California Elder Law Attorney Blog

The golden years for many seniors slip away under a dark shadow of financial and physical abuse, most often caused by the hands they trust most to care for them.

It usually happens behind closed doors. It usually goes unreported.

Law enforcement and elder advocates said the rate of elder abuse is growing at an alarming speed as people live longer, baby boomers reach retirement age and the economy remains shaky.

Recently, near El Cajon, sheriff's deputies discovered 93-year-old Pearl Harbor survivor Arnold V. "Max" Bauer in his squalid house clutching a photo of his war-era ship. They saw rat feces, rotting food, a sink filled with unwashed dishes and trash strewed about. Bauer's live-in caretaker, who is now in custody, allegedly bilked him for thousands of dollars.

Bauer would hardly be a rare victim.

Experts estimate that only one in 13 elder-abuse cases are reported nationwide, based on various surveys and studies.

"We are only getting the tip of the iceberg," said San Diego County Sheriff's Sgt. Mark Varnau, who oversees financial- and elder-abuse crime units for his agency. "It's a dirty little secret and Mr. Bauer's case is a very clear example of how someone is isolated and forgotten about."

In San Diego County, the District Attorney's Office has seen the number of elder-abuse prosecutions rise in the past five years -- from 183 cases in 2006 to 238 last year. The county's elder-abuse hotline receives nearly 10,000 calls a year; about 40 percent of them directly involve financial abuse.

Many cases have both financial and physical abuse, said Paul Greenwood, deputy district attorney and head of the office's Elder Abuse Prosecution Unit.

"People are getting more desperate," he said. "They look around and they see who has the money and they target them."

While some agencies have worked to educate the public, cooperate with mandatory reporters such as banks and set up hot lines and other reporting systems, elder-abuse experts and law-enforcement officials remain concerned about a lack of resources.

"We are not able to provide the infrastructure to deal with the avalanche of referrals that are going to be coming in the next five years," Greenwood said.

An addendum to the national Healthcare Reform Act, which Congress approved last year, would provide money for combating elder abuse. But there has been no funding allocation so far.

Nearly 95 percent of seniors live at home and almost all elder abuse occurs there, the majority perpetrated by family members, said Kathleen Quinn, executive director of the Illinois-based National Adult Protective Services Association. "Trusted others" -- such as home health-care workers, neighbors and friends -- make up the next largest group of abusers.

"It's absolutely an enormous problem," Quinn said.

Other cases include abuse in nursing homes, home-improvement scammers preying on seniors, financial planners who fleece older clients, and home-care workers who get paid but do nothing and even steal from their clients says Los Angeles Nursing Home Abuse and neglect Attorney Steven C. Peck.

Seniors may be well enough to hire a home health worker or share their financial records with an adult child or a new friend, but there is no system for ensuring they are safe as they become vulnerable due to frailty or illness, said Greenwood and Varnau.

Amy Waszak sees these situations every day in her job. She is one of 43 investigators for the San Diego County Office of Aging & Independence Services.

Each month, she looks into about 20 reports of possible abuse within her assigned area of Oceanside, including allegations of financial, emotional and sexual abuse, along with incidents of self-neglect.

"Sometimes we walk into some awful situations," Waszak said. "We've been to hoarders' homes. We've been to rodent-infested homes. ... We've been to homes where there is human waste, like urine soaked into the carpet."

She makes unannounced visits and if it appears there's a serious problem, she often refers the matter to law enforcement officials. Waszak's agency helps victims obtain restraining orders against their abusers and will assist them in tapping into a range of services, including medical care and programs like Meals on Wheels.

"These crimes occur because families are separated by distance and a new "friend" comes into the lives of these elders," Greenwood said. "They don't rob elders with guns and knives, they extract the assets through charm and flowers and boxes of chocolates."

Reporting senior abuse can be difficult for those who may notice something is off: a garden that's usually lovingly tended becomes overgrown, a once-tidy house falls into disarray, a sociable senior no longer answers the phone or chats over a fence line, an elderly person is confused about the household finances, a caretaker sounds overly defensive.

It is a complex line for neighbors and friends to tread between individual freedoms and pushing for answers about a senior's treatment. Seniors themselves often don't speak out because they're embarrassed by their failings, Varnau said.

