California Elder Law Attorney Blog

Those who are aged, unwell or who have mobility issues are the most at risk of developing bed sores. Bed sores are also commonly called pressure sores or pressure ulcers or Decubitus Ulcers.

For example, people at risk for Bed Sores, Pressure Sores also known as Decubitus Ulcers says Van Nuys Nursing Home Abuse and Neglect Attorney Steven C. Peck include those with:

Incontinence problems - The dampness caused by incontinence can make the skin susceptible to damage
Illnesses, for example diabetes, motor dysfunction, immune deficiencies and nutritional disorders
Dementia, which can prevent people recognising discomfort and regularly moving their bodies in the normal way.
Those who are in a wheelchair, chair or bed for the majority of the time.

Identifying bed sores, pressure sores and Decubitus Ulcers:

The following symptoms are signs that someone may have a Bed Sore, Pressure sore, Decubitus Ulcers says Woodland Hills Elder Abuse Attorney Steven C. Peck or be at risk of developing one:

Is the skin discoloured? Look out for red or purple-coloured skin
Sometimes pressure ulcers can have a foul odour
The area is likely to be redder and warmer than the rest of the body
There will often be swelling
Ask the patient if the area is painful to the touch
Sometimes pressure sores ooze pus

Preventing pressure sores, bed sores and Decubitus Ulcers:

It's important to prevent bed sores as far as possible as they can deteriorate in condition and cause discomfort. Here are some tips on keeping pressure ulcers at bay:

The patient's position must be shifted regularly - a minimum of once every two hours or every hour for very frail individuals. Someone needs to be on hand to do this if they can't move themselves around.
Eating a healthy diet can help prevent pressure sores
The skin must be kept as clean and dry as possible. Although the skin should be moisturised to prevent dryness, it should never be wet to the touch.
Incontinence pads should be used if the patient is incontinent. They should be changed regularly.
If you're not a medical professional, consult a doctor or nurse if you think that pressure sores may be developing.
Use specially designed sheets, pillowcases, underwear and bootees which are designed to avoid friction and shear on the skin and tissue.

Treating pressure sores, bed sores and Decubitus Ulcers:

When you treat pressure sores, you want to avoid the ulcer becoming any worse.

Make sure pressure is relieved from pressure points at regular intervals - keep moving the patient every hour or so
Encourage the patient to keep pressure off vulnerable areas such as knees, elbows and hips.
Keep wounds clean and dry
Use non friction and anti-shear dressings so that there is no drag or rub on the wound

Johnnie was 77 years old when she was treated at Marshall Hospital for pneumonia. She recovered and went to El Dorado Care Center in Placerville for physical therapy to regain her strength, then go home.

But two weeks into her stay in the nursing home, her health had deteriorated. She was rushed back to the hospital, where she died in 2008.

"If she had received proper care, she would still be alive today," says Encino Nursing Home and Abuse Attorney Steven C. Peck.

He sued El Dorado Care Facility and parent company Horizon West, which owns 27 nursing homes.

"She basically did not receive care. She was neglected, warehoused,"

Esco sued for elder abuse and wrongful death. The suit alleged the nursing home staff failed "to provide basic custodial and nursing care services, a failure to assess and treat her pain and a failure to prevent Mrs. Esco from developing a severe and life-threatening bowel impaction."

It also alleged that Horizon West "failed to staff El Dorado Care with sufficient numbers of trained and supervised caregivers."

In taped depositions, employees say they were understaffed.

Horizon West spokesman Dan Niccum would not comment on the Esco case, citing the Health Insurance Portability and Accountability Act and company patient privacy policies.

He did talk to KCRA 3 about overall patient care and staffing.

"It's our position that, in all instances, and it's our goal in every facility, that every resident receives appropriate and timely care," he said.

Niccum said since 2005, Horizon West has exceeded state minimum required staffing levels and is implementing quality improvement changes.

But Clement said her research shows Horizon West increased its acuity levels, accepting more of the sickest and most expensive Medicare patients, while at the same time, decreased the nursing staff qualified to care for them.

She said Horizon West puts profit above patient care.

"That is probably the most ridiculous statement that you could make about Horizon West," Niccum contended.

He said Horizon West has lost money in the past five years.

