California Elder Law Attorney Blog

Methicillin-resistant Staphylococcus aureus or MRSA is staph infection that has become immune to many types of antibiotics. Staphylococcus aureus is a common bacteria that lives on our skin and, most of the time, causes no ill effects. The problems begin to happen if there is a break in the skin - through a cut, a puncture, or some other opening - that allows the staph to enter into the body.

Unchecked MRSA may develop into sepsis. Sometimes called blood poisoning, sepsis is the body's often deadly response to infection or injury. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival.

Worldwide, one-third of patients who develop sepsis die. Almost 20% of patients who develop sepsis after surgery die. Many who do survive are left with organ dysfunction and/or amputations. (What is the prognosis (outcome) with sepsis?)

There are two types of MRSA infections: community acquired (CA) and hospital acquired (HA). Hospital-acquired infections of any type are called nosocomial infections. The most common type is HA-MRSA, but CA-MRSA is becoming more common.

MRSA infection can also cause pneumonia. This must be treated as quickly as possible to help avoid serious complications.

Continue reading "Sepsis and MRSA A Lethal Combination For Disaster says Nursing Home Abuse and Neglect 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" »

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

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

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

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

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

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

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

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

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

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

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

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

Dehydration, depending on the severity, sometimes creates only small telltale signs while having a big effect on the body, especially in the elderly.

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

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

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

Complications of dehydration may occur because of the dehydration, and/or because of the underlying disease or situation that causes the fluid loss.

Kidney failure
Kidney failure is a common occurrence, although if it is due to dehydration and is treated early, it is often reversible. As dehydration progresses, the volume of fluid in the intravascular space decreases, and blood pressure may fall. This can decrease blood flow to vital organs like the kidneys, and like any organ with a decreased blood flow; it has the potential to fail to do its job.

Coma
Decreased blood supply to the brain may cause confusion and even coma. If enough organs begin to malfunction, the body itself may fail, and death can occur.

Shock
When the fluid loss overwhelms the body's ability to compensate, blood flow and oxygen delivery to the body's vital organs become inadequate and cell and organ function can begin to fail.

Heat-related illnesses and associated complications
In heat-related illness, the body's attempt to cool itself by sweating may cause dehydration to the point that muscles may go into spasm (heat cramps). It is often the muscles that are being stressed that will spasm (for example, in people who work outside in a hot environment, arm and leg muscles may spasm from lifting and moving heavy objects or equipment; in athletes, leg muscles may fail from running). As fluid loss increases, the patient may be so dehydrated that there is not enough water to sweat and heat exhaustion or heat stroke may occur. Heat stroke is a true medical emergency and 911 or the Emergency Response System should be activated immediately in this situation.

Electrolyte abnormalities
In dehydration, electrolyte abnormalities may occur since important chemicals (like sodium and potassium) are lost from the body through sweat. For example, patients with profuse diarrhea or vomiting may lose significant amounts of potassium, causing muscle weakness and heart rhythm disturbances. The health care practitioner is often aware of the fluid and electrolyte balance in the dehydrated patient and may decide to monitor electrolyte levels by checking blood tests. Some examples of symptoms caused by abnormal electrolyte levels include muscle weakness due to low potassium, heart rhythm disturbances due to either low or high potassium, and seizures due to low (hyponatremia) or high sodium. In many patients with dehydration, the kidneys are able to compensate and regulate electrolyte levels.

It is reasonable to remember that dehydration does not occur quickly, and sometimes it may take hours to slowly correct the fluid deficit and allow the electrolytes to redistribute themselves appropriately in the different spaces in the body. If rehydration is done too slowly, the patient may remain hypotensive and in shock for too long. If done too quickly, water and electrolyte concentrations within organ cells can be negatively affected, causing cells to swell and eventually die.

Continue reading "What Are The Complications of Dehydration?" »

Infections are very common in the setting of long-term care facilities and
represent a major cause of morbidity and mortality among institutionalized
elderly individuals in nursing homes indicates Van Nuys Nursing Home Abuse and Neglect Attorney Steven Peck.

Some characteristics specific for the setting of a nursing home favor the spread of infectious diseases. Residents are clustered in a confined living arrangement and daily activities often take place in groups.

Some residents are cognitively impaired and unable to follow basic hygiene
precautions. Caregivers are often inadequately trained and may have little
knowledge of the fundamental principles of infection control. As a consequence,
adherence to hand washing in particular and other universal precautions
is poor.

Moreover, understaffing is a common problem in nursing homes. Nursing home residents are particularly susceptible to infections because they are physiologically old and often have comorbid underlying diseases that predispose them to site-specific infections. It is often difficult to diagnose infections in the elderly. As a result, the diagnosis and treatment may be delayed. These host and setting related factors facilitate direct or indirect transmission of infectious diseases among the residents in nursing homes.

