California Elder Law Attorney Blog

Is there existing legal protection for patient safety information exchanged across institutional boundaries?
Federal protection 42 U.S.C. §299c-3(c)

Perhaps the most promising source of existing Federal protection for safety information exchanged across institutional boundaries lies in 42 U.S.C. §299c-3(c), which specifies that information collected in the course of activities sponsored or supported by the Agency for Healthcare Research and Quality (AHRQ) may not be used for any purpose other than the purpose for which it was supplied. Although the data collected by AHRQ-sponsored entities are clearly protected under 42 U.S.C. §299c-3(c), it is uncertain whether that protection extends to data collected in the course of AHRQ-sponsored activities, but which are later disseminated to other organizations, i.e., other members of a regional health care safety consortium for non-AHRQ-sponsored safety activities. ,

If individuals inside a health care institution are gathering identifiable medical error information as part of AHRQ-supported grant or contract research, and it is conveyed outside the institution, e.g., for analysis in an AHRQ-supported central databank, even if the reporters lost their protection against being subpoenaed to testify under State law, the Federal statute would cover and protect the identifiable information they acquired pursuant to AHRQ's statutory research authority.

When a AHRQ-sponsored entity collects the data, and in turn disseminates such data to non-AHRQ-sponsored entities. AHRQ protection may be attenuated if non-AHRQ-sponsored entities collect patient safety data and the AHRQ-sponsored entity acts only as a repository or an intermediary that then disseminates such data to other non-AHRQ entities. Protection under this statute also requires that at least one member of a safety consortium, preferably the member collecting the data, be AHRQ-sponsored. Notably, Federal grantees often have some discretion to alter the nature and scope of funded projects beyond that outlined in their original funded proposal. It may be reasonable to postulate that such expansion to include additional safety initiatives and institutional participants would have similar protection.

42 U.S.C. §241(d)/DHHS certificates of confidentiality
Another possible source of legal protection for patient safety information exchanged among health care organizations lies in 42 U.S.C. §241(d), which states that the Secretary of Health and Human Services may authorize persons engaging in research to protect the identity of research subjects by withholding from all persons not connected with such research the names and other identifying characteristics of such individuals.3 Persons so authorized may not be compelled in any legal proceeding to disclose identifying information of such individuals. By its terms, however, the protections mentioned above only apply to the identity of research subjects, or to data that would allow possible identification of such individuals. It seems then, that patient safety data that are de-identified per (for example) the medical privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) would still be potentially ascertainable, although the utility of such data may be limited. The question also arises as to whether this provision of law applies to patients who have presumably not consented to becoming patient safety research subjects. Additionally, since the purpose of this law is to protect patients' privacy, patients may be able to waive the protections of 42 U.S.C. §241(d) as to their own information, which they presumably would do if they were plaintiffs in a malpractice lawsuit. The protections of 42 U.S.C. §241(d) also necessitate an application to the National Institutes of Health (NIH), a division of the Department of Health and Human Services (DHHS), for a "Certificate of Confidentiality." While readily obtainable, such a certificate may generate a false sense of security, as cases interpreting §241(d) are few in number and the validity of the statute has never actually faced challenge.4 Furthermore, none of the questions mentioned above has yet been answered by any binding authority.

Conflict of 42 U.S.C. §§241(d) and 299c-3(c) with FRCP 26(a)
No court has yet had occasion to interpret §§241(d) and 299c-3(c) in light of existing Federal law. In addition to the various legal challenges that either statute may face, both may conflict with existing Federal discovery requirements. Per the Federal Rules of Civil Procedure (FRCP), a defendant is required to disclose all information he or she may use to support his or her defense, as well as the locations and custodians of such information. An argument could be made that a defendant could be required to disclose protected information if that defendant reviewed protected information in support of his or her defense.

However, §241(d) states that persons "so authorized may not be compelled in any Federal, State, or local civil, criminal, administrative, legislative, or other proceedings to identify such individuals." Section 299c-3(c) states that identifiable information may not "be used for any other purpose than for which it was supplied." Thus, Federal law in this area appears contradictory, a conflict that no court has yet resolved. While FRCP Rule 26(d) states that privileged materials are not discoverable, FRCP Rule 26(b)(5) states that to assert a privilege in Federal court, one must describe the nature of the privileged material sufficiently to allow a fact finder to assess its applicability.4 However, in these circumstances, even materials not admissible in court may still be subject to discovery as long as they are "reasonably calculated" to lead to admissible materials. This could include any information relevant to a patient injury, including patient safety information and the location of that information, such as the specific consortium members who hold the data and have provided the reports. Hence, under general discovery rules, protection of safety information may be limited due to the low threshold required for access to consortium information.

State law protections: California peer review/quality assurance privilege:
Peer review is defined as "[t]he concurrent or retrospective review by practicing physicians or other health professionals of the quality and efficiency of patient care practices or services ordered or performed by other physicians or other health professionals." says California Eler law Attorney Steven C. Peck. In all States, the peer review privilege protects the proceedings and records of peer review committees from civil discovery or subpoena in actions where staff privileges are not at issue. The issue of peer review privilege arises in the context of exchanging patient safety data among health care organizations in one of two ways. The first issue is whether exchanging patient safety data would constitute an implied waiver of any existing peer review protection to which the reporting health care provider might be entitled.The second is whether the peer review privilege is interinstitutional, i.e., whether it applies to consortia composed of health care institutions engaging in peer review-like activities, but on a multi-institutional basis. indicated California Nursing Home Abuse and neglect Attorney Steven C. Peck.

No waiver of peer review in California
In California, the law may allow implied waiver of evidentiary privileges by third party disclosure. However, a review of the medical peer review cases under Evidence Code §1157 appears to indicate that peer review is considered "an immunity," rather than a "privilege," and hence is not subject to waiver in specified circumstances. indicates California Elder Abuse Attorney Steven C. Peck.For example, beginning in 1974 with Matchett v. Superior Ct., it was held that "§1157 establishes an immunity from discovery rather than an evidentiary privilege." While the court in Matchett made no mention of waiver, this distinction became important in subsequent cases. In Newhall v. Superior Ct., the court specifically addressed the issue of "whether or not a hospital waives the immunity from discovery provided in Evidence Code §1157... by filing a transcript of its staff committee hearing in an unrelated administrative mandamus proceeding...." The plaintiff contended that by voluntarily filing a copy of the staff committee transcript in the administrative action, the hospital had waived any privilege provided by California Evidence Code §1157. The court found that there was no waiver of §1157 and stated that "to hold otherwise would render hollow immunity provided in section 1157 and subvert the underlying public policy of section 1157...." The court, however, held that the hospital must assert the protection in "timely and in proper form." So while holding that §1157 was not waived in this case, the court also established at least some constraints on peer review protection, including timeliness and form.

The next California case to address the issue of waiver was West Covina v. Superior Ct. Here, the appellate court specifically referred to the principles of waiver in its analysis, stating that "[t]he idea that an individual may 'waive the [peer review] privilege' is incongruous to the provisions and purpose of the statute." On appeal to the California Supreme Court, however, the majority reversed, holding instead that §1157 was inapplicable to voluntary testimony, thereby avoiding any further waiver analysis.The dissent in the California Supreme Court opinion reiterated the language of Matchett, stating that §1157 "creates for the protected material an absolute immunity from discovery...."

In the fourth case to address the issue of waiver, University of Southern California v. Superior Ct., the plaintiff, a surgical resident alleging wrongful termination, sought to compel production of records of her evaluation along with evaluations of other residents, terminated or otherwise. When the defendant only produced records pertaining to the plaintiff, the plaintiff contended that "by producing records relating to her personally, USC waived the discovery exemption in section 1157." The court responded by again distinguishing between evidentiary privileges and immunities, stating while "some decisions use the word 'privilege' to describe the exemption from discovery set forth in section 1157." The court responded by again distinguishing between evidentiary privileges and immunities, stating that while "some decisions use the word 'privilege' to describe the exemption from discovery set forth in section 1157... '[p]rivileges' are covered by Division 8 of the Evidence Code, which contains familiar section 912 regarding waiver of privilege. Section 1157, by contrast, is contained in Division 9...." The court went on to state that any waiver analysis was inapplicable since "[s]ection 1157 clearly does not create a privilege,"12 thereby implying that immunities were not waivable. The court, however, did not go so far as to state that §1157 immunity could never be explicitly waived, instead stating that assuming a waiver doctrine of some kind did apply, waiver would necessarily have to involve all those protected by §1157, including the committee members, physician reviewers, and other resident surgical trainees who were reviewed.

More recently, the California Supreme Court again addressed this question in Fox v. Kramer. In Fox, the plaintiff attempted to subpoena the expert testimony of an investigator for the California Department of Health Services (DHS), where that investigator had relied substantially on hospital peer review committee records in forming his opinions. When the hospital objected, citing §1157, the plaintiff claimed that the protections of §1157 were waived once the hospital turned over its committee records to the DHS or, in the alternative, when a redacted form of the report was given to the plaintiff by the DHS. The court ruled in favor of the defendants, finding that "[t]he fact of DHS review did not constitute a general waiver by the hospital of discovery immunity under Evidence Code section 1157, subdivision (a): the hospital peer review committee records did not lose their immunity from discovery simply because they were reviewed in the course of an administrative investigation."

Thus, according to Fox, Newhall, and University of Southern California, and supported by the dissent in West Covina, the protection provided by §1157 is an immunity, which is not waived by disclosure to outside parties. It is important to note, however, that in all the cases that specifically addressed this issue, the disclosure was made in furtherance of some sort of secondary litigation. In Newhall, the disclosure took place pursuant to an unrelated administrative mandamus proceeding. In University of Southern California, the disclosure took place during the defense of a wrongful termination action. And in Fox, the disclosure took place when the hospital was compelled to turn over its committee records to the Department of Health Services.

