California Elder Law Attorney Blog

A decubitus ulcer is a pressure sore or what is commonly called a "bed sore". It can range from a very mild pink coloration of the skin, which disappears in a few hours after pressure is relieved on the area, to a very deep wound extending to and sometimes through a bone into internal organs. These ulcers, as well as other wound types, are classified in stages according to the severity of the wound.

All decubitus ulcers have a course of injury similar to a burn wound. This can be a mild redness of the skin and/or blistering, such as a first-degree burn, to a deep open wound with blackened tissue, as in a third degree burn. This blackened tissue is called eschar.

Mechanism of Formation:
The usual mechanism of forming a decubitus ulcer is from pressure. However it can also occur from friction by rubbing against something such as a bed sheet, cast, brace, etc., or from prolonged exposure to cold. Any area of tissue that lies just over a bone is much more likely to develop a decubitus ulcer. These areas include the spine, coccyx or tailbone, hips, heels, and elbows, to name a few. The weight of the person's body presses on the bone, the bone presses on the tissue and skin that cover it, and the tissue is trapped between the bone structure and bed or wheelchair surface. The tissue begins to decay from lack of blood circulation. This is the basic formation of decubitus ulcer development.

Nursing Care, Prevention and Treatment of Decubitus Ulcers:
The common areas of decubitus ulcer formation and prevention is a basic nursing principle covered in nursing school curriculum (LVN/LPN or RN) and most nursing assistant programs as well. Prevention consists of changing position every 2 hours or more frequently if needed. This 2-hour time frame is a generally accepted maximum interval that the tissue can tolerate pressure without damage. Prevention also consists of protection and padding to prevent tissue abrasion, and maintaining hydration, nutrition and hygiene.
Protect your loved one from nursing home neglect or abuse talk to California Nursing Home Abuse and Neglect Attorney Steven C. Peck toll free at 1.866.999.9085.

The treatment for a decubitus ulcer involves keeping the area clean and removing necrotic (dead) tissue, which can form a breeding ground for infection. There are many procedures and products available for this purpose. The use of antibiotics, when appropriate is also part of the treatment. Some deep wounds even require surgical removal or debridement of necrotic tissue. In some situations amputation may be necessary.

The second portion of the treatment involves removing all pressure from the involved area(s) to prevent further damage of tissue and to promote healing. Frequent turning is mandatory to alleviate pressure on the wound and to promote healing. Along with cleaning, removal of dead tissue, and alleviating pressure, the individual must have increased nutrition to allow for proper healing of the wounds. Without all of these elements being in place, the wounds will not heal and, in fact, will quickly worsen.

Prevention:
The basic treatment of decubitus ulcers is prevention. Prevention cannot be stressed too strongly. To this end, there are any number of devices designed to protect and prevent the formation of decubitus ulcers. The decision of which device to use is based on the location and severity of the wound. These devices may be a Medicare/Medicaid/Insurance-covered item when medically necessary. Most insurance's will cover any needed device, material, or equipment necessary to prevent and treat decubitus ulcers. Prevention is the most humane and cost effective approach to care.

Standards of Care:
It remains true that decubitus ulcers are generally considered preventable and the development of decubitus ulcers is evidence of some form of neglect [nutrition, hydration, positioning, infection control, etc]. Many paralyzed or terminal individuals with very poor nutrition can remain free of decubitus ulcers. This is accomplished by good patient care often being provided by family members and non-licensed hired caregivers. Professional medical personnel generally provide only a minimum amount of medical assistance. Prevention is achieved by diligent care.

Decubitus Ulcer Formation and Treatment in Long-Term Care Facilities
In long-term care facilities the rate of decubitus ulcer development is higher for a variety of reasons. Due to staffing shortages, medical funding cuts and an array of issues, most long-term care facilities are chronically understaffed. This results in patients not being turned, cleaned and fed as often as the ideal standard of nursing would dictate.

It is known that almost all decubitus ulcers are preventable. However the reality of long-term care concludes that if a patient does not have massive weight loss, chronic infections, or wounds that do not heal in two weeks then that individual is receiving a reasonable standard of care. It is not uncommon for small wounds to develop, be treated and heal quickly. This is considered adequate care.

Massive weight loss, massive deep wounds over Stage II and chronic infections continue to be an unacceptable standard of care. Massive wounds are generally a strong indication of negligence in more than one area [hygiene, nutrition, infection control, positioning, etc.].

Another emerging factor in long-term care is patient directed care. Alert and generally oriented individuals determine their own care. These persons, though elderly and frail, are not declared incompetent. Patient's rights, as it is currently practiced, allows for patient refusal of medications, food, fluids and treatments such as turning. This often results in a lesser quality of care being provided due to patient noncompliance. When this occurs, the ideal situation is to involve the patient, family, staff and physician in a plan of care that will be acceptable and beneficial. Patient refusal of nutrition and positioning may lead to the development of decubitus ulcers as well.

In summary: In almost all situations, the development of massive decubitus ulcers is evidence of some form of neglect. Generally the neglect is in more than one area, i.e., hygiene and nutrition. It would be a very rare exception for this to not be true.

