California Elder Law Attorney Blog

Washington is a pioneer in elderly care with 2,984 privately owned homes dedicated to the assistance of seniors, according to the Seattle Times. The social service boom has left in its wake an absence of government regulation. Quality of care has not been maintained due to lack of responsibility in caregiver-patient relations.

Adult homes are less expensive alternatives to nursing homes that usually only house a maximum of six individuals under care by a state-licensed caregiver says California Elder Abuse Attorney Steven C. Peck.

Our Declaration of Independence states each citizen has "...certain unalienable rights, that among these are life, liberty and the pursuit of happiness." These are the fundamental requirements for a government to protect. By not regulating these adult homes and allowing for the premature deaths of elders to go unchecked and without penalty, our government is violating its most basic principles indicates California Nursing Home and Abuse Lawyer Steven C. Peck.

The licenses given to these facilities are worthless in evaluating the actual qualifications of the individuals obtaining them. The Department of Social and Health Services does not require reviews unless licenses have already been suspended or revoked, according to their website. DSHS may conduct additional reviews at their discretion, but only after complaints have been filed and even then a review is only optional.

To be a licensed adult home supervisor, an individual must complete 320 hours of care in an adult home, be certified in first aid and CPR and have good moral and responsible character with no previous criminal convictions. These qualifications are about as difficult to jump through as obtaining a food permit. Also, many testimonies by families to abuses in these homes have been blatantly ignored by DSHS, according to the Seattle Times.

The department's mission statement says its responsibilities are to "improve the safety and health of individuals, families and communities by providing leadership and establishing and participating in partnerships." The mission should continue to claim a duty to preserving human life. The department is responsible for reporting these injustices and investigating abuse. It is illegal to witness a crime and not report it.

Still, there have been many undocumented cases of premature deaths such as choking, falling and bed sores that are left unattended for long periods of time. These sores will actually bury to the bone, killing those under supposed supervision -- an easily avoidable and painful death that can only be caused by sheer neglect.

The Seattle Times says that nursing homes are 3.5 times less likely to see deaths due to pressure sores and 15 times less likely to have death by choking occur.

Other states are replicating our new system of adult homes despite these oversights. The issue is not the services themselves, but the lack of regulation by government officials. They allow for the mistreatment of these patients.

Government officials should conduct frequent checkups without notice to ensure quality care. Reviews of licenses should happen every couple of years like driver licenses to ensure continued quality. Whistleblower protection should be instituted so abuses will be reported before premature death occurs. The systems allows for dangerous practices to be pushed under the carpet. This is an outrage to those who place their loved ones and their trust in the hands of these individuals. The fact that the government has allowed these abuses to go unchecked shows a neglect for human life and a direct violation of the obligations of our officials.

Continue reading "Absence of Governement Regulation Surrounds Elder Assisted Living in The State of Washington" »

Not only can bedsores, pressure sores and decubitus ulcers be prevented, they can be easily cured should they develop. Nevertheless, approximately 25% of nursing home residents will experience bed sores, pressure sores, or decubitus ulcers at some point during their stay. Because nursing home residents have a greater chance of developing bedsores, staff members should take extra caution when caring for these individuals. Those susceptible to pressure sores include:

Residents aged 75 or older
Those who cannot feed themselves
Residents who cannot reposition themselves, due to physical limitations or the use of restraints
Individuals who do not understand the need to turn or reposition in bed
Underweight residents
Individuals with dry skin
Residents who are incontinent or have decreased mental ability
Residents with serious medical conditions such as diabetes, cancer and multiple sclerosis

Federal law requires that the nursing home workers must prevent the development of bedsores unless the resident's medical condition proves that decubitus ulcers were unavoidable. However, in many cases, bedsores are avoidable and the reason for their development is often nursing home neglect. In addition, nursing home staff members must, under law, prevent the progression of any pressure sores present at the time of entry to the facility.

Continue reading "There Are Certain Risk Factors for Bedsores, Pressure Sores and Decubitus Ulcers" »

There are four stages of bedsores. A stage IV bedsore is the deepest and most serious stage. This sore extends from the skin and soft tissue into the muscle, tendon or bone. Someone suffering from a stage IV bedsore requires immediate medical attention by a doctor, nurse or other qualified nursing home professional, due to the extreme seriousness of the injury. Stage III bedsores, while generally not life-threatening, are still very serious injuries that extend into the subcutaneous tissue layer under the skin, inhibiting the blood supply says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

A Stage II bedsore is an open wound that looks like a bruise or blister. Some of the skin has worn away and the area around the sore is discolored. Stage II bedsores typically heal quickly, if there is medical attention. A Stage I bedsore is an area of red, irritated skin that may hurt to the touch. Stage I bedsores go away once a person is moved, but can develop into more serious bedsores if nothing is done. Bedsores at any stage can be serious due to their potential to progress if not treated expeditiously and correctly.

Bedsores, also known by the terms pressure sores, pressure ulcers, and decubitus ulcers, are serious, sometimes devastating and disfiguring injuries. In order to avoid bedsores, a nursing home must exercise extra care for patients confined to their beds.

Continue reading "Severity of Bedsores, Pressure Sores and Decubitus Ulcers and the Potential for Death" »

Is there is no such thing as an unavoidable pressure ulcer,? although now the Federal Government seems to be saying otherwise. Or, are they really? We shall now examine this more closely. The term "unavoidable pressure ulcer" itself is an oxymoron because to say that a pressure ulcer was unavoidable is to say that prolonged continuous pressure is unavoidable, which the standards of care require that it be avoided. In other words, how can we say that something is unavoidable if we are obligated to avoid it? Yet the nursing facility that claims that a stage 4 necrotic pressure ulcer developed despite providing all of the required care (which included relieving pressure) has to show that it employed the specialty bed and turned the patient every two hours as well as attending to all other needs says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Thus in actuality, any ulceration that continues to deteriorate despite that the pressure was relieved at the proscribed intervals has some underlying etiology other than pressure that makes it unavoidable. Then by definition it cannot be categorized as a pressure ulcer and the focus needs to be redirected to the underlying condition and whether or not it was properly diagnosed and treated.

So, when it comes to bedsores, AKA pressure ulcers, and decubitus ulcers it is always a matter of what was missing; assessment of risk, nursing care plan and implementation; all centered on alleviating pressure and slowing down the skin's susceptibility to having its circulation cut off. In every one of the bedsore cases that I have reviewed there was always something missing in the documentation either in the assessment, plan, implementation or all three. It all boiled down to one simple fact; pressure. If ulceration occurs without pressure then you can't call it a pressure ulcer; you have to give it another name like arterial, venous stasis, diabetic or PVD ulcer. A pressure ulcer invariably happens only because of prolonged pressure even though there are certain factors that make it happen faster for some than others like nutritional status, hydration, clinical condition, etc. However, if the pressure is intermittent the bedsore will be avoided or at least prevented from getting worse because the tissue is receiving the required blood circulation.

On the other hand, there is a fairly recent blurb from CMS (Centers for Medicaid and Medicare Services) called the "F314 tag" which offers a distinction between "Avoidable" and "Unavoidable" pressure ulcers. "Avoidable means that the resident developed a pressure ulcer and that the facility did not do one or more of the following: evaluate the resident's clinical condition and pressure ulcer risk factors; define and implement interventions that are consistent with resident needs, resident goals, and recognized standards of practice; monitor and evaluate the impact of the interventions; or revise the interventions as appropriate.