All of these disclosures, which were later held not to constitute waivers, were necessary to defend against another action--civil, quasi-criminal, or administrative. The question then arises as to whether a court would find voluntary disclosure by a peer review committee to a regional patient safety consortium with no other litigation pending to be similar to these cases. While the issue has never been specifically addressed by a court of competent jurisdiction, at a minimum for the immunity to possibly apply, the assertion of immunity must be timely and in proper form, there must be no Federal jurisdiction, and explicit waiver by all those protected by §1157--including committee members, physician reviewers, and physicians reviewed--must not have occurred.

In California, the peer review privilege does not apply across institutional boundaries
Although the IOM report optimistically characterized the peer review privilege in California as "the most promising existing source of legal protection"1 for protecting interinstitutional exchange of patient safety data, even the broad protection of California's peer review statute does not protect the interinstitutional exchange of patient safety information. Section 1157 covers only the proceedings and records of peer review committees composed of the medical staff within an institution. Even in the broadest of §1157 interpretations in California, courts have never read the phrase "proceedings and records" expansively enough to include the proceedings and records of a committee existing outside the aegis of a single health care institution, such as a regional patient safety consortium. Similarly, "proceedings and records" and "medical staff" encompassed by §1157 have never been held to cross organizational lines. Rather, "medical staff" has consistently been associated with an individual health care organization, either as employees or physicians with staff privileges. Additionally, in a large State like California, the interpretation of these terms may actually be different between appellate courts. (For example, some California appellate courts have tended toward a narrowing of the meaning of the definition of "proceedings and records," while others have maintained a broader interpretation.) In the case of a regional patient safety consortium, the majority of members would likely have no official association with more than one health care organization within the consortium. Hence, it is unlikely that even a deferential court would find that the legislature intended for the "proceedings and records" of a "medical staff," both of which exist outside the aegis of a single health care organization, would be covered by §1157.

The peer review privilege may not apply in Federal court
Even if peer review privilege was found to apply to a regional patient safety consortium, a potential litigant may be able to "end run" any protection provided by such a statute by obtaining Federal jurisdiction, a system which does not necessarily recognize State law evidentiary privileges.14 Federal jurisdiction requires either a Federal question (i.e., a conflict arising under Federal law), differences (i.e., "diversity") of State citizenship among litigants, the United States as a party to the action, an action between two or more States, or a case governed by admiralty or maritime law.15 The Federal Rules of Evidence provide that the question of whether a Federal court shall adopt an evidentiary privilege

shall be governed by the principles of the common law as they may be interpreted by the courts of the United States in the light of reason and experience. However, in civil actions and proceedings, with respect to an element of a claim or defense as to which State law supplies the rule of decision, the privilege... shall be determined in accordance with State law.16
Hence, in Federal actions based on diversity of the litigants' residence, State law applies, including any protection provided by State peer review statutes. But if the claim involves at least one Federal issue or if the litigant sued a Federal institution, the Federal law and its limited recognition of the peer review privilege could apply.

Federal courts are split as to whether the peer review privilege is recognizable under Federal law, depending on the underlying claims and laws at issue.17 The U.S. Supreme Court has not yet addressed whether any medical peer review privilege exists under Federal common law.18 This means that even if a malpractice claim was filed in a State that had found that state peer review privilege does apply to interinstitutional activities, the privilege might be defeated if the action was successfully removed to a Federal court in a jurisdiction that does not recognize the peer review privilege. Even if the particular Federal court did recognize peer review privilege as existing in Federal common law, there is no guarantee that it would interpret such privilege as applying to interinstitutional activities in the same manner as in the State where the action took place.19

Recommendations
Given the review above, even in the absence of some additional form of Federal legislative protection, there is some potential to allow a regional patient safety consortium to exchange information without fear of discovery, as long as certain precautions are undertaken.

AHRQ sponsorship or support is highly desirable
Since 42 U.S.C. §299c-3(c) is the strongest potential source of protection for exchanged information, it should be the foundation for any information exchange paradigm. Therefore, if no member of the consortium has AHRQ sponsorship, it should be sought. Thus, AHRQ should be encouraged to foster the formation of such patient safety consortia through flexible grant or contract mechanisms, even if they can be supported with only very limited levels of funding. Once AHRQ sponsorship is obtained, the AHRQ-sponsored entity should act as the central repository of the information for the consortium. Only fully de-identified data should be transmitted by members to the AHRQ-sponsored entity. The data should then be stripped of all indications of organizational affiliation before retransmittal to other members. This method of information management conforms to provisions of §299c-3(c), which clearly protects data collection on behalf of an AHRQ-sponsored entity.

Review specific State laws to determine if State peer review protections apply
Providers interested in creating safety consortia should assess their specific State laws to determine if, and to what extent, the peer review/quality assurance privilege applies, and under what conditions. Pay attention to what forms of information must be placed, the committees and other entities that will see the data, and the circumstances where such privilege appears to be lost. This review should also assess under what circumstances the peer review/quality assurance privilege may be weakened in conflicts brought in Federal court.

Other issues to consider
The creation of a regional consortium of unaffiliated health care institutions has the potential for advancing patient safety communitywide through the sharing of knowledge, joint learning, and collaborative initiatives. However, in the creation of such a consortium, the potential member organizations need to consider a number of other factors besides concerns about waiver of protection from discoverability, as discussed above. Other issues requiring evaluation include patient privacy issues (e.g., HIPAA), the legal and organizational structure of the consortium, membership issues, confidentiality and indemnification, and the need for human subjects review. In the interest of brevity and focus, we cannot address these issues here. However, sample questions with which the consortium members must struggle might include--

•What kinds of data do we feel comfortable sharing--from the highest (actual patient adverse events) to the lowest (structure of quality assurance and safety initiatives) risk?

•Can the consortium's activities be more clearly and closely associated with individual member's medical staff peer review processes?

•What kind of legal structure can best protect members from inadvertent disclosure by the consortium or by other members?

•In the event of a lawsuit, would there be joint liability, and if so, how might individual members be shielded from excessive or inappropriate liability?

•Should the consortium be a separate corporation, a partnership, an unincorporated association, or some other formal or informal structure?

Continue reading "Legal Protection For Patient Safety Information" »

The following is a summary of the actual AHCPR Clinical Practice Guideline. It is strongly recommend that you obtain and read a copy of this document.

For a copy, here are two options:

Call 1-800-358-9295 or write to: AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907.

Write to Office of the Forum for Quality and Effectiveness in Health Care, AHCPR, Willco Building, Suite 310, 6000 Executive Boulevard, Rockville, MD 20852.
Also, find it online at http://www.ahrq.gov/clinic/cpgonline.htm

Pressure Ulcer Staging
Please refer to the Staging section of this internet guide for a complete review.

Stage 1 ulcers may be superficial, or they may be a sign of deeper tissue damage.
Stage 1 pressure ulcers are not always reliably assessed, especially in patients with darkly pigmented skin.
When eschar is present, a pressure ulcer CANNOT be accurately staged until the eschar is removed. Do not remove a "stable" heel eschar. Stable is defined as not having edema, erythema, fluctuance or drainage.
Physical barriers may make it difficult to assess a pressure ulcer. (ie. casts, stockings, orthopedic devices)

Assessment of the Patient
Assessment is the starting point of ulcer treatment. The entire patient, not just the ulcer, must be assessed.
Note the size, depth, necrotic and granular tissue present
Reassess at least weekly or sooner if deterioration of the ulcer is noted. Clean pressure ulcer with adequate blood flow should show some improvement in 2 - 4 weeks.
Monitor the overall medical condition of the patient and watch for other complications like amyloidosis, endocarditis, maggot infestation, meningitis, peptic arthritis, squamous cell carcinoma in the ulcer, systemic complications of topical treatment, etc.
Nutritional Assessment and Management - perform a Nutritional assessment at least every 3 months for patients at risk for malnutrition. Vitamin and mineral supplements may be necessary. Positive nitrogen balance and protein intake are important as well.
Pain Assessment - The goal is to eliminate the cause of the pain, to provide analgesia, or both. Cover the wound, adjust support surface, reposition, give analgesia as needed or appropriate in an effort to reduce pain.
Psychosocial Assessment - The goal is to create an environment conducive to patient adherence to the pressure ulcer treatment plan.

Tissue Load Management
The goal of load management is to create an environment that enhances soft tissue viability and promotes healing of the pressure ulcer (s).
The vigilant use of proper positioning and support surfaces are important.
Avoid positioning patients on a pressure ulcer. Do not use donut-type-devices.
Use devices like pillows or foam to keep the heels off the bed, keep knees and ankles from touching
Maintain the head of the bed at the lowest degree medically necessary.
No evidence to show that any one support surface consistently performs better than another.
A patient should avoid sitting if he/she has an ulcer on a sitting surface.
Move a sitting patient at least once an hour.

Ulcer Care
Initial ulcer care involves debridement, wound cleansing, dressing application and possible adjunctive therapy.
Debridement should be performed to remove moist, devitalized tissue. See types of debridement for details.
Small wounds can be debrided at bedside, extensive wounds in the operating room or special procedure room.
Stable heel ulcers with eschar DO NOT need to be debrided. Edema, erythema, fluctuance or drainage would necessitate eschar debridement.
Wound Cleansing - Weigh benefits of cleaning against trauma to tissue bed caused by the cleaning. Do not use povidone iodine, iodophor, sodium hypochlorite solution, hydrogen peroxide and acetic acid as they have been shown to be cytotoxic. Use normal saline at a pressure between 4 and 15 pounds per square inch (psi).
Dressings - See product index for more information. An ideal dressing should protect the wound, be biocompatible, and provide ideal hydration. The cardinal rule is to keep the ulcer tissue moist and the surrounding intact skin dry.
Electrotherapy has been shown to be effective in pressure ulcer treatment. See Physical Therapy Modalities.