Decubitus ulcers need to be viewed as a preventable injury, not an excusable one.

Stages of Wounds:
Wounds are often categorized according to severity by the use of stages. The staging system applies to burn wounds, Decubitus ulcers, and several other types of wounds.

Stage I
This stage is characterized by a surface reddening of the skin. The skin is unbroken and the wound is superficial. This would be a light sunburn or a first degree burn as well as a beginning Decubitus ulcer. The burn heals spontaneously or the Decubitus ulcer quickly fades when pressure is relieved on the area.

The key factors to consider in a Stage I wound is what was the cause of the wound and how to alleviate pressure on the area to prevent it from worsening. Improved nutritional status of the individual should also be considered early to prevent wound worsening. The presence of a Stage I wound is an indication or early warning of a problem and a signal to take preventive action.

Treatment consists of turning or alleviating pressure in some form or avoiding more exposure to the cause of the injury as well as covering, protecting, and cushioning the area. Soft protective pads and cushions are often used for this purpose. An increase in vitamin C, proteins, and fluids is recommended. Increased nutrition is part of prevention.

Stage II
This stage is characterized by a blister either broken or unbroken. A partial layer of the skin is now injured. Involvement is no longer superficial.

The goal of care is to cover, protect, and clean the area. Coverings designed to insulate and absorb as well as protect are used. There is a wide variety of items for this purpose.

Skin lotions or emollients are used to hydrate surrounding tissues and prevent the wound form worsening. Additional padding and protective substances to decrease the pressure on the area are important. Close attention to prevention, protection, nutrition, and hydration is important also. With quick attention, a stage II wound can heal very rapidly.

A wound can appear to be a Stage I wound upon initial evaluation, and actually be reevaluated as a Stage II wound during the course of care. Quick attention to a Stage I Decubitus ulcer or pressure wound will prevent the development of a Stage III Decubitus ulcer or pressure wound. Generally Decubitus ulcers or pressure wounds developing beyond Stage II is from lack of aggressive intervention when first noted as a Stage I. [see notation].

Stage III
The wound extends through all of the layers of the skin. It is a primary site for a serious infection to occur.

The goals and treatments of alleviating pressure and covering and protecting the wound still apply as well as an increased emphasis on nutrition and hydration.

Medical care is necessary to promote healing and to treat and prevent infection. This type of wound will progress very rapidly if left unattended. Infection is of grave concern.

Stage IV
A Stage IV wound extends through the skin and involves underlying muscle, tendons and bone. The diameter of the wound is not as important as the depth. This is very serious and can produce a life threatening infection, especially if not aggressively treated. All of the goals of protecting, cleaning and alleviation of pressure on the area still apply. Nutrition and hydration is now critical. Without adequate nutrition, this wound will not heal.

Anyone with a Stage IV wound requires medical care by someone skilled in wound care. Surgical removal of the necrotic or decayed tissue is often used on wounds of larger diameter. A skilled wound care physician, physical therapist or nurse can sometimes successfully treat a smaller diameter wound without the necessity of surgery. Surgery is the usual course of treatment. Amputation may be necessary is some situations.

Stage V
This is an older classification and not now used in all areas. A stage 5 wound is a wound that is extremely deep, having gone through the muscle layers and now involves underlying organs and bone. It is difficult to heal. Surgical removal of the necrotic or decayed tissue is the usual treatment. Amputation may be necessary is some situations.

Notation
It is possible for a wound to "go from a stage I wound to a stage III or IV" without the intermittent stage[s] being observed. All wound stages were present just not obvious, hence the need to treat all wounds as serious with the potential of rapidly worsening.

Nursing home abuse and neglect are often the cause of decubitis ulcers. When a nursing home facility provides a sub-standard level of care by failing to prevent decubitis ulcers, or neglecting to avoid the causes, patients can suffer serious and life threatening injuries. At least 60,000 people die from the complications and causes of decubitis ulcers each year in the United States. People who are vulnerable to developing decubitis ulcers must be frequently moved to avoid development of these sores, and adequately cared for in order to avoid serious injury. That means keeping the areas where pressure occurs (wherever the body rests with the most pressure in a bed - anything from heels and elbows to buttocks, shoulders, the back of the neck, the hips, even the side of the foot or leg. If a person can't move, they need a way to BE moved.

Prevention:

If bedridden or immobile with diabetes, circulation problems, incontinence, spinal problems, bone fractures, or mental disabilities, in addition to intensive care of the skin and keeping areas free from pressure - less than two hours in any given position for any part of the body-the patient should also be checked for pressure sores daily, especially every morning. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps:

Change position at least every two hours to relieve pressure.

Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.

Eat healthy, well-balanced meals with extra vitamin C, if possible. Vitamin C helps build tissues..

Exercise daily, including range-of-motion exercises for immobile patients.

Keep skin clean and dry. Persons with incontinence need to take extra steps to limit moisture

THE NUMBER ONE CAUSE OF THE 100,000 LIMB AMPUTATIONS THAT OCCUR JUST IN THE US IS DECUBITIS ULCERS - the bedsore!