Continue reading "Dangerous Infections Are Very Common In Nursing Homes Indicates Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck" »

Disability Rights California, a non-profit advocacy organization mandated to advance the human and legal rights of people with disabilities, supports bill, SB 558.

Disability Rights California supports SB 558 because it will help prevent elder and dependent adult abuse. Elder and dependent adult abuse is an epidemic, which often goes unreported and unpunished. When it is reported, procedural delays and unrealistic legal standards make it difficult to prosecute, letting the perpetrators off the hook and allowing them to continue the abuse.

SB 558 will help prevent physical abuse of elderly and dependent adults by providing stricter civil enforcement of the Elder & Dependent Adult Civil Protection Act (EADACPA or the Elder Abuse Act). The current standard of clear and convincing evidence makes it nearly impossible to prosecute these crimes. This bill allows civil cases to be enforced using a preponderance of the evidence standard, a legal standard consistent with financial abuse cases and virtually every other civil cause of action says Los Angeles Elder Abuse Attorney Steven Peck.

With the growing senior population and recent budget cuts, it is more important than ever to prosecute the perpetrators of crimes against elders and dependent adults indicates California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Continue reading "Disability Rights of California Supports SB 558 Because It Will Help Prevent Elder Abuse and Neglect" »

The United States Census Bureau projected in 2000 that California's elderly population will have doubled by 2025 to 6.4 million - a larger growth rate than any other state says Woodland Hills Nursing Home Abuse and Neglect Attorney Steven Peck.

The California State Department of Finance claims that the number of California residents age 85 and older - those who are most likely to need nursing homes --- will nearly double by the year 2030, when the bulk of baby boomers will come of age.

In 2005, the Office of Statewide Health Planning and Development reported that one-fifth of California's nursing facilities did not meet state-mandated requirements for staffing levels.

In 2006, Centers for Medicare and Medicaid Services reported that twice as many of California's 115,000 plus residents are placed in physical restraints as are nationally.

From 2001 to 2005, the California Department of Health Care Services, found that two-thirds of all reported deficiencies caused or could have caused significant harm to one of more residents in nursing homes. More than half of all complaints in nursing homes are related to poor quality of care. Eighteen percent of substantiated complaints were related to mistreatment or abuse.

Together, these staggering statistics and projections illustrate the urgent need to address and remedy the poor quality of care in many of California's skilled nursing facilities says Peck Law Group Elder Abuse Lawyer Steven Peck.

Continue reading "California's Elder Population Will Double by the Year 2025 Says Los Angeles Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Nearly one-sixth of U.S. nursing homes are cited for deficiencies in infection control, according to a May study published in the American Journal of Infection Control says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck.

Researchers from the University of Pittsburgh Graduate School of Public Health analyzed records from 2000 to 2007 relating to the certification process nursing homes must accomplish before qualifying for payment from the Centers for Medicare & Medicaid Services.

The study, based on records representing 96% of U.S. nursing homes, found that infection control citations were linked to lower nurse staffing levels (www.ncbi.nlm.nih.gov/pubmed/21531271) . Nursing home infections kill 400,000 patients a year.

Continue reading "Infection Control a Major Problem In United States Nursing Homes Says California Nursing Home Abuse and Neglect Attorney Steven Peck" »

An understaffed nursing home can be hazardous to your health if you're a resident there. The latest evidence comes from a study conducted by researchers at the University of Pittsburgh's Graduate School of Public Health, published in the May issue of the American Journal of Infection Control (AJIC).

The study found "a strong correlation between low staffing levels and the receipt of an infection control deficiency citation" at nursing homes, according to a news release from the Association of Professionals in Infection Control and Epidemiology, publisher of APIC. And infections are the leading cause of death in nursing homes, according to the release, responsible for nearly 400,000 deaths per year says Nursing Home and Abuse Attorney Peck.

Inadequate staffing levels leave the people who are working with too much to do, and that seems to be what leads to the increase in infections. "With low staffing levels," wrote the authors of the study, "these caregivers are likely hurried and may skimp on infection control measures, such as hand hygiene."

The researchers found the percentage of nursing homes nationally that received deficiency citations for infection control from the Centers for Medicare&Medicaid Services (CMS) was 17.3% in 2007 -- more than one in six. And that percentage was up sharply from 12.9% in 2000. The increase comes as no surprise when you know the study also found a strong correlation between infection citations and nursing homes' for-profit status. Investment groups began gobbling up nursing homes over the past decade; CMS data shows the percentage of nursing home nationally that are operated as for-profits rose from 65.6% in 2004 to 67.4% in 2008.