Managing Bacterial Colonization and Infection
All stage 2,3,4 ulcers are invariably colonized by bacteria. Topical antibiotics are appropriate. Watch for response and sensitivity.
Swab cultures should not be used. They will only show surface contaminants.
Use needle aspiration to obtain fluid or soft tissue biopsy for determining infecting organism.
Bone biopsy is the gold standard for assessing osteomyelitis. WBC, ESR and plain x-ray have a positive predictive value 69 percent when all three tests are positive.
Use appropriate systemic antibiotic therapy for patients with bacteremia, sepsis, advancing cellulitis or osteomyelitis.
Use sterile instruments and clean dressings during wound care. Treat the most contaminated ulcer LAST in patients with multiple wounds. Change gloves and wash hands between patients.

Continue reading "Decubitus Ulcers, Pressure Sores & Bedsores Some Good Facts To Know" »

The following information was copied verbatim from the AHCPR Guidelines, which is consistent with the recommendations of the National Pressure Ulcer Advisory Panel (NPUAP) Consensus Development Conference:

Stage 1
Nonblanchable erythema of intact skin, the heralding lesion of skin ulceration. In individuals with darker skin, discoloration of the skin, warmth, edema, induration, or hardness may also be indicators.

A Stage I pressure ulcer is an observable pressure related alteration of intact skin whose indicators as compared to the adjacent or opposite area on the body may include changes in one or more of the following:
skin temperature (warmth or coolness), tissue consistency (firm or boggy feel) and/or sensation (pain, itching).
The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.

Stage 2
Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage 3
Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage 4
Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage 4 pressure ulcers.

Continue reading "Staging Decubitus Ulcers, Pressure Sores & Bedsores" »

Decubitus ulcers/bed sores aka Pressure Sores afflict patients inside hospitals throughout the world. Various means of reducing bedsores have be tried, from frequent turning to synthetic padding, however medical research have shown that 1 of the a large amount effective means of reducing the occurrence of bedsores is the utilize of natural sheepskin padding. indicates Los Angeles Bed Sore Attorney Steven C. Peck.

Bedsores build up as a result of constant pressure on certain parts of the body, a large amount commonly the bony protuberances such as elbows and heels. On traditional mattresses, these points approach to bear inordinate amounts of corpse weight, because a large amount beds lack the pressure distribution properties of memory foam or additional extra advanced materials.

Bedsores occur when the blood supply to the capillaries is restricted inside excess of a period of time. Bedsores be too called pressure ulcers. Since the unique character of memory foam is it's ability to melt away from anywhere that pressure is applied, divan sores be reduced or eliminated.

Bed ridden patients inside nursing house or assisted living facilities build up divan sores that be able to facilitate their demise. Paraplegics and quadriplegics build up localized pressure sores that be able to instigate life-threatening infections. Situations that impede circulation such as complications following surgery, congestive heart failure, rheumatoid arthritis, peripheral ulcers, vascular disease, and traumatic injury assist cause wounds.

Bed sores be too known as pressure sores, pressure ulcers, decubiti, or decubitus ulcers. They start as red, painful areas on the skin (often the legs and backside) and might twist purple or still black if undetected or untreated. In a number of cases, divan sores be able to lacerate and become infected, causing further medical problems.

Bed sores pretense a threat to anyone facing extended periods of divan relax or divan confinement, or anyone who is immobilized or handicapped. Bed sores build up as a result of constant pressure on certain parts of the body, a large amount commonly the bony areas such as shoulder blades, hips, heels and elbows . Other factors that contribute to bedsores include excessive moisture from sweating and friction from rubbing next to the lower sheet.

Additionally, memory foam have be widely used inside hospitals and rehabilitation centers across the nation for recovery from debilitating injuries, major surgeries and for extended term care because it prevents some divan sores or additional problems inside the middle of public who have to wait inside 1 position for a extended occasion to heal.

The perfect cushion is a preventive of "bed sores" which perform not necessarily approach from a divan however rather the chaffing of skin next to a surface, and by means of inactivity of the body, the blood flow to these skin surfaces be slowed and result inside skin lesions.

Check the person's corpse for divan sores and additional injuries and inquire questions if anything seems suspicious. If the behavior continues, file a complaint and locate another facility.

The warmth retaining properties of the foam makes pain extra bearable for a patient suffering from reverse injuries. Thus memory foam is too used inside medical treatments of patients developing "bed sores" and for public suffering from postural problems. Besides the utilize of memory foam inside a mattress, nowadays it is too used inside pillows, positional slumber aids, office furniture, automobile seat padding, footwear, infant cribs, automobile seats, helm chair cushions, computer carrying cases and a lot of more.

Continue reading "Decubitus Ulcers, Bed Sores, Pressure Sores Afflict Elders In Long Terms Facilities Throughout the World" »

An orthopedic rehabilitation patient who developed multiple decubitus ulcers on his back and heels has filed a lawsuit against the nursing home where the wounds developed.

The lawsuit alleges that Highland Health Care Center and its parent company Covenant Care Midwest failed to implement preventative measures to avoid the development of decubitus ulcers during a short-term admission. The nursing home patient was admitted to the facility for physical therapy and nursing care following a complete knee replacement surgery.

Despite the facilities knowledge that the man had limited mobility due to his recent surgery, the facility failed to mobilize the man and get him out of bed- and perform the physical therapy he was at the facility for in the first place.

In addition to the role the nursing home played in the the development of the patients decubitus ulcers (similarly called: pressure ulcers, pressure sores or decubitus ulcers), the lawsuit alleges that the facility exacerbated the severity of the wounds when they delayed obtaining medical treatment. As a result of the severity of the decubitus ulcers, the dead skin needed to be removed surgically by a process known as surgical debridement.

The lawsuit specifically alleged the following negligent acts on the part of the nursing home resulted in the patients decubitus ulcers:

Failing to notify a physician of the change in the man's medical condition
Failing to implement medical treatments ordered by the man's physician
Failing to note changes in the man's medical condition in the man's chart
Failing to implement a decubitus ulcer prevention program
The lawsuit is pending in Madison County Circuit Court in Southern Illinois.

Rehabilitation Patients In Nursing Home

In our nursing home litigation practice, we see a significant number of cases where a rehab patient has developed a decubitus ulcer during a short-term admission to a nursing home. The underlying reasons may be varied, but I suspect that because many rehab patients tend to be younger and have an outward appearance that they are healthy, staff in nursing homes may be less likely to encourage them to engage in activity.

Similarly, short-term stays may result in abbreviated or incomplete 'care plans' which set forth with specificity what facilities must do to prevent wounds from developing in the first place. Clearly, by accepting a patient- even for a short term stay- nursing homes must take the necessary steps to ensure their well-being. As we see in the above matter, when facilities ignore this obligation significant problems may result.

Continue reading "Orthopedic Rehabilitation Patient Developed Multiple Decubitis Ulcers" »

Probably the most common type of elder abuse is shear neglect. This can easily be visible by bad hygiene, uncleanliness, and recurring illness. Watch for bed sores, abrasions, infection, weight loss, and an unkempt and unclean environment. Luckily neglect can usually be avoided by taking the time to do your research thoroughly when choosing the right nursing home. You can pay attention to the demeanor and health of the other tenants as well if you're concerned that something might be going on. Don't hesitate to ask about their living conditions. You might be surprised with what they have to say. Contact Los Angeles Elder Abuse and Neglect Attorney Steven C. Peck toll free at 1.866.999.9085 if you have questions on the kind of action you should take.

One of the easiest forms of abuse to recognize is of the physical nature. Bruising, sores, broken bones, scratches, abrasion and tenderness should all warrant further investigation. Particular, be on the look out for recurring injuries without any legitimate explanation. Often times, a caretaker will place the blame on the elderly person but if you notice that these injuries are occurring and your loved one doesn't have a history of clumsiness or unsteadiness, you should be concerned. IT is common for elderly individuals to fall down and they bruise much more easily than most of us, but you should still be suspicious of anything that seems like foul play. If that's the case, we recommend that you contact California Elder Abuse Attorney Steven C. Peck toll free at 1.866.999.9085.

Estimates for the frequency of elder abuse in the general population range from 2 percent to 10 percent as the number of elders (generally defined for research purposes as people over 65) who suffer some form of elder abuse says Los Angeles Elder Abuse Attorney Steven C. Peck.

Elder Abuse is Underreported
The variance of those figures depends to a large extent on how information is gathered and measured, but one point of agreement among most researchers is that elder abuse is significantly underreported.

For every case of elder abuse, neglect, exploitation or self-neglect that is reported to authorities, about five more go unreported, according to the National Center on Elder Abuse.

Incidence of Elder Abuse Could Be Much Higher
Yet, even that startling figure may be low. Other sources place the ratio of unreported to reported elder-abuse cases as high as 14-to-1 for elder abuse in domestic settings, excluding self-neglect, and 25-to-1 for cases of elder abuse defined as financial exploitation.

Aging Population Expected to Increase Risk of Elder Abuse
A 2008 study sponsored by the British Geriatrics Society concluded that one in four vulnerable elders are at risk of abuse, and only a small proportion of the abuse is detected. As the population ages, and the number of people over age 65 worldwide continues to grow, the incidence of elder abuse is expected to increase.

