California Elder Law Attorney Blog

15 Red Flags of Fiduciary Abuse, Exploitation, Neglect, and Misappropriation
1. Protected person has no relatives or active friendships
2. Large estates
3. Late or no accountings filed
4. Multiple ATM transactions
5. Health or personal problems of the fiduciary
6. Use of several attorneys by the fiduciary
7. Attorneys representing the fiduciary withdrawing from the fiduciary's cases
8. Singular control of information by the fiduciary
9. No automated record keeping by the fiduciary
10. Financial difficulty of the fiduciary (tax liens, judgments, bankruptcy, divorce)
11. Revocation or failure to renew fiduciary bonds
12. Large expenditures in the accounting not appropriate to the client's setting
13. The fiduciary has minimal experience
14. Pattern of letters and verbal complaints against the fiduciary
15. Lack of oversight on the case by Counsel assigned or Court staff

Continue reading "15 Red Flags Constituting Fiduciary Abuse of the Elderly" »

The terms decubitus ulcer and pressure sore often are used interchangeably in the medical community. Decubitus, from the Latin decumbere, means "to lie down." Decubitus ulcer, therefore, does not adequately describe ulceration that occurs in other positions, such as prolonged sitting (eg, the commonly encountered ischial tuberosity ulcer). Because the common denominator of all such ulcerations is pressure, pressure sore is the better term to describe this condition.

A study by Howard and Taylor found the incidence of pressure sores in nursing home residents in the southeastern United States to be higher in black patients than in white ones. The authors examined data from 113,869 nursing home residents, none of whom had pressure sores at nursing home admission. They determined that 4.7% of black residents developed postadmission ulcerations, compared with 3.4% of white residents. In addition, the racial differences in pressure sore incidence displayed a sex predilection based on patient characteristics. The variation in incidence between black and white males occurred in residents who were dependent in mobility, while in females, such variation occurred in black and white residents who were bedfast and living in nursing homes with fewer than 200 beds.1

History of the Procedure
Pressure sores have probably existed since the dawn of our infirm species. They have been noted in unearthed Egyptian mummies and addressed in scientific writings since the early 1800s. Presently, treatment of pressure sores in the United States is estimated to cost in excess of $1 billion annually.

Problem
Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath. These pressures are often in excess of capillary filling pressure, approximately 32 mm Hg. In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, conscious and unconscious, from the areas of compression leads individuals to change body position. These changes shift the pressure prior to any irreversible tissue damage.

Individuals who are unable to avoid long periods of uninterrupted pressure over bony prominences--a group of patients that typically includes elderly individuals, persons who are neurologically impaired, and patients who are acutely hospitalized--are at increased risk for the development of necrosis and ulceration. These individuals cannot protect themselves from the pressure exerted on their body unless they consciously change position or have assistance in doing so. Even the most conscientious patient with an extensive support group and unlimited financial resources may develop ulceration resulting from a brief lapse in avoidance of the ill effects of pressure.

Frequency
Two thirds of pressure sores occur in patients older than 70 years. The prevalence rate in nursing homes is estimated to be 17-28%.

Among patients who are neurologically impaired, pressure sores occur with an annual incidence of 5-8%, with lifetime risk estimated to be 25-85%. Moreover, pressure sores are listed as the direct cause of death in 7-8% of all paraplegics.

Patients hospitalized with acute illness have a pressure sore incidence rate of 3-11%. In a study of 658 patients aged 65 years or older who underwent surgery for hip fracture, Baumgarten et al found that 36.1% developed an acquired pressure sore within 32 days after hospital admission.5 (The authors defined an acquired pressure sore as one that arose after hospital admission and had reached stage II or higher.) Although the 32-day period included time spent by patients in rehabilitation facilities and nursing homes, the highest incidence rate for pressure sores occurred during the patients' acute hospital stays.

Disturbingly, even with current medical and surgical therapies, patients who achieve a healed wound have recurrence rates of as high as 90%.

Etiology
Many factors contribute to the development of pressure sores, but pressure leading to ischemia is the final common pathway. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures slightly above capillary filling pressure initiates a downward spiral towards ulceration.6,7

Impaired mobility is an important contributing factor. Patients who are neurologically impaired, heavily sedated, restrained, or demented are incapable of assuming the responsibility of altering their position to relieve pressure. Moreover, this paralysis leads to muscle and soft-tissue atrophy, decreasing the bulk over which these bony prominences are supported.

Contractures and spasticity often contribute by repeatedly exposing tissues to pressure through flexion of a joint. Contractures rigidly hold a joint in flexion, while spasticity subjects tissues to considerable repeated friction and shear forces.

Sensory loss also contributes to ulceration, by removing one of the most important warning signals, pain.

Paralysis and insensibility also lead to atrophy of the skin with thinning of this protective barrier. The skin becomes more susceptible to minor traumatic forces, such as friction and shear forces, exerted during the moving of a patient. Trauma causing deepithelialization leads to transdermal water loss, creating maceration and adherence of the skin to clothing and bedding, which raises the coefficient of friction for further insult.

Malnutrition, hypoproteinemia, and anemia reflect the overall status of the patient and can contribute to vulnerability of tissue and delays in wound healing. Poor nutritional status certainly contributes to the chronicity often observed with these lesions. Anemia indicates poor oxygen-carrying capacity of the blood. Vascular disease also may impair blood flow to the region of ulceration.

Bacterial contamination from improper skin care or urinary or fecal incontinence, while not truly an etiological factor, is an important factor to consider in the treatment of pressure sores and can delay wound healing.

Pathophysiology
The inciting event for a pressure sore is compression of the tissues by an external force, such as a mattress, wheelchair pad, or bed rail. Other traumatic forces that may be present include shear forces and friction. These forces cause microcirculatory occlusion as pressures rise above capillary filling pressure, resulting in ischemia. Ischemia leads to inflammation and tissue anoxia. Tissue anoxia leads to cell death, necrosis, and ulceration.

Irreversible changes may occur after as little as 2 hours of uninterrupted pressure.

Presentation
Clinical presentation of pressure sores can be quite deceiving to the inexperienced observer. Soft tissues, muscle, and skin have a differential resistance to the effects of pressure. Generally, muscle is the least resistant and will necrose prior to skin breakdown. Also, pressure is not equally distributed from the bony surface to the overlying skin. Pressure is greatest at the bony prominence, decreasing gradually towards the periphery. Once a small area of skin breakdown has occurred, one may be viewing only the tip of the iceberg, with a large cavity and extensive undermining of the skin edges.

Many classification systems for staging pressure ulcers have been presented in the literature. The most widely accepted system is that of Shea, which has been modified to represent the present National Pressure Ulcer Advisory Panel classification system. This system consists of 4 stages of ulceration but is not intended to imply that all pressure sores follow a standard progression from stage I to stage IV. Nor does it imply that healing pressure sores follow a standard regression from stage IV, to stage I, to healed wound. Rather, it is a system designed to describe the depth of a pressure sore at the specific time of examination, in order to facilitate communication among the various disciplines involved in the study and care of such patients.

Stage I represents intact skin with signs of impending ulceration. Initially this would consist of blanchable erythema from reactive hyperemia that should resolve within 24 hours of the relief of pressure. Warmth and induration also may be present. Continued pressure creates erythema that does not blanch with pressure. This may be the first outward sign of tissue destruction. Finally, the skin may appear white from ischemia.

Stage II represents a partial-thickness loss of skin involving epidermis and possibly dermis. This lesion may present as an abrasion, blister, or superficial ulceration.

Stage III represents a full-thickness loss of skin with extension into subcutaneous tissue but not through the underlying fascia. This lesion presents as a crater with or without undermining of adjacent tissue.

Stage IV represents full-thickness loss of skin and subcutaneous tissue and extension into muscle, bone, tendon, or joint capsule. Osteomyelitis with bone destruction, dislocations, or pathologic fractures may be present. Sinus tracts and severe undermining commonly are present.

Other important characteristics of the wound should be noted in addition to depth. One should note the presence or absence of foul odors, wound drainage, eschar, necrotic material, and soilage from urinary or fecal incontinence. This provides information regarding the level of bacterial contamination and the need for débridement or diversionary procedures.

The overall state of health, comorbidities, nutritional status, mental status, and smoking history also should be noted. Presence or absence of contractures and spasticity also are important in the formulation of a treatment plan. One should note where the patient normally resides and the extent of his or her support structure. Examining the support surfaces present on the patient's bed or wheelchair also is important.

Relevant Anatomy
The hip and buttock regions account for 67% of all pressure sores, with ischial tuberosity, trochanteric, and sacral locations being most common. The lower extremities account for an additional 25% of all pressure sores, with malleolar, heel, patellar, and pretibial locations being most common.

The remaining 10% or so of pressure sores may occur in any location that experiences long periods of uninterrupted pressure. Nose, chin, forehead, occiput, chest, back, and elbow are among the more common of the infrequent sites for pressure ulceration. No surface of the body can be considered immune to the effects of pressure.

Continue reading "Decubitus Ulcers, Pressure Sores aka Bed Sores Cost over $ 1 Billion Annually To Treat " »

In early 2008, a resident was admitted to the Los Angeles nursing home in order to rehabilitate a fractured hip. The 84 year old resident died following the misplacement of a feeding tube. At the time the resident was admitted to the nursing home, he was noted as having no swallowing or chewing problems. After some weight loss, his doctor ordered feedings via nasogastric tube.

In what turned out to be a fatal mistake, staff inserted the tube through the residents nose, and it placed in the residents lung instead of stomach. Once feedings began, the lungs filled with the feeding materials that were meant to go to the stomach, making him sick at once. He succumbed to aspiration pneumonia three days later.

Hancock Park Rehabilitation, the facility where the incident took place, did not follow established protocols for inserting the tube, and did not check to make certain it was properly placed in the stomach, according to the report from the Department of Public Health. When the 84 year old patient was rushed to a hospital emergency room, it was revealed by a chest x-ray that the tube extended in to the lungs instead of the abdomen.

This isn't the first time Hancock Park Rehabilitation Center has received violations. The facility has a history of prior incidents, and in 2006 and 2008 received multiple violations related to improper care of patients.

Continue reading "California Nursing Home Fined $ 100,0000.00 Penalty for Resident's Death" »

According to the National Center on Elder Abuse (NCEA), "elder abuse" is a term referring to any knowing, intentional or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.

The victims of elder abuse come from all walks of life, but they share the common characteristic of being over the age of 60 and in some states over the age of 65 says California Elder Abuse Attorney Steven C. Peck.

Abusive actions result in physical, emotional, sexual or financial harm to the victim and can be the result of neglect or abandonment. The key factor is the infliction of pain, injury or the deprivation of a basic need.

While many think of elder abuse as resulting from the actions of others, a recent report by the Clearinghouse on Abuse and Neglect of the Elderly (CANE) finds that the most common type of elder mistreatment reported to adult protective services nation-wide is the result of self-neglect.

In situations of self-neglect, addressing the problem is often difficult because self-neglectors refuse services or resist interventions which will likely remedy or resolve the problem.

There are several risk factors for elder abuse to watch for, according to the University of Washington Division of Gerontology and Geriatric Medicine. These include characteristics of the abused person, living situations and characteristics of the abuser.

Usually, the mistreated elder suffers from poor health accompanied by functional impairment, cognitive impairment and social isolation. Elder abuse generally occurs in a shared-living arrangement where there may be some form of external stress, and it frequently involves strained financial situations.

The abuser may have a history of substance abuse or mental illness, may be dependant on the victim in some way and often has a history of violence.

Elders can take steps to protect themselves from elder abuse, and more importantly, they should take steps to maintain their health. Professional help should be sought in the event of addiction, alcoholism or depression.

Support services should be utilized if domestic violence is present. Seniors should plan for their own financial and health care future. Whenever finances are involved, seek independent advice from a trusted, knowledgeable and unbiased source before making a decision. Stay active in the community, and do not become isolated. Finally, know that you have the right to express your preferences and concerns.

Protection of others from abuse involves knowing the warning signs. Elders and others should keep a watchful eye on their loved ones, friends and neighbors and should be unafraid to voice their concerns. While elder abuse is a serious problem, government and private organizations and Elders themselves are taking an active role in its detection, prevention and elimination.

The warning signs of elder abuse are: (1). Signs of physical injury or unexplained marks. (2). Signs of restraint. (3). Signs of neglect such as bedsores, soiled clothing, malnutrition, dehydration or unexplained weight loss. (4). Injuries to the genitals or breasts. (5). Frequent arguments between an elder and a caregiver or other person in a close relationship with the elder. (6). Sudden changes in an elder's living arrangements. (7). Repeat or unreasonable violations of an elder's privacy by another person. (8). Changes in behavior, particularly if they involve withdrawal, anxiety, agitation or depression. (9). Sudden financial changes, unusual bank activity, unpaid bills or a discrepancy between means and standard of living and (10). An elder expressing that he or she is being abused or exploited.

