California Elder Law Attorney Blog

Low nurse staffing levels are considered the strongest predictor of poor nursing home quality leading to abuse and neglect says California Elder Abuse Attorney Steven Peck.

The 10 largest for-profit chains operate about 2,000 nursing homes in the United States, controlling approximately 13 percent of the country's nursing home beds.

In recent decades, nursing home chains have undergone a considerable expansion. A number of chains were publicly-traded companies until the early 2000s, when five of the country's largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses.

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share.

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing which lower staffing could lead to bed sores, malnutrition, dehydration, and infections.

Recent Medicare cuts in payment rates for nursing home residents - by 11 percent in October, 2011 - may further jeopardize the health and safety of residents if the chains respond by reducing staffing and wages, Harrington said.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse "staffing hours" than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, bed sores and decubitus ulcers, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents such as malnutrition and dehydration.

The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

The authors said that more study is needed on the subject. They also said that greater accountability and quality oversight mechanisms would help improve nursing home care, along with effective funding incentives and sanctions for low staffing and poor quality.

Source: UCSF

Continue reading "Low Nurse Staffing Levels are Considered the Strongest Predictor of Poor Nursing Home Quality Leading to Abuse and Neglect says California Elder Abuse Attorney Steven Peck" »

A couple of new developments on the C. difficile front should be encouraging news to anyone who is familiar with this potentially deadly bacterial infection. You might also know it as CDI, or Clostridium difficile infection.

First, scientists from UCLA and the University of Texas have been looking at possible cellular defense mechanisms against the two toxins that are released into the gut whenever C. difficile germs are growing in number. The scientists believe that human cells in the gut are capable of releasing molecules that will knock down these toxins, and that the cells can put up a fight through a drug-induced process called protein s-nitrosylation.

The process is seen as a much-needed new therapeutic approach toward an infection that often resists treatment with antibiotics. As of August 2011, the research team was ready to conduct clinical trials on humans, after successful trials on animals.

Second, the fight against C. difficile continues with at least three different research projects that show the effectiveness of fecal microbiota transplants for those patients whose infections keep recurring. That's right -- fecal material is transplanted into the patient's body, usually by colonoscopy or by an infusion into the rectum.

Though it may sound unpleasant, the evidence suggests it can quickly stop C. difficile-related diarrhea and may eventually prove useful in reversing inflammatory bowel disease. The introduction of healthy fecal bacteria can restore balance to a digestive system wracked by CDI, the experts said.

The majority of C. difficile infections occur in hospital or nursing home settings, often because of poor hygiene. Overuse of antibiotics poses another problem, as the body loses the strains of bacteria that could normally fend off C. difficile.

In the United States, hundreds of thousands of people acquire C. difficile infections each year, with fatalities numbering between 15,000 and 20,000, according to an April 14, 2009, article in The New York Times. The symptoms include moderate to severe diarrhea, fever, nausea, loss of appetite, abdominal pain and, in some cases, colitis.

Continue reading "C. Difficile Infections Are Prevelant In Nursing Homes says Elder Abuse Lawyer Steven Peck" »

Sepsis refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms says Elder Abuse Lawyer Steven Peck. Sepsis is also called bacteremia. Closely related terms include septicemia and septic syndrome.

Sepsis can originate anywhere bacteria can gain entry to the body; common sites include the urinary tract, the liver and its bile ducts, the gastrointestinal tract, and the lungs. Broken or ulcerated skin (bed sores, pressure sores and decubitus ulcers) can also provide access to bacteria commonly present in the environment. Invasive medical procedures, including dental work, can introduce bacteria or permit it to accumulate. Entry points and equipment left in place for any length of time present a particular risk. Heart valve replacement, catheters, ostomy sites, intravenous(IV) or arterial lines, surgical wounds, or surgical drains are examples. IV drug users are at high risk as well.

The most common symptom of sepsis is fever, often accompanied by chills or shaking, or other flu-like symptoms. A history of any recent invasive procedure or dental work should raise the suspicion of sepsis and medical help should be sought.

The presence of sepsis is indicated by blood tests showing particularly high or low white blood cell counts. The causative agent is determined by blood culture.