Continue reading "Elder Abuse is Severely Under Reported" »

Bed sores aka Pressure Sores and Decubitus Ulcers area commonly found in immobile patients who remain in one position for extended periods of time. The underlying mechanics behind the development of bed sores is that unrelieved pressure on areas of the body resulting in diminished blood flow to skin and muscle causing the tissue to die. As the tissue dies, a wound develops and in some situations, 'opens' exposing internal organs and bones. In addition to the pain and embarrassment that accompanies bed sores, studies have determined that patients with advanced bed sores are at a high risk for infection, sepsis and other complications says California Nursing Home Abuse and Neglect Lawyer Steven C. Peck.

What makes bed sores (also called pressure sores, pressure ulcers or decubitus ulcers) different from many other medical conditions is the fact that in most situations they can be prevented with the most basic care. Keeping patients clean, dry and alternating their positions greatly reduces the likelihood of patients developing the wounds. In order to prevent bed sores, facilities need to train staff on the techniques to prevent bed sores and and have adequate staff to assure there is enough manpower to implement the necessary care.

Many situations involving the development of bed sores during an admission to a medical facility give way to a claim or lawsuit against the facility. In the case of patients who have developed bed sores and subsequently died from the wound, the family of person may similarly be entitled to pursue to lawsuit premised on wrongful death.

Continue reading "Bedsore, Pressure Sores, Decubitus Ulcers Are Caused by Unrelieved Body Pressure" »

According to the National Institute on Aging, there were an estimated 1.5 million nursing home residents in 2004 alone. In the last couple of years, these numbers have increased significantly. While nursing homes can provide a useful service, it has sadly become a source of fear for some residents. Elder abuse has become a widespread problem in the long term care facilities, assisted living centers, and other residencies designed to protect the elderly.

However, residents and the family of these persons do have rights and legal options to pursue which may include both criminal and civil action. This is why it is so important that a personal injury lawyer be consulted when and if an individual believes a loved one is being subjected to abuse by a caregiver. Elder abuse is preventable and should not be tolerated. If a parent needs long term care, there are a few simple things that can decrease the chance of abuse.

Investigating the facility and speaking with some of the other residents and their family before choosing a nursing home is always a good idea. Take time to visit the facility. Is it well staffed? Statistics indicate that elder abuse is more prevalent in nursing homes with staffing issues.

Does someone take the time to listen to your concerns and answer any questions that you may have? These are just a few of the things that should be considered before placing a parent in a nursing home. If you don't feel comfortable with the facility, you may want to move on. Finding suitable arrangements for an elderly parent does not however, does not mean that abuse will not occur.

There are various types of elder abuse that may take place. Some of the most common types of abuse can include both physical and emotional abuse, neglect, and stealing from the resident. At times, signs of the abuse may seem obvious, while in other instances it may not be as noticeable. Recognizing the signs of abuse and neglect of an elderly parent can make a difference.

Visit often and take note of how your parent behaves in the presence of staff. Fear, anxiety, and unexplained bruising are only a few warning signs. If you believe that your parent is being abused in any manner, speak out. Immediately removing the resident from danger, contacting the family law lawyer, and the local ombudsman should be the first steps taken.

The facility should be held accountable for their actions. As the population of seniors increase, so does the need for quality care free from abuse and neglect. Utilizing legal options not only protects the victim, but can help prevent abuse from happening to someone else. A personal injury lawyer can help the abused resident and the family get the entitlement that they deserve and help put a stop to abuse and neglect at the hands of a caregiver.

If you are in the Southern California area be sure to contact Steven Peck's Premier Legal toll free at 1.866.999.9085 to talk to experienced California personal injury lawyers for effective representation when you are injured.

Elder abuse" is recognized as a health and human rights issue and includes a range of offenses. Abuse is sometimes hard to detect; elder abuse is frequently inflicted by a known, trusted person, often a family member. Neglect, self-neglect and financial exploitation are common forms of abuse.

A startling example of financial exploitation was the story of a Los Angeles woman accused of convincing an elderly man, suffering from dementia, to marry her and empty his bank account the very same day. this kind of exploitation happens everyday and is quite common says California Financial Elder Abuse Lawyer Steven C. Peck.

Incidents like this prompted new lawmaking in the State of Washington The new law applies to older vulnerable adults, and requires financial institutions to train certain employees to better identify older adults who may be victims of financial exploitation, and gives institutions the right to withhold fund disbursement while the request is investigated. California already has these mandatory reporting requirements Peck says.

As community members, family and friends, we must be vigilant. Signs of mistreatment often include unexplained physical injuries, repeated accidents, behavior changes such as crying and isolation, or deteriorating health and hygiene. Financial troubles that appear out of the blue can signal financial exploitation.

Continue reading "Financial Exploitation & Financial Elder Abuse Transpire Quite Frequently In Our Society" »

You probably have heard in the news about cases of elder abuse and financial exploitation. When you hear of elder financial exploitation, you might think of unscrupulous home improvement contractors, phony investment schemes or Internet
scams. According to law enforcement officials, abuse and exploitation by family, caretakers and "new best friends" are just as common. and are thriving says Los Angeles Elder Abuse Attorney Steven C. Peck.

The National Center on Elder Abuse reports more than 1 million cases of elder abuse are reported each year. This number does not represent the actual incidence of elder abuse because these crimes often go unreported. The center said because of the intimate and family nature of elder abuse, as many as four out of five cases go unreported.

Elder abuse and financial exploitation also is drastically on the rise in a seriously depressed economy as desperate people prey on the population most likely to have income and assets, accumulated after a lifetime of work.

One method of elder exploitation I have seen many times is a child or other family member who is a professional dependent.

One type of professional dependent is the child who might have convinced you they need your help. You now are regularly giving them checks to help them out. These checks could be in the thousands of dollars.

Another type of professional dependent is a child who regularly takes you to the bank to withdraw cash for your day-to-day living expenses. That cash, sometimes also in the thousands of dollars, then just mysteriously disappears.

A child who lives with you also can be a professional dependent. You might have a child who lives with you but contributes nothing to the household operation, either financially or timewise. All too often, a child will move in with you and just sponge off of you.

It could be the child who never moved out and who, now is in his 50s, still is trying to decide what he wants to do with his life. He might even have a job but never helps out with the household expenses or chores.

It is not uncommon for a child to move in with you "temporarily" after a major life event such as a divorce or loss of a job. He or she might even bring their significant other. The "child" then just sleeps, sits around watching television or playing video games, doesn't look for a job and doesn't help with household chores. This "temporary" arrangement many times becomes permanent.

Continue reading "Child or Family Member Most Likely Candidate For Financial Elder Abuse" »

Bed sores (also known as pressure sores, pressure ulcers, or decubitus ulcers) are caused by unrelieved pressure on bony prominences of the body. Over time, the unrelieved pressure restricts necessary blood circulation to the skin and tissue resulting in the death of the tissue and the surrounding muscle. What may begin as a small area of skin irritation can rapidly develop into a large wound.

In order to help identify bed sores and implement medical treatment, a 'staging system' has been established by the medical community to provide a standardized system of identify and treating wounds.

Stages of Bed Sores

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. For patients confined to a wheelchair, they are most likely to develop a pressure sore on: their tailbone or buttocks, shoulder blades and spine. Some wheelchair patients may develop bed sores on the backs of their arms and legs where they rest against the chair. Bed-bound patients are prone to develop pressure sores in the following additional areas: back or sides of your head, the rims of your ears, shoulders, hip bones, lower back or tailbone, backs or sides of your knees, heels, ankles and toes.

Unstageable - Unstageable bed sores are usually referred to as an extremely advanced wound where there is involvement of skin, muscle and bone.

Medical Facilities Duty To Prevent Bed Sores

As a known threat to patient health and well-being, staff in nursing homes, hospitals and other medical facilities must be diligent in preventing bed sores from developing. Perhaps the most important part of bed sore prevention is to identify patients who are at high risk for developing bed sores and implementing a care plan for them.

The following conditions, put a patient at high-risk for developing bed sores:

Limited mobility or bed-bound
Old age
Malnourishment
Dehydration
Incontinence
Prevention of Bed Sores

The most widely accepted ways of preventing bed sores is to keep patients clean and dry. This means removing soiled clothing and bedding as soon as feasible and bathing patients regularly. Additionally, for patients who have limited mobility, staff must actively turn patients on a regular basis (every 2 hours) to avoid unrelieved pressure from forming on the body.

The areas of the body most vulnerable to bed sores are:

Heels
Hips
Buttocks
Back
By some estimates, more than 500,000 patients develop bed sores in nursing homes and hospitals every year. In addition to the pain and embarrassment that accompanies bed sores, bed sore patients are at risk for developing a variety of medical complications.

Medical Complications Associated With Bed Sores

Sepsis

Sepsis is an illness caused by infection in the bloodstream by bacteria that frequently enter the body through open wounds or bed sores. Sepsis must be identified and treated as early on as possible in order to provide the best chances of survival. If left undiagnosed and untreated, sepsis can be fatal. 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 4000 cells/mm.

Gangrene

Gangrene is a complication that may develop due to the death of tissue in and around the bed sore. Severe bed sores may result in the reduction of blood flow in and around the wound. The reduced blood flow increases the ability of bacteria to grow. Bacteria produce toxins that the body is unable to remove. Once the toxins accumulate, deterioration of tissue ensues. Ultimately, as the tissue deteriorates the common gangrene symptoms may occur (black or green discoloration of skin and foul odors).

Osteomyelitis

Osteomyelitis is an inflammation of the bones that is caused by bacteria. In adults, the most common types of osteomyelitis causing bacteria are S. Aureus, Enterobacter and Streptococcus. In cases of severe bed sores (also referred to as decubitus ulcers, pressure ulcers or pressure sores) the bacteria enters the body through the open wound and attacks the bone. Once the bone becomes infected, enzymes are released that restrict the bodies ability to heal. If left untreated osteomyelitis can spread into the bone marrow and surrounding joints, leading to further medical complications or even death.

