California Elder Law Attorney Blog

Urinary tract infections, or UTIs, are a common infection that affect more women then men. Most often, they are treated quickly and effectively with antibiotics, the infection becoming a distant memory. Unfortunately, not all UTIs are treated quickly and some aren't even identified quickly, particularly in people who have limited no sensation below the waist or unable to speak for themselves.

An untreated UTI may spread to the kidney, causing more pain and illness. It can also cause sepsis. The term urosepsis is usually used to describe sepsis caused by a UTI.

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.

People shouldn't die from a UTI, but if sepsis begins to take over and develops to severe sepsis and then to septic shock, this is exactly what can happen. More than half the cases of urosepsis among older adults are caused by a UTI. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with organ dysfunction and/or amputations.

What Is a Urinary Tract Infection?A urinary tract infection is an infection in the urinary tract, which runs from your kidneys, through the ureters, the urinary bladder and out through the urethra. UTIs are very common and, in general, easy to treat.

A lower UTI, the more common type, affects the lower part of the urinary tract, the urethra and urinary bladder. Infection of the urethra is called urethritis and of the bladder is called cystitis. If the kidney is infected, called pyelonephritis, this is an upper UTI, as the kidney is the highest part of the urinary tract.

A UTI can be caused by bacteria (the most common type of infection) or a fungus.

How Do You Get a UTI?The design of the human body makes it so it isn't difficult to get a bacterial UTI, because the infection comes from outside, through the urethra. Although the UTI is a sterile environment, free of bacteria, the genital area is not. The bacteria can be near the opening of the urethra and find its way in, either through wiping after going to the bathroom, sexual activity, or unsanitary conditions. Once the bacteria has entered the urethra, the body tries its best to fight it off, but sometimes the immune system can't do this, the bacteria multiply, and cause the infection.

In the case of a fungal infection, usually the fungus gets to the urinary tract through the blood stream. Those who develop this type of infection are usually ill with a disease that has compromised their immune system, such as AIDS. (Sepsis and HIV/AIDS)

In general, women get more UTIs than do men and this increases with age. Statistics show that many women get more than one. Almost 20% of women who have had one UTI will go on to have a second. Of this 20%, 30% of those will have a third, and in turn, 80% of these women will have more.

Continue reading "Sepsis and Urinary Tract Infections Can Cause Wrongful Death Indicates Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Medical professionals have been debating the exact definition of sepsis for decades. However, one thing they can agree upon is the origin of the disease. The word sepsis comes from the Greek meaning "decay" or "to putrefy." In medical terms, sepsis is defined as either "the presence of pathogenic organisms or their toxins in the blood and tissues" or "the poisoned condition resulting from the presence of pathogens or their toxins as in septicemia."

Patients are given a diagnosis of sepsis when they develop clinical signs of infections or systemic inflammation; sepsis is not diagnosed based on the location of the infection or by the name of the causative microbe. Physicians draw from a list of signs and symptoms in order to make a diagnosis of sepsis, including abnormalities of body temperature, heart rate, respiratory rate, and white blood cell count. Sepsis may be diagnosed in a 72-year-old man with pneumonia, fever, and a high white blood count, and in a 3-month-old with appendicitis, low body temperature, and a low white count.

Sepsis is defined as severe when these findings occur in association with signs of organ dysfunction, such as hypoxemia, oliguria, lactic acidosis, elevated liver enzymes, and altered cerebral function. Nearly all victims of severe sepsis require treatment in an intensive care unit for several days or weeks. While most cases of sepsis are associated with disease or injury, many events follow routine, even elective surgery.

More frightening is that sepsis can rage in response to incidents as seemingly benign as a playground scrape or a nicked cuticle from the beauty parlor. American hospitals spend approximately $20 billion each year combating sepsis, 40% of patients diagnosed with severe sepsis do not survive. Until a cure for sepsis is found, early detection is the surest hope for survival.

Continue reading "Definition of Sepsis Sometimes Called Blood Poisoning is the Body's Often Deadly Response to Infection or Injury" »

A Yucaipa-based nursing home is named with three people in a criminal complaint filed by the California Attorney General's Office alleging elder abuse.

Braswell's Hampton Manor, Barbara Davis, 44, and Timothy Walker, 56, entered pleas of not guilty at an arraignment on December 22, 2011 in San Bernardino Superior Court.

The nursing home, Davis, Walker and a third person, Amy Nicole Hillrich, are each charged with one felony count of elder abuse causing great bodily injury occurring on Aug. 6, according to court records. The case was filed Dec. 16.

Hillrich, 38, was scheduled for video arraignment Thursday afternoon, according to court personnel. But it was not known if she had been arraigned.

Davis and Walker were released on their own recognizance. They return to court March 12.

In a separate case, Hillrich and David Olvera, 25, and Emilio Pelayo Saldana, 22, face murder charges in the death of Hillrich's ex-husband, John Hillrich, of Fontana, on Aug. 16 in Ontario.

Hillrich, Olvera and Saldana are being held without bail at West Valley Detention Center in Rancho Cucamonga, according to the Sheriff's Department.

Continue reading "Nursing Home Named In Criminal Complaint says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

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

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

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

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

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

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

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

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

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

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

Zinc oxide is a common ingredient in these.

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

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

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

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

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

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

Appropriate documentation should always be performed on admission to nursing homes and all long term care medical facilities. This shall prevent clinicians from being held responsible for something that certainly could not have developed within that nursing home and / or hospital stay if the symptom had been documented as "present on admission."