Continue reading "Elder Abuse Is The Intentional Or Reckless Acts That Cause Harm To Vulnerable Adults" »

Pressure Ulcers and Infections
Pressure ulcers also known as Bed Sores and Decubitus Ulcers and infection are a serious risk to patients in long term nursing home facilities. Approximately one million people develop pressure ulcers, also known as bed sores and decubitis ulcers every year in America. At least sixty thousand lives are lost as a result of pressure ulcers and infections or other complications each year. Three of every four people who suffer pressure ulcers and infections are seventy years of age or older. In light of this fact, the prevention and treatment of pressure ulcers and infections are major issues in the nursing home industry.

Pressure ulcers and infections can affect patients who are bedridden, unconscious, unable to feel pain or sensation, or are immobile and use a wheelchair. Pressure ulcers develop after a period of prolonged pressure which cuts off circulation to the skin and causes it to die. When pressure ulcers develop, they begin as superficial irritations to the skin that appear as reddish or otherwise discolored patches of skin. If left untreated, deeper pressure sores and infections can develop.

When pressure ulcers are not prevented or treated, tissue deterioration can deepen to invade the tissues and underlying structures. When pressure ulcers become open wounds they are very vulnerable to infection. Infection occurs when bacteria enters the affected areas. Pressure ulcers and infections are characterized by pus discharge, foul odor, fever, and tenderness, heat, or redness around the pressure ulcer. Sweat, feces, urine, and other sources of moisture are all common causes of pressure ulcers and infections. Incontinent patients, those who are paralyzed, and other disabled patients are at a greater risk of developing pressure ulcers and infections says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

When patients suffer from pressure ulcers and infections it is vital that they be promptly and adequately treated to avoid life threatening complications. Nursing staff have a duty to administer antibiotics and pain medicine when appropriate, clean and bandage affected areas, and respond to all the needs of patients with pressure ulcers and infections. When pressure ulcers and infections are left uncared for serious complications can threaten the lives of these patients.

Pressure ulcers and infections can lead to a variety of serious complications. Infections can cause gangrene or tissue death. Osteomyelosis is a serious bone infection that occurs with advanced stages of pressure ulcers. A patient can develop scar carcinoma, or cancer in the scar tissue of a pressure ulcer. Sepsis is a serious infection that occurs when bacteria enters the blood stream via a pressure ulcer. Sepsis is fatal in fifty percent of all pressure ulcers and infections cases.

When nursing home patients develop pressure ulcers and infections it can be the result of nursing home abuse or negligence. Nursing care professionals have a legal duty to prevent patients from suffering from pressure ulcers and infections. If they fail to do so, they can be held liable for any injury or death that ensues.

Continue reading "Bedsores, Pressure Sores & Decubitus Ulcer Infections" »

What are Bed Sores, Pressure Sores also known as Decubitus Ulcers?

Bed sores are ulcers that occur on areas of the skin that are under extended periods of pressure. The pressure may be a result of lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Bed sores can occur when a person is bedridden, unconscious, unable to sense pain, or immobile. Bed sores are ulcers that occur on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time.

Bed sores are commonly found on the tail bone area, hips, back, elbows, heels and ankles. They can become deep, extending into the muscle.

Bed sores are also called Decubitus Ulcers and Pressure Sores. indicates Los Angeles Elder Abuse Lawyer Steven C. Peck.

Can Bed Sores be Treated?

Yes. It is important to treat bed sores as soon as they appear. If left untreated, the skin can break open and become infected. The treatment will depend on the severity of the sores and may include several methods. Treatment is more difficult if the skin is broken.

Common treatments of bed sores include:

•removing pressure on the affected area
•protecting the wound with medicated gauze
•keeping the wound clean
•medication (antibiotics and pain relievers)
•antibiotic ointments
•surgical removal of dead tissue
Can bed sores be prevented?

Yes. Some of the ways to prevent bed sores are:

•good nutrition
•clean and dry linens
•frequent turning and repositioning of immobilized individuals
•providing soft padding in wheelchairs and beds to reduce pressure
•keeping the skin clean and dry

Continue reading "What Are Bed Sores, Pressure Sores also known as Decubitus Ulcers?" »

Contractures are a medical condition where a joint is held in a fixed position due to the shortening of a muscle or tendon due to stress exerted on the muscle or spasticity (uncontrolled muscle movement). Older patients and those with limited mobility are especially prone to develop contractures. Contractures most commonly form in:
•Hands
•Feet
•Arms
•Legs
Once an individual has developed contractures, little can be done to alleviate the problem aside from aggressive orthopedic surgery. Consequently, medical facilities (hospitals and nursing homes) should provide physical and occupational therapy to people who are at risk for developing contractures and to keep the body flexible.

Once a person has developed contractures they are at a heightened risk for developing bed sores, also known as Pressure Sores and Decubitus Ulcers due to their bodies limited ability to move- with or without assistance and the unnatural pressure put on the body in a rigid state.

The rigidity that accompanies contractures generally means that many of the repositioning techniques commonly used to prevent bed sores may be unfeasible. As a general rule, the more immobile an individual is, the higher likelihood they have in developing bed sores. Long Term Care Facilities have the duty to prevent bed sores, pressure sores and Decubitus Ulcers.

Continue reading "Contractures Can Be A Cause of Decubitus Ulcers, Bed Sores and Pressure Sores" »

Definitions of what constitutes as Elder Abuse are also diverse: some sources define elder abuse as only physical abuse, while other sources include emotional abuse, sexual abuse and financial abuse. Accurate numbers are also extremely difficult to compile since many incidents of abuse go unreported. Many elderly are afraid or ashamed to report incidents of abuse, especially if the perpetrator is a family member. Seniors at times are emotionally or physically abused by a familiar person, and are often unable to recognize it as abuse or rationalize it says California Elder Abuse Attorney Steven C. Peck.

What can be done to eliminate incidences of elder abuse? Society should shoulder the responsibility to protect the elderly, but it begins with the family of the senior. Many of the children and other relatives of the elderly feel that once they have a care giver to care for the elderly their work is done. Far from it, they need to remain vigilant in directing and overseeing that good care is in fact what is provided.

When visiting an elder loved one, you should be alert to the warning signs of abuse:

Emotional or Psychological Abuse:

Are there insults or threats directed at the elder? Are they living in social isolation? The elder may be extremely upset, withdrawn, unresponsive, or exhibiting other unusual behavior. He or she may have a vacant look in their eyes or exhibit fear; they may not always express those verbally, so look for signs in their face or behavior.

Physical and Sexual Abuse:

Look for suspicious bruises or other injuries. Look for signs of restraints, such as a rope burns. See if he or she shows sudden changes of behavior, such as unexplained anger, fear, withdrawal, or has become very quiet. Note if a worker or caregiver refuses to let you visit the elder, making all kind of excuses.

Neglect:
Look for signs of malnutrition, if there is noticeable weight loss, dehydration, bed sores, or if personal hygiene is noticeable neglected. Note if the elder is sitting in soiled clothing, unshaven, unkempt, without dentures, or with long or dirty nails, are they walking around at midday still wearing pajamas? Listen to complaints from the senior as to whether or not their aide is listening to them or following their wishes and follow up on them.

Financial Abuse:

Keep an eye out for unexplained bank withdrawals, unauthorized use of bank and credit cards, reports of stolen or missing checkbooks and bank cards, or if your parent or elder writes checks as a loan or gift to the aide. Be on the lookout for valuables suddenly disappearing. Monitor any sudden changes in the will or banking documents, and be alert if assets are suddenly transferred to a family member or to someone outside the family.

Continue reading "What Constitutes Elder Abuse and Neglect" »

Every American deserves to live his or her golden years with dignity and respect. Unfortunately, too many of our country's seniors are abused and neglected, often by the very people responsible for their care. According to the best available estimates, approximately 700,000 to 3.5 million older Americans are abused, neglected, or exploited each year. Elders who experience abuse, neglect, or self‐neglect face considerably higher risk of premature death, up to 300% higher, than elders who have not been mistreated. Elder abuse can occur anywhere, and it affects seniors across America, of all socioeconomic groups, cultures, and races. Across these groups, however, studies show that the majority of victims are female.

In response to this growing issue, on June 15, 2006, The International Network for the Prevention of Elder Abuse collaborated with organizations around the globe to launch World Elder Abuse Awareness Day.

Also in 2006, provisions were added to the Violence Against Women Act (VAWA) to allow those funds to assist victims of elder abuse and late life domestic violence. But there is still much work to be done. New provisions protecting the elderly are the smallest appropriation of VAWA funds at about 1%, and only 1.5% of domestic violence programs have support groups for older victims.

Today, we recommit ourselves to fighting elder abuse. To commemorate the 5th Annual World Elder Abuse Awareness Day, agencies and organizations across the country are encouraging individuals to recognize this underreported issue and raise awareness about the mistreatment of seniors. This is especially important, as research suggests that elder abuse is significantly under-identified and under-reported, and that as few as 1 in 6 cases of elder abuse come to the attention of authorities.

The HHS Administration on Aging and the Department of Justice are co-sponsoring an event to highlight the issue. And the National Center for State Courts is launching its Center for Elders and the Courts website, which will provide tools and information on aging issues, elder abuse, and guardianships for judges and court staffers. Statewide activities will also occur throughout the day to join the effort to protect our nation's elders.

Continue reading "Too May Seniors Are Abused and Neglected" »

Assisted living facilities also known as board and care and RCFE's are rapidly becoming the nursing homes of the future. According to the National Center for Assisted Living, there are over 36,000 licensed assisted living facilities nationwide with an estimated 1 million residents. However, because there is no common definition for assisted living facilities, this number may not adequately reflect the prevalence of these facilities. In fact, in 2002 the National Conference of State Legislatures hailed the assisted living market as one of the fastest growing long-term care options for senior citizens; the number of seniors in assisted living facilities receiving Medicaid benefits has grown nearly 50% over the past few years.

These facilities tend to aggressively market and recruit residents, many times promising staffing levels or services that, in reality, are not available. In an attempt to compete with nursing homes, assisted living facilities are accepting patients with higher acuity. Most major chains promote special Alzheimer's Disease Units, and are accepting patients with significant cognitive impairment. The reality is that many of these facilities have staffing that is inferior to the staffing levels present in nursing homes and simply cannot meet the needs of the higher acuity residents. The end result is that residents throughout the county are suffering from serious injuries due to the neglect and abuse that is taking place in these facilities says California Elder Abuse and neglect Layer Steven C. Peck.

A. Assisted Living v. Nursing Home Care

Assist living abuse and neglect cases and nursing home abuse and neglect cases are similar in some respects, i. e. , both involve supervision and care of the elderly, but evaluating the assisted living case involves a greater perception of the differences in the two types of facilities.

1. Standards of Care. The litigation of assisted living abuse and neglect cases, like the litigation of nursing home abuse and neglect cases, can be an effective tool in forcing the industry to comply with proper standards. However, since most states have weak regulations, it often becomes difficult to establish the legal standard of care for a particular facility. Many times a plaintiff may have to fall back on basic community practice nursing standards that will apply when an assisted living facility contracts to provide more than just room and board.

Nursing homes are highly regulated and must comply with the regulations set forth in the Omnibus Budget Reconciliation Act ("OBRA") of 1987 (otherwise known as the federal Nursing Home Reform Act) which set minimum standards of care for long term care facilities that receive federal funding. Unlike nursing homes, assisted living facilities are not regulated by the federal government, and the state regulations that do exist are inconsistent and, for the most part, not aggressively enforced.

When considering the basis for liability, one must consider whether the assisted living facility breached regulatory or community practice standards in admitting the resident whose needs may have been too great to be met by the assisted living facility. Many assisted living facilities, especially those with "Specialized Alzheimer's Units" are accepting residents with advanced dementia who would normally be admitted to a nursing home, and possibly even a skilled wing of the nursing home. In such cases, it would be advisable to obtain an expert who will evaluate the resident's condition and the relevant admission criteria. Such an evaluation will likely be beyond the abilities of a lay person, although many admissions decisions in assisted living facilities are being made by non-medical personnel.

Almost all states prescribe some limitation on who can be admitted into an assisted living facility. For example, Virginia regulations prohibit adult care facilities from admitting or retaining patients with a variety of conditions, including ventilator dependency, dermal ulcers stages III and IV, those requiring intravenous therapy or injections directly into the vein, nasogastric tubes, and those who require continuous licensed nursing care. 22 VA. ADMIN. CODE § 40-71-150 (West 2003). Other states contain similar limitations with prohibitions aimed at excluding patients with a demonstrated need for skilled or specialized care. Assisted living facilities do not provide skilled care; consequently, they are uniformly required to screen patients to determine the level of care needed and reject patients whose needs exceed their capacity. State regulation of assisted living facilities is lax and, for the most part, ineffective. Only a few facilities in the Commonwealth of Virginia have been denied a license for regulatory noncompliance. It is the opinion of this author that weak regulatory enforcement is in part due to inadequate regulations that do not adequately specify industry standards.