Necrotizing Fasciitis

Because people with severe bed sores literally have an open wound, they are at a higher risk for contracting the infection causing bacteria that can cause necrotizing fasciitis. The early stages of necrotizing fasciitus are characterized by severe pain and swelling in the area of the infection frequently accompanied by diarrhea and vomiting. Rather than 'eating' the flesh, as is commonly suggested, necrotizing fasciitis infection causes flesh to die.

Bed Sore Treatment

Medical treatments can help improve the pain associated with the wounds and may prove to literally save the life of the patient. It goes without saying, that patients with bed sores should seek treatment from practitioners who have experience in wound care.

Wound Care

In order for bed sores to heal, attention must be paid to the removing dead tissue and protecting the wound from infection causing bacteria. Dressings are usually applied to help the body heal itself. The type of dressing and the frequency with which it is to be changed is ordered by a physician with the application and changes carried out by nurses.

Surgical Debridement

Surgical debridement is when a surgeon uses a scalpel to remove the dead tissue, bone and fluid from the area around the bed sore. Surgical debridement of the bed sore may be accompanied by 'flap reconstruction'. Flap reconstruction is when tissue is harvested from a healthy area of the person's body to cover the open wound. The goal of reconstruction is to improve the hygiene and appearance of the wound and reduce the risk of infection.

Colostomy

When bed sores develop on the buttocks or sacrum, a physician may recommend a surgical procedure to prevent fecal material getting into the wounds. The surgical procedure is referred to as a 'colostomy' or 'diverting colostomy'.

A colostomy is a major surgical procedure that involves 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. Many colostomy procedures can be reversed, if and when they are no longer needed.

Amputation

One of the most dramatic examples of how truly devastating bed sores can be is when a limb must be amputated due to severe bed sores or medical complications. In severe cases (where surgical debridement, antibiotics, and oxygen treatment are unsuccessful), amputation of the limb might be required to prevent the infection from spreading further. This is especially true in elderly people, especially those who are malnourished, because of poor blood flow.

Liability of Medical Facility For Patients Who Develop Bed Sores During An Admission

When a bed sore (similarly referred to as: pressure sore, pressure ulcer or decubitus ulcer) develops during an admission to a medical facility, it is usually an indication that the facility was not properly caring for the patient. The underlying reasons may be varied: under-staffing, poor training or staff simply not following orders, the fact remains- medical facilities can be held responsible for the pain, decline in the quality of life and medical expenses associated with subsequent treatment.

Continue reading "Bedsores, Pressure Sores & Decubitus Ulcers Are A Form Of Elder Abuse & Neglect" »

A lawsuit accusing a Hammond hospital of negligent care including failure to change medical tubing and letting bedsores become infected, has been transferred to the U.S. District Court in Hammond.

The suit claims that Select Specialty Hospital, a long-term acute care center located inside St. Margaret Mercy Hospital, failed to properly care for Aubrey Rawlins, who stayed there from April 22, 2005, to June 14, 2005, when he was recovering from pneumonia.

Rawlins' stay was supposed to last just two weeks but extended to six when his health became worse, according to the lawsuit.

He was eventually moved to another hospital and eventually died, although the lawsuit does not say when. His wife, Sarah Rawlins, filed the suit on his behalf in the U.S. District Court in Chicago, but the judge transferred it to Hammond because she said the court lacked jurisdiction.

Sarah Rawlins, of Markham, Ill., says in the lawsuit that Select made numerous errors, including giving her husband aspirin and Tylenol when he was on an anticoagulant, a drug combination that caused rectal bleeding. That led to two surgeries and several blood transfusions because he had lost so much blood, the lawsuit says.

Nurses failed to turn him, and he developed bed sores that went all the way to the bone, according to the lawsuit. Rawlins' arm and genitals started to swell a month into his stay, and his wife discovered his catheter hadn't been changed since his admission three weeks before, Sarah Rawlins says in the suit. When he was moved to another hospital, he was diagnosed with having a staph infection in his bedsores and lungs, according to the lawsuit.

Other charges blame hospital employees with leaving dirty linen and clothes on his room's floor and at one point failing to hang a glucose bag, which caused Rawlins, who had diabetes, to become semi-comatose.

Sarah Rawlins has also filed a charge with the Indiana Patient Compensation Fund. According to its Web site, one doctor found evidence to support malpractice although two others found against malpractice.

The case is still open.

Sarah Rawlins is asking for a jury trial and compensation for her husband's pain and suffering.

Continue reading "Lawsuit Alleges Bedsore Infection Leading to Staph Infection" »

California's nursing homes have reaped $880 million in additional funding from a 2004 state law designed to help them hire more caregivers and boost wages.

But about a quarter of the state's homes flouted the law's purpose. They cut staff or slashed wages, while padding their bottom lines, a California Watch investigation has found.

The 232 homes that made those cuts -- including 20 in Santa Clara and San Mateo counties -- collected about $236 million through 2008, the last year of available data. And the law that made it all possible included few safeguards to ensure it was spent as intended.

About two dozen homes that made the deepest caregiver cuts had about a third more deficiencies than other state facilities, California Watch found. Violations ranged from neglecting bedsores to giving patients the wrong drugs.

Overall, regulators documented nearly 1,000 deficiencies for inadequate care in California nursing homes in 2008 -- a 65 percent increase compared with 2005.

"There was an implicit good faith agreement that things would get better "... and that was broken," said state Sen. Elaine Alquist, D-San Jose, chairwoman of the Senate Health Committee.

But James Gomez, chief executive of the state's nursing home trade organization, said the 2004 law has led to a 6 percent increase in average staffing for nursing homes. "Is it working in every facility every day? No," said Gomez, leader of the

California Association of Health Facilities. "But is it working in total? Absolutely."

Chain's profits

Of the homes that made cuts, 13 owned by Orange County-based Covenant Care stand out.

Thanks to $15 million in new funding, profits at those homes averaged more than $900,000 in 2008 -- far higher than the average for the remaining 632 homes California Watch analyzed. Four of those Covenant Care homes are among the six it operates in Santa Clara County.

The chain's chief operating officer has said part of its business plan calls for housing more medically fragile patients. The tactic opens the door to higher government reimbursements, according to critics, who say it can be dangerous to combine lower staffing rates with patients who need more attention.

Patients like Raymond Yniguez.

The 78-year-old Gilroy man went to the chain's Morgan Hill home, Pacific Hills Manor, on Feb. 6, 2008, to recover from spinal surgery. Three weeks later, he fell and hit his head, but the staff sent him home that afternoon. Two days after his release, Yniguez died of a massive brain hemorrhage.

Yniguez's widow has sued Pacific Hills Manor, alleging wrongful death, medical negligence and elder neglect or abuse. Robert Bohn, her lawyer, said the home's staff knew Yniguez was at high risk of falling. But after finding him on the floor with a large bump on his cheek, they spoke with a doctor by phone, Bohn said, then released Yniguez without having him seen by a physician.

"The problem with these nursing homes is they're all understaffed," Bohn said.

Records show a 7 percent decline in staffing levels at Pacific Hills Manor from 2004 to 2008.

Covenant Care lawyer John Supple defended the home's conduct, noting the Yniguez incident did not lead to a state citation. Supple said the staff checked on Yniguez throughout the day and released him under guidance from his doctor.

The Covenant Care chain, meanwhile, rewarded top administrators and nursing supervisors with bonuses based, in part, on how much profit each home generated, records show. CEO Robert Levin declined repeated requests to be interviewed about the company's staffing levels.

Oversight lacking

The Nursing Home Quality Care Act of 2004 was designed to fix a glaring problem: Daily Medi-Cal rates paid to California's 1,100 homes were among the lowest in the nation.

An alliance of labor leaders and nursing home owners pushed to replace a flat fee-per-patient system with one that reimbursed homes based on their costs.

Some patient advocacy groups and experts bristled over the proposal's lack of teeth. The California AARP ran full-page newspaper ads that said, "No blank check for bad nursing homes."

Still, the bill flew through the Legislature. When Gov. Arnold Schwarzenegger signed it, he directed regulators to "closely monitor implementation" and "reward quality care."

But the state agency that oversees nursing home funding failed to follow through.

Toby Douglas, chief deputy director for health care programs at the Department of Health Care Services, conceded that some homes may have cut staff. But he said that most have invested more heavily in caregivers.

Douglas said his department is in the "very preliminary" stages of improving the funding law by linking nursing home pay to factors such as patient satisfaction or payment of fines for poor care.

Yet some advocates question whether the state -- now in a budget crisis -- missed an opportunity to use the funds to drive improvement.

The revenue increases to nursing homes were suspended last year because of opposition from patient advocates, but homes have been pushing to restore the funding. Alquist, the state senator who heads the health committee, says the law will be scrutinized during a legislative review this year.

Staffing lags

California Watch inspected financial and staffing data for the 645 homes that serve the largest number of Medi-Cal patients who need round-the-clock care. The 2004 law was set up to benefit these homes the most.

Since the legislation was enacted, the Department of Health Care Services rewarded the homes analyzed with a total funding increase of nearly 25 percent.

But the lowest-paid workers, who perform the vast majority of patient care in nursing homes, did not see that kind of raise. Adjusting for inflation, more than 400 homes cut those workers' wages, the California Watch analysis shows.

In 2008, dozens of homes also operated beneath a minimum staffing level set by the state nearly a decade earlier.

Gomez, of the California Association of Health Facilities, said the state should aggressively investigate homes that operated with staffing levels below the standard -- which is set at 3.2 hours of caregiver attention a day for every nursing home patient.

"I don't have an issue with them looking at those facilities," he said of the 68 homes below the minimum in 2008.

The state, however, has not issued staffing-related fines to any of the homes that failed to reach the minimum staffing level, records show.