As far back as 2001, a University of California, San Francisco study found "for-profit nursing homes are much more likely than their non-profit counterparts to be cited for deficient quality"; similar findings came from a federal study in 2008. (This 2007 New York Times story by Charles Duhigg describes how for-profit operators cut staffs after taking over non-profit nursing homes.)

Infection rates can be reduced all the way to zero, with proper procedures. But those procedures take time to execute. As Tina Rosenberg wrote on The New York Times' web site, hand washing "has to be done dozens or hundreds of times a day by busy health care workers who may be doing two or three things at once and have their hands full of supplies." It's harder to keep your hands clean when your workload is increased as the result of understaffing.

There are good reasons why California and other states have minimum staffing requirements for nursing homes -- and why there are penalties for failure to meet those requirements. The risk of spreading lethal infections is one of those reasons.

Continue reading "An Understaffed Nursing Home Will Be Hazardous to Your Health States Los Angeles Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Mr. Jones has several serious medical conditions. Due to the atrophy of his muscles from the chest down, he has very little cushion in his legs and buttocks to protect his feet, legs, coccyx (tail bone), and sacrum (lower back), which easily become bruised or affected by pressure sores.

Pressure (bed) sores are lesions caused by unrelieved compression of tissues between bone and surrounding surfaces. Bed sores are slow-healing and can be fatal if untreated. Proper treatment is to relieve pressure by turning the patient at least every two hours, and keeping the wounds free of bacteria and dead tissue (because bacteria grow in dead tissue and can greatly compromise wound healing). Mr. Jones also has edema (an abnormal accumulation of fluid beneath the skin) in his feet, which creates pressure that can exacerbate any bed sores. Treatment requires him to elevate his feet above his head at night in order to drain excess fluid.

Mr. Jones also suffers from severe spasticity--involuntary muscle contractions that cause lower-body muscles to jump and jerk. Because he has sensation down to his knees, his spasticity causes pain and interferes with sleep. The spasticity, which prevents Mr. Jones from sleeping completely flat, is treated by elevating both his legs and upper body with the aid of an adjustable hospital bed. In addition, he has an intrathecal pump under his skin that administers the drug baclofen directly into his cerebral spinal fluid (baclofen dampens the spasticity).

Continue reading "Lack of Care For Muscle Spasticity Causes Pressure (Bed) Sores and Infection Which Could Lead to Death Says San Diego Nursing Home Abuse and Neglect Lawyer Steven Peck" »

What is Urosepsis?

Urinary Tract Infection is how people generally define Urosepsis. However Urosepsis is actually a disease that is caused by an infection in the urinary tract. The condition involves a sepsis, or an accumulation of pus-forming bacteria or their toxins in the blood of the urinary tract. This leads to a poisoning of the blood and gives rise to severe health complications like damage of organs which can even cause death says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck.

In acute cases, the infection in the urinary tract spreads to the entire body.
Urosepsis Symptoms

Urosepsis is characterised by a number of symptoms. Some of these are externally visible while there are symptoms that can be felt only by the sufferer. As the definition of Urosepsis suggests, the symptoms mainly involve urinary problems. But there may be some other symptoms as well.

Continue reading "Urosepsis is Caused By a Urinary Tract Infection Which Can Cause Death In Elders" »

Sepsis is a life threatening blood infection that kills millions of people. In the United States, sepsis kills more than 200,000 people every year, taking the lives of more people than from lung and breast cancer combined indicates California Elder Abuse Attorney Steven Peck.

The cause of sepsis is by a bacterial infection that can originate anywhere in the body. Most commonly, the infection that is the cause of sepsis will start from the kidneys, the liver, the gall bladder, the bowel, the skin or the lungs. Bacterial infections that can be the cause of sepsis can also stem from intravenous lines, surgical wounds, surgical drains and sites of skin ulcers or bedsores. The high prevalence of sepsis is attributed to many different factors, one of them being the widespread nation-wide epidemic of nursing home abuse and neglect.

There are nearly 17,000 nursing homes in the United States that care for 1.6 million residents. This figure is expected to quadruple to 6.6 million residents by 2050. Under qualified, under trained, underpaid and understaffed nursing home workers, sometimes with previous records of abuse and/or neglect, caring for the million plus residents in need of specialized care has proved inadequate. Severe bedsores being the cause of sepsis, and sometimes death, continue to be reported among other serious violations.

Continue reading "Sepsis Kills Millions Of People and Is Attributable To Nursing Home Abuse and Neglect" »

Elder abuse is defined as any form of mistreatment (resulting in injury or loss) against an elderly person. There are several types of elder abuse.