For example, a patient with the stage 3 decubitus ulcer, also known as a pressure sore and bed sore noted on the third day in the facility obviously did not develop that condition during that admission, but if this is not documented on the intake, it could cause litigation that might have been avoided.

Continue reading "Appropriate Documentation In Hospitals and Long Term Care Facilities May Determine Ultimate Legal Responsibility says California Nursing Home Abuse and Neglect Lawyer Steven Peck" »

If the skin is intact or appears red on a person whose skin color is lighter, then the person's condition falls under stage I of pressure ulcers. Some other characteristics of the skin are that it does not lighten for a short period of time when it is touched and the site on the skin may feel painful, firm, soft and either warmer or cooler when compared to the skin that surrounds the site.

If the pressure ulcer is an open wound, then it is considered to be in stage II. In this stage both the upper layer of the skin and a part of the underlying layer are either damaged or even lost. The wound itself will look like a shallow and basin-like wound, red in color. In some cases it may look like a blister.

If the decubitus ulcer, pressure sore or bed sore has become a deep wound and looks like a crater, then it is already in stage III. The loss of skin is present and even some fat is visible. It is common for the bottom of the ulcer to have some dead tissue of yellow color. At this stage it is not only the healthy layers of the skin that are damaged.

Stage IV is the final and most severe stage of pressure ulcers and bed sores. The wound on the skin will show muscle, bones and tendons and the bottom of it will usually contain slough which is dark in color. Multiple layers of skin are damaged in the final stage.

Every person whose movement is limited needs to make sure to inspect the skin almost daily as a part of routine nursing or home care. At the first signs of pressure ulcers the patients need to contact the doctor because there are a lot more chances of success if the condition is treated in the early stages. If a person experiences a fever or drainage or foul odor from the wound, he or she should immediately contact the doctor and be very concerned about deadly infection.

Continue reading "The Different Stages of Decubitus Ulcers also known as Pressure Sores and Bed Sores" »

•7.6-11% of people 60+ at home are victims of elder abuse, neglect or exploitation.
•47% of people with dementia at home are abused or neglected by their caregivers.
•For every one case of elder abuse that comes to light, 23.5 do not.
•50-90% of nursing homes are understaffed at levels that harm residents.
"Elder abuse includes abuse, neglect and financial exploitation. It occurs in homes and facilities; cuts across all demographic groups; and causes untold suffering and cost, not just for its victims, but also for those who care about and for them. Victims often live their last years--impoverished, injured, neglected and in fear--with little effective assistance, protection or attention from any system.

Victims of elder abuse suffer more injuries and illnesses and are three times more likely to die sooner than non-victims. In addition to depleting the resources of already stressed individuals and families, elder abuse costs taxpayers billions of dollars annually in Medicare, Medicaid and other federal, state and local program expenditures.

"We are at the early stage of a hidden epidemic. As 77 million baby boomers age and caregiving shortages grow more acute, the problem will grow. Wealth and fame do not provide immunity, as the plight of Mickey Rooney and Brooke Astor show. A 2011 General Accountability Office (GAO) report documents the need for more funding and federal leadership. Yet, our response to elder abuse lags 40 years behind child abuse and 20 years behind domestic violence." says California Elder Abuse Lawyer Steven C. Peck.

Continue reading "Elder Abuse Victims Are Three Times More Likely To Die Sooner Than Non-Victims" »

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

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

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

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

Continue reading "Elder Abuse Is A Serious Problem" »

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

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

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

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

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

The agency mentions these warning signs of elder abuse:

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

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

July is Elder Abuse Awareness Month. Why is that significant? Studies show that in up to 90 percent of elder abuse cases, the abuser is a family member or trusted advisor. According to AARP, the financial exploitation of the elderly costs as much as $2.6 billion per year.

As part of its findings at the beginning of its recently enacted Elder Justice Act, Congress stated that the "proportion of the United States population age 60 years or older will drastically increase in the next 30 years as more than 76,000,000 baby boomers approach retirement and old age." It further noted, "Each year between 500,000 and five million elders in the United States are abused, neglected or exploited." And perhaps most importantly, "most cases ... are never reported."

What is elder abuse? It comes in many forms. The Peck Law Group identifies seven types that, in reality, are not mutually exclusive: physical, sexual, emotional, confinement, passive neglect, willful deprivation and financial exploitation.

Continue reading "Elder Abuse Awareness is Significant" »

Long-term care residents also are often highly functionally impaired. Many are incontinent, immobile, and confused or demented. The worse the functional status, the greater the likelihood of infection or colonization with resistant microorganisms

For example, incontinence and impaired mental status have consistently been associated with asymptomatic urinary tract infection . MRSA colonization is more likely to be identified in residents with pressure ulcers or fecal incontinence or who are bed bound or require feeding tubes or urinary catheters . In most cases, impaired functional status is a determinant of admission to long-term care and is not modifiable. If the major predictors of infection in long-term care facilities are poor functional status and co-existing chronic illness, and these conditions cannot be altered, to what extent is it realistic to anticipate that endemic infections can be prevented in such residents? In addition, with the number and severity of existing conditions, how much illness or death is attributable to infections per se, rather than to underlying chronic disease? Assessing the impact of infection on patient outcome in evaluating interventions to prevent infection is, thus, often problematic. An example is a decision to provide comfort care but not to treat pneumonia with antibiotics in severely impaired patients.

Continue reading "Infections in Long-Term Care Facilities" »