"I have a real issue with the portrayal of Horizon West as a greedy corporation, which it is not. Or B, being a corporation that doesn't care, because that is all we are about. We are a company that cares," Niccum said.

Esco and Horizon West settled the lawsuit out of court. They won't say for how much, but KCRA 3 is told the nursing home paid a significant amount of money to Esco.

The California Department of Public Health licenses and regulates 1,200 nursing homes statewide.

It also investigates complaints.

It released findings in the Esco case in April, finding El Dorado Care Center failed to consult with a physician and notify the patient's family when her condition worsened, failed to ensure prompt care and its staff failed to properly administer medications.

The public health department can cite and fine nursing homes; the most serious violations involving patient deaths draw fines up to $100,000.

In the Esco case, the state fined El Dorado Care Center $18,000.

"My wife's death was ruled unwarranted, but the facility was fined $18,000. That is ridiculous," Esco said.

The public health department issued a statement saying "The violations... while severe and likely to cause harm and possibly death to the patient, could not be isolated as the direct cause of death in this case."

It said it "levied the highest fine the law allowed."

Carole Herman, with Foundation Aiding the Elderly, is appealing the decision.

"She definitely died from the lack of care at this convalescent hospital, and the state did not give them the proper citation," Herman said.

Niccum said "the people who work in this facility today, are members of this community. They care about what goes on in this facility. They are in this industry because this is what they love to do."

KCRA 3 reviewed state records related to Horizon West's 27 nursing homes. In the past five years, the public health department has issued 195 citations, totaling $700,000 in fines.

Niccum said, as the largest skilled nursing provider in the Sacramento area, the numbers aren't surprising.

"Our entire team focus every day is on improving the quality of care we provide our residents," he said.

But advocates and Esco believe even one citation is too many.

Dermatological diseases in psychiatric patients are common; however, epidemiological data on this subject are scarce and to our knowledge integral studies of dermatological disease in psychiatric inpatients are not available yet.Aim The aim of this study was to describe the incidence of dermatological problems in psychiatric inpatients.Method This study evaluates the consultations for new dermatological problems by inpatients of a general psychiatric hospital of over 700 beds during a 6-month period.Results A total of 255 patients consulted their physician because of a new dermatological problem. Diagnoses (n = 360) included skin infections (32%), accidents (7%), decubitus ulcers (7%), complications of medical treatment (3%), auto mutilation (1%) and neoplasms of the skin (1%). Patients with skin infections were likely to have diabetes [odds ratio (OR) = 3.6; 95% confidence interval (CI): 1.56[ndash]8.40]. Patients with decubitus ulcers were likely to have an addiction problem (OR = 6.4; 95% CI: 1.46[ndash]28.00). Dermatitis was associated with affective disorder (OR = 2.5; 95% CI: 1.12[ndash]5.43) but not with psychosis (OR = 0.5; 95% CI: 0.23[ndash]0.90). Only a poor correlation existed between the length of hospital stay and skin problems.Conclusions Dermatological problems are common in hospitalized psychiatric patients. Patients with diabetes mellitus are at high risk for skin infections. There are significant relationships between the psychiatric and the dermatological diagnoses. The length of the admission to a psychiatric hospital does not seem to play a major role in skin diseases.

Continue reading "Dermatological Disease Such as Bed Sores, Infections, etc.. In Psychiatric Patients Are Common" »