The sheriff's department processes 70 to 150 cases of elder abuse a year. Many of those cases involve home health workers, who are hired by the individual with private or county funds.

Home-care workers, who provide nonmedical assistance such as cleaning, bathing and feeding, aren't required to undergo a background check unless they are paid through a government program. Health care companies and agencies, which provide nurses or other licensed personnel, operate under different regulations.

Elder-care advocates and law enforcement authorities said the home-care-worker system needs more oversight.

Home-care workers who are paid through San Diego County's In-Home Supportive Services program do undergo a background check that looks for evidence of child abuse, elder abuse and fraud against a government agency, said Ellen Schmeding, assistant deputy director for the county's office of Aging & Independence Services.

Starting Feb. 1, the check also will encompass felony and violent convictions. But seniors can still choose to hire individuals with a criminal past, because the law recognizes them as the final employer.

This worries law enforcement officials, who want more safeguards in place to monitor seniors as they age.

"It's not a question of if they are going to fail," Varnau said. "It's a matter of when. People slip away and become completely vulnerable to being victimized."

Decubitus ulcers, often called "bed sores" or "pressure sores," are a common ailment among individuals who are wheelchairs, nursing homes, or have extended bed rest for any reason. These sores are caused by prolonged pressure and friction in certain areas, which break down the skin and prevent healthy blood and oxygen circulation to that area. says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Hospitals and care facilities are liable for decubitus ulcer prevention and must pay for any treatment that has to be undergone as a result of any lack of care on their part, but sedentary individuals outside of care facilities must know how to prevent decubitus ulcers on their own. These often include people in wheelchairs, women who are on bed rest with high-risk pregnancies, and those who are immobile and have in-home care.
Change Position

In inpatient or long-term care, the standard of decubitus ulcer prevention is to change the patient's position every two hours. According to Expert Law's malpractice information, this is the maximum amount of time that skin can undergo constant pressure before it starts breaking down, so if you're able to change position yourself -- or have a dedicated caretaker - then more often is recommended.
Relieve Pressure

Using beds, pillows, and pads that fit the contour of your body and relieve pressure points can all help prevent decubitus ulcers. Even a fleece pad on a wheelchair can help prevent pressure points when you're seated for long hours. There are also specially-made seat pads that allow for a more ergonomic fit and are very effective in preventing decubitus ulcers.

Continue reading "Decubitus Ulcers, often called "Bed Sores" or "Pressure Sores," are a common ailment among individuals who are in wheelchairs and nursing homes," »

Pressure ulcers, also known as decubitus ulcers or bedsores, are skin ulcers that develop on areas of the body where the blood supply has been reduced because of prolonged pressure; these may occur in people confined to bed or a chair, or in those who must wear a hard brace or plaster cast. Skin ulcers may become infected, with serious health consequences says California Elder Abuse Attorney Steven C. Peck.

Continue reading "Bed Sores, Decubitus Ulcers, and Pressure Sores Develop Where Body Blood Supply Has Been Reduced" »

Shortly after his grandmother moved into a residential care home in Fair Oaks, Sean Suh installed a small camera beside her bed to make sure the staff knew someone was watching.

But often when he visited, he said, he would find the "Grannycam" unplugged.

Suh decided to find a new place for Kyong Hui Duncan, a Korean immigrant and beloved matriarch who had become too frail to live on her own. But by the time he found one, Duncan, 73, was dead from a constellation of problems that her grandson said were inflicted upon her at Fair Oaks Residential Elderly Care.

A short video clip captured by Suh's "Grannycam" that shows a staffer violently shaking Duncan in her wheelchair now plays a key role in the state's decision to shut down the care home. The clip, which Suh discovered only after Duncan's death, is also at the center of a civil lawsuit the family filed Thursday that charges abuse, neglect and wrongful death.

Following an investigation spurred by Suh's complaint, the California Department of Social Services on January 13, 2011 ordered the care home's operators, Myung S. Kim and Jay J. Kim, to cease operations by the end of the business day. The state is moving to permanently revoke the home's license.