2. Experts. To litigate a nursing home abuse and neglect case it almost always requires the use of medical experts who will define the standard of care and address breaches in the standards. As assisted living facilities are generally not considered health care providers, one may question whether an expert is necessary. This will obviously depend on the facts of your case. But in almost every case, at the very least, you will require an expert to establish causation and damages. Since many times injuries in assisted living facilities result in the patient requiring long term care in a nursing home, you may also want to consider obtaining a life care plan from a qualified expert. indicates California Elder Abuse Attorney Steven C. Peck.

Once you have obtained records, you should have the case reviewed by a nursing expert you can rely upon. Unlike nursing homes where there DON and Administrators are RNs, many of the nurses who work in the assisted living arena are LPNs and lack the background that you may be looking for in an expert. Finding talented nurse experts who are actively involved in assisted living care is a challenging task. This author has used the ATLA list serve, and random calling of facilities to locate qualified experts.

B. Evaluating the Assisted Living Case

1. Facility Records. The first step in assessing liability against an assisted living facility will be to obtain the records from the facility and the contract that was signed. The contract will likely define the duties undertaken by the facility. Most assisted living facilities have various levels of service. Level one might be the basic service which would include only room, board, meals and activities. Level four, or the highest level of service, might include resident assessment, care or service planning, medication administration, and dementia and nursing care. The standards applied by these facilities could be analogized to standards of care applied by a nursing home that was not providing skilled care.

2. Freedom of Information Act. In addition to obtaining the records, you will need to do a Freedom of Information Act request. This will help you identify the corporate entity that actually owns and operates the facility and may also allow you to see surveys or inspections that were done on this facility. The license should always be available, and may include information about the scope of services that the defendant facility is authorized to provide. Do not expect the surveys or inspection reports to contain the wealth of information that are available for nursing homes. Many times surveys are performed by the local Department of Social Services and do not include assessments of whether or not these facilities are complying with regulatory standards of care.

3. Case Review. The following are some factors to consider early on in deciding whether or not to prosecute an assisted living facility for negligence or abuse:

a. The nature of the resident's condition upon admission. If she was mentally competent and independent with acts of daily living, you will confront significant problems with contributory negligence and comparative fault defenses.

b. The nature of the contract and duties assumed by the facility. If they only agreed to provide room, board, and meals, the defense will argue their duties are analogous to that of a landlord in an apartment building.

c. The quality of the relationship between the personal representative and the victim. If the victim is deceased, this may take on a greater importance as the nature of that relationship may define your damages under the applicable wrongful death act.

d. Whether the family members make good fact witnesses, appear genuinely outraged by the facility's conduct, and complained and/or removed their loved one from the facility.

e. Whether the facility had serious staffing shortages or a pattern of neglecting their residents.

f. Did the victim suffer a significant injury in the facility that adversely affected the quality of her life for the future, or caused her death?

g. Do you have strong witnesses and powerful exhibits? Do you have an insider who is willing to blow the whistle on rampant staffing shortages? Do you have color photos of that pressure?

h. Do you have significant economic specials that are not encumbered by a Medicare or Medicaid lien?

i. Is the defendant a charitable organization, religious affiliate, or part of a large assisted living chain?

C. Theories of Liability

With weaker regulation, variety in industry standards, and market competition, it is not surprising that the U. S. General Accounting Administration, in 1999, identified problems in assisted living facilities that included inadequate or insufficient resident care, insufficient trained staff, improper medication administration, and not following admission and discharge policies required by state regulation. A 2000 study by the U. S. Department of Health and Human services found that a high percentage of the staff at assisted living facilities were not knowledgeable about the normal aging process and at least 60% of the staff did not know how to properly manage difficult behavior among assisted living residents.

Liability: Improper Admission. Many times, liability based upon an improper admission results when someone is admitted into a facility that is not locked down or enclosed. Many residents with dementia have a tendency to wander and they should simply not be admitted into facilities that are not locked down or do not have appropriate wander guard systems and/or alarms on the doors.

In Selvin v. DMC Regency Residence, Ltd. , 807 So. 2d 676 (Fla. Dist. Ct. App. 4th Dist. 2001) a resident of an assisted living facility wandered off and was found dead in a nearby canal. Plaintiff's complaint alleged two different theories of liability: the first was a statutory wrongful death action and the second was based on alleged violations of statutes relating to assisted living facilities. Plaintiff alleged that the facility had a common law and statutory duty to supply at least the level of services and care that all licensed assisted living facilities generally furnish elderly patients of the plaintiff's decedent's classification and condition. At the time of trial, plaintiff sought to introduce expert testimony about specific safety precautions that were the industry standard and further sought to show that the facility should have built a fence to prevent elders from wandering near the dangerous area of the canal. The trial court precluded this testimony, finding that the facility had no legal duty to fence off the canal to the general public. The Appellate Court reversed, finding that the facility undertook to furnish certain services of care and security which created such a duty of protection. The Appellate Court also held it was an error to exclude testimony regarding industry standards of what could have been done to protect these impaired residents from falling into the canal.

1. Liability: Falls. Another common area of liability in assisted living facilities involves falls. Expert testimony may not be required in such cases. See, Walker v. Southeast Alabama Med. Ctr. , 545 So. 2d 769 (Ala. 1989). However, fall assessment and fall prevention planning is usually done by a nurse or other medical provider and it may be advisable to have an expert address this issue. In large part, the need for an expert will be determined by the facts of your particular fall. If the staff simply dropped the resident during a transfer, an expert may not be necessary. However, if the resident came in to the facility with multiple risk factors for falling which were never assessed or care planned and he fell one day while wandering the hallway, you should retain an expert to discuss how the standard of care for fall prevention was breached. To establish causation, she will have to testify that if appropriate standards were followed, it would have, more likely than not, prevented the particular fall which caused injury to plaintiff. As this is an area of first impression in many jurisdictions, it is advisable to educate the court with a trial memorandum addressing experts and other issues prior to trial.

D. Other Theories of Liability

Attorneys who prosecute assisted living facilities have an opportunity to be far more creative in the prosecution of these claims, given the broad range of theories that are available. Below are some typical theories that can be advanced against an assisted living facility.

1. Common Law Negligence. This is probably the most common theory of liability advanced in assisted living cases. Make sure you do not plead breaches in medical or nursing standards of care, or you may face the argument that you have pled a traditional malpractice case. You can plead the breach of regulatory standards and/or industry standards which proximately caused injury to your client. As assisted living facilities are not health care providers, they should not be subject to caps or other discovery limitations (i. e. , quality assurance privileges) that apply to traditional health care providers.

2. Violations of the Consumer Protection Act. Make sure to inquire of your client what representations were made as an inducement to enter the facility. Obtain the brochures that were handed out by the marketing representative. Most consumer protection statutes provide relief for misrepresentations which were made as an inducement to enter into the consumer transaction. Case law has allowed such theories to be advanced even against health care providers, so there should be no reason that this theory could not be advanced against an assisted living facility. The advantage is that many states' consumer statutes allow for the recovery of costs and attorney's fees.

3. Adult Protection Act. Most states have statutes that have been specifically enacted to protect the rights of elder Americans, California enacted the Elder Abuse Dependant Adult Civil Protection Act in 1992.

4. Breach of Contract. Almost all assisted living facilities will make their residents sign a contract as a condition of admission. Scrutinize the contract carefully, as it may contain waivers of liability or waivers of the resident's right to a jury trial. Such waivers can be asserted irrespective of whether one pleads a separate breach of contract claim. Under the laws of most states, contract damages will be limited to foreseeable economic damages, so it would be disadvantageous to plead this as your only theory of liability. However, the contract may have required that certain services be delivered to the resident (i. e. , activities, assistance with acts of daily living, 24 hour supervision) which were not, in fact, provided. The resident may have suffered no physical injury from the failure to deliver such services and the defense will argue that such evidence should be excluded at the time of trial. With the contract theory properly pled, plaintiff can argue that such evidence is admissible to prove contract damages and recover monies for services which were not provided.

Be wary that the defense may argue that since plaintiff failed to quantify the extent of services that were not provided, any award of contract damages would be based on speculation. As such, you should make an attempt to have your client provide a good faith estimate in percentage terms as to what services were not provided. However, if you have a strong negligence claim based on a discreet event (i. e. , a fall causing a hip fracture) you may not want to confuse the jury with a lot of collateral facts and issues that may not have a strong bearing on your damages.

5. Negligent Hiring and/or Retention. Consider this claim where you have intentional torts committed by an employee and some evidence that the defendants knew or should have known that this was a troubled employee. Many assisted living facilities don't adequately screen their employees. This evidence may not be revealed until the discovery process begins and it is essential that you obtain the employee's personnel file early on in litigation so you can amend your complaint if necessary. Depending on the tolling provisions of your individual claim, the cause of action may still relate back because it arguably arises out of the same set of operative facts. It is also a good idea to sue the employee individually. The same defense firm may represent both the employee and corporation, making it impossible to argue that the employee was not operating within the scope of his employment.

6. Wrongful Death. In any case where there is evidence that the facility's negligence caused or contributed to the resident's death, a separate wrongful death claim should be asserted. If there is any good faith basis to conclude that the negligence contributed to plaintiff's death, you should plead both survivorship and wrongful death claims. Any long term care case has greater value if you can argue that defendant's neglect caused plaintiff's death. You may also have separate claims for injury that in no way contributed to the resident's death. Such claims should be pled with your survivorship claims. Research the law in your jurisdiction to determine what forms of damages are recoverable under a wrongful death statute. If you're in one of those unfortunate jurisdictions that allow only economic damages, you may not want to plead a wrongful death claim.

7. Punitive Damages. As the nature of economic damages in an assisted living case may not be impressive, and as your client will likely have suffered from several preexisting conditions that may weaken your compensatory damage claim, you should, whenever possible, plead punitive damages. Successfully pleading a punitive damage claim will also provide you with the basis for exploring defendant's conduct with respect to other residents who were neglected in substantially similar ways to that of your client. Cases from around the country have upheld such punitive damage claims against nursing homes, and there is no reason that such precedent would not apply equally to assisted living facilities.

8. Americans with Disabilities Act/Fair Housing Act. The Fair Housing Amendments Act of 1988 (FAA)[ prohibits discrimination in virtually all housing and related activities, whether such conduct takes place in the private or public sector. This law is complemented by the Americans with Disabilities Act, which, while it specifically does not include entities covered by the FAA, applies to non-housing functions of a facility, such as common areas, meeting rooms, cafeterias, adult day care, or long term care under Title II (state and local) and Title III (public accommodations) programs.

The longest Humboldt County, California trial in recent memory continues with attorneys delivering closing arguments in the civil suit against Skilled Healthcare Group Inc. -- one of the largest nursing home chains in the country.

Lawyers for the plaintiffs detailed for the jury stories of a handful of patients being represented in the suit. Patients who they contend did not receive showers on a regular basis, walked around with catheters leaking and dragging on the ground, had wounds left untreated and were forced to sit in soiled bed sheets for hours or, in some cases, even days.

Attorney Michael Thamer specializes in fighting corporate abuse, and represented the plaintiffs in the closing arguments.

He made it clear to the court that the suit does not take any issue with how hard the staff members at various Skilled Healthcare facilities are working -- but that the number of them is simply not enough to provide the necessary care for patients.

"In my opinion, they (staff members) are set up to fail before they even start," said Thamer.

Once the closing arguments are complete, the jury will deliberate and decide if Skilled Healthcare is guilty of intentional misconduct. The suit, which spans from 2003 to 2009, represents some 32,000 patients who lived at various Skilled Healthcare facilities statewide.

The issue at the heart of the case is whether or not the nursing homes maintained the staffing levels required by the state.

California law mandates that nursing homes provide a minimum of 3.2 hours of care per resident, per day. This is only the services defined as direct patient care, and includes work by registered nurses, licensed vocational nurses and certified nursing assistants.

Michael Crowley, a Eureka attorney who has worked on the case with Thamer since last November, said that Skilled Healthcare routinely failed to meet these levels.

"Each person represented in the case did not get what they paid for," said Crowley, who added that this includes taxpayers who pay into the Medicare and medical system. "They (Skilled Healthcare) are taking money for something they did not provide."

Crowley said up to 80 percent of funding for patients living in the facilities comes from Medicare. He said that in investigating the daily work logs at various facilities, the attorneys for the plaintiffs found a pattern of understaffing.