Identifying the specific cause ultimately determines how sepsis is treated. However, time is of the essence, so a broad-spectrum antibiotic or multiple antibiotics will be administered until blood cultures reveal the culprit and treatment can be made specific to the organism. Intravenous antibiotic therapy is usually necessary and is administered in the hospital.

Septic shock is a potentially lethal drop in blood pressure due to the presence of bacteria in the blood.

Septic shock is a possible consequence of bacteremia, or bacteria in the bloodstream. Bacterial toxins, and the immune system response to them, cause a dramatic drop in blood pressure, preventing the delivery of blood to the organs. Septic shock can lead to multiple organ failure including respiratory failure, and may cause rapid death. Toxic shock syndrome is one type of septic shock.

During an infection, certain types of bacteria can produce and release complex molecules, called endotoxins, that may provoke a dramatic response by the body's immune system. Released in the bloodstream, endotoxins are particularly dangerous, because they become widely dispersed and affect the blood vessels themselves. Arteries and the smaller arterioles open wider, increasing the total volume of the circulatory system. At the same time, the walls of the blood vessels become leaky, allowing fluid to seep out into the tissues, lowering the amount of fluid left in circulation. This combination of increased system volume and decreased fluid causes a dramatic decrease in blood pressure and reduces the blood flow to the organs. Other changes brought on by immune response may cause coagulation of the blood in the extremities, which can further decrease circulation through the organs.

Septic shock is seen most often in patients with suppressed immune systems, and is usually due to bacteria acquired during treatment at the hospital. The immune system is suppressed by drugs used to treat cancer, autoimmune disorders, organ transplants, and diseases of immune deficiency such as AIDS. Malnutrition, chronic drug abuse, and long-term illness increase the likelihood of succumbing to bacterial infection. Bacteremia is more likely with preexisting infections such as urinary or gastrointestinal tract infections, or bed sores, pressure sores and decubitus ulcers. Bacteria may be introduced to the blood stream by surgical procedures, catheters, or intravenous equipment.

Septic shock is usually preceded by bacteremia, which is marked by fever, malaise, chills, and nausea. The first sign of shock is often confusion and decreased consciousness. In this beginning stage, the extremities are usually warm. Later, they become cool, pale, and bluish. Fever may give way to lower that normal temperatures later on in sepsis.

Other symptoms include:

•Rapid heartbeat
•Shallow, rapid breathing
•Decreased urination.
•Reddish patches in the skin.

Septic shock may progress to cause "adult respiratory distress syndrome," in which fluid collects in the lungs, and breathing becomes very shallow and labored. This condition may lead to ventilatory collapse, in which the patient can no longer breathe adequately without assistance.

Diagnosis of septic shock is made by measuring blood pressure, heart rate, and respiration rate, as well as by a consideration of possible sources of infection. Blood pressure may be monitored with a catheter device inserted into the pulmonary artery supplying the lungs. Blood cultures are done to determine the type of bacteria responsible. The levels of oxygen,carbon dioxide, and acidity in the blood are also monitored to assess changes in respiratory function.

Septic shock is treated initially with a combination of antibiotics and fluid replacement. The antibiotic is chosen based on the bacteria present, although two or more types of antibiotics may be used initially until the organism is identified. Intravenous fluids, either blood or protein solutions, replacethe fluid lost by leakage. Coagulation and hemorrhage may be treated with transfusions of plasma or platelets. Dopamine may be given to increase blood pressure further if necessary.

Respiratory distress is treated with mechanical ventilation and supplemental oxygen, either using a nosepiece or a tube into the trachea through the throat.

Identification and treatment of the primary infection site is important to prevent ongoing proliferation of bacteria.

Septic shock is most likely to develop in the hospital, since it follows infections which are likely to be the objects of treatment. Because of this, careful monitoring and early, aggressive therapy can minimize the likelihood of progression. Nonetheless, death occurs in at least 25% of all cases.

The likelihood of recovery from septic shock depends on may factors, including the degree of immuno suppression of the patient, underlying disease, promptness of treatment, and type of bacteria responsible. Mortality is highest in the very young and the elderly, those with persistent or recurrent infection,and those with compromised immune systems.

