, there were no accidental bruises on the neck, ears, genitalia, buttocks, or soles of the feet. And, if the bruise was on the trunk (torso) of the body, the subjects were more likely to know the cause of the bruise. 

Therefore, nursing home staff should pay particular attention to bruises that occur on a resident’s face, arm, and back because these areas have been shown to have the greatest incidence of bruising in cases of mistreatment. 

If you notice bruising on a family member who lives in a nursing home, you should ask the staff members about the cause of the bruising. Elderly adults are vulnerable to abuse and neglect and every effort should be made to prevent or stop mistreatment. 

Resources:

Mayo Clinic: Easy Bruising, Common As You Age

Medicine Net: Bumps and Bruises

Kansas University Law School: Elder Abuse in Nursing Homes, Does Bruising Tell a Story?

Journal of the American Geriatrics Society: Bruising as a Forensic Marker of Physical Elder Abuse

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In an effort to identify instances of nursing home abuse and neglect, the Illinois Department of Public Health has implemented a death reporting program in ten counties in Illinois.  The pilot program requires nursing homes to immediately report nursing home deaths to the county coroner.  Once reported, it is up to the county coroner to investigate the facts surrounding the death and determine if the death was related to nursing home abuse or neglect.

From July 1, 2007 through June 30, 2008, 8 suspicious deaths were attributed to mistreatment in nursing homes out of a reported 3,669 total nursing home deaths.  The pilot program empowered coroners to investigate deaths by phone, fax, or in person each and assess if abuse or neglect might have contributed to a resident's death.   The pilot program ran in the Illinois counties of Champaign, Effingham, Kane, Kankakee, Lake, LaSalle, Lee, McLean, McHenry and Morgan. 

Of the eight deaths that were attributed to improper nursing care, several fines were imposed against the facilities by state and federal authorities.  In Champaign County, the coroner's tip-off resulted in federal officials imposing a fine against the Champaign County Nursing Home of $13,600 for the death of a 94-year-old woman who died from a pulmonary embolism shortly after fracturing her leg during a transfer out of bed.  Also in Champaign County, the coroner's tip-off lead to a $52,500 state fine was imposed against Pleasant Meadows Christian Village Nursing Home for improper treatment of a resident's bedsore that had advanced to sepsis and ultimate death.

Richard Dees, Chief of Public Health's Bureau of Long-term Care, says it appears the project failed to show that a state law requiring nursing home death reporting and investigations would have a 'conclusive' benefit.  Pointing to the relatively small number of suspicious deaths reported by local coroners.

Arkansas and Missouri are currently the only states that require nursing homes to report all nursing home deaths to local coroners.  In Illinois, it is left to the coroner's discretion as to investigate the death.  Most coroners and medical examiners only investigate nursing home deaths if the family requests they do so or if criminal activity is suspected.  Sadly, the failure of the state to implement any laws mandating the report of nursing home deaths will result in countless cases of improper nursing home care--especially cases of nursing home neglect-- that will forever go undetected. 

Read more about this pilot program for Illinois Nursing Homes here.

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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.

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In situations where there has been a specific incident involving a serious injury or abuse, the nursing home resident themselves or their family will seek out the advice of a nursing home attorney for representation.

The majority of nursing home neglect cases are far more subtle and many people are hesitant to seek out an attorney.  The best rule of thumb is to trust your instinct.  If something doesn't seem right--it's probably not.  Because most cases of nursing home neglect involve ongoing mistreatment, it is important to contact an attorney when you begin to suspect the nursing home may be treating your loved one improperly. 

Pay attention to the physical signs.  Most elderly are hesitant to report situations involving nursing home abuse or neglect and may be scared to confront the people responsible for providing their care.  Patterns of injury should not be tolerated.  Repeated falls, bruising, cuts or infection deserve to to investigated as they are easily preventable situations that are indicative of staffing problems at a facility.