Along with subsidiary Skilled Healthcare LLC, Skilled Healthcare Group Inc. is being named as the defendant in the case, with 22 of its nursing homes currently under close scrutiny.

This includes Eureka facilities Granada, Seaview, Pacific and Eureka Healthcare and Rehabilitation, as well as St. Luke Healthcare Rehabilitation Center in Fortuna. In the first quarter of 2010 alone, Skilled Healthcare reported over $188 million in revenue.

"We are trying to send this corporation a message," said Crowley. "They need to care more about their patients and less about their bottom profit line."

More than 32,000 people are represented in the case, including two locally who were named on the case and have since passed away. Vinnie Lavender was 102 when she died at the Grenada facility in Eureka; and Robert Vilchinsky was a patient at St. Luke Healthcare and Rehabilitation before he died from complications associated with multiple sclerosis. Both were represented in court by family members.

The Humboldt County District Attorney's Office intervened in the lawsuit, and has been largely a bystander in the case from the start. District Attorney Paul Gallegos said that his office is planning to file an injunction against the defendant later this week that would order Skilled Healthcare to be in compliance with the law in the future.

Gallegos said the penalties, depending on how the court interprets them, could amount to up to $2,500 for each infraction. If you multiply this by the number of patients represented in the case, Skilled Healthcare is looking at a possible 1.4 million violations.

"It's been a long-term problem," said Gallegos. "There is overwhelming evidence that the law has been broken."

Skilled Healthcare officials say the allegations that their facilities are understaffed are false, and that staffing levels should be set by each individual facility.

Kippy Wroten, an attorney with Wroten and Associates based out of Irvine in Southern California, is representing Skilled Healthcare in the case. Wroten said that she can't comment on specifics of the case because it is still ongoing.

"Our client strives to meet the individual needs of their patients," said Wroten. "They do a wonderful job under extremely difficult circumstances."

Wroten will have a chance to make her closing arguments today, which marks the 106th day in court for the trial.

(Reported by Matt Drange/The Times-Standard can be reached at 441-0514 or mdrange@times-standard.com.)

Decubitus ulcers are also called pressure sores or bed sores. They are caused by prolonged pressure on an area that lies just over a bone. The skin over the hip, tailbone, heels and elbows is often an area of pressure sore development. The pressure may be created by an object such as a bed or wheelchair. The pressure cuts off blood circulation to the area, and the tissue in the area may die if the person's position is not changed. People who are not able to move their bodies easily, such as those suffering from an illness, disability or weakness, are most susceptible to pressure sores states California Nursing Home and Abuse Attorney Steven C. Peck.

Older people often have thinner skin, fat and muscle layers than younger people and are therefore more susceptible to pressure sores. If someone is underweight or suffering from malnutrition he or she is more likely to develop pressure sores, since there is less fat to cushion the pressure on the bone. Friction created as a body part slides over the pressure area can also cause a sore. Moisture trapped in the area of pressure (such as moisture created from incontinence or perspiration) can cause the skin to break down. Some people with diabetes have circulation problems and are more prone to pressure sores.

Continue reading "Decubitus Ulcers Also Called Pressure Sores or Bed Sores Are Caused By Prolonged Pressure To The Bone" »

One out of five Americans over the age of 65 has been the victim of a financial scam, according to a survey by a nonprofit organization.

More than 7.3 million senior citizens have been taken advantage of financially through inappropriate investments, high fees or fraud, said the survey, which was released today by the Washington-based Investor Protection Trust.

"We now know that a shockingly large number of older Americans are already victims of financial swindles and millions more are in danger of being exploited in such a fashion," Don Blandin, chief executive officer and president of Investor Protection Trust, which promotes investor education, said in a statement.

Forty percent of children who have parents age 65 and older said they are "very" or "somewhat" worried that their parents have already become or will become less able to handle their personal finances over time.

Most American households at or near retirement "are consumed by fear," said Anthony Webb, associate director of research at Boston College's Center for Retirement Research. The average 401(k) account balance as of March 31 was $66,900, according to Boston-based Fidelity Investments, which has 11 million participants. The average monthly Social Security benefit as of April was $1,067.

Almost 40 percent of survey respondents age 65 and over said they've received phone calls or mailers asking for money compared with 19 percent of adult children who said they believe their parents are being pitched what the survey called schemes.

Basic Investment Knowledge

About 45 percent of respondents age 65 and over got at least two out of four questions wrong about basic investment knowledge -- they said that an investment registered with the Securities and Exchange Commission or state securities regulators means it's been reviewed to make sure it's safe and that a very high rate of return is only okay as long as the investment is guaranteed or bonded.

"It is imperative that a serious national campaign be launched to end rampant elder financial exploitation and to protect and help vulnerable older victims," Kathleen Quinn, executive director of the National Adult Protective Services Association, a national nonprofit, based in Springfield, Illinois, said in a statement.

The survey was conducted in May among a sample of 2,022 adults age 18 and over by Infogroup Inc., a provider of market research based in Omaha, Nebraska. The group included 706 adult children with at least one parent age 65 and older and 590 adults who are age 65 and older.

To contact the reporter on this story: Alexis Leondis in New York aleondis@bloomberg.net.

To contact the editor responsible for this story: Rick Levinson at rlevinson2@bloomberg.net.

Under current Medicare guidelines, hospitals are no longer reimbursed for additional care resulting from pressure ulcers (also known as bed sores or decubitus ulcers) as the government has determined that development of bed sores at a hospital is a so-called "never event." Additionally, hospitals cannot bill patients directly for such care. The denial of reimbursement for such reasonably preventable treatment errors should provide hospitals with financial incentive to institute and implement appropriate patient safety measures geared toward preventing the development of bedsores.

While there has been discussion about extending this policy to include long term care facilities including nursing homes and assisted living centers, nursing homes are not presently subject to these guidelines. Nursing homes are therefore presently permitted to receive payment for care and treatment related to bedsores that develop in their facilities, while hospitals cannot. This writer firmly believes that these Medicare "never events" guidelines should be extended to include nursing homes and other long term care facilities so that these facilities will have the same financial incentive as hospitals do to improve patient safety measures relating to preventing the development of bedsores.

Like hospital patients, nursing home residents are often at risk for developing bedsores as a result of their underlying medical problems and/or mobility issues.

A pressure sore/decubitus ulcer is a bedsore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain. Patients experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points. Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection.

A stage 1 ulcer presents as redness of the skin without a break in the skin and represents tissue injury that does not disappear when pressure is relieved. A stage 1 ulcer is classified as nonblanchable erythema with intact skin. Erythema is redness of the skin produced by congestion of the capillaries. Erythema is the initial reactive hyperemia caused by pressure, and nonblanchable erythemia represents stage 1 pressure ulcer.

A stage 2 ulcer is characterized by partial-thickness skin loss, that is, the epidermis is interrupted as an abrasion, blister or shallow crater.

A stage 3 ulcer features full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia. The ulcer appears as a deep crater, with or without undermining of adjacent tissue.

A stage 4 ulcer involves full-thickness skin loss (exposing bone or muscle) with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).

Once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and potentially fatal complications. With stage 3 or stage 4 pressure sores, the extent of the disease may not be evident because of covering necrotic material or eschar. To establish the extent of the disease and promote healing, the necrotic material needs to be removed and surgical consultation may be required. When ulcers develop over bony prominences, osteomyelitis is a potential complication. Pressure ulcers are chronically contaminated wounds and the combination of bacteremia and pressure sores can be painful and life threatening.

Fortunately, as reflected by Medicare's "never event" guidelines, pressure ulcers may be entirely avoidable so long as proper care and preventative measures are instituted and implemented by the health care provider. The time is right to extend these "never event" guidelines to include nursing homes and other long term care facilities.

Elder abuse takes many forms -- physical, emotional, financial and neglect -- but seniors might not recognize abuse or be reluctant to talk about being hurt by people they trust.

"Elder abuse is basically taking advantage of an older adult or putting them at risk," says California Elder Abuse Attorney Steven C. Peck. Depending on the type of abuse, there are a number of red flags.

"It can be injuries, bruising, missing teeth, broken false teeth or problems with hearing aids or glasses -- that could be the result of physical abuse," "Emotional abuse is much more subtle. You may see people who used to be out and vibrant in the community no longer going out and being engaged with friends or no longer carrying on long conversations on the phone because they're living with extended family and they're not free to have those conversations."

There could be a sign of financial abuse if a person suddenly discontinues eating out with friends. That could be related to the economy and people's retirement incomes, but it can also signal that a vulnerable senior's assets have been seized by adult children -- sometimes to support their addictions.

"We've heard some real horror stories about large amounts of money that people have grabbed from parents," states California Financial Elder Abuse Attorney Steven C. Peck.

"There are lots of people who are victims of abuse in one way or another and they may not know it is abuse or they may not know how to deal with it," Peck says.

Estimates suggest only one in 10 cases of older adult abuse is officially reported. Many seniors are women who lived in a household where they might have had little responsibility for family finances, yet in their later years they end up dealing with money matters since they tend to outlive men.

"It's important they learn how to deal with these issues," Peck says. "There are some things that you can do to protect yourself and there are things you can do if you are a victim of abuse."

Continue reading "Elder Abuse Can Take Many Different Forms" »

The relationship of dehydration with the development of bed sores (or pressure sores, pressure ulcer or decubitus ulcers-- whatever you prefer to call them) is quite appalling.

Simply put: dehydration occurs when a person does not receive enough liquids though eating, drinking or through mechanical intervention such as intravenous fluids or a feeding tube to maintain their optimal physical functioning. When the body is deprived to fluid intake, imbalances in the bodies chemistry occur and there is a reduction of blood volume.

Alterations in blood chemistry and reduction in blood volume interfere with essential circulatory issues. As the volume of blood in the body gets reduced, the life sustaining properties of blood to skin and tissue gets reduced.

Without the life sustaining components a properly operating circulatory system provides-- tissues, particularly those under pressure from a person's body weight begin to die.

Particularly in the physically disabled or bed bound, pressure tends to build on areas of the body literally supporting the persons body weight: the buttocks, sacrum or heels. When the reduced physical capability couples with the increase in pressure on areas of the body, bed sores are more likely to occur.

How to ensure your loved one is getting enough fluid?

Only a medical professional can realistically determine what each patient's fluid intake requires after analyzing the person's body weigh and fluid output. However, a commonly agreed upon starting point for optimal hydration is 1,500 to 2,000 ml (six to eight glasses) of fluid per day-- minimum.

Therefore, as a caregiver or just a concerned friend or family member, it is important to recognize that hydration needs and realize the hydration plays a critical role in general well-being and reducing bed sores amongst patients in a nursing home or hospital setting. Consequently, be on the lookout for symptoms of potential dehydration including:

•Sunken eyes
•Cracked lips
•Ashen skin
•Rapid decline in cognitive function
•Chills
•Dark colored urine
•Overall physical weakness
When you visit check to:

•Ensure fluids are within reach of the patient
•Make sure the patient is capable of consuming the fluids-- straw, handled cup, ect.
•Address hydration needs with an attending physician or nurses-- particularly if the patient is incapacitated or in a coma
•Always keep a glass of water or juice on the night stand when you leave.

Continue reading "The Relationship Between Dehydration and the Development of Pressure Sores, Bed Sores & Decubitus Ulcers" »

Fourteen years ago, Paul Greenwood had never even heard about the problem of elder abuse. Today, his mission is to bring its perpetrators to justice.

Greenwood, a deputy district attorney in San Diego, brought his passion for prosecuting elder abuse crimes to the Albemarle Tuesday, serving as guest speaker at the World Elder Abuse Awareness meeting in Currituck County.

Greenwood warned area social workers, law enforcement, medical staff, care givers and others about the graphic photographs he would be showing them during the course of the event.

"I don't apologize for them because that is what is happening out there," said Greenwood, who has tried 200 felony cases for elder abuse and dependent adult abuse. "This is what is happening in our community and we can't hide from that."

Greenwood flashed a picture of the bruised and battered face of Sandy, a 76-year-old victim. Sandy had innocently permitted a vacuum salesman into her home and ended up buying a $2,300 vacuum she didn't need.

The exploitation did not stop there, however. Later the salesman returned and asked to use her phone. Once inside, the man beat Sandy, tied her head to foot with duct tape and threw her into the back of her own car. After 26 harrowing hours in the trunk, Sandy was rescued by an observant deputy sheriff who thought her Dodge Magnum looked out of place in the neighborhood he was patrolling.

Sandy is one of many older adults who are abused in a variety of ways, Greenwood said. Incidents often go unreported --victims often are either too afraid or embarrassed, too weak or vulnerable to speak out -- but that is beginning to change.

"We are about where child abuse ... was 30 years ago," he said.

