California Elder Law Attorney Blog

People are paying a bundle to keep a loved one in a nursing home these days. The average cost of an annual stay at a facility is $71,000 for a private room in the United States. What is appalling is that this estimate doesn't reflect the care and attention that patients deserve when submitted to these facilities. One of the reasons for this rise in substandard care is under-staffing. And Facilities that are understaffed usually have patients that suffer from nursing home abuse and neglect.

The majority of homes in the US are for-profit enterprises, usually operating with too few staff assigned to too many patients. The Department of Health and Human Services estimate that over 90 percent of nursing homes operating in the United States do not have enough staff to provide proper care. Staff also tends to be overworked and underpaid, which leads to a high turnover rate at most facilities. Replacement rates at some nursing homes approach 100 percent annually. With new staff coming and going, it is easy to see how a patient's particular needs might not receive the special care that they deserve.

Over several decades, many many states have tried to pass legislation to force the nursing home industry to provide better care. Unfortunately for victims of abuse and neglect, legislators are not trying hard enough. Ultimately it is up to the families and friends of the patient to bring about real change. One step you can take to prevent abuse is visiting your loved one often. If a patient doesn't receive a lot of visitors, staff forgets that the patients are real people. Another step you can take if you suspect abuse is to talk to The Peck Law Group Nursing Home Abuse and Neglect Lawyers.

Continue reading "Understaffing is A Major Cause of Nursing Home Abuse and Neglect" »

Recent front-page Sacramento Bee headlines about tragedies in California nursing homes should be glaring reminders about the reasons California pioneered the Adult Day Health Care (ADHC) alternative to nursing home care 40 years ago.

If you are old, or are planning to be - pay attention - because this system is about to vanish.

Facing severe budget pressures, the Department of Health Care Services (DHCS) is currently dismantling the ADHC program in California.

This proven cost-effective program that has worked well to keep Californians out of nursing homes for the past four decades has fallen victim to an annual game of "budget chicken."

How did this happen?

In response to well-documented stories of institutional abuse in long-term care facilities in the 1980s, California pioneered Adult Day Health Care, a community-based, integrated health and social services program designed to keep frail and disabled persons out of nursing homes.

Since that time, the ADHC daytime congregate care program has saved the state hundreds of millions in nursing home and emergency services costs by providing frail seniors with multiple complex medical conditions a safe daily care setting.

Over the past several years, California's continuing fiscal woes have seen Republican and Democratic Governors alike cutting this MediCal "optional" program. Each time, advocates sued, with the courts blocking the cuts. In fact, a suit to block the elimination of ADHC is pending now.

Gov. Jerry Brown proposed the elimination of the ADHC program in his 2011-12 budget.

Without support for revenue extensions, all Assembly Democrats voted for the governor's proposal, with the understanding that AB 96, legislation that provided for a "step-down" alternative ADHC program would take its place.

This new program, "Keeping Adults Free of Institutions" - or KAFI - was budgeted at $85 million, half of the current cost of ADHC.

The governor vetoed AB 96 unexpectedly at the end of July, throwing the ADHC community into confusion and chaos.

With a looming deadline of Dec. 1, 2011 for program elimination, DHCS has started to shift ADHC recipients to Medi-Cal managed care and is contracting with out-of-state corporations to provide less reliable and more costly services.

Thirty-seven of my colleagues, including 35 Assembly members and two state senators,

There is no doubt that the destruction of the ADHC program will result in increased 911 calls, hospital emergency room visits, nursing home placements, and investigations for abuse and neglect.

Demands for mental health care, and in-home supportive services will also rise--at a time when budgets for all of these programs are being slashed.

Without safe adult daycare, working family members will either have to quit their jobs to care for their loved ones or place their family members in less appropriate settings - often, nursing homes.

Both Gov. Brown and I are senior citizens. My hope is that you will become one, too.

With an exploding population of baby boomers, persons with autism and Alzheimer's, returning veterans with disabling conditions and traumatic brain injuries, along with increasing numbers of impoverished adults with multiple chronic conditions in our communities, is this the time to take a wrecking-ball to a proven, cost-effective program serving our state's most vulnerable?

Will the courts again provide relief at the expected November 8 hearing, three weeks before the Dec. 1 elimination date?

History will be the judge of my vote and the governor's veto. But unless we raise our voices now, we will all surely suffer the consequences.

Continue reading "California Adult Day Health Care An Alternative To Nursing Home Care Shall Soon Vanish" »

Litigation adds to the burden of health care costs. This is especially true in long-term care, where nearly 87% of verdicts and out of court settlements against facilities are awarded to the plaintiffs. One report reviewed 54 nursing home law suit cases from September 1999 to April 2002 involving pressure ulcers.