Statute of limitations, or specific time allotments, govern how much time one has to bring a lawsuit against the nursing home or long-term care facility.  Statute of limitations may provide years for pursuing a cause of action.  However, the sooner an attorney is contacted, the sooner an investigation can be started to determine what may have caused the injury or abuse.  Many cases involving nursing home abuse, neglect or injury require the review of extensive medical records and expert witness consultation--time consuming practices to say the least. 

Even in situations where there may seem to be a lack of evidence to prove neglect on the part of the nursing home, an experienced nursing home attorney will be able to sort through the evidence and determine if there is a case and how to proceed.  Most nursing home attorneys work on a contingency fee, meaning they only receive a fee if they are successful in obtaining compensation for the injured party.  No out of pocket expenses are required on behalf of the client. 

There has been a recent trend, in some situations involving severe injury, where the nursing home or hospital may seem to take responsibility for an injury.  Representations may be made by the staff at these facilities that they will 'do whats right' to remedy the situation.  Don't be lulled into believing this song.  Rarely --if ever -- do these individuals really have the interests of the injured party in mind.  Moreover, without the consult of an attorney well versed in what damages an injured person is entitled to receive, the nursing home or hospital will use its uneven bargaining position in its favor.

If you or a loved one suspect the nursing home, long-term care facility, home nurse or hospital may have caused or contributed to an injury or situation involving abuse, why not speak to an attorney who has your interests in mind without any charge to you?

Resource:

Nursing Home Injury Laws

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 A video has surfaced regarding a recent blog post that shows nurses at a New York nursing home abusing and neglecting their residents.  The use of video camera has lead to 26 arrests of nursing home workers.  It is scary to think what other criminal acts these nurses may have done in the course of their employment that WAS NOT caught on tape.

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Eyes On Living had an interesting blog post recently 'Florida Nursing Home Abuse Lawsuits Increasing Thanks To Aggressive Lawyers.'  The article is a little tongue in cheek with respect to how attorneys want to help victims out of the kindness of their own heart, but the author does acknowledge that lawsuits filed in states with a substantial elderly population has actually improved the quality of nursing home care.

This got me thinking about the impact of nursing home litigation has on the overall care received by nursing home residents.  Do nursing home lawsuits have an impact on the quality of nursing home care?  The answer, in my eyes, is a resounding 'yes'. 

Sure, we all hear about juries awarding people with superficial injuries large awards and the recipients going out and spending their awards on lavish things.  The reality of the overriding majority of nursing home injury cases, it that many of these people have been downright neglected or abused and their lives have been forever changed by the acts of nursing homes for the worse.

For many victims of nursing home abuse and neglect their golden years have become anything but happy and satisfying.  Too often, the lives of seniors have been cut short or painfully altered by the acts of facilities that were intended to care for them.  

The purpose of the Nursing Home Care Act in Illinois is similar to laws in place in Florida and Texas--it is intended to help residents of nursing homes and other long-term care facilities from being taken advantage of and ultimately injured.  These laws also allows for attorneys to recover their legal fees if they are successful in their case against the nursing home.

Bad nursing homes are being forced to change their ways.  Many facilities that once cut corners with respect to patient safety can longer do so or they face claims and lawsuits for serious injury.  If improving patient safety and care means that some facilities are forced to close their doors, in the long run we all will be better off.  

Excuse me while I go look look for a billboard...

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California Governor, Arnold Schwarzenegger recently signed a state budget for California that cuts funding for local ombudsman programs.  Ombudsman programs investigate complaints of nursing home abuse and nursing home neglect and provide training for nursing home staff on how to prevent abuse.

The budget cuts will make it harder to respond to nursing home complaints and protect the rights of residents in long-term care facilities, according to Kathleen Johnson of Advocacy Inc.  Advocacy Inc. operates an ombudsman program in two counties in California and oversees approximately 2,500 nursing home residents in 44 facilities.  All of the facilities in the two counties have been cited for deficiencies during inspections.  Johnson goes on to say,

"The governor makes it clear that the most vulnerable and least visible population in our state does not merit protection, advocacy respect or a voice."