The risk of developing septic shock can be minimized through treatment of underlying bacterial infections, and prompt attention to signs of bacteremia.

Continue reading "Sepsis Infection Can Cause Septic Shock a Potentially Lethal Drop In Blood Pressure Due to the Presence of Bacteria In the Blood indicates Elder Abuse Lawyer Steven Peck" »

Nursing Service -Patient Care.
(a) No patient shall be admitted or accepted for care by a skilled nursing facility except
on the order of a physician.
(b) Each patient shall be treated as individual with dignity and respect and shall not be
subjected to verbal or physical abuse of any kind.
(c) Each patient, upon admission, shall be given orientation to the skilled nursing facility
and the facility's services and staff.
(d) Each patient shall be provided care which shows evidence of good personal hygiene,
including care of the skin, shampooing and grooming of hair, oral hygiene, shaving or
beard trimming, cleaning and cutting of fingernails and toenails. The patient shall be free
of offensive odors.
(e) Each patient shall be encouraged and/or assisted to achieve and maintain the highest level of self-care and independence. Every effort shall be made to keep patients active, and out of bed for reasonable periods of time, except when contraindicated by physician's
orders.
(f) Each patient shall be given care to prevent formation and progression of decubiti,contractures and deformities. Such care shall include:
(1) Changing position of bedfast and chairfast patients with preventive skin care in
accordance with the needs of the patient.
(2) Encouraging, assisting and training in self-care and activities of daily living.
(3) Maintaining proper body alignment and joint movement to prevent contractures and
deformities.
(4) Using pressure-reducing devices where indicated.
(5) Providing care to maintain clean, dry skin free from feces and urine.
(6) Changing of linens and other items in contact with the patient, as necessary, to
maintain a clean, dry skin free from feces and urine.
(7) Carrying out of physician's orders for treatment of decubitus ulcers. The facility shall
notify the physician, when a decubitus ulcer first occurs, as well as when treatment is not
effective, and shall document such notification as required in Section 72311(b).
(g) Each patient requiring help in eating shall be provided with assistance when served,
and shall be provided with training or adaptive equipment in accordance with identified
needs, based upon patient assessment, to encourage independence in eating.
(h) Each patient shall be provided with good nutrition and with necessary fluids for
hydration.
(i) Measures shall be implemented to prevent and reduce incontinence for each patient
and shall include:
(1) Written assessment by a licensed nurse to determine the patient's ability to participate
in a bowel and/or bladder management program. This is to be initiated within two weeks
after admission of an incontinent patient.
(2) An individualized plan, in addition to the patient care plan, for each patient in a bowel
and/or bladder management program.
(3) A weekly written evaluation in the progress notes by a licensed nurse of the patient's
performance in the bowel and/or bladder management program.
(j) Fluid intake and output shall be recorded for each patient as follows:
(1) If ordered by the physician.
(2) For each patient with an indwelling catheter:
(A) Intake and output records shall be evaluated at least weekly and each evaluation shall be included in the licensed nurses' progress notes.
(B) After 30 days the patient shall be reevaluated by the licensed nurse to determine
further need for the recording of intake and output.
(k) The weight and length of each patient shall be taken and recorded in the patient's
health record upon admission, and the weight shall be taken and recorded once a month
thereafter.
( l) Each patient shall be provided visual privacy during treatments and personal care.
(m) Patient call signals shall be answered promptly

Continue reading "Patient Care In Nursing Homes Is Regulated In The State of California says Nursing Home Abuse and Neglect Attorney Steven Peck" »

Surgical Treatment There are many different types of surgeries used to treat pressure sores, bed sores and decubitus ulcers.. Debridement is an option to surgically clean and remove any dead or infected skin and muscle. This debriding creates a larger wound, but the area is healthy and more likely to heal. In many cases a small amount of bone is also removed from the base of the wound to decrease recurrence of infection. In some cases, the hip joint will need to be removed along with a portion of the thigh bone.