The average monetary recovery was more than $13.5 million and included awards of up to $312 million in one case, when determined by a verdict or settlement. In litigation cases related to pressure ulcers, jury awards are highest for multiple causation factors. When awards were related to single causes, the highest awards were for those where inadequate nutrition was alleged to be the cause of pressure ulcers .

However, it is important to note that in the past few years a few states have passed legislation limiting malpractice awards which may help to control these cost burdens in the future.

Continue reading "Litigation Costs Are Very High In Cases Involving Bed Sores, Pressure Sores and Decubitus Ulcers" »

The Braden Scale is an excellent nursing assessment tool for evaluating a patient's general condition. It should alert us that a patient requires our utmost vigilance. However, implementing preventive measures should be similar to implementing universal precautions - every at-risk patient, no matter what the Braden Scale score, should be afforded the best preventive care possible. There should be zero expectation that any patient will develop a pressure ulcer. The Braden Scale has no predictive validity unless the assumption is that the care is going to be inadequate.

Pressure ulcer and Bed Sore prevention, to use the old cliche, is a 24-hour-a-day job. On a daily basis, we are entrusted with the care of thousands of at-risk patients. Are we honestly up to the challenge?

Continue reading "Every At Risk Patient for Bed Sores, Pressure Sores and Decubitus Ulcers Must Be Afforded The Best Preventive Care Possible" »

Elder abuse is a serious problem. It is important, however, to put elder abuse in context. Studies show that 60 million Americans provide care to adult relatives, with an average lifetime economic cost per person of $300,000, mostly from early retirement or reduced work hours. If the public paid for this, costs would be four times what the federal government now pays for long-term care.

The great majority of these caregivers do exemplary jobs, sacrificing free time, sleep and sometimes their own health. University research conducted also shows that older people in residential-care settings describe both exemplary paid care providers and some who are mediocre or poor.

This positive quality of care, however, is not newsworthy, and most news stories focus on the few, horrific cases where abuse or neglect leads to harm or death. In elder care, there are most certainly a few villains but many, many unsung heroes.

We must watch the villains and to continue to monitor the facilities and individuals that fail to provide the servicdes that are needed for the upkeep of our elders.

Continue reading "Elder Abuse Is A Serious Problem" »

Pressure Ulcer Definition

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.

Pressure Ulcer Stages

Suspected Deep Tissue Injury:

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Further description:

Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

Stage I:

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Further description:

The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate "at risk" persons (a heralding sign of risk)

Stage II:

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Further description:

Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
*Bruising indicates suspected deep tissue injury

Stage III:

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Further description:

The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable.

Stage IV:

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Further description:

The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.

Unstageable:

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Further description:

Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed.

Continue reading "How Are Bed Sores, Pressure Sores and Decubitus Ulcers Staged says California Nursing Home Abuse and Neglect lawyer Steven Peck" »

The potentially dangerous diarrhea bug Clostridium difficile(C. diff.) is making the rounds in the community -- outside the hospital setting it once called home.

Each year, C. diff strikes about 500,000 Americans, mostly in hospitals and nursing homes. But anywhere from 15,000 to 180,000 of those cases are now acquired in the community.

Why the huge range? Estimates are based on one-year snapshots of different communities, with no studies tracking cases over time,

C. diff disease can range from mild diarrhea to life-threatening intestinal inflammation known as colitis. The bug produces toxins that destroy the mucosal lining of the gut.

C. diff Risk Factors
Most cases of hospital-acquired C. diff occur in people taking so-called broad-spectrum antibiotics, including clindamycin, fluoroquinolones, and penicillins that kill many different types of pathogens.

Spores enter the body through the mouth, which is the entryway for the gastrointestinal tract. The broad-spectrum antibiotics kill "good" bacteria in the gut that keep C. diff. at bay.

Use of antibiotics is also a risk factor for community-acquired C. diff, but not to the same degree. Studies implicate antibiotics in as many as 90% of hospital cases, but fewer than half of community-acquired cases.

Other risk factors include age over 65 and recent discharge from the hospital. You're at risk for the first few weeks after you get out.

In younger people, underlying medical conditions such as lung disease may increase susceptibility to the bug.

People who have already had a few bouts with C. diff are especially at risk.

Still, the vast majority of cases are spread from human to human.

Continue reading "Clostridium difficile(C. diff.) is A Very Dangerous Infection" »

Mobility and activity limitations are strong independent predictors of pressure ulcers. The recent NPUAP-EPUAP guideline states that if the individual is bedfast or chairfast and immobile, he/she is considered to be risk for pressure ulcers. Other factors (eg, nutrition, moisture) mayhave an impact on risk status, but activity and mobility limitations are the primary considerations.

Turning or repositioning the immobile individual helps reperfuse ischemic skin, temporarily removing pressure from vulnerable tissues. Repositioning may include partial turns or small body movements that do not always remove pressure from the sacrum or heels rather than full turns of 30° or more that lift the sacrum from the bed. .