The state's suspension order accuses the home of violating the personal rights of residents. One of the concerns the state cites stems from the "Grannycam" clip, which shows staff members moving Duncan from the floor to her wheelchair, then dumping the chair backward with Duncan in it and shaking it. Among other allegations: that staff members improperly restrained Duncan and failed to quickly attend to her after she had fallen.

Once, the state alleges, family members arrived to find Duncan, crying and unattended, positioned upside down in her wheelchair. The order also cites instances in which Duncan suffered mysterious bruises and infections that went untreated.

Duncan's autopsy report showed potentially toxic levels of narcotics in her system, at least one of which her doctor had never prescribed, according to the document. The lawsuit charges that she suffered injuries, infection and "lethal doses of drugs," all of which contributed to her death.

The state also accuses the home of fire code violations, failing to dispose of contaminated needles, using prescription medicines that had expired and forging prescriptions.

Continue reading "Fairs Oaks, California RCFE Closed Over Alleged Elder Abuse and Wrongful Death" »

Despite greater awareness, nursing home abuse is still running rampant in the United States. Our elderly family, friends, and neighbors are still being abused neglected to the point where serious harm can come to them. And many of them are being forced to try to survive in absolutely terrible living conditions says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Neglect or physical abuse is any failure or any action that can cause unreasonable misery, suffering, harm, or injury to the resident of a nursing home that is caused by a care custodian and / or healthcare provider.

Financial abuse includes misusing the resident's funds to pay for services that have already been paid by a federal or state program. It could also be the misuse of nursing home resident's funds that weren't authorized by the resident, the trustee, the guardian, or the administrator of the resident.

Physical abuse includes sexually assaulting the resident, striking the resident, and/or withholding adequate or necessary physical care, food, or medical attention.

Reports signify that there was nursing home abuse in over 10,000 residences that are responsible for the well being of some of our elderly population.

The abuses that were reported include bed sores, dehydration, malnutrition, sexual abuse, physical abuse, verbal abuse, and more.

Continue reading "Nursing Home Abuse and Neglect Is Still Rampant In The United States" »

Federal and state nursing home laws require that elder care facilities provide high quality and individualized care to each nursing home resident. Furthermore, these regulations protect nursing home residents who complain about substandard care from retaliation. When a nursing facility or employee violates the rights of a nursing home resident, they have the option of filing a complaint against the nursing home and/or taking legal action in cases of serious elder abuse. If you have made the difficult decision of placing a loved one in a nursing home facility, it's important that you learn the rights provided to nursing home residents.

Federal law provides nursing home residents with a set of rights, known collectively as the resident's bill of rights. Examples of nursing home resident rights include the following: the right to access medical records; the right to refuse treatment; the right to complain without retaliation; the right to be free from unnecessary physical or chemical restraints; the right to privacy; and the right to be free from nursing home abuse or neglect. In addition, because many cases of nursing home abuse and neglect result from staffing shortages, nursing home facilities are also required by law to uphold certain staffing standards to ensure the highest levels of well-being for their residents.

Although elderly residents are awarded certain nursing home rights, some facilities, either unknowingly or intentionally, may violate these basic rights. If you suspect your loved one is being abused in a nursing home or otherwise deprived of their nursing home resident rights, such as bed sores, dehydration, malnutrition, under staffing, physical abuse, you should immediately contact us toll free at 1.866.999.9085 or on-line at www.thepecklawgroup.com for a free thorough case review and evaluation. This case review is being offered at no cost and shall help determine whether you should take legal action on behalf of your elder / dependent adult loved one. We Will Help You!!!

Sepsis describes a bacterial infection of the blood which can become fatal without treatment. The elderly often present a high risk for developing sepsis due to having weak immune systems especially if they have also pre-existing medical conditions. Improper or neglectful nursing home care of residents with bed sores, surgical or slow healing wounds, or using intravenous lines or catheters can result in a septic infection.

Cause of Sepsis
1. Sepsis is caused by bacterial infection which spreads from any vulnerable point of the body into the bloodstream. Some symptoms of sepsis include irregular body temperature, and respiration, nausea, vomiting, seizures and body pains. M
Bed Sores and Skin Ulcers
2. Bed ridden or incapacitated residents are vulnerable to skin ulcers or bed sores. Some treatments include relieving pressure in affect areas, antibiotics, and cleaning and covering of wounds. Without treatment these wounds can blister, break open, and become infected. The infection can eventually develop into sepsis.