And when homes are cited for serious violations, the 2004 law helps bail them out. For the first time, it allowed homes to bill the state for legal costs spent to fight fines, citations and lawsuits alleging abuse and neglect.

"The policy is outrageous," said Michael Connors, an advocate with watchdog group California Advocates for Nursing Home Reform. "By paying the legal fees of nursing homes that are neglecting and abusing residents, the state is subsidizing their mistreatment."

While state officials could not identify exactly how much they spent reimbursing nursing homes to fight penalties, records show that since the 2004 law passed, homes are challenging twice as many citations. The arrangement worked in the favor of a small home in San Jose, Homewood Care Center. Despite having been convicted of federal tax fraud, its owner used state funds to appeal a $100,000 citation issued by state regulators who, in a settlement, agreed to reduce the fine to $5,000.

The citation was issued in response to the events of Oct. 17, 2006, when Harold Schreifels, 67, died while awaiting surgery to repair a dialysis shunt. Homewood staff had noted that the diabetic man's blood sugar was dangerously low. But despite his pleas, they ignored their policy to notify a doctor about his condition, enforcing a 15-hour fast before surgery. The home's owner, Jack Easterday -- who, ironically, was convicted of failing to pay payroll taxes for his eight nursing homes the day the Schreifels fine was announced -- acknowledges the death might have been avoided if his staff had given intravenous nutrients. Still, a mediator discounted the fine by $95,000.

Easterday acknowledged the state helped pay his legal fees to fight the fine, but he described the contribution as "minuscule." The state was unable to determine how much it paid.

Gary Davis, Schreifels' stepson, said he could not believe the state stood by the reduced fine.

Continue reading "California Nursing Homes Reap $880 Million In Additional Funding Earmarked To Help Hire More Caregivers and Boost Wages" »

It can be confusing to tell the difference between the natural aging process and signs of nursing home neglect, especially in bedridden elderly individuals. The aging process is not always pleasant and sometimes the human body responds by painful and unattractive means. However, Decubitus ulcers are a form of neglect. More commonly known as bed sores, these sores develop from pressure point cause by the bones continually pressing against the skin. Bed sores are a definite sign of nursing home neglect.

When a healthy person comes down with the flu, often spending too much time in bed in the same position becomes painful. This is true of those who suffer from bed sores and neglect. That pain that we can all identify when we lay on one position for too long is intensified exponentially when it comes to bed sores. Victims of neglect often find bed sores developing on their body which range anywhere from small red marks to sores that penetrate all the way through the skin to the bone or an internal organ.

Nursing home neglect or nursing home abuse victims can rarely call out for help. They are often so dependant on the nursing home staff that they are afraid to cause any trouble. Sometimes the victims are physically incapable of speaking out against abuse or neglect. Imagine being in agony and having no way to ask for relief or no sense of safety to request relief.

Nursing home neglect laws require that patients be regularly turned in their beds to prevent these bed sores. No matter how small bed sores seem in the beginning, they are still an obvious sign of nursing home neglect, and they still require medical attention. Bed sores that turn into open wounds can not only cause serious health complications but have the potential to lead to death.

In reality, many forms of nursing home neglect can lead to serious health complications or death. While it is true that bed sores can happen in naturally thin elderly individuals despite being turned every couple of hours, but if even the smallest bed sore develops there should be immediate action on behalf of the nursing home doctors and nursing staff to correct the situation, even if that means that the patient needs more frequent turning than is required by law.

Nursing home neglect is a very serious problem, and can often be a little harder to recognize than nursing home abuse. Neglect can lead to death via these bed sores, slow starvation, or dehydration. It is not necessary to wait until bed sores are out of control and obviously remarkably painful to report the facility for neglect. In fact, doing so is a form of nursing home neglect as well.

The initial onset of a bed sore should be dealt with immediately, and if it is not handled to the very highest of your expectations, this is blatant nursing home neglect and should be reported immediately. Patients in nursing homes are virtually helpless to reach out beyond the walls of those who care for them to report neglect on their own. It is vital that those who can not speak for themselves have an advocate that is willing to risk a moment of discomfort to help keep them safe.

Nursing homes are not always easy to deal with when it comes to issues such as neglect or abuse. Those who are typically involved in the abuse are usually tired and callous and may not even readily recognize their own behavior as a form of nursing home neglect. There is always a convenient explanation on hand to explain away your concerns. Explanations pale in comparison to immediate and swift action.

The victims of nursing home neglect are not always forthcoming about the abuse they suffer. Why would they be? If a report of abuse or neglect is ignored or leads to an investigation with no action, the have no recourse for keeping themselves safe. Where are they supposed to turn?

Reporting neglect can be as simple as placing a phone call, however, many people choose to consult with a nursing home abuse and nursing home neglect lawyer in order to deal with the circumstances surrounding the alleged neglect in the most effective and safest method. A qualified lawyer can often give sound advice for dealing with the nursing home staff regarding the abuse and help in filing of any paperwork to ensure that legal action can be taken should the neglect allegation become proven via an investigation.

Never wait to report nursing home neglect. It is imperative both for the purposes of a lawsuit and the safety and health of the victim that the suspected neglect is reported immediately.

Pressure Ulcer Staging and Management
The treatment of pressure ulcers has progressed due to technical advances from manufacturers of wound care products and associations dedicated to the exchange of ideas and clinical experience. As with other chronic wounds, the focus of treatment has shifted from consideration of the wound in isolation, to a broader approach that includes examining and treating the underlying etiology, addressing specific wound requirements with specialist dressings, and treatment of the patient as a whole; for example, with systemic factors such as nutrients and antibiotics.

It is now recognized that pressure ulcers will not heal without assessment and removal of the source of pressure. As simple as this may sound, the treatment of "bed sores" or decubitus ulcers had been seriously impeded by insufficient attention to turning schedules or the application of pressure reduction or relief devices. The development of risk assessment tools has helped establish the many factors that must be addressed to prevent or heal pressure ulcers. Treatment regimes now include management of pressure, mobility/sensation, incontinence, and nutrition, and caregivers now implement treatments that cover all aspects of the patients' needs and wound treatment requirements. Many niche products have been developed to support care of patients prone to pressure ulcers. In addition to pressure relief products, there are sensitivity testing products, probes for diagnosing un-viable skin, posture improving rehabilitation products, products to monitor and indicate too much pressure for too long, and compliance monitors for nursing staff and patients.

Recognition of immobility as a risk factor has led to the establishment of standardized turning schedules for bed-bound patients and repositioning schedules for chair-bound individuals, such as paraplegics confined to wheelchairs. Repositioning schedules and good wound care will continue to help many to heal; however, those patients with the greatest number of risk factors will require pressure-reduction or pressure relief devices to decrease pressure and re-establish sufficient blood flow to the wound.
Manufacturers responded quickly to market demand with a proliferation of pressure reducing products including massive air-fluidized beds, low air-loss beds and mattress covers, and a plethora of foam and gel products. Faced with a large number of choices, clinicians have understandably been overwhelmed by the sheer number of alternative devices and price points. This market is defined by generic products that compete on a cost competitive platform with suppliers offering a full line of products that will suit an individual customer's particular treatment bias.

After relieving the pressure, proper maintenance of the wound environment becomes imperative for proper healing. Clinicians who used early transparent film dressings readily observed that wounds with a warm, moist surface healed more rapidly and with fewer complications than those allowed to dry out under gauze pads. Exuding wounds, however, required constant maintenance to remove excess fluid that built up under transparent dressings with frequent dressing changes or aspiration of fluid through the dressing.

Hydrocolloid dressings, introduced in the 1980s, absorbed fluid and sustained a moist wound environment for an extended period of time. Hydrocolloids rapidly replaced transparent dressings in exuding wounds, and both physicians and nurses soon became proponents of the "moist wound healing" philosophy. Regardless of their initial claims, all subsequent advanced wound care dressings have been more or less ranked by their fluid-handling ability in practice. For example, alginate dressings were launched with interesting claims suggesting that some ion exchange properties affected wound healing; however, alginates are now generally considered useful when exudates exceeds that easily managed by hydrocolloids.

The next factor considered by the clinician is the need to fill the wound void including the crater, undermining, and sinus tracts. A foam dressing may be used if there is a significant crater to fill and the wound is exuding. Hydrocolloid pastes and powders are used to fill dead space and increase absorptive capacity.

Nutritional support for pressure ulcer patients has been recognized as contributing to faster wound healing. Proper nutrition is necessary to provide sufficient calories to support the nutritional needs of the wound. Various nutritionally based claims have been made for topical supplements, such as zinc in bandages, but the evidence supporting such claims remains inconclusive. However, anabolic steroids, growth factors, gene therapy and tissue-engineered constructs have been suggested for use in patients to encourage the production of granulation tissue and increase the padding that is provided by muscle mass.

Manufacturers promoting their products need to respond to the reality of pressure ulcer care and provide comparative performance data and supporting clinical evidence. Their products should fall within the context of the overall treatment protocols and include pressure reduction, moist wound care, and nutritional support in order to gain credibility with the sophisticated buyer.

Staging of Pressure Ulcers

•Stage I ulcers are indicated by damaged friable surface skin with considerable hidden cell death caused by continuous pressure damage usually from immobilization in a single position. Identification of signs of pain and early indications of visible damage is a significant event in that it alerts caregivers of the need for interventions to prevent more serious damage.

•Stage II ulcers present as partial thickness wounds, which may heal with early intervention by regeneration under advanced wound care techniques.

•Stage III ulcers are usually full-thickness pressure sores. These are often difficult to classify due to the presence of eschar that obscures visualization of the wound bed. The presence of eschar does indicate a full thickness wound but the eschar must be removed (debrided) before classification can be established.
Early Stage III or Stage IV pressure ulcers may superficially resemble Stage I ulcers. A wound initially classified as Stage I may, therefore subsequently appear to progress to higher stages as the already damaged deeper tissues slough off or as auto-debridement occurs with moist wound healing therapy.