Continue reading "The Bedfast and Immobile Are Major Risks for Bed Sores, Pressure Sores and Decubitus Ulcers" »

During your research of proper skilled nursing facilities for your elderly or disabled family member, you may have learned about nursing home abuse. One issue that results from abuse and neglect is infections . Infections can occur through lack of proper hygiene, improper food safety, and building safety. There are two highly common infections that are seen in nursing homes : MRSA and VSRA. These are not the only two infections and health problems. Focus are on these two because they are the more common issues.
MRSA stands for Methicillin-resistant Staphylococcus aureus. It is a bacterium that is highly difficult to treat once a patient is infected. It is known by other names like Oxacillin-resistant Staphylococcus aureus and multidrug-resistant Staphylococcus aureus. By definition it means the strain is resistant to antibiotics like penicillin. It is found in hospitals and skilled nursing facilities (SNFs) because these individuals may have open wounds or susceptible immune systems.

Continue reading "Be Vary Wary of Infections In Long Term Skilled Facilities" »

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.

Continue reading "Dehydration in Nursing Homes Causes Urinary Tract Infections, Bed Sores, and Death In Elderly Patients" »

Many seniors are frail and unable to fully care for themselves. They are particularly vulnerable to intentional abuse or neglect, the U.S. Administration on Aging says.

The agency mentions these warning signs of elder abuse:

Any sign of physical harm, including bruises, fractures, burns, or marks on the skin.
Sudden withdrawal, depression and reduced alertness, or other changes in behavior or personality.
Unexpected changes in financial status, which could indicate that the elderly person is being exploited.
Unexplained weight loss, bedsores or lack of personal hygiene.
Signs of being threatened or belittled.
Frequent arguing between caregiver and the elderly person, and signs of strain in the relationship.

Continue reading "Seniors Unable To Care For Themselves Are Venerable To Elder Abuse and Neglect" »

Nursing homes are understaffed, and the big problem seems to be workload. Only 41 percent of the facilities agreed that the facility had enough staff to handle residents' needs safely, and almost two-thirds agreed that staff had to hurry because there was too much work to do.

Size matters -- a lot, though it's not clear why. In nursing homes with 49 or fewer beds, 77 percent of staff awarded their facility high safety ratings overall. In facilities with more than 100 beds, only 59 percent would.

Continue reading "Nursing Homes Are Seriously Understaffed" »

Lower urinary tract infections (UTIs) are a major cause of morbidity and mortality for adults in long-term care (LTC).1 Community studies have shown prevalence rates of bacteriuria to be 11% in the elderly, 18% for those living in congregate living arrangements, and 25-50% for residents in nursing home environments. In fact, the most common cause of bacteremia in LTC residents is due to UTIs.

The prevalence of UTI increases in both sexes with age, resulting in a female-to-male ratio of 2:1 in the elderly population. The annual incidence of symptomatic bacterial UTIs is estimated to be as high as 10%. For asymptomatic bacteriuria, the estimated cumulative prevalence is 30% in women and 10% in men. Interestingly, the female-to-male ratio in the incidence of UTI narrows in the elderly population, which is thought to be related to the fact that with increasing age, men develop an increase in residual urinary volume after voiding, which increases their risk of bacteriuria and UTI; women engage in less sexual activity with age, and thus have one less predisposing risk factor for introduction of bacteria into the urinary tract.

Continue reading "Urinary Tract Infections Are a Major Cause of Morbidity and Mortality in Long Term Care Facilities" »

If you have ever been confined to bed for any length of time, you probably understand how bedridden people can develop pressure ulcers, also known as bedsores. Lack of movement greatly reduces circulation in the body, and pressure against the skin reduces blood supply to that area and the affected tissue dies. Pressure ulcers start as a red area of the skin that does not turn white when pressed. This develops into a blister or open sore and then forms a crater. Pressure ulcers are very painful and tend to develop more on areas where the bones are close to the skin, such as elbows, heels, hips, ankles, shoulders, back and the back of the head, although they can certainly form anywhere on the body.

While there are many different therapies for preventing and treating pressure ulcers such as using sheepskin and powders sprinkled on bedding to reduce friction, one of the best and most proven therapies is to use a Low Air Loss and Alternating Pressure mattress.

The longer it takes for any wound to heal, the greater the risk of infection, re-hospitalization or surgery. Anyone with circulatory issues such as those with diabetes, severe burns or obesity, or individuals who are unable to move due to brain injuries or disabilities can certainly benefit from an overlay air mattress that not only provides effective pressure redistribution, but by combining the overlay with the microprocessor-controlled pump, it provides direct low air loss at the interface of the patient and the support surface to assist in managing the microclimate to help prevent skin maceration.

Continue reading "How to Prevent and Treat Pressure Ulcers with Low Air Loss Therapy" »