Continue reading "Nursing Home Abuse and Neglect From Infected Bed Sores Will Cause Sepsis" »

A sepsis infection is a serious condition. When a sepsis infection has occurred it is because an individual's body has experienced another infection leading up to the sepsis infection. The events leading up to a sepsis infection can vary but bed sores from neglectful nursing home care can eventually cause the dangerous bacterial condition. Despite medical advances and aggressive sepsis infection treatments, nothing as of yet has been able to curb or decrease the fatalities associated to sepsis infection.

Every year hundreds of thousands of people suffer from instances of sepsis infection and die. The number of people affected by sepsis infection is expected to continue increasing. With nursing home residents already suffering weakened physical conditions and lower immunity, a sepsis infection can greatly increase the risk of the sepsis infection becoming deadly.

Nursing Home Violations Found to be Common

A recent report issued by the Department of Health and Human Services (DHHS) has found that nearly all nursing homes in the U.S. have received citations for health and safety violations in 2007. Led by Daniel Levinson, the inspector general of DHHS, federal investigators inspected and evaluated complaints from the nation's 15,000 nursing homes.

Of these facilities, roughly 67 percent are "for-profit" homes, 27 percent are nonprofit companies and 6 percent are owned by the government.

The results of this nationwide inspection found that 94 percent of for-profit facilities and 88 percent of nonprofit organizations received citations for non-compliance last year.
Details of This Reports Findings

In addition to calculating the percentage of homes violating federal standards, this investigation also looked into the amounts and types of violations occurring at particular homes.

These analyses found that:

• On average, 8 violations occurred at each non-compliant for-profit facility in 2007.
• About 6 violations occurred at each non-compliant nonprofit and government home in 2007.

In most cases, violations cited by federal inspectors consisted of any combination of:

• Infected bed sores
• Malnutrition
• Medication mishaps
• Patient abuse (either psychological or physical)
• Patient neglect

DHHS investigators contend that lack of adequately trained nursing home staff is primarily responsible for such rampant and disturbing nursing home violations. This contention is supported by the fact that independent researchers have found that having a higher ratio of staff to patients typically results in better care for the patients.
Medicare Violations at Nursing Homes

Along with finding such inhumane abuses, the DHHS report also uncovered the fact that some nursing homes were guilty of stealing funds from Medicare and Medicaid - as the facilities were billing these programs for services they didn't provide or provided extremely deficiently.

Bedsores are also called decubitus ulcers, pressure ulcers, or pressure sores. These tender or inflamed patches develop when skin covering a weight-bearing part of the body is squeezed between bone and another body part, or a bed, chair, splint, or other hard object.

Each year, about one million people in the United States develop bedsores ranging from mild inflammation to deep wounds that involve muscle and bone. This often painful condition usually starts with shiny red skin that quickly blisters and deteriorates into open sores that can harbor life-threatening infection.

Bedsores are not cancerous or contagious. They are most likely to occur in people who must use wheelchairs or who are confined to bed. In 1992, the federal Agency for Health Care Policy and Research reported that bedsores afflict:

* 10% of hospital patients
* 25% of nursing home residents
* 60% of quadriplegics

The Agency also noted that 65% of elderly people hospitalized with broken hips develop bedsores and that doctors fees for treatment of bedsores amounted to $2,900 per person.

Bedsores are most apt to develop on the:

* ankles
* back of the head
* heels
* hips
* knees
* lower back
* shoulder blades
* spine

People over the age of 60 are more likely than younger people to develop bedsores. Risk is also increased by:

* atherosclerosis (hardening of arteries)
* diabetes or other conditions that make skin more susceptible to infection
* diminished sensation or lack of feeling
* heart problems
* incontinence (inability to control bladder or bowel movements)
* malnutrition
* obesity
* paralysis or immobility
* poor circulation
* prolonged bed rest, especially in unsanitary conditions or with wet or wrinkled sheets
* spinal cord injury

Causes and symptoms

Bedsores most often develop when constant pressure pinches tiny blood vessels that deliver oxygen and nutrients to the skin. When skin is deprived of oxygen and nutrients for as little as an hour, areas of tissue can die and bedsores can form.

