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

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.

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In December 2008, the Illinois Department of Public Heath (IDPH) completed a survey of Rockford Healthcare & Rehab Center, located at 1920 North Main Street in Rockford, Illinois.  Finding significant problems with the facility, it issued a notice of a Type A violation and a fine of $15,000.

IDPH found that Rockford Healthcare & Rehab Center failed to monitor residents who were at risk for pressure sores or to follow physician directions for care of pressure sores.  As a result of their failure to implement prvention techniques, some residents suffered from worsening conditions and developed new pressure ulcers during their admission. 

The IDPH also faulted the facility for inadequate supervision.  On one occasion, two residents wandered off without the knowledge of staff after the residents got into an elevator with a visitor and walked straight past a receptionist who assumed the residents were also visitors.  One resident was found outside the building, smoking a cigarette.  The other resident, a woman with Alzheimer’s who was known to be a wanderer, had left the facility and was found walking along a four-lane state highway without a coat on a rainy night when the wind-chill temperature was just 29 degrees.

Rockford Healthcare & Rehab Center is a for-profit nursing home with 97 Medicare/Medicaid-certified beds.  The U.S. Department of Health and Human Services, which operates a “five-star” rating system for nursing homes, gave the facility a below-average overall rating of “two-stars.”  It gave just one-star in the area of health inspections, noting that 62 health deficiencies were found in December 2008 (the Illinois average is eight health deficiencies).  Of particular concern are findings of immediate jeopardy to resident health and safety from treatment and prevention of pressure sores, “dangers that cause accidents,” and the absence of a doctor as a medical director and of a group to review and ensure quality. 

If you are concerned about the treatment of a resident at Rockford Healthcare & Rehab Center, call us at (888) 424-5757 for a confidential consultation.

Related Nursing Homes Abuse Blog Entries

Who Regulates Nursing Homes?

First Quarter 2009 Illinois Nursing Home Violators Released 

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

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Following a trial and appeal, the family of Alice Limbrick has reached a settlement with the assisted-living facility where she was a resident.  In the lawsuit (Roy Limbrick et al v. Mariner Health Care, Inc.), the deceased woman's family claimed both the assisted living facility where she was a resident and a hospital where she underwent medical treatment, were negligent in allowing her to developed pressure sores that ultimately led to the amputation of her legs. 

Following the fall and resulting hip fracture at Green Acres Parkdale, Limbrick was admitted to Baptist Hospitals of Southeast Texas where she underwent medical treatment for her hip fracture.  It was during admission to the hospital, Limbrick developed pressure ulcers and blisters on her heels and left leg. 

Despite the pressure ulcers, Limbrick was discharged from the hospital and sent back to Green Acres for rehabilitation of her hip.  At Green Acres, the pressure ulcers on Limbrick's heels worsened, necessitating a re-admission to Baptist Hospital with a diagnosis of gangrene on both heels.  As a result of complications related to the pressure ulcers, both of Limbrick's legs were amputated below the knee. 

At trial the assisted living facility argued the family was partially responsible for their mothers medical condition because they did not sent her to an acute facility.  Additionally, the facility claimed the amputations were unpreventable as Limbrick suffered from a variety of debilitating medical conditions such as: a weakened immune system, diabetes, poor circulation, Alzheimer's and general old age.

Despite the assisted living facilities arguments, a jury recognized the the facilities negligence in failing to properly treat the pressure ulcers and awarded the family $80,000 for past mental anguish, $20,00 for past medical expenses and $300,000 for past disfigurement and impairment damages.  It is unknown what the actual settlement between the parties entered into during the appeal process.  The case against the hospital was resolved prior to trial. 

Cases involving elder neglect and abuse commonly involve multiple parties.  When proceeding in a claim against multiple parties it is important to put together a time-line to differentiate what facility was rendered care to the individual at the particular time.  It is also helpful to consult with an expert, such as doctor or nurse, to determine what the individuals condition was both at the time of admission and the time of discharge from the facility.

Read more about this lawsuit involving a Texas nursing home here.

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Rarely do nursing homes have isolated problems.  Rather, problems with patient care usually stem from a culture of poor staff training and under-staffing.  Case in point-- The Summerville at Potomac nursing facility in Maryland.  Following a routine inspection, state and county nursing home surveyors discovered numerous violations governing patient care in nursing homes.  Among the violations, the surveyors discovered: improperly care for pressure ulcers, mismanaged patients' medication, lack of fall precautions for patients prone to falling and patients with excessive weight gain and loss.  

According to Wendy Kronmiller, director of the Maryland Department of Health and Mental Hygiene's Office of Health Care Quality, many of the reported problems can be attributed to a lack of coordination of care.  The survey found that Summerville lacked a delegating nurse to monitor care of each resident. Despite state laws that require a delegating nurse to visit the facility every 45 days, no delegating nurse had visited the facility for months.

In addition to receiving a $10,000 fine and a ban on admission of new patients, the facility was ordered to complete a six-point 'directed plan of correction'.  The plan includes the following mandates:

• Appointment of a full-time registered nurse
• Conduct an examination of each patients skin
• Hire a wound care specialist to address pressure ulcers
• Hire a monitor to report conditions to officials
• Notify residents families about the conditions found in the survey

Obviously the nursing home's decision to provide a 'bare bones' staffing of the facility had a drastically negative impact on patient care.  Nonetheless, a $10,000 fine still seems like little more than a slap on the wrist to a publicly traded corporation that owns the facility. The Summerville at Potomac is owned by Emeritus Corporation.  Emeritus owns and operates 289 nursing homes in 37 states.  Read more about this Maryland Nursing Home here.

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By the time a pressure ulcer has progressed to Stage 4, the wound is deep the muscle and bone in the area is involved--usually decayed.   Frequently, infection can develop in the dead tissue impeding the healing process.

Advanced stage pressure ulcers need to be free of dead or damaged tissue in order to heal. Even with the most attentive medical care, some pressure ulcer's require surgical intervention.  Surgical Debridement is when a surgeon uses a scalpel to remove the dead tissue, bone and fluid from the area around the pressure ulcer. 

Debridement of the pressure ulcer may be accompanied by 'flap reconstruction'.  Flap reconstruction is when tissue is harvested from the persons body to cover the open wound.  The goal of the reconstruction is to improve the hygiene and appearance of the wound and and reducing the risk of further infection.

Surgical treatment of pressure ulcers has one of the highest complication rate of any surgical procedure.  Recovery from the procedure is time intensive and painful.  Therefore, the use of surgical intervention to treat pressure ulcers is usually considered to be a last resort.

Pressure ulcers are preventable.  If your loved one has developed a pressure ulcer while a resident of a nursing home, hospital or assisted living facility, contact the the team at Strellis & Field.  We can  help determine what parties may be at fault and advise you of your rights.

Resources For Pressure Ulcer Treatment

Emedicine: Pressure Ulcers, Surgical Treatment and Principles

Mayo Clinic: Bedsores. Treatments and Drugs

Related Bed Sore FAQ Entries:

What is mechanical debridement of bed sores?

What is chemical debridement of bed sores?

What is biological debridement of bed sores?

What is surgical debridement of bed sores?

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