Bed sores are ulcers with diverse possible degrees of intensity, appearing upon human bodies. Decubitus ulcers by nature, these types often referred to as pressure sores. The severity of this type of sore ranges between a mild light red temporary place on our bodies which gets taken out within a couple of hours of removing the pressure to glaring ulcers which pierce deep into the human body exposing the particular internal bodily organs as well as bone tissues. This manner of sore could very well be incredibly painful, and the ones bedridden as a consequence of extented periods of sickness, paralysis and broken bones are even known to die through septic conditions occurring as a result of acute bedsores. Thus, understanding and using the correct treatment of health to avoid and get rid of these ulcerous lesions is extremely vital.
Signs and symptoms
There are 4 levels of a bed sore depending upon the degree of severity. The degree happen to be formally classified by the National Pressure Ulcer Advisory Panel. The actual phases are the following.
Stage 1: The actual sore begins showing up like a prolonged pink or reddish skin. It may well itch or hurt, and also a touch within this vicinity may feel padded and warm.
Level 2: Skin loss begins occurring - both external and also inner layers of the skin start getting lost - and the pressure sores start resembling blisters.
Phase 3: The bed ulcer now goes deeply directly into the tissues underneath. A hollow wound is clearly visible. By at this point it really is quite painful.
Stage 4: By now there is damage to underlying muscles and also potential exposure of bones. The actual ulcer now is in extremely advanced stages.
Causes
Bed sores come from maintained pressure applied to a particular part of the body. These are typically seen to occur more above the portions possessing bones and cartilages. The leading factors behind these acute wounds are the following.
Pressure: Sustained pressure applied to some parts of the body is one of frequent reason for catching these ulcers. This particular happens most often within cases where the patient is immobile. Good examples of immobility are fractures and paralyses, to name just a few. The tissues under constant pressure get deprived of the specified levels of nutrients such as oxygen. This can lead to bed sores.
Friction: Friction happening often enough at given areas of the body could bring about these ulcerous wounds. Switching side-to-side constantly as well as skidding down the wheelchairs are some primary sources of harmful friction.
Prevention
They say, prevention is preferable to cure. Your better option to protect yourself against decubitus ulcers would be to protect oneself. Presently there are products specially created for these purposes. The exact unit to use would depend upon the actual depth as well as stage of the ulcer, including its level of severity and position of the sore wound on the body. Generally, medical insurances cover the price of such devices - but it is advisable to double-check with your insurance provider before you commit.
Last but not least, ignoring bed ulcers can lead to severe complications. Including but is not limited by cellulitis, sepsis, joint infections, bone issues as well as cancer. Therefore it is vitally important that you take adequate safety measures in order to save yourself from bed sores.

Continue reading "Bed Sores, Pressure Sores aka Decubitus Ulcers Can Be Septic Causing Death" »

While bed sores do not directly cause osteomyelitis, the open wounds that accompany severe bed sores leave many patients susceptible to infection. Osteomyelitis is an inflammation of the bones that is caused by bacteria. In adults, the most common types of osteomyelitis causing bacteria are S. Aureus, Enterobacter and Streptococcus. In cases of severe bed sores (also referred to as decubitus ulcers, pressure ulcers or pressure sores) the bacteria enters the body through the open wound and attacks the bone. Once the bone becomes infected, enzymes are released that restrict the bodies ability to heal. If left untreated osteomyelitis can spread into the bone marrow and surrounding joints says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

In order to provide the best prognosis, osteomyelitis must be identified as early on as possible. Early signs of osteomyelitis may be treated with antibiotics. More advanced cases may require surgical debridement. In severe cases of osteomyelitis, amputation may be required to prevent the infection from spreading. Sadly, the mortality rate for people with osteomyelitis related to bed sores is extremely high.

Continue reading "Open Wounds That Accompany Severe Bed Sores, Pressure Sores and Decubitus Ulcers Leave Many Elders Susceptible to Infection." »

Contractures are a medical condition where a joint is held in a fixed position due to the shortening of a muscle or tendon due to stress exerted on the muscle or spasticity (uncontrolled muscle movement). Older patients and those with limited mobility are especially prone to develop contractures. Contractures most commonly form in the hands, feet, arms and legs.

Once an individual has developed contractures, little can be done to alleviate the problem aside from aggressive orthopedic surgery. Consequently, medical facilities (hospitals and nursing homes) should provide physical and occupational therapy to people who are at risk for developing contractures and to keep the body flexible.

Once a person has developed contractures they are at a heightened risk for developing bed sores due to their bodies limited ability to move- with or without assistance. The rigidity that accompanies contractures generally means that many of the repositioning techniques commonly used to prevent bed sores may be unfeasible. As a general rule, the more immobile an individual is, the higher likelihood they have in developing bed sores.
(Taken from Jon Rosenfeld's wonderful elder abuse blog)

In early 2008, a resident was admitted to the Los Angeles nursing home in order to rehabilitate a fractured hip. The 84 year old resident died following the misplacement of a feeding tube. At the time the resident was admitted to the nursing home, he was noted as having no swallowing or chewing problems. After some weight loss, his doctor ordered feedings via nasogastric tube.