"Unavoidable means that the resident developed a pressure ulcer even though the facility had evaluated the resident's clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate."Not surprisingly, this government tag identifying the theoretical existence of "unavoidable pressure ulcers" doesn't change anything. If you look at the "defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice;" you will find within it the duty owed to the patient/resident to alleviate those conditions that cause prolonged continuous pressure.

Moreover, if you follow the requirement to "monitor and evaluate the impact of the interventions; and revise the approaches as appropriate" you will find that as the wound deteriorated, becoming deeper, larger, more necrotic and foul smelling, the facility has to demonstrate that it tried every available technology and approach to prevent worsening and promote healing.

In summary, since the government has defined the theoretical existence of the "unavoidable pressure ulcer" it certainly opened the door for an affirmative defense, but it did set forth very stringent criteria that shift the burden of proof on to the facility to demonstrate that the pressure ulcer occurred and deteriorated even though the continuous pressure had been alleviated while all other needs were being met and all available treatment modalities employed.

Continue reading "The Battle of the Bedsores, Pressure Sores and Decubitus Ulcers : Avoidable versus Unavoidable" »

California State public health officials fined an Arden Arcade nursing home $90,000 on Monday October 25, 2010 in connection with the death of a 97-year-old patient three years ago.

The patient fell to the floor from her bed at the Gramercy Court nursing home while an attending nurse had her back turned to the patient, the Department of Public Health says in its investigation.

The patient's spine was broken from the fall and she was rushed to a hospital. Investigators said a bed rail, which could have prevented the fall, was not in place. The woman, who was not identified, died four days later.

State officials classified the violation, a Class AA citation, as the most severe the agency could impose - although it fell short of fining the nursing home the maximum penalty of $100,000.

In 2008, the state levied a similar penalty against Gramercy Court after investigators ruled that a 73-year-old patient suffered an infection in 2006 and ultimately died because Gramercy staff members failed to keep her hydrated.

Continue reading "Nursing Home Fined $ 90,000.00 On Death of Elder Resident" »

Despite what the nursing homes often claim, we have consulted with medical witnesses who feel that bed sores are almost never unavoidable. Certain medical conditions do make sores more likely. These include diabetes and peripheral vascular disease, each of which restricts blood flow to the extremities. A patient is also at risk if he or she has limited mobility, cannot control his/her bowels and bladder, and has poor hydration and nutrition. If your loved one has these conditions, you should be aware of this risk and keep an eye out for breakdown of the skin. That being said, if the nursing home considers these risks and takes adequate precautions, sores should be avoidable.

Continue reading "Are Bed Sores, Decubitus Ulcers and Pressure Sores Unavoidable?" »

A decubitus ulcer/pressure sore is a bed sore caused by unrelieved pressure on the skin that comes from lying or sitting in the same position too long and is associated with pain.
Unfortunately, once a bedsore progresses to stage 3 and stage 4 and becomes infected, it is difficult to achieve healing and avoid painful and potentially fatal complications. These individuals may develop osteomyelitis (infection of the bone) and sepsis (blood infection) ultimately resulting in death indicates California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

The standard of care applicable to nursing homes requires the nursing home staff to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable. The nursing home staff must also ensure that a resident having pressure ulcers receives necessary and proper wound care treatment and services to promote healing, prevent infection and prevent new ulcers from developing. The nursing home staff must relieve pressure by turning and repositioning the resident at least every two hours while in bed and every hour while in a Geri-chair or wheelchair, maintain adequate nutrition and hydration, and prevent contractures of the extremities.

Nursing homes develop and implement internal policies and procedures pertaining to the prevention, care, treatment and monitoring of pressure sores /decubitus ulcers. In our experience litigating decubitus ulcer lawsuits, all too often these policies and procedures are not adhered to by the nursing home staff and elderly residents develop otherwise avoidable fatal bedsores says California Elder Abuse Attorney Steven C. Peck.

The failure of a nursing home to adhere to their own policies and procedures is important evidence that will be taken into consideration when the nursing home's attorneys and in-house representatives evaluate the claim. This is also very powerful evidence that can be presented to the jury.

Continue reading "Standard of Care In A Skilled Nursing Facility Is That Bed Sores Should Not Develop Unless Medically Unavoidable" »

Contractures are painful, disfiguring deformities of the joints, caused by immobility, and often resulting in reduced range of motion. Muscles shorten when a person endures long periods of immobility. Infrequent use causes the muscles to become rigid or fixed. Joints do not move as freely or smoothly as they once did. Movement is painful when the joint is moved because the shortened muscles are being stretched beyond their ability.

Progression of Contractures:

As contractures progress, a person loses all voluntary movement in the contracted joint. Bathing, dressing, and daily care become more difficult. It is harder to position a resident properly because the contracture creates pressure points that may lead to pressure sores

Symptoms of Contractures: The Four Stages

Contractures progress through four stages based on severity.

•Stage I contractures can develop in as few as four days.
•Stage II contractures develop after an additional week or two. Unfortunately, most contractures are not identified until they are at Stage III.
•Stage III contractures need many as 500 days (a year and a half) to work themselves out.
•Stage IV contractures exist when a nursing home resident's muscles and joints are so stiff that the resident is folded into the fetal position.

Causes of Contractures

Joint movement is affected by age, body size, genetics, and the presence or absence of disease. The normal movement of the joints is called range of motion. Healthy people do range-of-motion movements many times each day during normal activities. Nursing home residents in long term care facilities may not move each joint through its normal range each day. The muscles atrophy and eventually shrink leading to a reduced range of motion called a contracture.

Prevention of Contractures

For the prevention of cantractures ask the nursing home staff about what type of exercises you can help the resident do. Check with qualified professionals before attempting new exercises or routines, and follow the general guidelines for exercises listed below. Encourage a nursing home resident who can still move independently to exercise frequently. Remind a nursing home resident with limited mental abilities when it is time to exercise in order to prevent cantractures.

Nursing Home Staff and the Prevention of Contractures:

Nursing home staff members must exercise an immobile nursing home resident's joints to prevent deformities. Nursing home staff should be trained to perform exercises on residents with various physical and mental conditions.

Active range-of-motion exercises are done independently by nursing home residents each day. Residents with limited mental ability may need reminders to exercise. Some may need to use stronger muscles and joints to exercise weaker ones. That's O.K., as long as the exercises get done.

Range of Motion Exercises to Prevent Contractures

Active-assistive range-of-motion exercises may be started by the nursing home resident and completed with the help of a nursing home aide, or they may started by the aide and completed by the resident. A nursing home resident may use elastic bands, pulleys or other equipment to perform the exercise.

In passive range-of-motion exercises, a nursing home aide manually manipulates the joints of a resident who is physically or mentally incapable. Passive range-of-motion exercises should be performed two to three times a day to prevent contractures and deformities. These exercises maintain flexibility, but they do not strengthen muscle.

Preventative Exercises for Prevention of Contractures:

Like pressure sores, contractures are much easier to prevent than to cure. Contractures are prevented by maintaining a resident's range of motion. Range-of-motion exercises can be conducted without a physician's order unless the resident has osteoporosis, severe arthritis or other joint or bone-related illnesses.

Range-of-motion exercises prevent contractures and atrophy. Range of motion exercises stimulate circulation (thereby reducing the risk of blood clots), and they improve the resident's general sense of well-being.

