California Elder Law Attorney Blog

Bed sores are ulcers with various potential examples of severeness, appearing on human bodies. Decubitus ulcers by nature, these types also known as as pressure sores. The degree of this type of sore can vary among a gentle light red temporary place on our bodies which will get taken out inside of a couple of hours of removing the pressure to glaring ulcers that pierce deep in the human body subjecting the particular inner bodily organs and also bone tissues. This type of sore can potentially become extremely painful, and people bedridden because of extented periods of illness, paralysis and fractured bones are even known to pass away through septic problems occurring as a result of severe bedsores. Thus, being familiar with and using the correct treatment of health in order to avoid and get rid of these types of ulcerous lesions on your skin is very vital.

Symptoms:

There are actually 4 levels of a bed sore based upon the level of severity. The levels happen to be formally indexed by the National Pressure Ulcer Advisory Panel. The phases are the following.

Level 1: The sore begins showing up as being a prolonged pink or reddish skin. It may itch or perhaps hurt, and also a touch on this area may well feel padded and warm.

Phase 2: Skin loss begins taking place - the external and also inner layers of the skin start getting lost - and also the pressure sores begin resembling blisters.

Level 3: The bed ulcer now will go deep directly into the tissues below the skin. A new hollow wound is clearly visible. By at this moment it really is quite painful.

Level 4: Chances are there may be destruction of underlying muscles as well as probable exposure of bones. The ulcer now is in very progressed stages.

Causes:

Bed sores develop from maintained pressure applied to a particular area of one's body. They're normally seen to occur a lot more above the portions having bones as well as cartilages. The principal factors behind these chronic wounds are the following.

Pressure: Sustained pressure put on some parts of the body is one of frequent cause of catching these ulcers. This particular occurs most often within instances where the patient is immobile. Good examples of immobility are fractures and paralyses, to name a few. The tissues under constant pressure get deprived of the desired levels of nutrients including oxygen. This leads to bed sores.

Friction: Friction happening often enough at given areas of one's body can potentially bring about these ulcerous wounds. Switching side-to-side constantly and skidding down the wheelchairs are some primary sources of harmful friction.

Prevention:

They say, prevention is better than cure. Your best option to safeguard yourself against decubitus ulcers is to protect yourself. Presently there are products specifically created for these purposes. The exact device to use depends upon the actual depth and stage of the ulcer, including its level of seriousness as well as position of the sore wound on the body. Generally, medical insurances cover the price of such devices - but it is best to double-check with your insurance provider before you commit.

Last but not least, disregarding bed ulcers can lead to severe complications. This includes but is not limited by cellulitis, sepsis, joint infections, bone issues and even cancer. Therefore it is critically essential that you take ample preventive measures in order to save yourself from bed sores.

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One of the most serious issues facing the elderly today is abuse by their caretakers. This harm can take the form of physical, emotional, sexual, neglect or exploitative abuse. Unfortunately, the elderly are often exploited, especially if they're mentally susceptible to manipulation or confusion. Although physical signs of abuse may be the most obvious, personality changes can also be a sign that abuse is happening. You should always keep your guard up for possible red flags indicating an abusive situation. In the event that you suspect your elderly loved one is the victim of elder abuse, you may need the help of California Elder Abuse Attorney Steven C. Peck in order to get proper compensation.

More than 7.3 million older Americans -- one out of every five citizens over the age of 65 -- have been victimized by a financial swindle. Elder abuse is found in all socioeconomic and ethnic populations and as more baby boomers age, the problem is getting worse. It is everyone's moral responsibility to care about these at-risk residents.

What is elder abuse and neglect?

Elder abuse, as defined by the National Center on Elder Abuse, refers to intentional or neglectful acts by a caregiver or "trusted" individual that lead to, or may lead to, harm of a vulnerable elder. Physical abuse, neglect, emotional or psychological abuse, verbal abuse and threats, financial abuse and exploitation, sexual abuse, and abandonment are considered forms of elder abuse.

One single indicator may not necessarily point to abuse but again, according to the NCEA, any of the following may be warning signs of a problem:

-- Bruises, pressure marks, broken bones, abrasions and burns may indicate physical abuse, neglect or mistreatment.

-- Unexplained withdrawal from normal activities, a sudden change in alertness and unusual depression may indicate emotional abuse.