In what turned out to be a fatal mistake, staff inserted the tube through the residents nose, and it placed in the residents lung instead of stomach. Once feedings began, the lungs filled with the feeding materials that were meant to go to the stomach, making him sick at once. He succumbed to aspiration pneumonia three days later.

Hancock Park Rehabilitation, the facility where the incident took place, did not follow established protocols for inserting the tube, and did not check to make certain it was properly placed in the stomach, according to the report from the Department of Public Health. When the 84 year old patient was rushed to a hospital emergency room, it was revealed by a chest x-ray that the tube extended in to the lungs instead of the abdomen.

This isn't the first time Hancock Park Rehabilitation Center has received violations. The facility has a history of prior incidents, and in 2006 and 2008 received multiple violations related to improper care of patients.

Continue reading "California Nursing Home Fined $ 100,0000.00 Penalty for Resident's Death" »

The longest Humboldt County, California trial in recent memory continues with attorneys delivering closing arguments in the civil suit against Skilled Healthcare Group Inc. -- one of the largest nursing home chains in the country.

Lawyers for the plaintiffs detailed for the jury stories of a handful of patients being represented in the suit. Patients who they contend did not receive showers on a regular basis, walked around with catheters leaking and dragging on the ground, had wounds left untreated and were forced to sit in soiled bed sheets for hours or, in some cases, even days.

Attorney Michael Thamer specializes in fighting corporate abuse, and represented the plaintiffs in the closing arguments.

He made it clear to the court that the suit does not take any issue with how hard the staff members at various Skilled Healthcare facilities are working -- but that the number of them is simply not enough to provide the necessary care for patients.

"In my opinion, they (staff members) are set up to fail before they even start," said Thamer.

Once the closing arguments are complete, the jury will deliberate and decide if Skilled Healthcare is guilty of intentional misconduct. The suit, which spans from 2003 to 2009, represents some 32,000 patients who lived at various Skilled Healthcare facilities statewide.

The issue at the heart of the case is whether or not the nursing homes maintained the staffing levels required by the state.

California law mandates that nursing homes provide a minimum of 3.2 hours of care per resident, per day. This is only the services defined as direct patient care, and includes work by registered nurses, licensed vocational nurses and certified nursing assistants.

Michael Crowley, a Eureka attorney who has worked on the case with Thamer since last November, said that Skilled Healthcare routinely failed to meet these levels.

"Each person represented in the case did not get what they paid for," said Crowley, who added that this includes taxpayers who pay into the Medicare and medical system. "They (Skilled Healthcare) are taking money for something they did not provide."

Crowley said up to 80 percent of funding for patients living in the facilities comes from Medicare. He said that in investigating the daily work logs at various facilities, the attorneys for the plaintiffs found a pattern of understaffing.

Along with subsidiary Skilled Healthcare LLC, Skilled Healthcare Group Inc. is being named as the defendant in the case, with 22 of its nursing homes currently under close scrutiny.

This includes Eureka facilities Granada, Seaview, Pacific and Eureka Healthcare and Rehabilitation, as well as St. Luke Healthcare Rehabilitation Center in Fortuna. In the first quarter of 2010 alone, Skilled Healthcare reported over $188 million in revenue.

"We are trying to send this corporation a message," said Crowley. "They need to care more about their patients and less about their bottom profit line."

More than 32,000 people are represented in the case, including two locally who were named on the case and have since passed away. Vinnie Lavender was 102 when she died at the Grenada facility in Eureka; and Robert Vilchinsky was a patient at St. Luke Healthcare and Rehabilitation before he died from complications associated with multiple sclerosis. Both were represented in court by family members.

The Humboldt County District Attorney's Office intervened in the lawsuit, and has been largely a bystander in the case from the start. District Attorney Paul Gallegos said that his office is planning to file an injunction against the defendant later this week that would order Skilled Healthcare to be in compliance with the law in the future.

Gallegos said the penalties, depending on how the court interprets them, could amount to up to $2,500 for each infraction. If you multiply this by the number of patients represented in the case, Skilled Healthcare is looking at a possible 1.4 million violations.

"It's been a long-term problem," said Gallegos. "There is overwhelming evidence that the law has been broken."

Skilled Healthcare officials say the allegations that their facilities are understaffed are false, and that staffing levels should be set by each individual facility.