Physical abuse happens when someone uses force to cause bodily injury or pain and includes battery and assault. Improperly restraining or drugging an elderly person is also considered physical abuse.

Sexual abuse occurs when an elderly person is raped or otherwise sexually assaulted without their consent. It can also happen when porn or other sexually explicit materials are shown to elders against their will, or when the elder is forced to watch sex acts between other people.

There are several other ways elders can be abused. For example, elder neglect (failure to attend to physical care needs) can be considered a form of abuse. This can happen intentionally, or because the caregiver is unaware of or in denial about the level of care the elder needs. Neglect happens very often in Skilled Nursing Facilities based upon the negligent failure to provide for a patient's medical needs says San Francisco Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Health care fraud is another form of elder abuse, in which the nursing home charges for services not rendered or overcharges for services performed. This can also happen when elders' meds are stolen or misreported to insurance companies.

It's also important to keep a close eye on your elderly relative's finances during their stay in a nursing facility. Some corrupt nursing homes or employees attempt to financially exploit the elderly. They may steal checks, credit card numbers or even their entire identity for illegal purposes. Nursing home employees also have been known to ingratiate themselves with elderly residents to attempt to be put into their wills or to forge signatures on documents to obtain money, goods or services in the resident's name.

Continue reading "San Francisco Nursing Home Abuse and Neglect Attorney Steven C. Peck Indicates Elder Abuse is Increasing" »

Sepsis is a severe illness caused by infection of the bloodstream by toxin-producing bacteria. Sepsis can begin from any site of infection , including such common sources as urinary tract infection, pneumonia, and open wounds such as bedsores and cellulitus. Without timely and appropriate treatment, sepsis can result in death.

Statistics

This year in the U.S.

* Sepsis will occur in 2 of every 100 hospital admissions
* Approximately 400,000 men and women will develop sepsis
* Approximately 100,000 men and women will die from sepsis
* Septic shock will be the most common cause of death in intensive care units
* Septic shock will be the 13th most common cause of death

Signs and Symptoms of Sepsis

The signs and symptoms of sepsis arise differently depending on the nature of the underlying source of infection. For example, if sepsis begins with a bed sore, there may be such signs as inflammation, redness, and infection of the bed sore and surrounding area. If sepsis begins with a urinary tract infection, there may be flank pain and difficulty with urination. As sepsis progresses, more signs and symptoms will become noticeable, including:

* Fever or hypothermia (low body temperature)
* Hyperventilation
* Chills
* Shaking
* Inflammation
* Rapid heart beat (tachycardia)
* Confusion or delirium
* Hypotension
* Lactic academia
* Progressive organ system dysfunction

If a patient reports to a doctor with signs of an infection and demonstrates symptoms such as those described above, the physician should conduct appropriate tests to rule out sepsis.

Diagnosing Sepsis

There are a number of tests that can be ordered to determine whether sepsis is present when a patient presents with signs and symptoms that are consistent with sepsis. These include:

* White blood cell count that is low or high
* Platelet count that is low
* Blood culture that is positive for bacteria
* Blood gases that reveal acidosis
* Kidney function tests that are abnormal (early in the course of disease)
* Peripheral smear may demonstrate a low platelet count and destruction of red blood cells
* Fibrin degradation products are often elevated, a condition that may be associated with a tendency to bleed
* Blood differential -- with immature white blood cells seen

Treating Sepsis

Sepsis requires timely and appropriate treatment that generally requires monitoring in an intensive care unit (ICU), the removal of sources such as infected intravenous lines or surgical drains, surgical draining of sources such as abscesses, and "broad spectrum" antibiotic therapy. The type and number of antibiotics administered can be refined once blood cultures and other diagnostic testing identify the causative organism. Supportive therapy with oxygen, intravenous fluids, and medications that increase blood pressure may also be required for a good outcome. Further, dialysis may be necessary in the event of kidney failure, and mechanical ventilation is often required if respiratory failure occurs.

Complications from Sepsis

If not diagnosed and treated in a timely fashion, sepsis can result in severe complications. These include septic shock in which there is low blood pressure, low blood flow, and the failure of vital organs, such as the brain, heart, kidneys, and liver. Another complication is disseminated intravascular coagulation, a disorder of diffuse activation of the clotting cascade that results in the depletion of clotting factors in the blood. Sepsis can also result in death. The death rate can be as high as 60% for people with underlying medical problems. The longer diagnosis and treatment are delayed, the higher the likelihood of complication and death.

Continue reading "Sespis is a Severe Illness Caused By Infection of the Bloodstream" »