The problem of elder abuse is likely to grow as a larger share of the population gets older, Greenwood said. The older population is expected to peak between 2010 and 2030 when "baby boomers" reach age 65. According to the National Center for Elder Abuse, older people will comprise 20 percent of the population by 2030, almost twice their number in 2007.

Another speaker at the event, Jay Burrus, director of the Dare County Department of Social Services, said the number of elder abuse incidents in Dare has risen 500 percent over the past few years. The trend is alarming because of Dare's rapidly increasing population of residents 60 and older, he said.

Protecting seniors from predators intent on stealing their money was one concern recently addressed by Dare's Elder Abuse Collaborative. The collaborative met with area bankers to discuss financial exploitation of elders with good results, Burrus said.

"Bankers saw it as a problem and didn't know how to handle it, and I think they were glad to know there were ways to handle it," he said.

During a conference break, Barbara Courtney, Currituck representative on the Albemarle Commission, said Currituck also could benefit from making banks aware of how to prevent financial exploitation of seniors.

Courtney said she came to the event, held at the Cooperative Extension Center in Barco, to learn more about elder abuse and how to apply the information in the county. An online nursing instructor for East Carolina University, Courtney said more people need to feel responsible for reporting incidents of elder abuse.

"If we had more eyes looking at all these problems, then we could make a difference," she said.

The 10-county event was designed to heighten awareness about issues involving elderly care, said Debra Sheard, regional ombudsman for the Albemarle Commission's Area Agency on Aging, which sponsored the event. Sheard said she had hoped more care givers, who work daily with the elderly, would have attended the session. Care givers need to understand that they are obligated to report what they see, she said.

At the beginning of the session, Greenwood flashed a picture of the Currituck Lighthouse on the screen, and said it was a symbol of what the event was trying to accomplish. The lighthouse is a beacon for those in need, and it also signals a warning about pending disaster, he said. Years ago, elder abuse was basically unheard of, but today more cases are being reported and the perpetrators are being punished.

"Once you place an importance on this subject and you shed light on it, it attracts attention," he said.

This year alone, Greenwood's office has prosecuted 270 cases on felony elder abuse, he said.

For too long, the problem has remained basically unnoticed, partly because the victims are reluctant or unable to report the abuse.

"There is a lot of silence in the community about elder abuse," Greenwood said.

Victims may be especially reluctant to report a problem if the abuser is a family member.

"It's a crime in North Carolina, but it is sadly going unpunished in some cases," he said.

Greenwood, who speaks widely about elder abuse protection, aims to bring more cases to trial. His plan is to protect "the greatest generation," those who like his parents survived World War II.

Society should be judged by how well it protects the defenseless, he said. And so he intends to keep on working, even to the age of 71, so that as a senior citizen he can prosecute those who abuse senior citizens.

(By CINDY BEAMON
Staff Writer

Elder Abuse is a growing social concern, but it's not new. Too many older adults have suffered abuse and neglect at the hands of family members and caregivers for too many years.

What is new is that there is a growing awareness and concern about elder abuse, putting a new face to this type of family violence.

Victims of elder abuse know and trust their abuser. Most victims of elder abuse depend on the people who hurt them, sometimes for food, shelter, personal care or companionship.

Too often the abuse and neglect of older adults is not readily identified by service providers and community members.

Some of the signs and symptoms of elder abuse can include depression, fear, anxiety or passivity, unexplained physical injuries, dehydration or lack of food, poor hygiene, urine sores or bed sores, over-sedation.

Many older adults may believe that abuse by a relative is a "family problem" and are ashamed to disclose that a family member is abusive. Noone is immune to elder abuse.

The majority of abused older adults are in their 60s and 70s. Women are typically more vulnerable to abuse and experience more forms of abuse.

Most victims of elder abuse are mentally competent and able to make decisions for themselves. However, loneliness and isolation make some seniors more susceptible to scams.

Continue reading "Elder Abuse Is a Growing National Social Concern" »

What is Fiduciary Abuse:
This is a situation by which an individual who is legally responsible for managing another persons assets uses his or her power to benefit financially in an unethical or illegal manner. Fiduciary abuse can be done by anyone such as a financial advisor, power of attorney, or family member.

A Growing Problem:
Many times the elderly have a difficult time managing their money, and so they are dependent on others for help. This is when that unscrupulous individuals step in and make attempts to obtain monies from property, land, goods and bank accounts.

Who are the Usual Abusers:

Personal Caretaker:
A surprisingly large number of cases of financial abuse occur between an older person and their caretaker. This can include guardian or family members who start out doing the right thing, but are in a strong position only to commit financial abuse because of the temptation. One way this happens is by gaining the confidence of the victim slowly the guardian of the person begins to take control of the victims possessions. Another way is through the use coercion. This is when an individual is forced to sign over land, property or access to bank accounts because of threat or feeling intimidated. Guardians can also manipulate the "authority" and the layout of the will.

Family member:
Another way this occurs is when a loved one is being cared for by a family member who takes advantage of the situation. This can happen several ways. One, the elder person is placed in a long term care facility and the family member continues to take the SSI check and spend it for their own bills. The SSI money is suppose to be spent of the care of the elder person not on the caretakers bills. Two, the caretaker charges the elder for there care and is also being paid by in-home support services. This also falls under fraud and should be reported to Medi-cal/Medicaide.

Long Term Care Facilities:
Many people are concerned about the quality of care for their relatives in nursing homes. They often forget to keep a watchful eye on the monetary portion of their loved ones care. The family must always make sure the charges for the level of care are correct. If the products and services account shows what you believe has not been provided then it is important for the family to discuss this with the Business Office Manager first then with the Administrator.

Deceivers:
Deceivers come in many shapes and sizes and from all over the world. The elderly have a higher probability of being scammed because of the constant evolution of technology and the potential diminished mental capacity. Phone scams often target older people who the scammers think they can manipulate and at times scare them .

One indicator may be an increased number if checks being used or excessive amounts of money being sent to an unknown person or entity. Always follow up with your loved ones in these financial decisions and keep a watchful eye on their finances when possible.

What Can Be Done:
If there is suspected financial abuse there are several things that can be done to stop it, protect your loved one and to prevent it from happening to others.

First, report it. It must be reported to the local authorities. Many of the law enforcement agencies these days have special units dedicated to fiduciary abuse. If they don't still request an officer to come out and take a report. You will need the report number when contacting the bank. Also, report it to APS (Adult Protective Services).

Second, assist the victim in contacting the bank. The bank will guide you through the process. Often the account is frozen or closed and moved to an new account. This will also help the victim recover some of the monies in some cases.

If the elder person is in a long term care facility report the situation to the Ombudsman, State Licensing and APS. Also, make sure the facility is aware. They must conduct their own investigation and follow-up. Often times the facility is the first to become aware of the situation and will take the initiative in starting the investigation and reporting it to the agencies.

One main thing to remember is to document everything you can. The documentation of all the agencies that have been contacted with the person's name you spoke to, the date and time are extremely crucial. It may help prevent the investigation from falling through the cracks.

•

Continue reading "What Is Considered Fiduciary Elder Abuse?" »

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 it qualifies as malpractice. It's not always easy to discern neglect from an elderly individual's typical withdrawal or lack of enthusiasm. While it is necessary to line patients along the corridor in order to efficiently wheel them to the dining room, leaving dependent patients in the hallways for hours on end quantifies neglect.

Nursing home abuse and neglect can come in many silent but devastating forms. Bed sores aka Decubitus Ulcers and 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, Decubitus Ulcers and Pressure Sores can be a glaring red flag that your loved one is a victim of nursing home abuse and neglect.

Nursing Home Abuse and Neglect can be masked too easily by staff members who fear the consequences, which places the burden of understanding abuse on the families and friends of those who are residing in nursing homes.

Toileting and bathing issues top the list for neglectand abuse issues. Many nurses and aids do not feel their paycheck reflects the humiliation that can accompany toileting issues. If you are trying to determine whether abuse is a possibility, ask your loved one if they are taken to the bathroom, how often, and how many accidents they are having, and how long they are required to sit in their soiled clothing. These answers can help determine the level of elder abuse and neglect that a facility may be liable for.

They can walk you through the filing process as well as the steps to reporting these issues. Nursing home abuse lawyers have ample experience in dealing with the tragedies associated with nursing home abuse and can be of invaluable assistance even if you are fortunate enough to discover that there is no abuse or medical malpractice at the suspected facility.

Continue reading "Nursing Home Abuse and Neglect Can Come In Many Silent But Devastating Forms" »

A decubitus ulcer is a pressure sore or what is commonly called a "bed sore". It can range from a very mild pink coloration of the skin, which disappears in a few hours after pressure is relieved on the area, to a very deep wound extending to and sometimes through a bone into internal organs. These ulcers, as well as other wound types, are classified in stages according to the severity of the wound.

All decubitus ulcers have a course of injury similar to a burn wound. This can be a mild redness of the skin and/or blistering, such as a first-degree burn, to a deep open wound with blackened tissue, as in a third degree burn. This blackened tissue is called eschar.

Mechanism of Formation:
The usual mechanism of forming a decubitus ulcer is from pressure. However it can also occur from friction by rubbing against something such as a bed sheet, cast, brace, etc., or from prolonged exposure to cold. Any area of tissue that lies just over a bone is much more likely to develop a decubitus ulcer. These areas include the spine, coccyx or tailbone, hips, heels, and elbows, to name a few. The weight of the person's body presses on the bone, the bone presses on the tissue and skin that cover it, and the tissue is trapped between the bone structure and bed or wheelchair surface. The tissue begins to decay from lack of blood circulation. This is the basic formation of decubitus ulcer development.

Nursing Care, Prevention and Treatment of Decubitus Ulcers:
The common areas of decubitus ulcer formation and prevention is a basic nursing principle covered in nursing school curriculum (LVN/LPN or RN) and most nursing assistant programs as well. Prevention consists of changing position every 2 hours or more frequently if needed. This 2-hour time frame is a generally accepted maximum interval that the tissue can tolerate pressure without damage. Prevention also consists of protection and padding to prevent tissue abrasion, and maintaining hydration, nutrition and hygiene.
Protect your loved one from nursing home neglect or abuse talk to California Nursing Home Abuse and Neglect Attorney Steven C. Peck toll free at 1.866.999.9085.

The treatment for a decubitus ulcer involves keeping the area clean and removing necrotic (dead) tissue, which can form a breeding ground for infection. There are many procedures and products available for this purpose. The use of antibiotics, when appropriate is also part of the treatment. Some deep wounds even require surgical removal or debridement of necrotic tissue. In some situations amputation may be necessary.

The second portion of the treatment involves removing all pressure from the involved area(s) to prevent further damage of tissue and to promote healing. Frequent turning is mandatory to alleviate pressure on the wound and to promote healing. Along with cleaning, removal of dead tissue, and alleviating pressure, the individual must have increased nutrition to allow for proper healing of the wounds. Without all of these elements being in place, the wounds will not heal and, in fact, will quickly worsen.

Prevention:
The basic treatment of decubitus ulcers is prevention. Prevention cannot be stressed too strongly. To this end, there are any number of devices designed to protect and prevent the formation of decubitus ulcers. The decision of which device to use is based on the location and severity of the wound. These devices may be a Medicare/Medicaid/Insurance-covered item when medically necessary. Most insurance's will cover any needed device, material, or equipment necessary to prevent and treat decubitus ulcers. Prevention is the most humane and cost effective approach to care.

Standards of Care:
It remains true that decubitus ulcers are generally considered preventable and the development of decubitus ulcers is evidence of some form of neglect [nutrition, hydration, positioning, infection control, etc]. Many paralyzed or terminal individuals with very poor nutrition can remain free of decubitus ulcers. This is accomplished by good patient care often being provided by family members and non-licensed hired caregivers. Professional medical personnel generally provide only a minimum amount of medical assistance. Prevention is achieved by diligent care.

Decubitus Ulcer Formation and Treatment in Long-Term Care Facilities
In long-term care facilities the rate of decubitus ulcer development is higher for a variety of reasons. Due to staffing shortages, medical funding cuts and an array of issues, most long-term care facilities are chronically understaffed. This results in patients not being turned, cleaned and fed as often as the ideal standard of nursing would dictate.

It is known that almost all decubitus ulcers are preventable. However the reality of long-term care concludes that if a patient does not have massive weight loss, chronic infections, or wounds that do not heal in two weeks then that individual is receiving a reasonable standard of care. It is not uncommon for small wounds to develop, be treated and heal quickly. This is considered adequate care.

Massive weight loss, massive deep wounds over Stage II and chronic infections continue to be an unacceptable standard of care. Massive wounds are generally a strong indication of negligence in more than one area [hygiene, nutrition, infection control, positioning, etc.].