Kippy Wroten, an attorney with Wroten and Associates based out of Irvine in Southern California, is representing Skilled Healthcare in the case. Wroten said that she can't comment on specifics of the case because it is still ongoing.

"Our client strives to meet the individual needs of their patients," said Wroten. "They do a wonderful job under extremely difficult circumstances."

Wroten will have a chance to make her closing arguments today, which marks the 106th day in court for the trial.

(Reported by Matt Drange/The Times-Standard can be reached at 441-0514 or mdrange@times-standard.com.)

Decubitus ulcers are also called pressure sores or bed sores. They are caused by prolonged pressure on an area that lies just over a bone. The skin over the hip, tailbone, heels and elbows is often an area of pressure sore development. The pressure may be created by an object such as a bed or wheelchair. The pressure cuts off blood circulation to the area, and the tissue in the area may die if the person's position is not changed. People who are not able to move their bodies easily, such as those suffering from an illness, disability or weakness, are most susceptible to pressure sores states California Nursing Home and Abuse Attorney Steven C. Peck.

Older people often have thinner skin, fat and muscle layers than younger people and are therefore more susceptible to pressure sores. If someone is underweight or suffering from malnutrition he or she is more likely to develop pressure sores, since there is less fat to cushion the pressure on the bone. Friction created as a body part slides over the pressure area can also cause a sore. Moisture trapped in the area of pressure (such as moisture created from incontinence or perspiration) can cause the skin to break down. Some people with diabetes have circulation problems and are more prone to pressure sores.

Continue reading "Decubitus Ulcers Also Called Pressure Sores or Bed Sores Are Caused By Prolonged Pressure To The Bone" »

Under current Medicare guidelines, hospitals are no longer reimbursed for additional care resulting from pressure ulcers (also known as bed sores or decubitus ulcers) as the government has determined that development of bed sores at a hospital is a so-called "never event." Additionally, hospitals cannot bill patients directly for such care. The denial of reimbursement for such reasonably preventable treatment errors should provide hospitals with financial incentive to institute and implement appropriate patient safety measures geared toward preventing the development of bedsores.

While there has been discussion about extending this policy to include long term care facilities including nursing homes and assisted living centers, nursing homes are not presently subject to these guidelines. Nursing homes are therefore presently permitted to receive payment for care and treatment related to bedsores that develop in their facilities, while hospitals cannot. This writer firmly believes that these Medicare "never events" guidelines should be extended to include nursing homes and other long term care facilities so that these facilities will have the same financial incentive as hospitals do to improve patient safety measures relating to preventing the development of bedsores.

Like hospital patients, nursing home residents are often at risk for developing bedsores as a result of their underlying medical problems and/or mobility issues.

A pressure sore/decubitus ulcer is a bedsore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain. Patients experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points. Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection.

A stage 1 ulcer presents as redness of the skin without a break in the skin and represents tissue injury that does not disappear when pressure is relieved. A stage 1 ulcer is classified as nonblanchable erythema with intact skin. Erythema is redness of the skin produced by congestion of the capillaries. Erythema is the initial reactive hyperemia caused by pressure, and nonblanchable erythemia represents stage 1 pressure ulcer.

A stage 2 ulcer is characterized by partial-thickness skin loss, that is, the epidermis is interrupted as an abrasion, blister or shallow crater.

A stage 3 ulcer features full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia. The ulcer appears as a deep crater, with or without undermining of adjacent tissue.

A stage 4 ulcer involves full-thickness skin loss (exposing bone or muscle) with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).

Once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and potentially fatal complications. With stage 3 or stage 4 pressure sores, the extent of the disease may not be evident because of covering necrotic material or eschar. To establish the extent of the disease and promote healing, the necrotic material needs to be removed and surgical consultation may be required. When ulcers develop over bony prominences, osteomyelitis is a potential complication. Pressure ulcers are chronically contaminated wounds and the combination of bacteremia and pressure sores can be painful and life threatening.

Fortunately, as reflected by Medicare's "never event" guidelines, pressure ulcers may be entirely avoidable so long as proper care and preventative measures are instituted and implemented by the health care provider. The time is right to extend these "never event" guidelines to include nursing homes and other long term care facilities.

The relationship of dehydration with the development of bed sores (or pressure sores, pressure ulcer or decubitus ulcers-- whatever you prefer to call them) is quite appalling.