-- Bruises around the breasts or genital area can occur from sexual abuse.

-- Sudden changes in financial situations may be the result of exploitation.

-- Bedsores, unattended medical needs, poor hygiene and unusual weight loss are signs of possible neglect.

-- Behavior such as belittling, threats and other uses of power and control by spouses may indicate verbal or emotional abuse.

-- Strained or tense relationships and frequent arguments between the caregiver and elderly person are also signs.

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Continue reading "Financial Elder Abuse: The Ultimate Elder Swindle" »

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A. Assisted Living v. Nursing Home Care

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

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

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

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

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

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

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

B. Evaluating the Assisted Living Case

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

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

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

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

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

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

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

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

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

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

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

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

C. Theories of Liability

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

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

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

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

D. Other Theories of Liability

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

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

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

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

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

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

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

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

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

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

What Constitutes Elder Abuse and Neglect?

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

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

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

What Can You Do?

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

Continue reading "What Constitutes Elder Abuse and Neglect" »

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

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

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

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

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

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

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

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

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

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

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

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

Decubitus ulcers/bed sores aka Pressure Sores afflict patients inside hospitals throughout the world. Various means of reducing bedsores have be tried, from frequent turning to synthetic padding, however medical research have shown that 1 of the a large amount effective means of reducing the occurrence of bedsores is the utilize of natural sheepskin padding. indicates Los Angeles Bed Sore Attorney Steven C. Peck.

Bedsores build up as a result of constant pressure on certain parts of the body, a large amount commonly the bony protuberances such as elbows and heels. On traditional mattresses, these points approach to bear inordinate amounts of corpse weight, because a large amount beds lack the pressure distribution properties of memory foam or additional extra advanced materials.

Bedsores occur when the blood supply to the capillaries is restricted inside excess of a period of time. Bedsores be too called pressure ulcers. Since the unique character of memory foam is it's ability to melt away from anywhere that pressure is applied, divan sores be reduced or eliminated.

Bed ridden patients inside nursing house or assisted living facilities build up divan sores that be able to facilitate their demise. Paraplegics and quadriplegics build up localized pressure sores that be able to instigate life-threatening infections. Situations that impede circulation such as complications following surgery, congestive heart failure, rheumatoid arthritis, peripheral ulcers, vascular disease, and traumatic injury assist cause wounds.

Bed sores be too known as pressure sores, pressure ulcers, decubiti, or decubitus ulcers. They start as red, painful areas on the skin (often the legs and backside) and might twist purple or still black if undetected or untreated. In a number of cases, divan sores be able to lacerate and become infected, causing further medical problems.

Bed sores pretense a threat to anyone facing extended periods of divan relax or divan confinement, or anyone who is immobilized or handicapped. Bed sores build up as a result of constant pressure on certain parts of the body, a large amount commonly the bony areas such as shoulder blades, hips, heels and elbows . Other factors that contribute to bedsores include excessive moisture from sweating and friction from rubbing next to the lower sheet.

Additionally, memory foam have be widely used inside hospitals and rehabilitation centers across the nation for recovery from debilitating injuries, major surgeries and for extended term care because it prevents some divan sores or additional problems inside the middle of public who have to wait inside 1 position for a extended occasion to heal.

The perfect cushion is a preventive of "bed sores" which perform not necessarily approach from a divan however rather the chaffing of skin next to a surface, and by means of inactivity of the body, the blood flow to these skin surfaces be slowed and result inside skin lesions.

Check the person's corpse for divan sores and additional injuries and inquire questions if anything seems suspicious. If the behavior continues, file a complaint and locate another facility.

The warmth retaining properties of the foam makes pain extra bearable for a patient suffering from reverse injuries. Thus memory foam is too used inside medical treatments of patients developing "bed sores" and for public suffering from postural problems. Besides the utilize of memory foam inside a mattress, nowadays it is too used inside pillows, positional slumber aids, office furniture, automobile seat padding, footwear, infant cribs, automobile seats, helm chair cushions, computer carrying cases and a lot of more.