Another emerging factor in long-term care is patient directed care. Alert and generally oriented individuals determine their own care. These persons, though elderly and frail, are not declared incompetent. Patient's rights, as it is currently practiced, allows for patient refusal of medications, food, fluids and treatments such as turning. This often results in a lesser quality of care being provided due to patient noncompliance. When this occurs, the ideal situation is to involve the patient, family, staff and physician in a plan of care that will be acceptable and beneficial. Patient refusal of nutrition and positioning may lead to the development of decubitus ulcers as well.

In summary: In almost all situations, the development of massive decubitus ulcers is evidence of some form of neglect. Generally the neglect is in more than one area, i.e., hygiene and nutrition. It would be a very rare exception for this to not be true.

Decubitus ulcers need to be viewed as a preventable injury, not an excusable one.

Stages of Wounds:
Wounds are often categorized according to severity by the use of stages. The staging system applies to burn wounds, Decubitus ulcers, and several other types of wounds.

Stage I
This stage is characterized by a surface reddening of the skin. The skin is unbroken and the wound is superficial. This would be a light sunburn or a first degree burn as well as a beginning Decubitus ulcer. The burn heals spontaneously or the Decubitus ulcer quickly fades when pressure is relieved on the area.

The key factors to consider in a Stage I wound is what was the cause of the wound and how to alleviate pressure on the area to prevent it from worsening. Improved nutritional status of the individual should also be considered early to prevent wound worsening. The presence of a Stage I wound is an indication or early warning of a problem and a signal to take preventive action.

Treatment consists of turning or alleviating pressure in some form or avoiding more exposure to the cause of the injury as well as covering, protecting, and cushioning the area. Soft protective pads and cushions are often used for this purpose. An increase in vitamin C, proteins, and fluids is recommended. Increased nutrition is part of prevention.

Stage II
This stage is characterized by a blister either broken or unbroken. A partial layer of the skin is now injured. Involvement is no longer superficial.

The goal of care is to cover, protect, and clean the area. Coverings designed to insulate and absorb as well as protect are used. There is a wide variety of items for this purpose.

Skin lotions or emollients are used to hydrate surrounding tissues and prevent the wound form worsening. Additional padding and protective substances to decrease the pressure on the area are important. Close attention to prevention, protection, nutrition, and hydration is important also. With quick attention, a stage II wound can heal very rapidly.

A wound can appear to be a Stage I wound upon initial evaluation, and actually be reevaluated as a Stage II wound during the course of care. Quick attention to a Stage I Decubitus ulcer or pressure wound will prevent the development of a Stage III Decubitus ulcer or pressure wound. Generally Decubitus ulcers or pressure wounds developing beyond Stage II is from lack of aggressive intervention when first noted as a Stage I. [see notation].

Stage III
The wound extends through all of the layers of the skin. It is a primary site for a serious infection to occur.

The goals and treatments of alleviating pressure and covering and protecting the wound still apply as well as an increased emphasis on nutrition and hydration.

Medical care is necessary to promote healing and to treat and prevent infection. This type of wound will progress very rapidly if left unattended. Infection is of grave concern.

Stage IV
A Stage IV wound extends through the skin and involves underlying muscle, tendons and bone. The diameter of the wound is not as important as the depth. This is very serious and can produce a life threatening infection, especially if not aggressively treated. All of the goals of protecting, cleaning and alleviation of pressure on the area still apply. Nutrition and hydration is now critical. Without adequate nutrition, this wound will not heal.

Anyone with a Stage IV wound requires medical care by someone skilled in wound care. Surgical removal of the necrotic or decayed tissue is often used on wounds of larger diameter. A skilled wound care physician, physical therapist or nurse can sometimes successfully treat a smaller diameter wound without the necessity of surgery. Surgery is the usual course of treatment. Amputation may be necessary is some situations.

Stage V
This is an older classification and not now used in all areas. A stage 5 wound is a wound that is extremely deep, having gone through the muscle layers and now involves underlying organs and bone. It is difficult to heal. Surgical removal of the necrotic or decayed tissue is the usual treatment. Amputation may be necessary is some situations.

Notation
It is possible for a wound to "go from a stage I wound to a stage III or IV" without the intermittent stage[s] being observed. All wound stages were present just not obvious, hence the need to treat all wounds as serious with the potential of rapidly worsening.

What Constitutes Elder Abuse and Neglect?

Abuse against the elderly takes many forms, and it encompasses a wide range of mental, physical and financial actions. Many older people, especially those suffering from dementia or Alzheimer's disease, are uniquely vulnerable to mistreatment. While it may seem unthinkable, it is all too common for in-home caregivers and those employed by long-term care facilities to act inappropriately and take advantage of them.

The blanket term "elder abuse" includes:
- Dehydration
- Withholding necessary medications
- Malnutrition
- Sexual assault (including everything from forcible rape to inappropriate touching)
- Physical abuse like slapping, punching, kicking or even biting
- Overdosing patients on sedative-type medications to keep them quiet
- Verbal/mental/psychological abuse

These actions result in myriad injuries, all of which should serve as indicators to you that abuse could be occurring. Some of these are:
- Unexplained bruising
- Marked weight loss/persistent hunger
- Acute emotional distress
- Fear of particular staff or family members
- Bed sores (technically called "decubitus ulcers", sometimes known as "pressure sores")
- Broken bones
- Exposure to the elements (common in dementia and Alzheimer's patients who, when inadequately supervised, wander away), including everything from frostbite and hypothermia to severe sunburn and wind-related chapping depending on the season
- Bodily reactions to an abundance of or sudden decrease in medication amounts

What Can You Do?

If you suspect that abuse or neglect is taking place, you need to take action. Your response could differ depending on the seriousness of the abuse, however. At the first signs of possible issues, speak with the management of the facility. Should you notice that your loved one is in immediate physical distress, call 911 for emergency response, and then contact local social welfare authorities.

Continue reading "What Constitutes Elder Abuse and Neglect" »

Research has revealed that more than one in 10 elderly adults in the United States experienced mistreatment during the previous year. Elder abuse is a growing problem and often underreported. There is increasing evidence that this mistreatment increases the risk of death. Our older population is growing larger due to lengthening life spans, and this can put more people at risk for mistreatment. There is help available for victims.

Today, June 15, 2010, marks the 5th commemoration of the world effort to raise awareness of elder abuse. With the uncertain economic times that we are in, it is more important than ever to promote elder abuse awareness so that vulnerable adults will not be forgotten. More people need to be made aware of programs that can help. Ultimately, the awareness is about change that leads to prevention for these vulnerable and older adults. We also want to recognize the dedication of the many professionals and advocates involved in this challenging field. Their efforts to enhance and protect the health, dignity, independence and well-being of older adults should not go unnoticed.

Concerned citizens can help by becoming aware of potential warning signs of abuse, neglect or exploitation:

Abuse: Unexplained bruises, fractures, black eyes, burns, pinch marks, scratches, fractures or broken bones, open wounds, cuts or untreated injuries in various stages of healing, fearful of caretaker or family member, sudden change in behavior of the adult, the caregiver's refusal to allow visitors to see an elder alone, laboratory findings of medication overdose or under-utilization of prescribed drugs, emotional or psychological mistreatments such as intimidation, harassment, humiliation, etc.

Neglect: Poor hygiene, bed sores, decayed teeth, lack of prosthetic devices, sudden weight loss, lack of medication, imposed isolation, lack of health care, wandering, dehydration, malnutrition, etc.

Exploitation: Unpaid bills, sudden change in living style, new "friends" helping with bank accounts, change in ownership of property, no spending money, missing belongings, inappropriate touching, unfair wages.

Continue reading "Elders In The United States Experience Abuse and Mistreatment" »

Today is World Elder Abuse Awareness Day.

It is estimated that more that one in 10 seniors in the United States have experienced some type of elder abuse or mistreatment during this past year, says California Elder Abuse Attorney Steven C. Peck.

Mistreatment can take many forms, she said, including neglect, physical abuse, emotional or psychological abuse and -- a growing problem -- financial abuse.

The National Center on Elder Abuse reports that there is no uniform means of reporting and tracking elder abuse. According to the best available estimates, however, between 1 and 2 million Americans age 65 or older have been injured, exploited or otherwise mistreated by someone on whom they depended for care or protection. The results of abuse, neglect and exploitation are damaging and long-lasting,and families may be the biggest contributors to elder abuse.

Continue reading "World Elder Abuse Awareness Day" »

An elderly woman in Brookdale Hospital's nursing home lost both legs to amputation after developing bedsores when staff neglected to properly rotate her body, a lawsuit charges.

"The poor woman was admitted to the Schulman and Schachne Institute for Nursing and completely dependent on their assistance . . . Within two weeks, she was infected with bedsores down to the bone,"

Almida Nanton was 89 and suffering from dementia when she was admitted in April 2007. Nurses or other staffers were supposed to rotate her bedridden body once every two hours.

Instead, her legs had to be amputated three months later, according to court papers filed in Brooklyn Supreme Court.

She died at the hospital in 2008 when a catheter placed in her neck accidentally punctured a vein, Leitner said.

Brookdale spokesman Ole Pedersen declined to comment, citing the pending litigation.

Last December, a Brooklyn jury awarded $19 million in a bedsore-related suit involving another nursing home.

Continue reading "Elder Loses Legs To Amputation After Developing Bed Sores" »

Involuntary weight loss and dehydration, among other risk factors, are associated with pressure ulcer development among residents in long-term medical care facilities, according to the National Pressure Ulcer Long-Term Care Study (NPULS). Pressure ulcers have a major impact on the care and costs associated with residents receiving long-term care.

According to the study, 2 nutrition-related risk factors are key points in the prevention and treatment of pressure ulcers. Involuntary weight loss was associated with an increased risk of 74%, and dehydration was associated with an increased risk of 42%. In addition, the data identify pressure relief management, incontinence management, and missing diet information on medical records as other primary considerations.

Many residents in long-term care facilities, home care patients, and elderly patients experience involuntary weight loss. Studies have demonstrated that up to 85% of residents in nursing homes are malnourished and prone to significant weight loss and severe complications, which include Bed Sores, Pressure Sores also known as Decubitus Ulcers.

Data was collected by medical teams for 12 weeks and covered more than 500 variables, including medications, pressure management, nutritional status and interventions, incontinence treatments, and the routine practices of care team members. The study was conducted in 109 facilities and included 2490 residents. The average age of residents was 79.8 years, and all had been receiving long-term care for at least 14 days.

The data showed that risk for the development of Bed Sores, Pressure Sores and Decubitus Ulcers is also associated with severity of illness, incontinence and catheter use, history of pressure ulcers, diabetes, being male, and dependency in more than 7 activities of daily living. In addition, a higher staff-to-resident ratio was associated with a lower risk of Bed Sore, Pressure Sore and Decubitus Ulcer development.

"These data are very important given the aging population and increasing numbers of residents requiring long-term care," ."Anyone who considers placing a family member in long-term care should know about prevention and treatment of Bed Sores, Pressure Sores and Decubitus Ulcers", says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Bed Sores, Pressure Sores and Decubitus Ulcers are one of the top 5 issues facing long-term care facilities. More than 1.8 million people develop pressure ulcers each year. These potentially devastating ulcers cost an estimated $1.3 billion annually in the United States and can expose facilities to litigation.

Bed Sores, Pressure Sores and Decubitus Ulcers are lesions caused by unrelieved pressure on the skin that result in damage to underlying tissue. In their most severe stage, they involve full-thickness skin loss with extensive destruction and damage to muscle, bone, or supporting structures and can be associated with increased morbidity.

Continue reading "Involuntary Weight Loss and Dehydration Cause Bed Sores, Pressure Sores, and Decubitus Ulcers To Resident In Long Term Care Facilities" »

Nursing home abuse happens on a daily basis, even in the smallest and friendliest of California cities and towns. Those to whom we entrust our loved ones' health often take advantage of their positions as nursing home nurses, aides, or caretakers. Our own family members may be facing mistreatment, abuse, or degradation -- but we don't have to sit back and wait for bad news says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

If you suspect a nursing home or other elder care facility is not caring for your loved one properly, you have elder abuse laws on your side. The trick may lie in discovering signs of abuse, pinpointing their causes, and proving that mistreatment occurred.

Nursing home abuse can range from verbal abuse to physical abuse and neglect. Here, the lines may seem fuzzy for residents and family members, especially if there are no physical signs of harm.

Here are just a few of the common signs of abuse or neglect:

· Bruises, cuts, scrapes, welts, and chaffing

· Broken bones, cracked ribs, and other physical injuries

· Bedsores

· Depression and attitude changes

· Weight loss

· Refusal to take visitors

· Shyness or withdrawn behavior, lack of social interaction, and lack of enthusiasm

· Medication errors

· Unsanitary conditions or poor personal hygiene

· Infections

· Dehydration or nutritional deficits

· Unexplained sedation or medical procedures performed without consent

Continue reading "Nursing Home Abuse and Neglect Happens Everywhere" »

In October 2008, the Center for Medicare & Medicaid Services (CMS) began requiring hospitals that receive federal funding from Medicare and Medicaid to begin disclosing "never events." CMS has stated that they will no longer reimburse hospitals for any costs associated with never events, and hospitals are prohibited from passing costs onto the patient.