Guidelines for Range-of-Motion Exercises:

•Check with a medical professional before performing range-of-motion exercises with a resident who has specific movement limitations, osteoporosis, arthritic deformities, or healing fractures.
•Do not exercise the resident's neck without a physician's order.
•If the resident physically resists range-of-motion exercises or has very stiff joints, it may be helpful to perform the exercises in a bathtub or whirlpool.
•Make enough space to accommodate a full range of movements.
•Position the nursing home resident on his or her back, in good body alignment, before beginning range-of-motion exercises.
•Respect the nursing home resident's dignity. Cover the resident and expose only the part of the body being exercised.
•Encourage and help the resident to relax.
•Talk to the resident. Explain the range-of-motion exercise before doing it, even if the nursing home resident is mentally confused.
•Perform each range-of-motion exercise at least three to five times. The more active, the better, though beware of fatiguing the nursing home resident or causing injury.
•Work systematically from the top of the body to the bottom.
•Support each joint during the range of motion exercise by placing one hand above and one hand below the joint.
•Move each joint slowly and consistently.
•Stop briefly at the end of each range of motion exercise before repeating.
•Avoid pushing the joint past a point of resistance.
•If the nursing home resident has a muscle spasm, hold the joint in position for a few seconds, applying gentle pressure.
•Stop the range of motion exercise if the resident resists or complains of severe pain.
•Stop the range of motion exercise if the resident's condition changes.
•There may be a problem if the nursing home resident experiences pain, shortness of breath, sweating, or a change in color.

WHAT YOU CAN DO :

1.Visit often. Residents who have frequent visitors are less likely to be ignored by staff.

2.Ask your loved one how they are.

3.When you visit check for signs of injury or loss of mobility in their hands or elsewhere

4.Don't be afraid to look under the sheets for the presence of bedsores. Bedsores usually develop on the lower back or buttocks and frequently are found on patients with contractures.

If you find any signs of contractures, injury or abuse, immediately bring it to the attention of the facility. Speak to the nurses, ask them what they know. Remember to document everything.

Continue reading "Contractures Can Lead To Bed Sores and Are A Sign of Nursing Home Abuse and Neglect" »

A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.

A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head. says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Causes:

These factors increase the risk for pressure ulcers:

* Being bedridden or in a wheelchair
* Fragile skin
* Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow
* Inability to move certain parts of your body without assistance, such as after spinal or brain injury or if you have a neuromuscular disease (like multiple sclerosis)
* Malnourishment
* Mental disability from conditions such as Alzheimer's disease -- the patient may not be able to properly prevent or treat pressure ulcers
* Older age
* Urinary incontinence or bowel incontinence

Symptoms:

Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst):

* Stage I: A reddened area on the skin that, when pressed, is "nonblanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.
* Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
* Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.
* Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

First Aid:

Any new or changing pressure sore should be discussed with your doctor or nurse. Once a pressure ulcer is identified, steps must be taken immediately:

* Relieve the pressure on that area. Use pillows, special foam cushions, and sheepskin to reduce the pressure.
* Treat the sore based on the stage of the ulcer. Your health care provider will give you specific treatment and care instructions.
* Avoid further trauma or friction. Powder the sheets lightly to decrease friction in bed. (There are many items made specifically for this purpose -- check a medical supplies store.)
* Improve nutrition and other underlying problems that may affect the healing process.
* If the pressure ulcer is at Stage II or worse, your health care provider will give you specific instructions on how to clean and care for open ulcers. It is very important to do this properly to prevent infection.
* Keep the area clean and free of dead tissue. Your health care provider will give you specific care directions. Generally, pressure ulcers are rinsed with a salt-water rinse to remove loose, dead tissue. The sore should be covered with special gauze dressing made for pressure ulcers.
* New medicines that promote skin healing are now available and may be prescribed by your doctor.

DO NOT:

* Do NOT massage the area of the ulcer. Massage can damage tissue under the skin.
* Donut-shaped or ring-shaped cushions are NOT recommended. They interfere with blood flow to that area and cause complications.

When to Contact a Medical Professional:

Contact your health care provider if an area of the skin blisters or forms an open sore. Contact the provider immediately if there are any signs of an infection. An infection can spread to the rest of the body and cause serious problems. Signs of an infected ulcer include:

* A foul odor from the ulcer
* Redness and tenderness around the ulcer
* Skin close to the ulcer is warm and swollen

Fever, weakness, and confusion are signs that the infection may have spread to the blood or elsewhere in the body.

Prevention:

If bedridden or immobile due to diabetes, circulation problems, incontinence, or mental disabilities, you should be checked for pressure sores every day. You, or your caregiver, need to check your body from head to toe. Pay special attention to the areas where pressure ulcers often form. 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 2 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 that contain enough calories to keep you healthy.
* Drink plenty of water (8 to 10 cups) every day.
* Exercise daily, including range-of-motion exercises for immobile patients.
* Keep skin clean and dry.
* After urinating or having a bowel movement, clean the area and dry it well. A doctor can recommend creams to help protect the skin.

Continue reading "Decubitus Ulcers, Pressure Sores, Bed Sores Transpire When You Stay In One Position Too Long Without Shifting Your Weight" »

The terms decubitus ulcer and pressure sore have been interchanged inappropriately over the years. Technically, the term decubitus ulcer refers to wounds developed over bony prominences while in the recumbent position (ie, sacrum, heel, occiput); the Latin decumbere means "to lie down." Therefore, semantically, wounds acquired from extended pressure in the seated or turned position (ie, ischial or trochanteric ulcers) are not decubitus ulcers. Therefore, in general, wounds acquired from pressure over bony prominences can always be called pressure sores.

Overall, patients with pressure sores are important users of medical resources. They require 50% more nursing time, remain hospitalized for significantly longer periods, and incur higher hospital charges.

Pressure sores are common conditions among patients hospitalized in acute- and chronic-care facilities. Studies have suggested that, at any given time, 3-10% of hospitalized persons have pressure sores and 2.7% develop new pressure sores.3 Among a selected population, the incidence rate for the development of a new pressure sore has been demonstrated to be much higher, with a range of 7.7-26.9% says California Nursing Home Abuse and neglect Attorney Steven C. Peck.

Two thirds of pressure sores that develop in hospitalized patients occur in patients older than 70 years.4 As elderly individuals become the fastest-growing segment of the population, with an estimated 1.5 million people living in extended-care facilities, the problem of pressure sores will have an even more profound influence on the American economy.5 Most studies found the prevalence rate of pressure sores in patients in nursing homes to be 3-6%. However, other studies reported prevalence rates as high as 25-33%. indicates California Elder Abuse lawyer Steven C. Peck.

Pressure sores also occur with a higher frequency in young patients who are neurologically impaired.5 Immobility and lack of sensation make these patients susceptible to developing pressure sores. The incidence rate of pressure sores in these patients has been demonstrated to be approximately 5-8% annually, and 25-85% of these patients develop a pressure sore at some time. Once again, the treatment of pressure sores in this patient population represents a financial challenge, with an average cost per admission of a patient with a pressure sore of $78,000 at one hospital.

In obtaining a history from the patient with a pressure sore, determine the associated medical cause for the ulcer (eg, paraplegia, quadriplegia, spina bifida, immobilization in hospital, multiple sclerosis). Other factors that should be elicited in the patient's history include onset, duration, other ulcers, prior medical treatment, wound care, and prior surgical treatment.

The patient's social situation also can impact treatment. Determine if the patient has a pressure-reducing mattress for the wheelchair and bed and an appropriate support system at home to minimize the risk of recurrence. Also, obtain a complete review of systems, including the presence of fevers, night sweats, rigors, weight loss, weakness, and loss of appetite.