Reconstructive surgery involves the removal of healthy tissue from one place on the body to cover a wound somewhere else. The skin and/or muscle (the flap) is usually taken from the back, buttocks or thigh. This flap tissue, which has a good blood supply, is repositioned to cover the wound and help nourish the tissue around the pressure sore. Once the pressure sore is covered, the area where the flap tissue was removed is closed. Sometimes skin grafts are used to close these areas.

Multiple Pressure Sores Some people have more than one pressure sore. It is not uncommon that surgery on these areas must be spread out over more than one surgery. If reconstruction can be accomplished with a single operation, it may require a more radical treatment option if there are multiple or very large wounds. In severe cases, a leg may be amputated to provide the necessary tissue for the reconstruction. For example, a total thigh flap requires amputation of the leg so the skin and muscle from the front of the thigh is used to fill the wound.

Postoperative Care After surgery, it is very important take care of the repaired area to reduce the risk for complication. Care starts with transferring from the operating table to the air-fluid bed. Patients are positioned flat in the air-fluid bed for 4 weeks. Movement is limited to prevent shearing and tension across the flap repair. After 4 weeks, patients can be wedged carefully into the semi-sitting position. Six weeks after surgery, patients can begin sitting for 10 minute intervals. After each interval, the flap area is examined for discoloration and wound edge separation. The sitting periods are increased at 10 minute intervals over 2 weeks and reaching up to 2 hours of sitting at a time. Pressure reliefs are needed for 10 seconds at least every 15 minute while sitting. Patients will need to continue using a pressure-reducing mattresses and turn in bed every 2 hours.

Individuals with SCI have other concerns. Involuntary muscle spasms must be well controlled to allow proper healing after surgery. Bacteria, which is the source of infection, is easily brought into the bladder with Intermittent Catheterization, Foley, and Suprapubic methods of bladder management. It is important to prevent infections, and antibiotic treatment is needed if bacteria are present in urinary cultures or urinalysis.

Special equipment is also needed to allow healing to progress normally. Because this is so important, all equipment are secured before surgery is scheduled. The equipment might include a pressure-reducing mattress (such as an air-fluidized bed or low air loss mattress) and a proper seat cushion for patients using wheelchairs. In addition, plans for recovery include setting up home health care or staying in a rehabilitation facility or assisted living center to recover.

In most cases the area of the pressure sore and reconstructive flap does not have sensation. It is also important to note that reconstruction cannot restore normal sensation. Wound disruption or delayed wound healing is possible, and some areas of the flap skin may heal abnormally or slowly.

Without these precautions, wound breakdown or pressure sore recurrence is extremely likely. Treatment may require frequent dressing changes or further surgery to remove the non-living tissue and an additional reconstructive procedure.

Risks of Flap Reconstruction
Every surgical procedure involves a certain amount of risk, and it is important that you understand the risks involved with the reconstruction of a pressure sore. An individual's choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience the following complications, you should discuss each of them with your surgeon to make sure you understand the risks, potential complications, and consequences of reconstruction with flap surgery.

Bleeding is possible during or after surgery. If bleeding occurs, it may require emergency treatment to drain accumulated blood (hematoma).

Infection can occur after surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary. If an infection does not respond to antibiotics, the reconstruction may to be opened. After the infection is treated, additional reconstruction may be needed.

Flap Failure is possible despite all best efforts. Failure sometimes occurs when a blockage or compression occurs at the point of blood flow to the flap.

Even though risks and complications occur infrequently, the risks cited above are the ones that are commonly associated with flap reconstruction surgery. Other complications and risks can occur but are uncommon. Should complications occur, additional surgery or other treatments may be necessary.

Every pressure sore, bed sore and decubitus ulcer is unique, and a great deal depends on individual circumstances. Ask your doctor to explain anything you do not understand. Also, you should also ask your doctor for educational information that specifically details the procedure you are considering for yourself.

Continue reading "Surgical Treatment of Bed Sores, Pressure Sores and Decubitus Ulcers Can Be Very Painful and Costly Says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

What Are Bedsores?
Bedsores are also known as pressure sores or pressure ulcers. They occur as a result of prolonged pressure on the skin and underlying tissue in sensitive areas, most often the boney areas of the body such as the back, buttocks, hips, ankles and heels. Bedsores can develop quickly and can be difficult to treat because those who are most often affected are those with mobility issues that keep them from changing positions easily. Those who are bedridden or are confined to a wheelchair are at a high risk for developing bedsores.