What are Never Events?
Never events are a series of medical errors that are defined by CMS as, "clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility." Included in the CMS financial year 2009 list of never events that will be denied federal reimbursement are the following medical errors:

List of Never Events covered under the FY 2009 provision
Object left in patient during surgery
Air embolism
Blood incompatibility
Catheter-associated urinary tract infection
Pressure ulcers
Vascular-catheter-associated infection
Surgical site infection (specifically mediastinitis after coronary artery bypass graft surgery)
Hospital-acquired injury due to external causes (fractures, dislocations, intracranial injury, crushing injury, burns, and other unspecified effects)

Obviously, never events can be quite costly for hospitals. Yet some occur much more frequently than others. Preventing bed sores can be difficult, but are preventable with treatment and appropriate monitoring.

Continue reading "Medicare & Medicaid (CMS) Shall No Longer Reimburse Long Term Health Care Facilities For Any Costs Associated With "Never Events"" »

Anyone who is confined to bed for a long time is liable to develop bedsores, especially if movement is restricted or if sensation is impaired. The sores occur on those parts of the body that bear the weight of the body or rub constantly against the bedclothes. The most common sites are the elbows, knees, shoulder blades, spine and buttocks states California Nursing Home Abuse Attorney Steven C. Peck.

A bedsore begins as a patch of tender, reddened, inflamed skin. Later, it can become purple. Then it breaks down and an ulcer or sore develops. If any skin redness or inflammation occurs, consult the physician right away. The ulcers generally take a long time to heal and are quite uncomfortable and harmful to the patient's health.

Bedsores can be prevented. Someone confined to bed can still get a kind of exercise unless he or she is paralyzed or otherwise immobile. Every hour or so, a period of wriggling the toes, rotating the ankles, flexing the arms and legs, tightening and relaxing muscles, and stretching the whole body will both stimulate circulation and prevent joint contracture, or stiffening. indicates Los Angeles Elder Abuse and Neglect Attorney Steven C. Peck.

If a stroke patient cannot move or is very weak, gently bend and straighten the joints manually at least once a day. Also, change his or her position as often as you can at least every two to three hours, but more often if possible so that the pressure of the body on any particular area is relieved. This is most easily done, especially if the sick person is a great deal heavier than you, by using a draw sheet or by rolling the person from side to side. Otherwise, lift the person into a new position (enlisting someone else's help if necessary).

Dragging the person may damage the skin and increase the chances of bedsores. Use a bed or foot cradle (frames that raise the covers) to keep the weight of the bed clothes off the sick person's legs and feet.

If the person is lying permanently on his or her side, support the upper arms and thighs with soft pillows to keep the elbows and knees apart, and put a pillow between the ankles to keep them from rubbing against each other. The person will still have to be turned frequently to prevent bedsores.

Make sure that the sheets are always clean, dry, crumb free, and pulled as tight as possible to prevent wrinkling. If the stroke or disabled person is likely to be bed ridden for a long time, you may want to get a fluffy sheepskin (preferably a synthetic, washable one) for the person to lie on, to help cushion the whole body. Sheep skin bootees can be bought also, to protect the heels and ankles.

Also, wash the patient frequently and keep the skin on places that are vulnerable to bedsores particularly clean and dry. If you notice any reddening, keep pressure off that area and let the physician know that a bedsore is beginning to form.

Continue reading "Confinement To A Bed For A Long Time Is a Cause of Decubitus Ulcers, Bed Sores & Pressure Sores" »

Too often, we hear that nursing home residents develop bed sores without really understanding what has happened to them. The terms "bed sore", "pressure ulcer" and "decubitus ulcer" mean the same thing and are used to describe any skin lesion or wound caused by unrelieved pressure that damages the underlying tissue. The term is one that fails to adequately describe how terrible these wounds are. Left untreated, these injuries can become infected and result in the amputation of a limb, or even death says California Nursing Home Abuse Attorney Steven C. Peck.

These wounds are graded on a scale from I to IV, with a grade I ulcer being a minor reddening of the skin and grade IV being an open wound with exposed muscle or bone. Stage III and Stage IV pressure ulcers have serious health consequences for nursing home residents because they involved major interruptions in the integrity of the skin. This can allow infecting organisms such as MRSA into the body and can cause systemic infections. indicates Los Angeles Nursing Home Lawyer Steven C. Peck.

The term "pressure ulcer" fits because they frequently happen on parts of the body where there is pressure between a bony prominence and another surface such as a bed or a chair. The places where pressure ulcers most typically occur include: the tailbone or sacrum, the buttocks, the hips, and the backs of the heels, although pressure ulcers can also occur on other parts of the body.

There are some common conditions which many nursing home residents suffer from leave them vulnerable to developing bed sores or pressure ulcers. These include: immobility, incontinence of bowel or bladder, and poor nutritional status. Even when a nursing home resident suffers from all of these risk factors, that does not mean that they will inevitably develop pressure ulcers. In fact, federal regulations put extensive responsibilities on nursing home to prevent and treat pressure ulcers.

The federal regulations covering nursing homes state that if a resident enters a nursing home without pressure ulcers, they should not develop them unless they are clinically unavoidable. This means that the nursing home staff must do everything possible to prevent the pressure ulcers from developing. Further, once a resident has a pressure ulcer, the federal regulations require the nursing home to provide care to promote healing and prevent infection.

Because the nursing home staff has such extensive responsibilities to prevent and/or treat pressure ulcers, poor care concerning pressure ulcers may be a viable basis for a claim of violations of the California Elder Abuse Dependent Adult Civil Protect Act (EADACPA) against the nursing home. Some theories might include:

• Failure to regularly re-position the resident, leaving one area of the body bearing the pressure of the resident's weight for long periods.
• Failure to provide adequate toileting and clothing changes for residents who are incontinent of bowel or bladder.
• Failure to provide adequate nutrition and fluids; if there is malnutrition and dehydration the skin will be less able to resist injury.

An adequate treatment regimen would include:
• Regular dressing changes
• Application of wound treatments
• Use of nutritional supplements
• Use of a pressure-reducing devices

When proper treatment is not initiated, bedsores frequently do progress and become infected. A full assessment of the treatment plan and its implementation is an important part of assessing the liability of the nursing home for the resident's injuries.

Continue reading "Federal Regulations Covering Nursing Homes State Elder Entering Nursing Home Should Not Develop Decubitus Ulcers, Bed Sores and / or Pressure Sores Unless They Are Clinically Unavoidable" »

Pressure Sores, Bedsore and Decubitus Ulcers are a problem in nursing home facilities. In Fiscal Year 2009, the latest data available, a staggering amount of citations, for skilled nursing facilities, were cited state Department of Health and Welfare for failing to properly care for their residents in such a manner as to prevent or heal pressure sores, bed sores and decubitus ulcers indicates Los Angeles Nursing Home Abuse and Neglect Attorney Steven C. Peck.

What is a "pressure sore" and why is this statistic important, you may ask. According to the website "Bed Sore FAQs," a "pressure sore" also known more commonly as a "bed sore" and a "decubitus ulcer" is a condition where a resident's skin is damaged from sustained pressure which stops the flow of blood. Remarkably, according to this blog, this condition can develop from being in a single position for a few hours. One simply way to prevent pressure or bed sores is to simply turn the resident at frequent and regular intervals.

The fact remains, however, pressure sores, bed sores and decubitus ulcers are preventable and are an unnecessary injury sustained by nursing home residents. If you are a resident who cannot move on your own, make sure the facility is providing you adequate care by turning you on a regular basis. If you have a loved one who is a resident of a nursing home, contact the facility and do the same. It is up to you to make sure nursing home facilities do all that is necessary to keep residents safe says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

What is financial abuse?
financial abuse is a different kind of abuse that the individual applies to the illegal diversion, theft or misappropriation of funds or property of the old one.

Often the elderly have a difficult time managing their resources, and so dependent on others for help. It 'at this time that unscrupulous individuals make attempts to obtain from in property, land, goods and money lawDeception, intimidation, etc.

Who could provide financial abuse of your loved ones?
To determine if your loved one is being abused financially, we must first clarify who could potentially lead to abuse. Violators were removed by family members near continents scammers reach.

Personal Concierge
A surprisingly large number of cases of financial abuse occur between an older person and their personal concierge., Often relatives or guardian family members are in a strong position only to commit financial abuse.

With the confidence of the victim in his hand, slowly possessions guardian of the person to steal home. You can also use coercion for individuals older to sign over land, property or access to bank accounts. Guardians can also manipulate the "authority" and the layout of the will.

A personal concierge can be abusiveserious problem, because it seems that the insiders of all issues in connection with your loved ones.

structured services (eg nursing homes)
Many people are concerned about the quality of care for their relatives in nursing homes (so should be maintained). However, one thing to do, some people forget to keep a watchful eye on how the nursing home fees and assume all of the finances of the elderly.

Always make sure the level of costs for comparisonLevel of care and attention. If the products and services account shows that you believe has never been carried out / why is it important to follow with the administrators of the case.

It 'also important that any new "best friends" can be developed to monitor your loved ones at home, particularly in relation to staff. If your loved one begins to add in these individuals or their willingness to buy extravagant things for them, could very easily a case of conning tower, intimidation or'Sweet Heart scams.

Deceiver
Cheaters come in all shapes and sizes and from all over the world. The elderly are more prone to it by the constant evolution of technology and the potential loss of acute mental-ness.

Some of the more crucial in telemarketing swindlers come. Phone scams often target older people who think they can frighten or force. Be sure to send a strong increase in checks for a review of unusual or excessiveAmount is sent to an unknown person / position. Always follow up with your loved ones in these financial decisions and keep a watchful eye on everything that seems real, dishonest, or even well-being.

The elderly are also vulnerable to infiltrate the credit card and account hijacking. It may be difficult for anyone to ensure their identity and numbers, and the elderly often have difficulty keeping pace with technology, accounts, phone numbers, etc.

The action in cases of abuse is discovered
If you do, meaning greetings to your loved ones, do not hesitate to act. Collect as much information and documents can be done about the abuse. Find a local attorney in your area that specializes in these types of cases and do your best to stay one step ahead of fraudsters.

Continue reading "What is Financial Elder Abuse?" »

Nursing home abuse and neglect are often the cause of decubitis ulcers. When a nursing home facility provides a sub-standard level of care by failing to prevent decubitis ulcers, or neglecting to avoid the causes, patients can suffer serious and life threatening injuries. At least 60,000 people die from the complications and causes of decubitis ulcers each year in the United States. People who are vulnerable to developing decubitis ulcers must be frequently moved to avoid development of these sores, and adequately cared for in order to avoid serious injury. That means keeping the areas where pressure occurs (wherever the body rests with the most pressure in a bed - anything from heels and elbows to buttocks, shoulders, the back of the neck, the hips, even the side of the foot or leg. If a person can't move, they need a way to BE moved.

Prevention:

If bedridden or immobile with diabetes, circulation problems, incontinence, spinal problems, bone fractures, or mental disabilities, in addition to intensive care of the skin and keeping areas free from pressure - less than two hours in any given position for any part of the body-the patient should also be checked for pressure sores daily, especially every morning. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps:

Change position at least every two hours to relieve pressure.

Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.

Eat healthy, well-balanced meals with extra vitamin C, if possible. Vitamin C helps build tissues..

Exercise daily, including range-of-motion exercises for immobile patients.

Keep skin clean and dry. Persons with incontinence need to take extra steps to limit moisture

THE NUMBER ONE CAUSE OF THE 100,000 LIMB AMPUTATIONS THAT OCCUR JUST IN THE US IS DECUBITIS ULCERS - the bedsore!

Chronic wounds remain inflamed and may take an inordinate amunt of time to heal - if at all.. These wounds are a major health problem in the United States and throughout the world. The most common chronic wounds are diabetic foot ulcers, venous leg ulcers, and pressure ulcers, although other wounds, such as surgical wounds, can also become a source of chronic non-healing.

Diabetic foot ulcers

Diabetics are prone to foot ulcers due to peripheral neuropathy: decreased sensation caused by this condition can result in a cut and trauma to the foot going unnoticed or can result in unusual pressures placed on the foot that are ignored. Diabetic foot ulcers are the most common chronic wound problem in the United States and the world. Some 25% of the 60 million diabetic patients in the United States develop foot ulcers - that's 15 million people--and approximately 100,000 limb amputations are performed in diabetic patients each year in the United States alone. It's an epidemic that has gone virtually unnoticed. It can happen to you.!