As the credit crisis on Wall Street spreads to Main Street, look for similar nursing home-related budget cuts in your state.  As Ms. Johnson points out, many nursing home related budget cuts are first in line because residents are tucked away out of the publics' view.  Read more about this potential problem for California nursing home residents here.

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How real of a problem is under-staffing in nursing homes?  I came across this post from the Nursing Home Reality blog from a nurse who works at a 200 bed facility.

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I came across this article regarding the abuse of Alzheimer's patients at a Minnesota Nursing Home --the extent of mistreatment makes me sick.  According to a Minnesota Department of Public Health report, 15 residents of the Good Samaritan Society Nursing Home fell victim to ongoing physical and psychological abuse of 4 teenage nursing assistants.  Since the results of the investigation have been disclosed, the employees have been terminated.

The employees were terminated party due to cooperation of a 5th teenage girl implicated in the investigation.  According to the teenage girl, the foursome victimized residents suffer from dementia or related disorders such as Alzheimer’s disease. The report alleges the following incidents of physical abuse and neglect:

• spitting in mouths
• poking breasts and nipples
• putting fingers in mouths
• touching and tapping genitals
• sticking rear ends in faces
• rubbing buttocks
• rubbing penises
• touching perinea
• anal insertion
• holding residents down
• teasing residents

This story is important because it demonstrates a culture of neglect that has developed in many nursing home.  The fact that multiple employees were involved in this incident makes me very skeptical that the nursing home administrator knew nothing if this criminal behavior.  Adding fuel to the fire, an employee told investigators that two of the girls had been “bragging about this for the past one to two months.”

There are 230 Good Samaritan Society locations nationwide, with several across Minnesota. Its full name is the Evangelical Lutheran Good Samaritan Society, but it is not part of the Evangelical Lutheran Church of America. The nonprofit company is based in Sioux Falls, S.D.

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There are many daily occurrences that occur in nursing homes that beg the question: what in the world were they thinking?  Everyday we hear about tragic incidents that are preventable not only with proper medical training, but plain old common sense. 

Some recent stories make me question the intelligence and sincerity of the people who work in nursing homes.  I mean everyone knows that: people need water, if you leave people laying in bed for days they will develop bedsores, sexual predators probably shouldn't be living amongst around the elderly, a bed-bound person will have a difficult time running out during a fire and nursing home residents require ongoing care.

Lara Pettiss Harrill of the South Carolina Nursing Home Blog, drives home nursing home residents' needs for basic care in her recent post on a Belleville, Illinois nursing home resident who filed a lawsuit after he contracted gangrene on his penis.  Ms. Harrill sums up the nursing home care issues faced by residents who suffer from nursing home neglect on a daily basis;

'Bottom line is, this gentleman was in a nursing facility, presumably because he needed nursing care - presumably because he needed assistance with activities of daily living, like bathing, dressing and using the bathroom.  What on earth were the employees doing (or not doing) that they could miss something like gangrene . . .'

The above situation further demonstrates a culture of neglect that has developed in many nursing homes where employees willingly ignore critical health problems and hope the worker on the next shift does the routine work they should have done.  Gangrene does not develop overnight.  Dare I say to the entire staff at the Calvin Johnson Care Center, 'what were you thinking?'

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Nursing homes, hospitals, and long-term care facilities should have 'call lights' for residents to get the attention of the staff.  Most call lights are connected to patient beds.  The call lights should be located within easy reach of the residents and the calls should be responded to promptly by staff.  Most call light systems are connected only to a central nursing desk.  As a result, some 'call light' pages may go unanswered or responses to the call lights may be delayed if the staff is not in close to the desk.

A newer call light system, utilizing pager technology would help staff respond quicker to residents requests.  Yet other call light systems allow residents to carry pagers which prompt nursing home staff to respond to a page regardless of where the residents it.  A mobile pager would be especially helpful for dealing with nursing home falls.

Look at the full Salt Lake City Tribune article here.

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