In addition to the patient history, perform a physical examination. Describe the specific location of the pressure sore based on the underlying bony prominence (eg, sacral, ischial, trochanteric). Infection of the pressure sore is suggested by wound edge erythema, foul odor, purulent discharge, and necrotic bone. Determine the level of tissue injury (ie, to epidermis, dermis, subcutaneous fat, muscle, bone, joint). Several classification systems of pressure sores are available based on this level of injury. One widely accepted classification system has 4 stages.11 Pressure sore staging from Barczak et al12 is as follows:

* Stage 1 - Skin intact but reddened for greater than 1 hour after relief of pressure
* Stage 2 - Blister or other break in dermis with or without infection
* Stage 3 - Subcutaneous destruction into muscle with or without infection
* Stage 4 - Involvement of bone or joint with or without infection

Also, note the character of the wound base and if it has granulation tissue or necrotic tissue. Verrucous heaps of white tissue within or around the wound suggest malignant transformation, as is observed with Marjolin ulcers (see images below). Document the size of the wound, wound edge undermining, additional pockets, and sinus tract communication with the hip joint or urethra. Note existing scars and the presence of colostomy and cystostomy. Also assess the extent of associated spasm.

Continue reading "An Overview of Decubitus Ulcers, Pressure Sores and Bedsores" »

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

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

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

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

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

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

Continue reading "Bed Sore, Pressure Sore and Decubitus Ulcers Staging Per AHCPR Guidelines" »

Bedsores, also known as decubitus ulcers or pressure sores, happen when the blood supply is cut off from the skin for more then two to three hours. The skin will turn red and painful at first, then a deeper color, next the skin will open up and usually become infected says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Immobilization is the number one reason for these pressure sores. Lying on pressure points, often referred to as bony prominences, such as ankles, heels, hip bones, elbows, shoulders, back, inside and outside of knees, coccyx/tail bone, and back of the head for an extended length of time can cause breakdown of the skin indicates California Elder Abuse Lawyer Steven C. Peck.

In long term care (nursing home), hospital and the private home, turning is crucial, for a bed bound or chair bound person. In nursing facilities, certified caregivers are trained to understand the cause and prevention of decubitus ulcers.

If a patient or resident is bed ridden and not able to turn on their own, caregivers should turn them at least every two hours from side, back, side, respectively. This continues round the clock. Pillows will be placed between the knees and ankles. If lying on their back a pillow will be placed under the feet of the resident/patient with their heels hanging off the edge of the pillow but not touching the bed in order to prevent heels from breaking down. Repositioning is a huge deterrent to prevent and/or help heal pressure sores. Pressure relieving mattress' are recommended for compromised patients.

If a patient or resident is chair bound, ulcers are very common on the coccyx area. Providing them a pressure relieving cushion and encouraging to reposition slightly, to lay in bed, move to another chair every two hours or more, can help prevent these painful and sometimes debilitating wounds.

In the home setting, family members often times care for their loved ones yet many are not trained to understand how to prevent these wounds from occurring. Skin care, repositioning, and pressure relieving cushions/mattress are very important in preventing decubiti.

Other preventatives which are very important are, nutrition, clean dry linens, clean dry skin, as well as frequent mobilization.

Decubitus ulcers, Bed Sores and Pressure Sores can be treated. If the skin is broken open the treatment becomes more in depth and will always depend on the severity of the wound. Several different treatments may be needed, which a physician or ostomy nurse should recommend.

Continue reading "Immobilization Is the Number One Reason For Bed Sores, Pressure Sores and Decubitus Ulcers" »

Nursing home abuse is a problem that stems from the overworked staff of nursing homes all crossways the country. Nurses with too many patients to handle are worn to the breaking point and beyond, often burning out and quitting, leaving nursing homes even shorter staffed. Those nurses that remain are often tired, overworked, and underpaid. None of this excuses neglect in nursing homes, but it certainly does seem to cause it in many cases.

In some cases, this mistreatment can lead to the death of the very loved ones that we were hoping to protect by placing them in the care of professionals. The very last thing that any of us wants to hear is that our loved one has passed away in a nursing home. It is even worse to hear that they had died of something that would have been entirely preventable with proper care.

Many nursing home patients in these places develop bed sores from lying in one position for too long. Others might get cuts or scrapes that become infected, and these infections are sometimes not noticed or properly cared for. Residents of nursing homes might have bandages that are infrequently changed or might become hurt while trying to move about and be left for extended periods of time by nurses and physicians who are too busy or exhausted to do a routine check.

This kind of neglect is the depressing result of understaffed nursing homes, and should not be treated as acceptable in any way. Our loved ones have been prefabricated to suffer, and the only way to make things superior for others is to ensure that the nursing homes are punished for their budget saving negligence.

If your relative's passing was the event that led you to discover the neglectful ways of the nursing home, then a nursing home abuse and neglect lawyer will work with you to get you and your family the money for your suffering that will help you be healthy to financially move on with your lives.

It is a terrible thing, to see a helpless elderly mortal become the victim of abuse or neglect, but it happens each day. A nursing home abuse lawyer will try to help you ensure that it doesn't happen again.

Continue reading "Overworked Staff Causes Nursing Home Abuse and Neglect" »

A man allowed his 91-year-old mother to soak for weeks in her own feces and urine, with the elderly woman developing severe bed sores and a widespread infection in her bloodstream, police allege.

The victim died after a short stay at the Hospital. An autopsy is scheduled today to determine the cause of death.

Her son, was ordered held in lieu of $10,000 cash bail after his arraignment..

The manwho authorities said was his mother's primary caretaker, is charged with permitting injury to an elderly or disabled person, and permitting serious injury to an elderly or disabled person.

"He left his mother to sit and rot in her own waste," .

Continue reading "91 Year Old Women Dies of Elder Abuse Caused by Severe Bedsores and Infection" »

A Sacramento County nursing home will have to pay $100,000 for the death of a 60-year-old patient who fell while attendants were moving her from her wheelchair to her bed.
The California Department of Health announced the fine--the largest allowed under state law--against Eskaton Care Center Manzanita indicates California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

The woman, whose name has not been released, was being moved onto the bed using a mechanical lifting device at the facility in Carmichael two years ago when the machine failed. The woman fell and hit her head. She died four days later of head trauma.

State investigators said the nursing home had not properly maintained the equipment.

Eskaton Care Chief Operating Officer Trevor Hammond called the death a "catastrophe." He told the Sacramento Bee the nursing home is reviewing the fine and is not sure it will appeal.

Continue reading "California Nursing Home Fined $100,000.00 For Resident's Death" »

The New York Times has reported that 90 percent of all nursing homes have been cited for violating federal health and safety standards. Even worse, 94 percent of all privately-owned facilities were cited for such violations. It is clear that nursing home abuse and neglect has become an epidemic, and anyone with a loved one in a nursing home needs to be aware of this issue.

Nursing home residents rights are guaranteed by the federal 1987 Nursing Home Reform Law. The law requires nursing homes to promote and protect the rights of each resident. Yet, as the New York Times recently made clear, nursing homes are not doing enough to protect their residents indicates California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of negligence and or abuse, though it concedes that the number is probably higher. According to the National Center's study, 57% of nurses aides in long-term care facilities admitted to having witnessed, and even participating in, acts of negligence and abuse. Data from the U.S. Centers for Disease Control and Prevention show that nursing home neglect played role in the deaths of nearly 14,000 nursing home patients between 1999 and 2002.

The New York Times report detailed a study conducted by the inspector general of the Department of Health and Human Services. According to the inspector general, more than 1.5 million people live in the nation's 15,000 nursing homes. To participate in Medicare and Medicaid, facilities must meet federal health and safety standards. These programs cover more than two-thirds of nursing home residents, and cost taxpayers more than $75 billion per year.