•Stage IV ulcers are characterized by full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining of healthy surrounding skin and sinus tracts may also be associated with Stage IV pressure ulcers.
The success of the four-stage system of pressure ulcer classification has led to attempts to utilize it for other wound types, with varying degrees of success. The four-stage system was developed for the initial assessment of the wound by determining the depth of injury and tissues involved. As full thickness wounds heal by granulation and scar formation it is inappropriate to use the system to describe the process of healing. Stage IV wounds do not become Stage III wounds during the course of healing. Tissues destroyed during the wounding process are not regenerated in full thickness wounds.

There are approximately 4.5 million pressure ulcers in the world that require treatment every year. Many chronic wounds around the world are treated sub-optimally with general wound care products designed to cover and absorb some exudates. The optimal treatment for these wounds is to receive advanced wound management products and appropriate care to address the underlying defect that has caused the chronic wound; in the case of pressure ulcers a number of advanced devices exist to reduce pressure for patients.Pressure ulcers occur most frequently over bony prominences where the padding effect provided by adipose tissue and muscle is least present. Pressure ulcers may also occur under casts, orthopedic devices and under compression bandages and stockings. The majority of pressure sores occur in the following regions:- lower spine (40%), feet (21%), trochanters 20%), scapula (5%), with upper spine, elbows, ribs, head, knees, and lower limbs making up most of the remainder.

Continue reading "Pressure Sore Staging and Management" »

When you make the choice to place your family members in the care of total strangers, you assume they'll be treated with dignity. But that isn't always the case. According to the National Center for Elder Abuse (NCEA), hundereds of thousands of cases of elder abuse are reported in the United States each year, and those are only the reported incidents. It unclear how many other victims do not tell their families about the pain they endure because of fear, shame or guilt.

The Ugly Side of Caregiving:Though there are three general categories of elder abuse--domestic elder abuse institutional elder abuse, and self-neglect or self-abuse--institutional abuse is the one farthest from your control.

Institutional abuse is abuse that occurs in residential facilities for older persons (e.g., nursing homes, foster homes, group homes, board and care facilities), according to the NCEA. The abusers are usually persons with a legal or contractual obligation to provide elder victims with care and protection (e.g., paid caregivers, staff, and professionals).

Types of institutional abuse and their symptoms include:
Physical abuse - bruises, pressure marks, broken bones, abrasions, and burns
Sexual abuse - bruises around the breasts or genital area
Emotional or psychological abuse - Withdrawal from normal activities and mild depression or odd behavioral changes; threatening or violent interaction with others
Neglect - bedsores, unattended medical needs, poor hygiene, and drastic weight loss
Financial or material exploitation - sudden fluctuations in money accounts or other material assets
Self-neglect
Abandonment

If you've recently become aware of a family member or family friend being abused, you don't have to fight these institutions alone. After you've established the problem, don't go sifting through the legalities of getting even by yourself. There is help available by contacting Steven Peck's Premier Legal toll free at 1.866.999.9085 or visit us on-line at www.premierlegal.org.

Bed­sores seem a nat­ural part of being tied in bed, espe­cially in elderly patients. The truth is that it elders should not develop pres­sure sores if the per­son is turned in bed often enough. Bed­sores can be as small as a red point on the hip or thigh, or could be as severe as an open wound that goes all the way to the bone. Bed­sores can be a sign of neg­li­gence and nurs­ing home neglect.

Nurs­ing home neg­li­gence is often much more com­mon than most of us are will­ing to believe especially when it concerns Decubitius Ulcer, Pressure Sores and Bedsores.

At the first signs of pres­sure ulcers, the sit­u­a­tion should be urgently addressed. The area should be treated and the patient should be increased to a rota­tion sched­ule that is much more com­mon, more than two hours between the rota­tion. It is pos­si­ble that pres­sure ulcers can develop when first start­ing,such as when the new patient is bedrid­den, has lost some weight recently, or have had pre­vi­ous sur­gi­cal pro­ce­dures performed.

How­ever, if the pres­sure ulcer is not treated imme­di­ately with an aggres­sive response, then it is time to con­tact a lawyer. Lawyers can often find pre­vi­ously unseen and unno­ticed neglect. Nurs­ing home attor­neys can iden­tify abuse and neglect often faster and more effi­ciently than a fam­ily mem­ber involved emotionally says Los Angeles Elder Abuse Attorney Steven C. Peck.

Many peo­ple believe that bed­sores are unavoid­able. Many experts and even some thought that bed­sores are a nat­ural part of adap­ta­tion or always bedrid­den patients. A high qual­ity facil­ity should not allow pres­sure ulcers to develop. Abuse can occur regard­less of the price asso­ci­ated with the elders par­tic­u­lar invest­ment in the facility. Watch your elder very very closely and as much as you can. Visit the facility, observe and talk to the elder.

Continue reading "Decubitus Ulcers, Pressure Sores & Bedsores Should Not Develop With Competent Nursing Care" »

Being an older American or senior citizen has lots of benefits. The store and restaurant discounts are wonderful, along with the special parking spaces.
Of course, aging does have some disadvantages as we all know. Physical and mental health issues, along with financial concerns, often weigh heavily on the minds of older Americans.
There is another concern that no one wants to talk about: elder abuse.
Abuse isn't always something you can see. Elder abuse can include physical, emotional, sexual, financial, neglect and self-neglect. Some families or couples are able to keep abuse a total secret says California Elder Abuse Attorney Steven C. Peck.
In today's economic situation, financial abuse is on the increase. Examples include a widowed mother who has to rely on a child for help, and may be threatened by that child, saying if she doesn't hand over money the child will no longer help her. An adult child, unemployed or with a drug or alcoholic habit, can manipulate elder parents to "put me on your account so I can do your banking" and then withdraws money without the parents' knowledge.
An elder can be abused by a family member, including a spouse, or by a caregiver. And elder abuse can happen to men and women.

Continue reading "Watch Very Carefully For The Signs of Elder Abuse" »

It's a scenario heard frequently by elder abuse experts. The son (or daughter) who has been given power of attorney starts cutting back on his mother's expenditures even though she has enough money to continue living as she had been. He decides where she lives and who she sees. He sells some of her favorite possessions. And as her on-hand cash declines, his swells. At the same time, new codicils to her will reduce the amount she had originally left to others and increase the amount for

Unintentionally, says her grandson Philip Marshall, Brooke Astor's greatest legacy may be as someone who raised awareness of elder abuse. Last October, when he was 85 years old, Astor's son (and Philip's father), Anthony Marshall, was convicted on 14 of 16 charges that included grand larceny, criminal possession of stolen property, forgery, scheming to defraud, falsifying business records, offering a false instrument for filing and conspiracy. He was sentenced to one to three years in prison, and the case is on appeal.

Astor died in 2007 at age 105. She had been diagnosed with Alzheimer's in 2000, and in 2002 Philip Marshall, a professor of architectural preservation in Rhode Island, became concerned that his father might be taking advantage of Astor's frail, confused state. The first hint was the missing $10 million painting, "Flags, Fifth Avenue" by artist Childe Hassam, which Astor had initially promised to the Metropolitan Museum of Art. Anthony Marshall sold the painting, reportedly with Astor's agreement because he had told her they needed the money, and then pocketed a $2 million fee for himself.

Philip Marshall was the keynote speaker recently at an all-day "Call to Action" in San Francisco hosted by the Elder Financial Protection Network. He said it was the first time since the December conviction of his father that he had spoken publicly about the case and his attempts to intervene in the care -- or lack of it -- his father was providing Brooke Astor. "All it takes for elder abuse to flourish is for family and friends to do nothing," he said, noting that difficult as it was to go against his father, he felt he had no choice.

After Philip Marshall noticed the missing painting, he started paying more attention to what was happening at Astor's Park Avenue duplex. Staff also took him aside, telling him that his grandmother was being denied access to medication and doctor's visits as well as to her beloved dogs and some of her friends. In order to save money, her son was even changing the products she had been buying for decades, staffers said. In addition, Anthony Marshall, a theatrical producer, fired the chauffeur, the butler and Astor's lawyer of 50 years and closed her New York country house, Holly Hill, where she had said she wanted to die. Philip took note and started keeping records of the reports. It was not until 2006 that he sought out Rockefeller and Annette de la Renta to help get better care for his grandmother. They hired a law firm that filed Philip's petition seeking a guardian to care for his grandmother. Before the case went to court, Anthony agreed that de la Renta could take over as guardian and he agreed to return $11 million in money, jewelry and art.

It wasn't just that his grandmother's money was being taken by his father, Philip says. "If my father and his wife had simply taken money and property of hers but provided for my grandmother, this story might be different." But the greed of his father, he added, came at a psychological and physical cost to his grandmother who was increasingly confused, frightened and in declining health. And she didn't understand why her staff, including her loyal, long-time butler, had disappeared. She assumed he must have died.

Elizabeth Loewy, the assistant district attorney who prosecuted the criminal case against Anthony Marshall, told the conference that while the Astor case may be unusual in its celebrity and amount of money at stake, it typifies what is a skyrocketing threat against elders -- financial exploitation. Jenefer Duane, founder and CEO of the San Francisco-based Elder Financial Protection Network (EFPN), concurred. "In today's economic climate, elders are at greater risk than ever of being targeted for fraud and financial abuse," she said.