Causes and Risk Factors
There are three factors that play a role in bedsores developing:
•Sustained Pressure: When the skin is trapped between a bony surface and the surface of a bed or wheel chair, blood flow can be interrupted because the pressure that depriving the area of blood flow is greater than the body's ability to pump blood to that area.
•Friction: When someone tries to move after being in a certain position for a long period of time, as is the case with those people in wheelchairs or those who are bedridden, friction between the skin and the surface they are on can contribute to bedsores. Friction is worse if the skin is moist, as in the case of those with urinary incontinence.
•Shear: Shear occurs when two surfaces move in opposite directions, such as when the head of a hospital bed is raised. As the head of the bed moves up, gravity pulls the body downward, resulting in a shear effect between a person's back and the bed.
Those most at risk for developing bedsores are those who have limited mobility. Immobility can be caused by a number of problems:

•Poor health
•Obesity resulting in immobility
•Sedation
•Injury or illness requiring bed rest or wheel chair use
•Recovery after surgery
•Paralysis
•Coma
Other factors that contribute to bedsores include:

•Lack of sensory perception
•Poor nutrition or hydration
•Age
•Decreased mental awareness
•Weight loss
•Incontinence
•Excessive moisture or dryness of skin
•Smoking
•Decreased circulation
•Muscle spasms

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Are a Result of Prolonged Pressure" »

Many factors contribute to the development of Pressure sores also known as Bed Sores and Decubitus Ulcers. Pressure leading to ischemia is the final common pathway. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures initiates a downward spiral towards ulceration.

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

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

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

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

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

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

Continue reading "There Are Many Distinct Factors Which Contribute to The Development of Pressure Sores, Bed Sores and Decubitus Ulcers says Elder Abuse Attorney Steven Peck" »

Nursing Home Neglect and Abuse is often caused by the understaffing of the nursing care facility. The results of understaffing in any medical care facility can be catastrophic. An overworked nursing staff may leave an elder patient sitting or lying too long in one place, fail to clean up an elder properly, or not give the resident their medication when it is critical that it is done so, Elder patients are especially vulnerable to skin breakdown and need to be turned and repositioned at least very two hours otherwise the elder will certainly acquire bed sores, pressure sores and decubitus ulcers.

Evidence shows that higher staff levels and lower nurse turnover are linked to fewer pressure ulcers, catheterized patients, and urinary tract infections. Inadequate food intake (malnutrition) is a major reason frail elderly people die in nursing homes. Nursing homes must be sufficiently staffed to attend to residents who need assistance and supervision at mealtimes to assure proper nutritional intake and hydration. Low staffed facilities are unable to encourage residents to remain as independent as possible and to encourage participation in activities intended to promote in mental acuity and physical health.

Continue reading "Nursing Home Abuse and Neglect Often Transpires Because of Understaffing" »

Health care-associated infections caused by antimicrobial drug-resistant bacteria have caused both endemic infections and outbreaks in nursing homes in the United States. The frequent movement of patients between hospitals and nursing homes undoubtedly facilitates the transfer of resistant microbes. During the last 2 decades, gram-negative uropathogens with multidrug resistance and methicillin-resistant S. aureus have received the most attention[. Gram-negative enteric bacilli have recently become resistant to fluoroquinolones and extended-spectrum cephalosporins. In addition, vancomycin-resistant enterococci and penicillin-resistant pneumococci have been identified in long-term care facilities[. The appearance of the latter organism, which is seldom regarded as a nosocomial pathogen, again underscores the unique situation of this health-care setting. Because the frequent interchange of patients between hospitals and nursing homes, infections caused by antimicrobial drug-resistant bacteria will continue to emerge in geriatric populations.