Continue reading "Decubitus Ulcers, Bed Sores, Pressure Sores Afflict Elders In Long Terms Facilities Throughout the World" »

Probably the most common type of elder abuse is shear neglect. This can easily be visible by bad hygiene, uncleanliness, and recurring illness. Watch for bed sores, abrasions, infection, weight loss, and an unkempt and unclean environment. Luckily neglect can usually be avoided by taking the time to do your research thoroughly when choosing the right nursing home. You can pay attention to the demeanor and health of the other tenants as well if you're concerned that something might be going on. Don't hesitate to ask about their living conditions. You might be surprised with what they have to say. Contact Los Angeles Elder Abuse and Neglect Attorney Steven C. Peck toll free at 1.866.999.9085 if you have questions on the kind of action you should take.

Estimates for the frequency of elder abuse in the general population range from 2 percent to 10 percent as the number of elders (generally defined for research purposes as people over 65) who suffer some form of elder abuse says Los Angeles Elder Abuse Attorney Steven C. Peck.

Elder Abuse is Underreported
The variance of those figures depends to a large extent on how information is gathered and measured, but one point of agreement among most researchers is that elder abuse is significantly underreported.

For every case of elder abuse, neglect, exploitation or self-neglect that is reported to authorities, about five more go unreported, according to the National Center on Elder Abuse.

Incidence of Elder Abuse Could Be Much Higher
Yet, even that startling figure may be low. Other sources place the ratio of unreported to reported elder-abuse cases as high as 14-to-1 for elder abuse in domestic settings, excluding self-neglect, and 25-to-1 for cases of elder abuse defined as financial exploitation.

Aging Population Expected to Increase Risk of Elder Abuse
A 2008 study sponsored by the British Geriatrics Society concluded that one in four vulnerable elders are at risk of abuse, and only a small proportion of the abuse is detected. As the population ages, and the number of people over age 65 worldwide continues to grow, the incidence of elder abuse is expected to increase.

Continue reading "Elder Abuse is Severely Under Reported" »

According to the National Institute on Aging, there were an estimated 1.5 million nursing home residents in 2004 alone. In the last couple of years, these numbers have increased significantly. While nursing homes can provide a useful service, it has sadly become a source of fear for some residents. Elder abuse has become a widespread problem in the long term care facilities, assisted living centers, and other residencies designed to protect the elderly.

However, residents and the family of these persons do have rights and legal options to pursue which may include both criminal and civil action. This is why it is so important that a personal injury lawyer be consulted when and if an individual believes a loved one is being subjected to abuse by a caregiver. Elder abuse is preventable and should not be tolerated. If a parent needs long term care, there are a few simple things that can decrease the chance of abuse.

Investigating the facility and speaking with some of the other residents and their family before choosing a nursing home is always a good idea. Take time to visit the facility. Is it well staffed? Statistics indicate that elder abuse is more prevalent in nursing homes with staffing issues.

Does someone take the time to listen to your concerns and answer any questions that you may have? These are just a few of the things that should be considered before placing a parent in a nursing home. If you don't feel comfortable with the facility, you may want to move on. Finding suitable arrangements for an elderly parent does not however, does not mean that abuse will not occur.

There are various types of elder abuse that may take place. Some of the most common types of abuse can include both physical and emotional abuse, neglect, and stealing from the resident. At times, signs of the abuse may seem obvious, while in other instances it may not be as noticeable. Recognizing the signs of abuse and neglect of an elderly parent can make a difference.

Visit often and take note of how your parent behaves in the presence of staff. Fear, anxiety, and unexplained bruising are only a few warning signs. If you believe that your parent is being abused in any manner, speak out. Immediately removing the resident from danger, contacting the family law lawyer, and the local ombudsman should be the first steps taken.

The facility should be held accountable for their actions. As the population of seniors increase, so does the need for quality care free from abuse and neglect. Utilizing legal options not only protects the victim, but can help prevent abuse from happening to someone else. A personal injury lawyer can help the abused resident and the family get the entitlement that they deserve and help put a stop to abuse and neglect at the hands of a caregiver.

If you are in the Southern California area be sure to contact Steven Peck's Premier Legal toll free at 1.866.999.9085 to talk to experienced California personal injury lawyers for effective representation when you are injured.

A lawsuit accusing a Hammond hospital of negligent care including failure to change medical tubing and letting bedsores become infected, has been transferred to the U.S. District Court in Hammond.