According to the inspector general's report, in the past year, poor nursing home conditions were the subject of 37,150 complaints. Of those, 39 percent were later substantiated by inspectors, and at least 20 percent involved the abuse and neglect of patients. What's more, 17 percent of nursing homes had deficiencies that caused actual harm or immediate jeopardy to patients, the report said.

About two-thirds of the nation's nursing homes are owned and operated by for-profit companies. Non- profit organizations own 27 percent, while government entities own and operate 6 percent. Of the facilities owned by non-profits, 88 percent were cited for violations, while 91 percent of government-run institutions received citations. According to the report for-profit nursing homes averaged 7.6 deficiencies per facility, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.

To protect a loved one living in a nursing home, it is important to understand what constitutes nursing home abuse and how to spot it. The most common type of nursing home abuse is neglect. Understaffing at nursing homes is the main culprit behind this kind of abuse. Evidence of nursing home neglect includes bedsores and stiff joints(contractures) as well as signs of depression. A patient who appears over medicated or is needlessly sedated could be a victim of nursing home neglect. The smell of urine or feces and poor personal hygiene are hallmarks of this problem. Extreme unexplained weight loss in an otherwise healthy resident can also be a sign of abuse. And if visitors are made to wait while the staff readies a patient to see them, - or does not allow the visit at all - neglect could be the reason.

Nursing home neglect is as much a crime as any other form of abuse. Nursing home neglect robs patients of their dignity, and it can be deadly. Neglected nursing home patients have been known to wander away from facilities, and sadly some of these patients have died of exposure. Other unattended patients have been allowed to die as a result of undetected internal bleeding or other ailments that could have been corrected with proper medical care.

Physical abuse is an unfortunate fact of life in many nursing homes. Nursing home staff are often guilty of this crime, but abuse among residents is not unheard of. About 2500 cases of physical abuse by nursing home staff are being reported each year. While physical abuse encompasses crimes like battery, it also includes placing a patient in excessive restraints or physically confining residents for no valid reason. Over-medicating patients simply to keep them quiet, or withholding medical care are also forms of physical abuse.

And sadly, sexual abuse also occurs in nursing homes. Again, both staff and other residents can be guilty of this type of abuse. According to a 1996 Medicaid Fraud Report, 10% of all physical abuse cases in nursing homes are of a sexual nature. Sexual elder abuse is defined as non-consensual sexual contact of any kind with a nursing home resident. Sexual contact with any person incapable of giving consent is also considered sexual elder abuse.

Often, nursing home sexual abuse goes undetected. Sadly, the physical and cognitive impairments common among nursing home patients make it impossible for them to fight off sexual assailants or report sexual abuse. Some physical signs of nursing home sexual abuse bruising around breasts, upper abdomen, or inner thigh; is often evidence of inappropriate touching or worse. Signs that a nursing home resident has been the victim of a sexual assault include bleeding from the vagina or anus; the presence of a sexually transmitted disease; troubles walking or discomfort when sitting; and irritation or itching in genitals.

Continue reading "Ninety Percent of All Nursing Homes Have Been Cited For Violating Federal Health and Safety Standards" »

Physical abuse:

* Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body
* Broken bones, sprains, or dislocations
* Report of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
* Broken eyeglasses or frames
* Signs of being restrained, such as rope marks on wrists
* Caregiver's refusal to allow you to see the elder alone

Emotional abuse:

In addition to the general signs above, indications of emotional elder abuse include

* Threatening, belittling, or controlling caregiver behavior that you witness
* Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to oneself

Sexual abuse:

* Bruises around breasts or genitals
* Unexplained venereal disease or genital infections
* Unexplained vaginal or anal bleeding
* Torn, stained, or bloody underclothing

Neglect by caregivers or self-neglect:

* Unusual weight loss, malnutrition, dehydration
* Untreated physical problems, such as bed sores
* Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
* Being left dirty or unbathed
* Unsuitable clothing or covering for the weather
* Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
* Desertion of the elder at a public place

Financial exploitation:

* Significant withdrawals from the elder's accounts
* Sudden changes in the elder's financial condition
* Items or cash missing from the senior's household
* Suspicious changes in wills, power of attorney, titles, and policies
* Addition of names to the senior's signature card
* Unpaid bills or lack of medical care, although the elder has enough money to pay for them
* Financial activity the senior couldn't have done, such as an ATM withdrawal when the account holder is bedridden
* Unnecessary services, goods, or subscriptions

Health care fraud and abuse:

* Duplicate billings for the same medical service or device
* Evidence of overmedication or undermedication
* Evidence of inadequate care when bills are paid in full
* Problems with the care facility:
- Poorly trained, poorly paid, or insufficient staff
- Crowding
- Inadequate responses to questions about care

Continue reading "What Are The Specific Types of Elder Abuse and Neglect?" »

There are different types of abuse one may be subject to endure while living in an ethically questionable nursing home. The first, and perhaps most common type of abuse evident in these types of environments, is neglect. Neglect is an indirect form of abuse in that a resident of a nursing home is perhaps being ignored or not receiving the care he or she wants and needs to be happy and comfortable. Neglect can cause both physical and emotional problems. There have been cases in which residents of nursing homes have been denied any reasonable amount of human contact for days and even weeks on end. Other forms of neglect could include not cleaning a resident properly, failure to follow a physician's orders, failure to provide medical care, etc. says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Direct abuse is also evident in nursing homes. Many nursing home employees have been convicted of hitting, kicking, punching, and attacking the residents for which they are hired to care and protect. Many residents are physically unable to inform their loved ones of this abuse. Others are threatened by the abusive staff, will result in more injuries, abuse and more pain. If you suspect at all that your loved one is the victim of nursing home abuse, do not hesitate to contact The Peck Law Group toll free at 1.866.999.9085 to talk to a personal injury lawyer right away.

Financial compensation is often necessary to cover medical fees incurred while the victim remained alive or the costly funeral arrangements to lay your loved one to rest. In order to receive financial compensation to help cover these costs and others, The Peck Law Group personal injury lawyers will help you with the process.

Continue reading "Neglect Is A Form of Elder Abuse When The Elder Is Ignored and Not Receiving Care" »

A colostomy is a major surgical procedure that involves cutting the colon into a shorter piece and bringing it through the wall of the abdomen. A colostomy bag is attached to the end of the colon exiting the abdomen where fecal material is collected. The end of the colon that leads to the rectum is closed off and becomes dormant. Many colostomy procedures can be reversed, if and when they are no longer needed.

While the thought of a colostomy may be disheartening, for many people suffering from severe bed sores it is likely an essential part of the overall healing process. Without a colostomy, many bed sore patients will continually suffer from recurring hygiene problems, infections and even sepsis which could manifest into septic shock causing wrongful death.

Continue reading "For Elders With Bed Sores, Pressure Sores and Decubitus Ulcers A Colostomy May Be Essential To Halt Septic Infection" »

Many of our nursing home negligence and medical malpractice cases involve patients who may have developed a pressure sore only to be confronted with another medical problem- sepsis. Sepsis is a severe infection that effects the complete body. Due to the open wounds that accompany advanced pressure sores (also called bed sores, decubitus ulcers or pressure ulcers), provide the perfect entry way for infection to enter the body.