Simply put: dehydration occurs when a person does not receive enough liquids though eating, drinking or through mechanical intervention such as intravenous fluids or a feeding tube to maintain their optimal physical functioning. When the body is deprived to fluid intake, imbalances in the bodies chemistry occur and there is a reduction of blood volume.

Alterations in blood chemistry and reduction in blood volume interfere with essential circulatory issues. As the volume of blood in the body gets reduced, the life sustaining properties of blood to skin and tissue gets reduced.

Without the life sustaining components a properly operating circulatory system provides-- tissues, particularly those under pressure from a person's body weight begin to die.

Particularly in the physically disabled or bed bound, pressure tends to build on areas of the body literally supporting the persons body weight: the buttocks, sacrum or heels. When the reduced physical capability couples with the increase in pressure on areas of the body, bed sores are more likely to occur.

How to ensure your loved one is getting enough fluid?

Only a medical professional can realistically determine what each patient's fluid intake requires after analyzing the person's body weigh and fluid output. However, a commonly agreed upon starting point for optimal hydration is 1,500 to 2,000 ml (six to eight glasses) of fluid per day-- minimum.

Therefore, as a caregiver or just a concerned friend or family member, it is important to recognize that hydration needs and realize the hydration plays a critical role in general well-being and reducing bed sores amongst patients in a nursing home or hospital setting. Consequently, be on the lookout for symptoms of potential dehydration including:

•Sunken eyes
•Cracked lips
•Ashen skin
•Rapid decline in cognitive function
•Chills
•Dark colored urine
•Overall physical weakness
When you visit check to:

•Ensure fluids are within reach of the patient
•Make sure the patient is capable of consuming the fluids-- straw, handled cup, ect.
•Address hydration needs with an attending physician or nurses-- particularly if the patient is incapacitated or in a coma
•Always keep a glass of water or juice on the night stand when you leave.

Continue reading "The Relationship Between Dehydration and the Development of Pressure Sores, Bed Sores & Decubitus Ulcers" »

Nursing homes can be a sad state of affairs, and walking through one can be simultaneously depressing and frightening. Nobody ever wishes to place a loved one in a nursing home and nobody ever wants to end up in one as well.

It can be an equally frightening proposition to confront neglect. Neglect is a silent form of abuse and it qualifies as malpractice. It's not always easy to discern neglect from an elderly individual's typical withdrawal or lack of enthusiasm. While it is necessary to line patients along the corridor in order to efficiently wheel them to the dining room, leaving dependent patients in the hallways for hours on end quantifies neglect.

Nursing home abuse and neglect can come in many silent but devastating forms. Bed sores aka Decubitus Ulcers and Pressure Sores are a natural occurrence for bedridden patients, but they should be minimized by constantly being moved around in the bed as a preventative method of keeping bed sores under control. Bed sores, Decubitus Ulcers and Pressure Sores can be a glaring red flag that your loved one is a victim of nursing home abuse and neglect.

Nursing Home Abuse and Neglect can be masked too easily by staff members who fear the consequences, which places the burden of understanding abuse on the families and friends of those who are residing in nursing homes.

Toileting and bathing issues top the list for neglectand abuse issues. Many nurses and aids do not feel their paycheck reflects the humiliation that can accompany toileting issues. If you are trying to determine whether abuse is a possibility, ask your loved one if they are taken to the bathroom, how often, and how many accidents they are having, and how long they are required to sit in their soiled clothing. These answers can help determine the level of elder abuse and neglect that a facility may be liable for.

They can walk you through the filing process as well as the steps to reporting these issues. Nursing home abuse lawyers have ample experience in dealing with the tragedies associated with nursing home abuse and can be of invaluable assistance even if you are fortunate enough to discover that there is no abuse or medical malpractice at the suspected facility.

Continue reading "Nursing Home Abuse and Neglect Can Come In Many Silent But Devastating Forms" »

A man died from infected bedsores within four weeks of being admitted into a nursing home because his care was inadequate, an inquest has ruled.

He had been taken to hospital suffering with 18 bedsores.

The neglected and Abused Elder was grossly unkempt, covered in dry feces and one of his sores could not be measured because he was in such pain.