According to a recent Metropolitan Life study, "Broken Trust: Elders, Family and Finances," seniors lose $2.6 billion a year to financial abuse. And for every known case of abuse, it is estimated that four or five cases may go unreported. Typically, those who exploit the seniors are not strangers and the exploitation and abuse can come in many forms: fraud, scams (on the Internet and off), undue influence, abuse of powers of attorney and guardianship, identity theft, failure to fulfill contracted health care services and Medicare and Medicaid fraud. Financial abuse of elders is the third most commonly substantiated type of elder abuse, according to the report, following neglect and emotional and psychological abuse. "And the problem appears to be growing," the report states.

"Raising awareness is key to confronting the problem of elder financial abuse, and I hope the visibility my grandmother gave to the issue becomes her lasting legacy," said Philip Marshall.

How elders can avoid scamsThere was no shortage of horror stories at the Elder Financial Protection Network's 6th Annual Call to Action event in San Francisco:

A young man sells a 75-year-old woman an expensive vacuum cleaner and comes back weeks later and asks to use the phone. He ties her up with duct tape, stuffs her in her own car, beats her repeatedly, makes charges on her credit card during her 26 hours in the trunk and has plans to kill her. She is found when an alert sheriff's deputy follows the car and stops it for running a red light.

A Las Vegas waitress befriends an elderly customer and then tells him the sad tale of her life. The customer gives her a $500 check. In conversation, she also gets his date of birth and his Social Security number. Eventually, she gets $750,000 through use of the identifying information she has coaxed out of him.

A caregiver starts out working at a house a couple of hours a day and then says he could give better care by moving in. He gains the homeowner's trust by cooking, cleaning, taking care of whatever needs doing. Eventually -- in this case, it was several years -- he controls the finances, takes title to the house and cleans out the bank accounts.
"It can happen to all of us," says Cynthia Healy, president and founder of Security Financial Advisors Inc. in Monterey. She'd like seniors to remember the acronym, SCAM:

S -- Surround yourself with family and friends. Do not isolate yourself.
C -- Caregivers. Do your own checks of caregivers even if they come from an agency.
A -- Ask for assistance from professionals such as accountants, attorneys, bankers, doctors. Build a team so there are checks and balances.
M -- Maintain security over your personal information.

Paul Greenwood, head of Elder Abuse Prosecutions for the San Diego District Attorney's Office, successfully prosecuted the young man who kidnapped the 75-year-old woman on charges of attempted murder, torture and kidnapping. An international speaker on elder abuse, he offers 10 tips for avoiding financial elder abuse:

Choose a caregiver with caution and make your own checks even if the caregiver comes from an agency.

Keep an inventory of all jewelry.

Use a shredder for everything with your name, address or any other identifying information on it.

Protect your incoming and outgoing mail.

Do a credit search on yourself at least two or three times a year.

Install caller I.D. to determine if a call is private or unknown and don't be afraid to hang up or use a whistle you keep by the phone.

Remember: You will never, ever win a foreign lottery.

Consider letting your bank send a duplicate of your monthly statement to a trusted family member or an accountant or attorney.

Don't assume that people doing work on your home are licensed. Check and also get three estimates in writing and a written contract.

Have a second line of defense, such as a locked screen door or a security chain guard, at your front door.

Continue reading "Elders Are Easy Targets For Fraud and Financial Elder Abuse" »

Every year in California, over 200,000 elderly American citizens suffer from financial abuse at the hands of unscrupulous family members and financial institutions. Yet, only about one in every 100 cases is ever reported. The Elder Abuse Reporting Act was implemented to make it everyone's legal responsibility to stand watch and report any suspicion of elder abuse.
In September 2005, California Gov. Arnold Schwarzenegger signed the Financial Elder Abuse Reporting Act in an effort to help protect the elderly citizens of California from financial abuse by family members, friends and con artists. According to the governor's strategy, he wants to protect the innocent elderly, "by keeping them out of the grasp of unscrupulous people."
How the Act Protects the Elderly
The enforcement of the Elder Abuse Reporting Act has now made it the responsibility of every employee at banks, savings associations and credit unions to be "mandated reporters of suspected financial abuse." They are now required to report to the local Adult Protective Services Department (APSD) or to law enforcement agencies any suspicions of financial abuse towards any elder or dependent person. But the responsibility goes beyond the financial institutions. The act also extends its obligations to the general public and they, too, are responsible to report any suspicions they have of elder abuse to the employees of financial institutions or to the APSD.
Mandate of the Act
The Elder Abuse Reporting Act was designed to protect not only the elderly, but the institutions that are being targeted. It protects elderly citizens from financial abuse and reduces the number of incidents involving elderly and dependent citizens. But it also protects the financial institutions from lawsuits that are being filed by family members of abused persons. Gov. Schwarzenegger believes that it's the responsibility of every citizen to help protect the innocent. During the press release at the time he announced the new act, he said, "I am committed to ensuring the safety and security of California's growing population of seniors. Our older Californians have worked hard all their lives and should enjoy the fruits of their labor."
Signs of Elder Abuse
There are many obvious signs, and some not so blatant signs, to be aware of while protecting elderly citizens from abuse. Most of them involve the unauthorized use of finances and property that is often carried out by family members, caregivers, insurance companies or scam artists. Some of these violations include the misuse of personal checks, credit cards and accounts; stolen cash, income checks or even household goods; a suspicious-looking signature that could be forged; and identity theft. More discrete signs include some family members gradually becoming more wealthy, new and unnecessary items being purchased, and the disappearance of wallets or money under the assumption that the elderly person misplaced them.
Criminal Offense
If an employee of a financial institution fails to report suspicions immediately, a fine of up to $1,000 could be issued against the institution. And a fine of $5,000 could be issued against the employee if it can be determined that the neglect was intentional.

Continue reading "The California Elder Abuse Reporting Act" »

How do you know if your loved one is being neglected in a nursing home? When you go to visit, everything looks fine, but your loved one is unable to express his/her pain to you in words. When a nurses aide comes in to attend to your loved one, you noticed a big sore on the side of their leg. When you question it, the nurses aide claims that it is noting but a simple sore. This is wrong. What you are actually looking at are signs of neglect.

A decubitus ulcer is commonly known as a bed sore. A decubitus ulcer can be a simple red or pink mark on the skin or it can be as bad as a very deep sore that reaches into the bone or internal organ. They are caused by prolonged pressure on a particular part of the body and are seen on patients who are bedridden (Thus the name, bed sore).

Most nursing facilities have a policy to turn bedridden patients once every two hours in order to prevent decubitus ulcers from forming. If your loved one has these decubitus ulcers, then they are not being turned in the bed as often as required and this is a form of neglect in a nursing home.

These decubitus ulcers can lead to further complications, including death if not treated. Therefore, if you have seen decubitus ulcers on your loved one, you should first consult with the doctors and nurses in the facility. If they fail to respond or give you a reasonable answer to why there are decubitus ulcers on your loved one, then you should consider filing a report or a complaint for nursing home neglect.

The decubitus ulcer is often painful. So, your loved one may be in severe pain and unable to express their pain. They may be crying for help, but no one is listening. This is neglect. No one should have to suffer the pain of decubitus ulcers. Simply turning or repositioning your loved one every two hours will prevent these ulcers from forming. They should not be there in the first place, but if you do notice them, you should be informed that your loved one is experiencing some form of neglect in their nursing home.

It is true that decubitus ulcers are considered preventable and the development of decubitus ulcers is evidence of some form of neglect. Many paralyzed or terminal individuals with very poor nutrition can be free of these ulcers. This can be accomplished by good patient care.

Continue reading "Decubitus Ulcers, Pressure Sores & Bedsore Development Is Evidence of Neglect" »

Nursing homes can be a sad state of affairs, and walking through one can be simultaneously depressing and frightening. Nobody ever wishes to place a loved one in a nursing home and nobody ever wants to end up in one as well.

It can be an equally frightening proposition to confront neglect. Neglect is a silent form of abuse and is the negligent failure to provide necessary medical services.

Nursing home neglect can come in many silent but devastating forms.Decubitus Ulcers also known as Bed Sores and / or Pressure Sores are a natural occurrence for bedridden patients, but they should be minimized by constantly being moved around in the bed as a preventative method of keeping bed sores under control. Bed sores can be a glaring red flag that your loved one is a victim of nursing home neglect.

Continue reading "Decubitus Ulcers, Pressure Sores & Bedsores Are A Glaring Red Flag of Nursing Home Abuse & Neglect" »

Our population is aging, and as we continue to age, we face complex and difficult legal issues to deal with. Convoluted laws and regulations with both Medicaid and the Veterans Administration do not make navigating your senior years any easier. In response to these challenges a new area of law is developing, that is, Elder Law.

Elder law is a growing area of legal practice where attorneys will work with seniors, people with disabilities and their families to develop legal and financial strategies to pay for long-term care and to assist clients in navigating the complex legal rules and regulations involved with the various governmental programs.

For example, say your mother has just been diagnosed with Alzheimer's disease and is looking at on-going nursing home bills at over $6,000 per month. A quality senior lawyer would be able to put together a plan that will protect Mother's assets from the nursing home, for the benefit of the family, by developing a long-term care strategy and navigating the governmental Medicaid program on your behalf.
Maybe, you father was a Veteran and is looking at needing assisted living or home health care. An Elder Law attorney (who should also be accredited by the Veterans Administration), would be able to help your father possibly qualify for the little known Veterans Administration Pension Benefit, which could help offset some of the costs of the assisted living center or home health care that your father is receiving.

Finding a well qualified Elder Law attorney can be difficult, as it is a specialized area of law. Your Elder law attorney should have credentials such as being a member of the National Academy of Elder Law Attorneys (NAELA), ElderCounsel, Elder Care Matters Alliance, and be accredited by the Veterans Administration to assist Veterans with receiving Veterans Benefits.

Continue reading "Elder Law Issues Are Rapidly Developing" »