Sepsis is a deadly, yet surprisingly common medical condition. According to a recent sampling of hospital patients:

* Sepsis is the 10th leading cause of death in the U.S.
* 33% of people who contract sepsis will die from the disease
* Medical expenses to treat sepsis cost approximately $17 billion per year

A Long Term Facility in California recognized the substantial problems associated with sepsis and has begun to implement a prevention and treatment program. Believed to be the first of its kind, this California hospital used a scientific formula to detect warning signs that indicate a patient is at risk for contracting sepsis. The diagnostic program evaluates:

* changes in body temperature
* increases in heart rate
* changes in respiratory rate
* decreases in white blood cell count

After the early symptoms of sepsis are identified, the hospital is able to rapidly administer medical treatment and greatly improve the patients survival rate. In the first two months of its use, the hospital credits the new program with the early detection of sepsis in 60 patients and likely a substantial number of lives as well.

Hopefully this sepsis detection tool can be applied to patients in a nursing home setting as well. Too often the implementation of medical treatment for nursing home patients is delayed due to inadequate training of staff and insufficient medical equipment.

Continue reading "Open Bed Sores, Pressure Sores and Decubitus Ulcers Provide the Perfect Way for Septic Infections" »

Watching for signs of illness in a loved one can be challenging. Some illnesses show up quite clearly, while others have a more subtle effect on daily living. Dehydration, depending on the severity, sometimes creates only small telltale signs while having a big effect on the body, especially in the elderly.

Dehydration occurs when a person loses more water than they take in. It takes an adequate amount of fluid for the body to function properly; for example, to regulate body temperature through sweating, maintain blood pressure, and eliminate bodily waste. If severe enough, dehydration can lead to confusion, weakness, urinary tract infections, pneumonia, bedsores in bed-ridden patients, or even death. In general, a human can survive for only about four days without any fluids.

Elderly dehydration is especially common for a number of reasons: some medications, such as for high blood pressure or anti-depressants, are diuretic; some medications may cause patients to sweat more; a person's sense of thirst becomes less acute as they age; frail seniors have a harder time getting up to get a drink when they're thirsty, or they rely on caregivers who can't sense that they need fluids; and as we age our bodies lose kidney function and are less able to conserve fluid (this is progressive from around the age of 50, but becomes more acute and noticeable over the age of 70). Illness, especially one that causes vomiting and/or diarrhea, also can cause elderly dehydration.

"Everybody has a normal state of body water that relates to their weight. Anything below that (normal state) is dehydration; everything above it is hyperhydration," Peck Law Group Nursing Home Abuse and Neglect Attorney Steven C. Peck, explains.

That normal level of hydration varies widely from person to person. Contrary to the mantra that everyone should drink eight glasses of water every day, Peck says there is nothing scientific to back that up. "People misinterpreted that to be, it had to be liquid and it had to be water,"

A person's diet can greatly affect hydration levels: fruits (especially watermelon), vegetables, and soups are mostly water-based. "Day in, day out, a lot of people get their water from foods, as well as behavioral attitudes towards food," California Elder Abuse Attorney Steven C. Peck explains. "For instance, when we walk by a water fountain, we tend to take a drink, and we tend to drink when we eat."

In general, larger people need to drink more water, as do athletes and those who perspire heavily, but that may mean more or less than eight glasses a day. "

Monitoring body weight to keep track of hydration levels is very very important. To monitor body weight, one should be weighed every morning. If they've lost two pounds or more from the day before, and especially if they feel thirsty or have a headache, they're probably dehydrated.

Mild dehydration is defined as losing 2 percent of your body weight. Severe dehydration occurs with 4 percent or greater body weight loss. Even mild dehydration can affect a person's health, especially if he already has cardiac or renal problems. "We have measured in the lab cognitive impairment," he says. "With severe dehydration, it puts a greater strain on the heart. Think of a pump trying to pump with less fluid. That would be one of the primary problems."

Peck says an active 65-year-old who exercises probably doesn't need to weigh herself every day, but a 75-year-old in a nursing home who has had issues with dehydration in the past or has had cardiac issues, should be weighed every day.

Complicating matters is that signs of dehydration in younger people don't always show up in the elderly. For example, if a young person was extremely dehydrated, his skin may be wrinkled or sagging. But, that certainly wouldn't be noticed in most cases of elderly dehydration.

Perhaps because of that delay in diagnosis, elderly dehydration is a frequent cause of hospitalization (one of the ten most frequent admitting diagnoses for Medicare hospitalizations, according to the Health Care Financing Administration), and it can be life-threatening if severe enough.

Other signs of dehydration to look for: confusion, problems with walking or falling, dizziness or headaches, dry or sticky mouth and tongue, sunken eyes, inability to sweat or produce tears, rapid heart rate, low blood pressure or blood pressure drops when changing from lying to standing, and constipation or decrease in urine output. Also check for a decrease in skin turgor--pull up the skin on the back of the hand for a few seconds; if it does not return to normal within a few seconds, the person is dehydrated.

To help make sure your loved one doesn't suffer from elderly dehydration, make sure he or she consumes an adequate amount of fluids during the day; eats healthy, water-content foods such as fruit, vegetables and soups; checks that urine color is light and output adequate (dark urine or infrequency of urination is a classic sign of dehydration).

Seniors also need to be educated to drink even when they're not thirsty. Keeping a water bottle next to the bed or their favorite chair could help, especially if they have mobility issues.

If your loved one is in a nursing home or other care facility, make sure that the staff has a hydration program in place, including assisting residents with drinking, offering a variety of beverages (remember, taste buds change with age, so a beverage they used to enjoy may no longer taste right), and providing drinks not only at mealtimes but in between meals. Also make sure that they monitor residents' weight and assess them if their physical condition or mental state changes. If dehydration is an issue and your loved one takes laxatives or diuretics, speak to his or her doctor about changing medication.

As with most illnesses, prevention is the key. Making sure your loved one stays hydrated now is much easier than treating him or her for dehydration later.

Continue reading "Elderly Dehydration Is Especially Common and May Be Deadly" »

Dehydration is a major cause for hospitalization among the elderly. Elderly citizens are more susceptible to dehydration due to less fluid content in the body; about 10 percent less than an adult body. It is also the physiological changes associated with aging like reduced sense of thirst and loss of appetite that triggers dehydration among senior citizens says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Dehydration in the elderly can be caused due to side effects of medications (e.g. diuretics and laxatives) and other medical problems like high blood sugar (hyperglycemia), diarrhea, vomiting, heat exhaustion (increased core body temperature), heat stroke, infections, and at times exercise. Very often, the signs of dehydration are mild and vague. They are more or less similar to dementia and Alzheimer's symptoms. Following are some of the signs of dehydration in the elderly.

* Confusion
* Muscle weakness
* Constipation
* Sunken eyes
* Dizziness
* Irritability
* Fever
* Pneumonia
* Disorientation
* Urinary tract infections
* Tachycardia
* Weight loss
* Dry and poor elasticity skin
* Less urine output
* Increased heart rate
* Low blood pressure (hypotension)
* Increased infections

If any of these symptoms is observed in an elderly person, it is advisable to consult and seek advice from a qualified physician. The best way to check dehydration among the elderly is monitoring body weight everyday. Dehydration is mild, if body weight loss is 2 percent; whereas, it is severe in case of 5 percent (or more) loss of body weight.

Proper diagnosis and treatment of dehydration is recommended to avoid certain medical consequences. You can discuss with the concerned physician about the side effects of the current medications that the patient is continuing. Treatment of dehydration among the elderly is necessary, especially if it is caused due to an underlying disease.