Read more: Bedsores - Definition, Description, Causes and symptoms, Diagnosis, Treatment, Alternative treatment, Prevention, Prognosis http://health.stateuniversity.com/pages/206/Bedsores.html#ixzz1AqyBExYc

Continue reading "Bed Sores, Decubitus Ulcers and Pressure Sores Usually Found In People That Are Confined" »

Bad Nursing Homes cause bedsores. Bedsores are a sign of neglect. Why do nursing home residents get bedsores twice as often as hospital patients? In part because nursing homes do not have the same guidelines for nurse to patient ratios as hospitals do. Without these tough rules nursing homes are allowed to focus on their bottom line, profits. With a reduced number of caregivers to care for all the residents of a nursing home, the profits are maximized. Due to the lower staffing in nursing homes, patients are forced to wait longer for care, such as the changing of soiled linens and clothes. If an older person cannot change themselves then they are forced to sit or lay in their own urine until a caregiver arrives. While the elderly wait in their urine their skin is being weakened by the moisture making them more susceptible to bedsores. And sadly, bedsores are the underlying cause of death for several thousand Americans each year.

Continue reading "Bed Sores, Decubitus Ulcers and Pressure Sores Are a Sign of Abuse and Neglect" »

Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization dedicated to the prevention and treatment of pressure sores, has defined each stage as follows:

* Stage I. A pressure sore begins as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.
* Stage II. At this stage, some skin loss has already occurred -- either in the outermost layer of skin (the epidermis), the skin's deeper layer (the dermis), or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration.
* Stage III. By the time a pressure ulcer reaches this stage, the damage has extended to the tissue below the skin, creating a deep, crater-like wound.
* Stage IV. This is the most serious and advanced stage. A large-scale loss of skin occurs, along with damage to underlying muscle, bone, and even supporting structures such as tendons and joints.

Continue reading "The Four Stages of Bed Sores, Decubitus Ulcers and Pressure Sores" »

Pressure sores or bed sores are painful skin ulcers that form when constant pressure on a part of the body shuts down the blood vessels feeding that area of skin. The resulting damage first appears on the skin surface as a red or dark patch. As the pressure sore progresses, the skin will break down to form blisters, dead skin, and ultimately infect underlying tissues, bones and joints. As little as two hours of sustained pressure will trigger skin damage. Skin damage can also be exacerbated by friction and moisture. The surface damage is just the tip of the iceberg; the real damage lies beneath the skin.

In the early stages, pressure sores can be treated at home by relieving the pressure, cleaning the sores and applying the appropriate dressing. In the later stages of severity, professional medical treatment, possibly, surgery, will be necessary. Pressure sores are especially prevalent on the lower back and buttocks, and on bony protruding areas, such as shoulders, hips, knees, heels and ankles. People who are bed-bound or in wheelchairs are particularly susceptible.
Things You Should Know

Pressure sores

* are caused by pressure, friction and moisture
* prolong the amount of time a person spends in the hospital
* increase risk of infection
* increase mortality
* represent an extra $10,000 a year in medical and nursing care costs, per person

Top

Risk Factors for Pressure Sores

* age
* immobility
* incontinence
* malnutrition and dehydration
* diseases and disorders that slow healing or lessen mental awareness
* diseases and disorders such as confusion or dementia that lessen mental awareness and may prevent a person from feeling the discomfort of a harmful body position
* medications, particularly sedatives

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Things to Look For

Warning signs of pressure sores

* discolored, torn or swollen skin, especially over bony areas
* signs of infection -- skin warmth, swelling, odor, pus

Seek professional care and treatment immediately for sores that are getting worse, not healing, or showing signs of infect

Continue reading "Bed Sores, Decubitus Ulcers and Pressure Sores Are Very Painful" »

Bed Sores -- The Basics

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 Bed Sores Develop

Bed sores 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 can result from one period of sustained pressure; however, most bed sores 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 do not always result from being in bed as the name would imply. Some of the most severe bed sores 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 "Bed Sores, Decubitus Ulcers and Pressure Sores: The Basics" »