The suit claims that Select Specialty Hospital, a long-term acute care center located inside St. Margaret Mercy Hospital, failed to properly care for Aubrey Rawlins, who stayed there from April 22, 2005, to June 14, 2005, when he was recovering from pneumonia.

Rawlins' stay was supposed to last just two weeks but extended to six when his health became worse, according to the lawsuit.

He was eventually moved to another hospital and eventually died, although the lawsuit does not say when. His wife, Sarah Rawlins, filed the suit on his behalf in the U.S. District Court in Chicago, but the judge transferred it to Hammond because she said the court lacked jurisdiction.

Sarah Rawlins, of Markham, Ill., says in the lawsuit that Select made numerous errors, including giving her husband aspirin and Tylenol when he was on an anticoagulant, a drug combination that caused rectal bleeding. That led to two surgeries and several blood transfusions because he had lost so much blood, the lawsuit says.

Nurses failed to turn him, and he developed bed sores that went all the way to the bone, according to the lawsuit. Rawlins' arm and genitals started to swell a month into his stay, and his wife discovered his catheter hadn't been changed since his admission three weeks before, Sarah Rawlins says in the suit. When he was moved to another hospital, he was diagnosed with having a staph infection in his bedsores and lungs, according to the lawsuit.

Other charges blame hospital employees with leaving dirty linen and clothes on his room's floor and at one point failing to hang a glucose bag, which caused Rawlins, who had diabetes, to become semi-comatose.

Sarah Rawlins has also filed a charge with the Indiana Patient Compensation Fund. According to its Web site, one doctor found evidence to support malpractice although two others found against malpractice.

The case is still open.

Sarah Rawlins is asking for a jury trial and compensation for her husband's pain and suffering.

Continue reading "Lawsuit Alleges Bedsore Infection Leading to Staph Infection" »

It's a scenario heard frequently by elder abuse experts. The son (or daughter) who has been given power of attorney starts cutting back on his mother's expenditures even though she has enough money to continue living as she had been. He decides where she lives and who she sees. He sells some of her favorite possessions. And as her on-hand cash declines, his swells. At the same time, new codicils to her will reduce the amount she had originally left to others and increase the amount for

Unintentionally, says her grandson Philip Marshall, Brooke Astor's greatest legacy may be as someone who raised awareness of elder abuse. Last October, when he was 85 years old, Astor's son (and Philip's father), Anthony Marshall, was convicted on 14 of 16 charges that included grand larceny, criminal possession of stolen property, forgery, scheming to defraud, falsifying business records, offering a false instrument for filing and conspiracy. He was sentenced to one to three years in prison, and the case is on appeal.

Astor died in 2007 at age 105. She had been diagnosed with Alzheimer's in 2000, and in 2002 Philip Marshall, a professor of architectural preservation in Rhode Island, became concerned that his father might be taking advantage of Astor's frail, confused state. The first hint was the missing $10 million painting, "Flags, Fifth Avenue" by artist Childe Hassam, which Astor had initially promised to the Metropolitan Museum of Art. Anthony Marshall sold the painting, reportedly with Astor's agreement because he had told her they needed the money, and then pocketed a $2 million fee for himself.

Philip Marshall was the keynote speaker recently at an all-day "Call to Action" in San Francisco hosted by the Elder Financial Protection Network. He said it was the first time since the December conviction of his father that he had spoken publicly about the case and his attempts to intervene in the care -- or lack of it -- his father was providing Brooke Astor. "All it takes for elder abuse to flourish is for family and friends to do nothing," he said, noting that difficult as it was to go against his father, he felt he had no choice.

After Philip Marshall noticed the missing painting, he started paying more attention to what was happening at Astor's Park Avenue duplex. Staff also took him aside, telling him that his grandmother was being denied access to medication and doctor's visits as well as to her beloved dogs and some of her friends. In order to save money, her son was even changing the products she had been buying for decades, staffers said. In addition, Anthony Marshall, a theatrical producer, fired the chauffeur, the butler and Astor's lawyer of 50 years and closed her New York country house, Holly Hill, where she had said she wanted to die. Philip took note and started keeping records of the reports. It was not until 2006 that he sought out Rockefeller and Annette de la Renta to help get better care for his grandmother. They hired a law firm that filed Philip's petition seeking a guardian to care for his grandmother. Before the case went to court, Anthony agreed that de la Renta could take over as guardian and he agreed to return $11 million in money, jewelry and art.