Some of the complications of dehydration are kidney failure, coma, shock, electrolyte abnormalities and other heat related diseases. The best way to prevent dehydration in the elderly is drinking lots of water, and other healthy drinks. Foods and drinks containing sodium and potassium should also be consumed to restore the electrolyte level in the body. It is also advisable to monitor the fluid intake and output, and check the body weight regularly.

Continue reading "What Are The Signs of Dehydration In the Elderly?" »

Bed sores are caused by unrelieved pressure on a particular area of the body, usually on lower backs, hipbones, and heels, can create a sore. Elderly nursing home residents who lack mobility must be turned or repositioned regularly to prevent the development of bedsores. Many nursing homes lack adequate numbers of nursing staff. As a result patient care suffers and the frequency of bedsores increases.

WHAT YOU CAN DO

1.Visit often. Residents who have frequent visitors are less likely to be ignored by staff.
2.Ask your loved one how they are.
3.When you visit check for signs of injury.
4.Don't be afraid to look under the sheets for the presence of bedsores. Bedsores usually develop on the lower back or buttocks and are not usually visible without exposing the patient.

If you find any signs of bedsores, dehydration, injury or abuse, immediately bring it to the attention of the facility. Speak to the nurses, ask them what they know. Remember to document everything.

Continue reading "What Are the Causes of Bed Sores, Pressure Sores and Decubitus Ulcers?" »

Bedsores are very serious conditions that in almost all cases are caused by neglect. The incidence of serious bedsores in a nursing home's population is one factor that should be used in choosing a facility.

WHAT ARE BEDSORES:

The definitions of the four pressure ulcer stages are revised periodically by the National Pressure Ulcer Advisory Panel (NPUAP) in the United States. Briefly, however, they are as follows:

* Stage I is the most superficial, indicated by redness that does not subside after pressure is relieved. This stage is visually similar to reactive hyperemia (a technical term for excessive redness) seen in skin after prolonged application of pressure. Stage I pressure ulcers can be distinguished from reactive hyperemia in two ways: a) reactive hyperemia resolves itself within 3/4 of the time pressure was applied, and b) reactive hyperemia blanches when pressure is applied, whereas a Stage I pressure ulcer does not. The skin may be hotter or cooler than normal, have an odd texture, or perhaps be painful to the patient. Although easy to identify on a light-skinned patient, ulcers on darker-skinned individuals may show up as shades of purple or blue in comparison to lighter skin tones.

* Stage II is damage to the epidermis extending into, but no deeper than, the dermis. In this stage, the ulcer may be referred to as a blister or abrasion.

* Stage III involves the full thickness of the skin, extending into, but not through, the subcutaneous tissue layer. This layer has a relatively poor blood supply and can be difficult to heal. At this stage, there may be undermining damage that makes the wound much larger than it may seem on the surface.

* Stage IV is the deepest, extending into the muscle, tendon or even bone.

* Unstageable pressure ulcers are covered with dead cells, or eschar and wound exudate, so the depth cannot be determined.

There are several factors that have been acknowledged as things that put a person more at risk of developing pressure sores.

As soon as a person is spotted as a high-risk individual, certain measures have to be taken to reduce or eliminate the risk of him or her developing bedsores.

It is imperative that the care provider, whether it is a nurse or a family member, is knowledgeable about these risk factors in order to be able to prevent the unnecessary and painful development of pressure sores.

The risk factors will vary according to the patient's specific circumstances; nevertheless, this is a list of the 5 most common risk factors:

1. Being confined to a bed, chair, or wheelchair
Individuals who are confined to a bed, a chair, or a wheelchair, and who are not able to move by themselves, are at high risk of developing pressure sores extremely fast; in as little as a couple of hours, if the pressure is not relieved regularly.

2. Being unable to change positions without assistance
Persons who are in a coma, who are paralyzed, and who are recovering from a hip fracture or other injury that limits mobility, are extremely prone to bed sores.

These patients must be moved consistently at regular intervals, and this is very difficult on caregivers, reason why it is imperative to get a pressure mattress to help both the patient and the caretaker.

3. Losing bowel or bladder control
People who have to remain in bed for long periods of time or permanently and lose the capacity to control their bladder or bowels are in danger of getting bedsores because the continuous moisture on the skin due to urine, stool, or perspiration can irritate and weaken it.

4. Eating bad, having an imbalanced diet and/or dehydration
Pressure sores develop more easily when the body and skin of people who have lost most of their mobility are not adequately nurtured.

5. Losing mental awareness
A person who is losing mental awareness may not have enough sensory perception or capacity to take action to prevent the development of pressure sores.

Continue reading "What Are the 5 Most Common Risks For Bed Sores, Pressure Sores and Decubitus Ulcer Development?" »

Common Names for Bed Sores:

"Bed sores" owe their name to the observation that patients who were bedridden and not properly repositioned, would often develop ulcerations or sores on their skin, typically over bony prominences. These bed sores, which result from prolonged pressure, are also called "decubitus ulcers", "pressure sores," and "pressure ulcers ."

How do Bed Sores, Pressure Sores aka Decubitus Ulcers Develop:

Bed sores, pressure sores aka Decubitus Ulcers are a localized area of tissue injury that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time. The external surface may be a mattress, a chair or wheelchair, or even other parts of the body. The soft tissues of the body, such as skin and muscle, depend upon blood vessels to carry nutrients to the tissues, and to remove waste products. Bed sores result when prolonged pressure prevents sufficient blood flow to supply the tissues with nutrients. The resulting bed sore represents the death of the involved soft tissues.

Bed sores, pressure sores aka Decubitus Ulcers can result from one period of sustained pressure; however, most bed sores, pressure sores and decubitus ulcers probably occur as a result of repeated incidents of blood flow interruption without adequate time for recovery. In fact, low pressure endured for long periods of time is believed to be more significant in producing pressure ulcers than higher pressure for shorter durations.
Most Common Areas

It is important to note that bed sores, pressure sores and decubitus ulcers do not always result from being in bed as the name would imply. Some of the most severe bed sores, pressure sores and decubitus ulcers can also result from sitting for a prolonged period of time. Thus, the location of the bed sores can depend upon the position of the patient. For individuals who are bed-bound, the sores are most likely to form on or around the heels, the hip-bone, and the lower back or tailbone. Pressure ulcers may also develop in a variety of other areas, including the spine, ankles, knees shoulders, and head, depending upon the position of the patient.
Risk Factors

Pressure sores are more likely to develop persons who are at higher risk due to one or more risk factors. A number of risk factors have been identified which put individuals at higher risk. Once a person is identified as being at increased risk for pressure sores, measures should be undertaken to reduce or eliminate those risks. Thus, healthcare providers must be aware of these risk factors when caring for patients in order to prevent the unnecessary development of pressure sores. While risk factors may vary depending upon the particular circumstances, the following represents a list of the most common:

1. Confinement to bed, chair, or wheelchair. Persons confined to beds, chairs, or wheelchairs who are unable to move themselves, can develop pressure-induced injuries in as little as 1-2 hours if the pressure is not relieved;

2. Inability to change positions without help. (Eg., an individual in a coma, who is paralyzed, or recovering from a hip fracture or other mobility limitation.)

3. Loss of bowel or bladder control. Sources of moisture on the skin from urine, stool, or perspiration can irritate the skin.