The Elder was admitted to a nursing home at which time he had three pressure sores but within four weeks he was in a life threatening condition and was re-admitted to hospital with 18 sores. says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

The nursing home staff staff failed to adequately review and assess the Elder's admission or ensure an effective care plan was in place. As a result thereof, the Decubitus Ulcers aka Bed Sores and Pressure Sores became severely infected causing the elder's death.

Continue reading "Infected Decubitus Ulcers, Bed Sores & Pressure Ulcers Cause an Elder's Death" »

Bed sores aka Pressure Sores and Decubitus Ulcers area commonly found in immobile patients who remain in one position for extended periods of time. The underlying mechanics behind the development of bed sores is that unrelieved pressure on areas of the body resulting in diminished blood flow to skin and muscle causing the tissue to die. As the tissue dies, a wound develops and in some situations, 'opens' exposing internal organs and bones. In addition to the pain and embarrassment that accompanies bed sores, studies have determined that patients with advanced bed sores are at a high risk for infection, sepsis and other complications says California Nursing Home Abuse and Neglect Lawyer Steven C. Peck.

What makes bed sores (also called pressure sores, pressure ulcers or decubitus ulcers) different from many other medical conditions is the fact that in most situations they can be prevented with the most basic care. Keeping patients clean, dry and alternating their positions greatly reduces the likelihood of patients developing the wounds. In order to prevent bed sores, facilities need to train staff on the techniques to prevent bed sores and and have adequate staff to assure there is enough manpower to implement the necessary care.

Many situations involving the development of bed sores during an admission to a medical facility give way to a claim or lawsuit against the facility. In the case of patients who have developed bed sores and subsequently died from the wound, the family of person may similarly be entitled to pursue to lawsuit premised on wrongful death.

Continue reading "Bedsore, Pressure Sores, Decubitus Ulcers Are Caused by Unrelieved Body Pressure" »

Bed sores (also known as pressure sores, pressure ulcers, or decubitus ulcers) are caused by unrelieved pressure on bony prominences of the body. Over time, the unrelieved pressure restricts necessary blood circulation to the skin and tissue resulting in the death of the tissue and the surrounding muscle. What may begin as a small area of skin irritation can rapidly develop into a large wound.

In order to help identify bed sores and implement medical treatment, a 'staging system' has been established by the medical community to provide a standardized system of identify and treating wounds.

Stages of Bed Sores

Stage 1 - Initially, a pressure sore appears as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.

Stage 2 - At this point, some skin loss has already occurred -- either in the epidermis, the outermost layer of skin, in the dermis, the skin's deeper layer, or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration. If treated promptly, stage II sores usually heal fairly quickly.

Stage 3 - By the time a pressure ulcer reaches this stage, it has extended through all the skin layers down to the muscle, damaging or destroying the affected tissue and creating a deep, crater-like wound.

Stage 4 - In the most serious and advanced stage, a large-scale loss of skin occurs, along with damage to muscle, bone, and even supporting structures such as tendons and joints. Stage IV wounds are extremely difficult to heal and can lead to lethal infections. For patients confined to a wheelchair, they are most likely to develop a pressure sore on: their tailbone or buttocks, shoulder blades and spine. Some wheelchair patients may develop bed sores on the backs of their arms and legs where they rest against the chair. Bed-bound patients are prone to develop pressure sores in the following additional areas: back or sides of your head, the rims of your ears, shoulders, hip bones, lower back or tailbone, backs or sides of your knees, heels, ankles and toes.

Unstageable - Unstageable bed sores are usually referred to as an extremely advanced wound where there is involvement of skin, muscle and bone.

Medical Facilities Duty To Prevent Bed Sores

As a known threat to patient health and well-being, staff in nursing homes, hospitals and other medical facilities must be diligent in preventing bed sores from developing. Perhaps the most important part of bed sore prevention is to identify patients who are at high risk for developing bed sores and implementing a care plan for them.

The following conditions, put a patient at high-risk for developing bed sores:

Limited mobility or bed-bound
Old age
Malnourishment
Dehydration
Incontinence
Prevention of Bed Sores

The most widely accepted ways of preventing bed sores is to keep patients clean and dry. This means removing soiled clothing and bedding as soon as feasible and bathing patients regularly. Additionally, for patients who have limited mobility, staff must actively turn patients on a regular basis (every 2 hours) to avoid unrelieved pressure from forming on the body.