It wasn't just that his grandmother's money was being taken by his father, Philip says. "If my father and his wife had simply taken money and property of hers but provided for my grandmother, this story might be different." But the greed of his father, he added, came at a psychological and physical cost to his grandmother who was increasingly confused, frightened and in declining health. And she didn't understand why her staff, including her loyal, long-time butler, had disappeared. She assumed he must have died.

Elizabeth Loewy, the assistant district attorney who prosecuted the criminal case against Anthony Marshall, told the conference that while the Astor case may be unusual in its celebrity and amount of money at stake, it typifies what is a skyrocketing threat against elders -- financial exploitation. Jenefer Duane, founder and CEO of the San Francisco-based Elder Financial Protection Network (EFPN), concurred. "In today's economic climate, elders are at greater risk than ever of being targeted for fraud and financial abuse," she said.

According to a recent Metropolitan Life study, "Broken Trust: Elders, Family and Finances," seniors lose $2.6 billion a year to financial abuse. And for every known case of abuse, it is estimated that four or five cases may go unreported. Typically, those who exploit the seniors are not strangers and the exploitation and abuse can come in many forms: fraud, scams (on the Internet and off), undue influence, abuse of powers of attorney and guardianship, identity theft, failure to fulfill contracted health care services and Medicare and Medicaid fraud. Financial abuse of elders is the third most commonly substantiated type of elder abuse, according to the report, following neglect and emotional and psychological abuse. "And the problem appears to be growing," the report states.

"Raising awareness is key to confronting the problem of elder financial abuse, and I hope the visibility my grandmother gave to the issue becomes her lasting legacy," said Philip Marshall.

How elders can avoid scamsThere was no shortage of horror stories at the Elder Financial Protection Network's 6th Annual Call to Action event in San Francisco:

A young man sells a 75-year-old woman an expensive vacuum cleaner and comes back weeks later and asks to use the phone. He ties her up with duct tape, stuffs her in her own car, beats her repeatedly, makes charges on her credit card during her 26 hours in the trunk and has plans to kill her. She is found when an alert sheriff's deputy follows the car and stops it for running a red light.

A Las Vegas waitress befriends an elderly customer and then tells him the sad tale of her life. The customer gives her a $500 check. In conversation, she also gets his date of birth and his Social Security number. Eventually, she gets $750,000 through use of the identifying information she has coaxed out of him.

A caregiver starts out working at a house a couple of hours a day and then says he could give better care by moving in. He gains the homeowner's trust by cooking, cleaning, taking care of whatever needs doing. Eventually -- in this case, it was several years -- he controls the finances, takes title to the house and cleans out the bank accounts.
"It can happen to all of us," says Cynthia Healy, president and founder of Security Financial Advisors Inc. in Monterey. She'd like seniors to remember the acronym, SCAM:

S -- Surround yourself with family and friends. Do not isolate yourself.
C -- Caregivers. Do your own checks of caregivers even if they come from an agency.
A -- Ask for assistance from professionals such as accountants, attorneys, bankers, doctors. Build a team so there are checks and balances.
M -- Maintain security over your personal information.

Paul Greenwood, head of Elder Abuse Prosecutions for the San Diego District Attorney's Office, successfully prosecuted the young man who kidnapped the 75-year-old woman on charges of attempted murder, torture and kidnapping. An international speaker on elder abuse, he offers 10 tips for avoiding financial elder abuse:

Choose a caregiver with caution and make your own checks even if the caregiver comes from an agency.

Keep an inventory of all jewelry.

Use a shredder for everything with your name, address or any other identifying information on it.

Protect your incoming and outgoing mail.

Do a credit search on yourself at least two or three times a year.

Install caller I.D. to determine if a call is private or unknown and don't be afraid to hang up or use a whistle you keep by the phone.

Remember: You will never, ever win a foreign lottery.

Consider letting your bank send a duplicate of your monthly statement to a trusted family member or an accountant or attorney.

Don't assume that people doing work on your home are licensed. Check and also get three estimates in writing and a written contract.

Have a second line of defense, such as a locked screen door or a security chain guard, at your front door.

Continue reading "Elders Are Easy Targets For Fraud and Financial Elder Abuse" »