4. Poor nutrition and/or dehydration. Bed sores are more likely to form when the skin is not properly nourished.

5. Decreased mental awareness. An individual with decreased mental awareness may not have the level of sensory perception or ability to act to prevent the development of pressure-induced injury. The lack of mental awareness may arise from medications.
Bed Sores and Neglect

Most pressure sores can be prevented, and those which have formed need not necessarily get worse. Each patient's individual circumstances must be taken into consideration by the caregiver in order to develop a plan of care which will best assure the patient will not unnecessarily suffer from a pressure sore. The following generally represent some of the precautions which health care providers should, but too often fail to undertake:

1. An appropriate and thorough and systematic assessment must be made of the patient's risk for developing a pressure sore;

2. Appropriate periodic reassessment should be made of the patient's risk;

3. The patient should be bathed appropriately;

4. The patient's incontinence should be assessed and treated to assure that moisture on the skin does not contribute to the development of a pressure sore;

5. Appropriate nutrition and hydration must be maintained;

6. Repositioning of the patient should occur with a frequency to assure that the pressure is adequately relieved;

7. Use of appropriate support devices should be maintained to relieve pressure from troublesome areas;

8. Postural alignment, distribution of weight, balance and stability, and pressure relief should be considered when positioning persons in chairs or wheelchairs;

9. Appropriate lifting devices and techniques should be used to assure that shear and friction related injuries are avoided;

10. Education should be given to the patient, family, and caregivers on measures to be taken to avoid pressure sores, and appropriate documentation of such measures.

It is essential to remember that every individual is different, and has different risk factors, thus requiring a customized plan of care and diligence in carrying out the plan of care.

Continue reading "What Are Bed Sores, Pressure Sores and Decubitus Ulcers?" »

Contrary to popular belief, it is not MS, but immobility, that creates an increased risk for pressure sores. Pressure sores (also commonly known as "bedsores," "pressure ulcers," "dermal ulcers" and "decubitus ulcers") are the result of breakdown of the skin due to the effects of friction.

Think of a blister that develops on your foot when wearing a new pair of shoes for the whole day. The blister is caused by the constant rubbing of the skin against the inner surface of the shoe. In fact, that blister is characterized as a stage II pressure sore. (I will explain staging a little later.) But pressure sores also develop on different areas of the body and usually occur when mobility is impaired.

Where Do Pressure Sores Develop?

Pressure sores are usually seen over bony prominences, including the coccyx (tailbone), buttocks, heels, elbows, and other areas. In such areas, the skin is pressed and rubbed between the bone underneath and the clothes or bedsheets above. The clothes and sheets act like sandpaper, rubbing away the layers of the skin. If this goes undetected, which may happen in an area of numbness, the skin can erode all the way down to the muscle, or even the bone. The exposed tissues may become infected and begin to decay from lack of blood circulation. In some cases, this can be life-threatening. Fortunately, pressure sores are preventable.

What Causes Pressure Sores?

While immobility is a primary cause, other factors also increase the risk of pressure sores. These include paralysis or spasticity, which can decrease mobility; numbness and loss of sensation, which can result in the inability to feel the friction or irritation; advanced age, which is often accompanied by decreased mobility; poor nutrition, which hinders healing of the skin; and incontinence, because moist, wet or soiled skin can exacerbate the irritation. To avoid developing pressure sores and lower your overall risk, practice the simple strategies that follow on a regular basis. If you have an aide or care-partner, be sure to share these strategies with them.

Strategies To Avoid Pressure Sores

To avoid pressure sores, the first strategy is vigilance. If you are a wheelchair user, check your skin for changes in color every day, particularly over the pressure points. While pressure sores can be painful, some people with MS may lack intact pain sensation and therefore be unaware of the sore. This is where visual inspection comes in. If you are doing a self-inspection, use a mirror for hard-to-see areas. If mobility or vision is impaired, have someone else help with the visual inspection. Whatever your situation - you can fight back. Vigilance is the first line of defense.

If a red or dark spot appears in a vulnerable area, it's time to take the pressure off. Don't lie on the side of the sore. Use foam pads and pillows to shift the weight away from the red or dark area. Try to have your weight resting on the fleshy part of your rear, rather then on a bony prominence. Change position every two hours. Frequent turning, or sitting upright if possible, is essential to alleviate pressure and promote healing.

If you are unable to move yourself easily in your wheelchair, it may be worthwhile to have a physical therapist evaluate you and your wheelchair. Simply tilting the back or adding a new cushion may provide significant benefit. Special gel cushions and other modifying devices are available to help keep the pressure off vulnerable areas. These devices can be used in bed, in a wheelchair, or other seating arrangement. Ensure that your wheelchair is comfortable and avoid chafing. If you use a brace, make sure that you aren't exposing any areas of your body to chafing. Check all strapped areas, as well as your ankles and feet.

Regular skin care is critical in preventing pressure sores. Keep your skin clean and dry, as free as possible from urine, stool, drainage, or perspiration. Use a mild soap with moisturizer and wash with warm - not hot - water. Use a hypoallergenic moisturizer sparingly to prevent dry skin. Avoid talcum powder, which tends to accumulate in skin folds. Use mild, non-irritating, unscented soap and detergent.

Watch for fluid accumulation in areas such as the feet, ankles, shins, and lower back. Fluid accumulation in these areas is called "edema." If persistent swelling occurs, be sure to tell your doctor. Over the long term, diabetes and smoking can decrease circulation to the limbs, which may impair healing and also increase your risk of developing pressure sores.

Nutritional Healing

If a pressure sore has developed, proper nutrition is necessary for your body to heal. If you don't get enough calories, protein and other nutrients, your body won't be able to heal, no matter how well you care for the pressure sore. Both protein deficiency and dehydration are linked to skin breakdown, impaired integrity of the skin, and delayed healing. On the other hand, proper nutrition and adequate hydration can help prevent pressure sores altogether. If you need help to modify or assess your diet, talk to your doctor, nurse or dietitian. Always inform your doctor if you experience unintentional weight loss.

In the earliest stage of a pressure sore, relieving pressure from the affected area may suffice. However, once the skin integrity has been breached, professional help is needed. Special dressing may be required and self-treating is not advised. Infected sores may need antibiotic therapy. Sometimes, the sores need to be cleaned of all dead tissue, a process called debridement. Serious pressure sores may require skin grafting or surgery.

It is important to realize that a pressure sore can quickly escalate from what appears to be a Stage I to what appears to be a Stage III or IV, although the stages may not be readily observed. Pressure sores do have the potential to worsen rapidly, so seek medical care promptly.

Prevention is always the best treatment and can help you avoid long-term and costly medical treatment. Remember, the skin is our primary barrier of protection from a world full of harmful bacteria. So, take care of it!

Pressure sores, as well as burns and other types of wounds, are categorized according to the degree of tissue damage:

Stage I: This stage is characterized by a dark area or a reddening of the skin that does not blanch on contact, which means that when lightly pressed with a finger, the skin does not turn white. This is the beginning of a pressure sore, an indication of a problem. Preventive action is needed.

Stage II: The skin develops a blister, which may be broken or unbroken. The deeper layer of the skin is still intact. With immediate attention, a stage II wound can heal rapidly. The area must be covered, protected and kept clean and dry.

Stage III: The wound looks like a crater that has eroded through all layers of the skin, down to the underlying tissues. Serious infection can occur and medical care is needed. Adequate nutrition and hydration are vital.

Stage IV: The wound has penetrated down to muscle, bone, or tendons and may also have injured these tissues. The depth of the wound is generally more significant than the diameter. This is very serious and can produce a life-threatening infection. Medical care by a wound care specialist is required.

Continue reading "Immobility Not Multiple Sclerosis Creates The Increased Risk for Bed Sores, Pressure Sores and Decubitus Ulcers" »