Continue reading "Nursing Home Infections Are Cause For Concern says Elder Abuse Attorney Steven Peck" »

Uninterrupted pressure exerted on the skin, soft tissue, muscle, and bone can lead to the development of localized ischemia, tissue inflammation, tissue anoxia, and necrosis. Pressure ulcers, Bed Sores also known as Decubitus Ulcers can result from these effects; about 3 million adults in the United States suffer from pressure ulcers, bed sores and decubitus ulcers. Estimates of the incidence of pressure ulcers vary according to the setting and range from 0.4 to 38.0 percent in acute-care hospitals, from 2.2 to 23.9 percent in long-term nursing facilities, and from 0 to 17 percent in the home-care setting.

Various systems have been used to assess the severity of pressure ulcers, but most use a four-stage categorization with higher numbers indicating higher severity.Healing rates of pressure ulcers vary considerably and are dependent on comorbidities, clinical interventions, and severity of the ulcer. This variability can add to the length of hospitalization and impede the return of patients to full functioning. Data on the costs of treatment for a pressure ulcer vary, but some estimates range between $37,800 and $70,000, with total annual costs in the United States as high as $11 billion.

Interventions to treat pressure ulcers are numerous and diverse and include strategies such as reducing pressure with various support surfaces, wound debridement and cleansing, surgical repair, and the use of various wound dressings, various biologic agents, and nutritional supplementation.In addition, various adjunctive therapies have been evaluated, including vacuum-assisted closure, ultrasound therapy, electrical stimulation, and hyperbaric oxygen therapy. The approach to treatment typically varies, depending on the stage of the wound and patient-related factors such as the existence of particular comorbidities says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Continue reading "Pressure Ulcers, Bed Sores and Decubitus Ulcers Come At An Annual Cost of $11 Billion because of Elder Abuse and Neglect" »

Bedsores are easier to prevent than treat. We must be vigilant, inspecting skin regularly, especially skin covering bony areas. If it is swollen, torn, shiny, discoloured (red, ashen purple), feels warm, or has pus, it is worth attention.

Caregivers should reposition clients regularly or encourage them to reposition themselves regularly where possible. Cushions (foam, gel, water-filled, air-filled) placed appropriately are helpful. Special mattresses, wedges, and pads are designed to protect 'at-risk' areas. Consult a physiotherapist for advice.

It is important to exercise good personal hygiene (mild soap and water). Manage urinary and bowel incontinence with hygiene practices, make frequent diaper changes where appropriate, and apply protective barrier creams. Protect potentially moist areas with talcum powder and protect dry areas with moisturising lotions and barrier creams.

Zinc oxide is a common ingredient in these.

More serious bedsores, which have broken skin or craters with dead flesh, require medical attention. Necrotic flesh (dead and infected) makes sores difficult to heal. Hydrocolloid adhesive dressings keep the bedsore environment moist while protecting it from contamination. Antibiotic creams control infection. Debridement is a method of removing necrotic flesh, and agents like collagenase and papain/chlorophyll are helpful. However,debridement surgery may be necessary.

Continue reading "Prevention of Bed Sores, Pressure Sores and Decubitus Ulcers Is A Must says Elder Abuse Attorney Steven Peck" »

The number of hospital patients with pressure sores, also called decubitus ulcers or bed sores, rose from 480,000 cases in 2007 to 655,000 cases in 2010 a substantial increase says California Elder Abuse Lawyer Steven Peck of the Peck Law Group.

Pressure sores typically result from prolonged periods of uninterrupted pressure on the skin, soft tissue, muscle, and bone. Vulnerable patients include the elderly, stroke victims, patients with diabetes, those with dementia, and people who use wheelchairs or are bedridden any patient with impaired mobility or sensation.

Patients aged 65 and older accounted for 72% of all hospitalizations during which pressure sores were noted. About 19% of such stays were for patients 45 to 64 years of age.

On average, patients admitted to hospitals primarily for treatment of pressure sores stayed nearly 13 days. But length of stay varied by age patients aged 18 to 44 accounted for the longest average stay (14 days), and those aged 85 and older had the shortest stays (10 days).

Nearly 9 of every 10 hospital stays involving pressure ulcers were covered by government health programs 66% by Medicare and 23% by state Medicaid programs.

Hospital charges for stays principally for treatment of pressure ulcers averaged $37,800, but average charges varied by payer, for example, the average charge to Medicaid was $39,100 while the average bill to the uninsured was $25,600.