The areas of the body most vulnerable to bed sores are:

Heels
Hips
Buttocks
Back
By some estimates, more than 500,000 patients develop bed sores in nursing homes and hospitals every year. In addition to the pain and embarrassment that accompanies bed sores, bed sore patients are at risk for developing a variety of medical complications.

Medical Complications Associated With Bed Sores

Sepsis

Sepsis is an illness caused by infection in the bloodstream by bacteria that frequently enter the body through open wounds or bed sores. Sepsis must be identified and treated as early on as possible in order to provide the best chances of survival. If left undiagnosed and untreated, sepsis can be fatal. In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below 4000 cells/mm.

Gangrene

Gangrene is a complication that may develop due to the death of tissue in and around the bed sore. Severe bed sores may result in the reduction of blood flow in and around the wound. The reduced blood flow increases the ability of bacteria to grow. Bacteria produce toxins that the body is unable to remove. Once the toxins accumulate, deterioration of tissue ensues. Ultimately, as the tissue deteriorates the common gangrene symptoms may occur (black or green discoloration of skin and foul odors).

Osteomyelitis

Osteomyelitis is an inflammation of the bones that is caused by bacteria. In adults, the most common types of osteomyelitis causing bacteria are S. Aureus, Enterobacter and Streptococcus. In cases of severe bed sores (also referred to as decubitus ulcers, pressure ulcers or pressure sores) the bacteria enters the body through the open wound and attacks the bone. Once the bone becomes infected, enzymes are released that restrict the bodies ability to heal. If left untreated osteomyelitis can spread into the bone marrow and surrounding joints, leading to further medical complications or even death.

Necrotizing Fasciitis

Because people with severe bed sores literally have an open wound, they are at a higher risk for contracting the infection causing bacteria that can cause necrotizing fasciitis. The early stages of necrotizing fasciitus are characterized by severe pain and swelling in the area of the infection frequently accompanied by diarrhea and vomiting. Rather than 'eating' the flesh, as is commonly suggested, necrotizing fasciitis infection causes flesh to die.

Bed Sore Treatment

Medical treatments can help improve the pain associated with the wounds and may prove to literally save the life of the patient. It goes without saying, that patients with bed sores should seek treatment from practitioners who have experience in wound care.

Wound Care

In order for bed sores to heal, attention must be paid to the removing dead tissue and protecting the wound from infection causing bacteria. Dressings are usually applied to help the body heal itself. The type of dressing and the frequency with which it is to be changed is ordered by a physician with the application and changes carried out by nurses.

Surgical Debridement

Surgical debridement is when a surgeon uses a scalpel to remove the dead tissue, bone and fluid from the area around the bed sore. Surgical debridement of the bed sore may be accompanied by 'flap reconstruction'. Flap reconstruction is when tissue is harvested from a healthy area of the person's body to cover the open wound. The goal of reconstruction is to improve the hygiene and appearance of the wound and reduce the risk of infection.

Colostomy

When bed sores develop on the buttocks or sacrum, a physician may recommend a surgical procedure to prevent fecal material getting into the wounds. The surgical procedure is referred to as a 'colostomy' or 'diverting colostomy'.

A colostomy is a major surgical procedure that involves cutting the colon into a shorter piece and bringing it through the wall of the abdomen. A colostomy bag is attached to the end of the colon exiting the abdomen where fecal material is collected. The end of the colon that leads to the rectum is closed off and becomes dormant. Many colostomy procedures can be reversed, if and when they are no longer needed.

Amputation

One of the most dramatic examples of how truly devastating bed sores can be is when a limb must be amputated due to severe bed sores or medical complications. In severe cases (where surgical debridement, antibiotics, and oxygen treatment are unsuccessful), amputation of the limb might be required to prevent the infection from spreading further. This is especially true in elderly people, especially those who are malnourished, because of poor blood flow.

Liability of Medical Facility For Patients Who Develop Bed Sores During An Admission

When a bed sore (similarly referred to as: pressure sore, pressure ulcer or decubitus ulcer) develops during an admission to a medical facility, it is usually an indication that the facility was not properly caring for the patient. The underlying reasons may be varied: under-staffing, poor training or staff simply not following orders, the fact remains- medical facilities can be held responsible for the pain, decline in the quality of life and medical expenses associated with subsequent treatment.

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