Venous leg ulcers
Venous leg ulcers are caused by a failure of valves in the veins of the legs, resulting in congestion and slowing of blood flow. Rubbing the legs downward increases the risk of vein failure in diabetics. Such ulcers occur spontaneously or in association with minor trauma to the leg. Venous leg ulcers can be very painful and can persist for more than a year. The older the patient, the more likely that venous leg ulcers will develop.

Pressure ulcers (decubitis ulcers or bed sores) result from pressure on skin, soft tissue, muscle, and bone that cuts off the ability of the capillaries to circulate blood for an extended period of time. The wounds that then develop occur in individuals unable to sense the pressure or who cannot change their body position to relieve the pressure. Pressure ulcers are a common and expensive problem in acute care, nursing home, and home care populations. In hospital settings the incidence of pressure ulcers has reached as high as 30% among those at risk.

Continue reading "Nursing Home Abuse and Neglect Is Often The Cause of Decubitus Ulcers, Bed Sores & Pressure Sores" »

On Tuesday, June 8, at 11:15 a.m. EDT, President Obama and Kathleen Sebelius, Secretary of Health and Human Services, will host a "tele-town hall" event with older adults in Wheaton, MD. The purpose of the event is to answer questions from older adults in person and by phone about how the Affordable Care Act will affect Medicare. NAELA is co-sponsoring the event along with other national organizations which represent older adults says California Elder Law Attorney Steven C. Peck.

Individuals interested in viewing the town hall may do so through the White House website or at a regional viewing events. The town hall will also likely be broadcast on C-SPAN. Obama Administration officials will be present at some of the regional viewing events in order to answer questions from participants. The list of regional events includes some private events highlighted in yellow. The rest of the events on the list are open to the public and include the location and contact information for the person organizing the event.

Individuals interested in asking a question of President Obama or Secretary Sebelius can call in during Tuesday's town hall at 1-800-837-1935, pass code: 80272058.

Continue reading "President Obama to Host Television Town Hall Event For Elders" »

Elder abuse is a general term used to describe certain types of harm to older adults. Other terms commonly used include: "elder mistreatment", "senior abuse", "abuse in later life", "abuse of older adults", "abuse of older women", and "abuse of older men".

One of the more commonly accepted definitions of elder abuse is "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person." This definition has been adopted by the World Health Organization.

The core feature of this definition is that it focuses on harms where there is "expectation of trust" of the older person toward their abuser. Thus it includes harms by people the older person knows or with whom they have a relationship, such as a spouse, partner or family member, a friend or neighbor, or people that the older person relies on for services. Many forms of elder abuse are recognized as types of domestic violence or family violence.

The term elder abuse does not include general criminal activity against older persons, such as home break ins, "muggings" in the street or "distraction burglary", where a stranger distracts an older person at the doorstep while another person enters the property to steal.

In 2006 the International Network for Prevention of Elder Abuse (INPEA) designated June 15 as World Elder Abuse Awareness Day (WEAAD) and an increasing number of events are held across the globe on this day to raise awareness of elder abuse, and highlight ways to challenge such abuse.

Types

Although there are common themes of elder abuse across nations, there are also unique manifestations based upon history, culture, economic strength and societal perceptions of older people within nations themselves. The fundamental common denominator is the use of power and control by one individual to affect the well-being and status of another, older, individual.

There are several types of abuse of older people that are generally recognized as being elder abuse, including:

Physical: e.g. hitting, punching, slapping, burning, pushing, kicking, restraining, false imprisonment/confinement, or giving excessive or improper medication

Psychological/Emotional: e.g. shouting, swearing, frightening, or humiliating a person. A common theme is a perpetrator who identifies something that matters to an older person and then uses it to coerce an older person into a particular action. It may take verbal forms such as name-calling, ridiculing, constantly criticizing, accusations, blaming, and general disrespect, or non verbal forms such as ignoring, silence or shunning.

Financial abuse: also known as financial exploitation. e.g. illegal or unauthorized use of a person's property, money, pension book or other valuables (including changing the person's will to name the abuser as heir). It may be obtained by deception, coercion, misrepresentation, or theft. The term includes fraudulently obtaining or use of a power of attorney. Other forms include deprivation of money or other property, or by eviction from own home

Sexual: e.g. forcing a person to take part in any sexual activity without his or her consent, including forcing them to participate in conversations of a sexual nature against their will; may also include situations where person is no longer able to give consent (dementia)

Neglect: e.g. depriving a person of food, heat, clothing or comfort or essential medication and depriving a person of needed services to force certain kinds of actions, financial and otherwise. The deprivation may be intentional (active neglect) or happen out of lack of knowledge or resources (passive neglect).

In addition, some U.S. state laws also recognzse the following as elder abuse:

Rights abuse: denying the civil and constitutional rights of a person who is old, but not declared by court to be mentally incapacitated.

Self-neglect: elderly persons neglecting themselves by not caring about their own health or safety. Self neglect ( harm by self) is treated as conceptually different than abuse (harm by others).

'Abandonment': deserting a dependent person with the intent to abandon them or leave them unattended at a place for such a time period as may be likely to endanger their health or welfare.

Institutional abuse refers to physical or psychological harms, as well as rights violations in settings where care and assistance is provided to dependant older adults or others.

Continue reading "Elder Abuse A General Term Describing Harm To Older Adults" »

A decubitus ulcer also known as a Bed Sore or Pressure Sore is essentially a hole caused by tissue death. Generally, we move when an area on our body in uncomfortable. In a person that cannot move or has decreased sensation, then they are not relieving pressure on the skin. When you press down on your skin, you see a lightening of the skin. This is caused by less oxygen enriched blood in that area, the blood was displaced by pressure. This will cause cell and tissue death. This is very very painful for the person says California Nursing Home Abuse and Neglect Lawyer Steven C. Peck who may be reached toll free at 1.866.999.9085.

When the tissue dies, it leaves behind a hole. The size depends on the pressure point involved. The depth (through different layers of skin) is classified as stages... dermis, epidermis, etc. This mostly depends on time. The longer the pressure was left unreleased, the deeper. However, there are cases that I have seen that within just a couple hours the sore was all the way to the bone indicates Los Angeles Elder Abuse Attorney Steven C. Peck.

Decubitus ulcer formation is even quicker when the body is running at a high speed. Times like fever cause an increase in heat production- which then is an increase in energy production- which then leads to a greater demand for oxygen (just like when you are running) Here, each cell is almost "running" and they wear out quickly. Add to that the inability for new blood to reach it... and you know the rest.

Treatment varies GREATLY. Some wounds are packed with saline soaked gauze and then sealed with a clear bandage. These wet dressings tend to do great for larger and deeper areas. This is one of hundreds of treatments. Treatments are based on past evidence, and each individual detail about each wound, as well as the patients history.

Prevention is the single most effective treatment.

If you or a loved one has developed bedsores in a facility, the facility by federal and most state regulations must prove that the sores were unavoidable and that the staff provided effective care.

Why do bedsores develop? In a number of cases, nurses fail to give proper care. In additional cases, a pervasive culture of abuse and neglect by the heatlh care facility might be to blame. For instance, as outrageous as it sounds, in a number of nursing homes, lazy staff have restrained patients to avoid having to care for them. These patients literally become prisoners inside in their beds and as a result thereof they incur horrific Decubitus Ulcers also known as Bed Sores and Pressure Sores, which become infected and in many many instances cause wrongful death.

Continue reading "Federal and State Laws Regulate The Development of Bed Sores in Health Care Facilities" »

A California nursing home has been hit with a nearly $30 million verdict in a wrongful death lawsuit, including $28 million in punitive damages for failing to provide proper care to a resident who died from an untreated bedsore in the nursing home indicatges California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

The verdict was handed down in May, 2010 by a Sacramento Superior Court jury, deciding a nursing home lawsuit brought by the family of Frances Tanner, 79, of Stockton. The complaint alleged that Colonial Healthcare of Auburn and its parent company, Horizon West of Rocklin, committed elder neglect, resulting in Tanner's death in 2005.

Tanner, who suffered from mild dementia, died at the nursing home after being there only seven months. Her death followed a nursing home fall that caused her to break her hip. She then suffered nursing home bedsores, which investigators say caused her death says Los Angeles Elder Abuse Attorney Steven C. Peck.

Bedsores, also known as pressure sores or decubitus ulcers, occur as a result of a lack of blood flow to an area of the skin caused by prolonged pressure on one area of the body. They most often develop in places with prominent bones beneath thin layers of skin, such as the heels, elbows and tailbone. The open sores often afflict nursing home residents and hospital patients with limited mobility who have trouble, or are unable, to move independently.

Most medical organizations consider nursing home bed sores to be a preventable condition that are easily treated if detected early through proper diligence on the part of medical staff and care providers. Failure to prevent, identify, or properly treat bedsores can result in life-threatening infections that enter the bloodstream, known as sepsis.

The lawsuit brought by Tanner's family included claims that the facility was understaffed and that it failed to keep proper medical records. The jury agreed, awarding the family $1.1 million in damages due to pain, suffering and lost of companionship. The jury then hit Colonial and Horizon West with $28 million in punitive damages, which are only awarded in cases where the jury believes there was malicious, fraudulent or oppressive action on behalf of the defendant.

Officials with Horizon West, which owns 33 nursing homes, disputes the claims of negligence and says it will appeal the verdict, according to a story in the Sacramento Bee.

The claims of poor management are echoed by the most recent review by the U.S. Centers for Medicare and Medicaid Services (CMMS). Federal investigators gave Colonial Healthcare a one-star rating, representing a "much below average" grade. It is the lowest grade a nursing home can be given by federal regulators. CMMS rated its health inspection track record and quality measures as particularly bad, and only rated its nursing home staffing as average.

Continue reading "$30 Million Dollar California Verdict Against Skilled Nursing Facility For Failure To Provide Proper Care and Wrongful Death Caused By Untreated Bedsores" »

Most of us have had or will have a relative or loved one cared for in a nursing home at some time in our lives. Perhaps many of us will, ourselves, be there one day. The graying of America has put many of our loved ones in the care of these institutions now. With the increase in our population of elders, the flaws in the care of elders become ever more apparent, leading to more complaints about care, billing, short staffing, administration and other problems. These complaints are certainly appropriate for mediation but few of them get there unless the family member faces a problem so grievous as to compel suing the institution. If the monthly charge for care is arbitrarily increased without justification, if clothes are being stolen, if dear old Mom doesn't always have an aide there to help him eat when she needs help, there may not be enough of a dispute with the nursing home to sue. However, there is certainly a cause for the family to complain. When the complaints are repeatedly ignored, there is growing outrage. Families want to place their frail elderly in safe nursing homes. Finding an appropriate facility is no easy task, and all beds are often full. In my own practice, I hear many more stories of families with valid concerns about everyday wrongs than I do stories of lawsuit-worthy situations, though, of course, both exist. Currently, there is nowhere to send the family with the less serious problem to assure that anyone will actually listen to their complaints. That was the impetus for the effort to create programs for mediation in nursing homes and hospitals. This is still a new field. Establishing programs to deal with disputes in pro-active ways through mediation requires that the administrators and insurers of these institutions accept the concept. When they do, it works very well. When they don't, we end up only mediating disputes which are litigated, often after great expense to both sides. No effort at prevention of a suit is normally made. The nature of many disputes is such that mediation can lead to greater understanding, a forum to voice distress, and an opportunity to problem solve before little annoyance piled on bigger annoyance drives people to seek ways to express their anger through the courts.

What lawyers can do, with positive experiences of mediation, is to educate those around us, suggest mediation whenever possible, and to seek the assistance of those in the field to implement this tried and true method of ADR in our own healthcare consumer experiences. If you have never had a complaint about your own healthcare or those who deliver it, you likely will in the future. Seniors are the biggest consumers of the healthcare dollar. We must bring ADR into the places where our seniors are at risk. Soon enough, we will be the ones at risk ourselves.

Continue reading "Healthcare Mediation: Helping the Elderly Resolve Their Disputes" »

A man died from infected bedsores within four weeks of being admitted into a nursing home because his care was inadequate, an inquest has ruled.

He had been taken to hospital suffering with 18 bedsores.

The neglected and Abused Elder was grossly unkempt, covered in dry feces and one of his sores could not be measured because he was in such pain.

The Elder was admitted to a nursing home at which time he had three pressure sores but within four weeks he was in a life threatening condition and was re-admitted to hospital with 18 sores. says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

The nursing home staff staff failed to adequately review and assess the Elder's admission or ensure an effective care plan was in place. As a result thereof, the Decubitus Ulcers aka Bed Sores and Pressure Sores became severely infected causing the elder's death.

Continue reading "Infected Decubitus Ulcers, Bed Sores & Pressure Ulcers Cause an Elder's Death" »