The 10 most common principal reasons for hospitalizations during which it was noted that patients also had pressure sores were septicemia; pneumonia; urinary tract infections; aspiration pneumonitis; congestive heart failure; rehabilitation care; fluid and electrolyte disorders; complication of device, implant, or graft; respiratory failure; and diabetes mellitus with complications.

Continue reading "Hospitalized Patients With Bed Sores, Pressure Sores and Decubitus Ulcers Is Increasing At An Alarming Rate Says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

What are pressure sores?
Pressure sores, Bed Sores and Decubitus Ulcers are areas of injured skin and tissue. They are usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn't occur often enough and the blood supply gets too low, a sore may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers.
What are the symptoms of a pressure sore?
There are 4 stages of pressure sores. Symptoms at each stage include the following:
Stage 1. The affected skin looks red and may feel warm to the touch. The area may also burn, hurt or itch. In people who have dark skin, the pressure sore may have a blue or purple tint.
Stage 2. The affected skin is more damaged in a stage 2 pressure sore, which can result in an open sore that looks like an abrasion or a blister. The skin around the wound may discolored. The area is very painful.
Stage 3. These types of pressure sores usually have a crater-like appearance due to increased damage to the tissue below the skin's surface. This makes the wound deeper.
Stage 4. This is most serious type of pressure sore. The skin and tissue is severely damaged, causing a large wound. Infection can occur at this stage. Muscles, bones, tendons and joints can be affected by stage 4 pressure sores.

Who gets pressure sores?
Anyone who sits or lies in one position for a long time might get pressure sores. You are more likely to get pressure sores if you are paralyzed, use a wheelchair or spend most of your time in bed.

However, even people who are able to walk can develop pressure sores when they must stay in bed because of an illness or an injury. Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for pressure sores to heal because of poor blood circulation.

Continue reading "What Are Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Treating a pressure sore is much more difficult than preventing one. The main goals of treatment are to relieve pressure on the sores, keep them clean and free of infection, and provide adequate nutrition. Adequate nutrition is important in helping pressure sores heal and in preventing new sores from forming. A well-balanced, high-protein diet is recommended as well as a daily high-potency vitamin and mineral supplement. Supplemental vitamin C and zinc may help with healing as well. Electrical stimulation, heat therapy, massage therapy, and hyperbaric oxygen therapy have not proven helpful.

In the earliest stage, pressure sores usually heal by themselves once pressure is removed. When the skin is broken, a doctor or nurse considers the location and condition of the pressure sore when recommending a dressing. Film (see-through) dressings help protect early-stage pressure sores and allow them to heal more quickly. Hydrocolloid (oxygen- and moisture-retaining) patches protect, keep the skin appropriately moist, and provide a healthy environment for deep sores. Other types of dressings may be used for deeper sores, those that ooze a lot of fluids, and those that are infected.

If the sore appears infected or oozes, rinsing with saline and dabbing gently with a gauze pad are helpful. A doctor may need to remove (debride) dead tissue with a scalpel or a chemical solution. Removal of dead tissue is usually painless, because pain is not felt in dead tissue. Some pain may be felt because healthy tissue is nearby. Health care practitioners may flood (irrigate) the sore, particularly its deep crevices, with a sterile solution to help clean away hidden debris.

Sometimes a bed that circulates air (an air-fluidized bed) is used in hospitals and nursing homes. This special bed helps reduce or redistribute pressure on the body.

Deep pressure sores are difficult to treat. Sometimes they require skin and muscle flaps, in which healthy, thicker tissue with a good blood supply is surgically repositioned to cover the damaged area. This type of surgery is not always successful, however, especially for frail older people who are malnourished. Often, when infections develop deep within a sore, antibiotics are given. When bones beneath a sore become infected, the bone infection (osteomyelitis---see see Bone and Joint Infections: Osteomyelitis) is extremely difficult to cure and may spread through the bloodstream, requiring many weeks of treatment with an antibiotic.

Continue reading "The Treatment of Pressure Sores, Bed Sores and Decubitus Ulcers Is More Difficult Than Prevention says Nursing Home Abuse and Neglect Lawyer Steven Peck" »