Chronic wounds remain inflamed and may take an inordinate amunt of time to heal - if at all.. These wounds are a major health problem in the United States and throughout the world. The most common chronic wounds are diabetic foot ulcers, venous leg ulcers, and pressure ulcers, although other wounds, such as surgical wounds, can also become a source of chronic non-healing.

Diabetic foot ulcers

Diabetics are prone to foot ulcers due to peripheral neuropathy: decreased sensation caused by this condition can result in a cut and trauma to the foot going unnoticed or can result in unusual pressures placed on the foot that are ignored. Diabetic foot ulcers are the most common chronic wound problem in the United States and the world. Some 25% of the 60 million diabetic patients in the United States develop foot ulcers - that's 15 million people--and approximately 100,000 limb amputations are performed in diabetic patients each year in the United States alone. It's an epidemic that has gone virtually unnoticed. It can happen to you.!

Venous leg ulcers
Venous leg ulcers are caused by a failure of valves in the veins of the legs, resulting in congestion and slowing of blood flow. Rubbing the legs downward increases the risk of vein failure in diabetics. Such ulcers occur spontaneously or in association with minor trauma to the leg. Venous leg ulcers can be very painful and can persist for more than a year. The older the patient, the more likely that venous leg ulcers will develop.

Pressure ulcers (decubitis ulcers or bed sores) result from pressure on skin, soft tissue, muscle, and bone that cuts off the ability of the capillaries to circulate blood for an extended period of time. The wounds that then develop occur in individuals unable to sense the pressure or who cannot change their body position to relieve the pressure. Pressure ulcers are a common and expensive problem in acute care, nursing home, and home care populations. In hospital settings the incidence of pressure ulcers has reached as high as 30% among those at risk.

Continue reading "Nursing Home Abuse and Neglect Is Often The Cause of Decubitus Ulcers, Bed Sores & Pressure Sores" »

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" »

How do you know if your loved one is being neglected in a nursing home? When you go to visit, everything looks fine, but your loved one is unable to express his/her pain to you in words. When a nurses aide comes in to attend to your loved one, you noticed a big sore on the side of their leg. When you question it, the nurses aide claims that it is noting but a simple sore. This is wrong. What you are actually looking at are signs of neglect.

A decubitus ulcer is commonly known as a bed sore. A decubitus ulcer can be a simple red or pink mark on the skin or it can be as bad as a very deep sore that reaches into the bone or internal organ. They are caused by prolonged pressure on a particular part of the body and are seen on patients who are bedridden (Thus the name, bed sore).

Most nursing facilities have a policy to turn bedridden patients once every two hours in order to prevent decubitus ulcers from forming. If your loved one has these decubitus ulcers, then they are not being turned in the bed as often as required and this is a form of neglect in a nursing home.

These decubitus ulcers can lead to further complications, including death if not treated. Therefore, if you have seen decubitus ulcers on your loved one, you should first consult with the doctors and nurses in the facility. If they fail to respond or give you a reasonable answer to why there are decubitus ulcers on your loved one, then you should consider filing a report or a complaint for nursing home neglect.

The decubitus ulcer is often painful. So, your loved one may be in severe pain and unable to express their pain. They may be crying for help, but no one is listening. This is neglect. No one should have to suffer the pain of decubitus ulcers. Simply turning or repositioning your loved one every two hours will prevent these ulcers from forming. They should not be there in the first place, but if you do notice them, you should be informed that your loved one is experiencing some form of neglect in their nursing home.

It is true that decubitus ulcers are considered preventable and the development of decubitus ulcers is evidence of some form of neglect. Many paralyzed or terminal individuals with very poor nutrition can be free of these ulcers. This can be accomplished by good patient care.

Continue reading "Decubitus Ulcers, Pressure Sores & Bedsore Development Is Evidence of Neglect" »

One in five of the nation's 15,700 nursing homes have consistently received poor ratings for overall quality, a USA TODAY analysis of new government data finds.
More than a quarter-million patients live in homes given another set of low scores within the past year, according to data released today by Medicare, which first released the star ratings of the nation's nursing homes in late 2008. The ratings are derived from inspections, complaint investigations and other data collected mostly in 2008 and 2009

USA TODAY found that all 50 states and the District of Columbia have homes with poor ratings from one year to the next. And dozens of those facilities are the only nursing homes for miles.

Late in the Bush administration, the Centers for Medicare & Medicaid Services began assigning nursing homes one to five stars for quality, staffing and health inspections, as well as an overall score. Nearly all homes that repeatedly received few overall stars -- one or two stars -- were owned by for-profit corporations, the data show.

"We want to see improvements, but we don't expect a nursing home will jump to a five-star rating within a one-year time period," says Medicare's Thomas Hamilton, who led the development of the rating system. He points to "positive trends" within the past year, including the reduction of one-star homes and vigilance among providers in the use of restraints.

"The issue is the owners have to take responsibility for the consequences" of poorly performing homes, says Larry Minnix, CEO of American Association of Homes and Services for the Aging. He says the nascent star-rating system should account for patient satisfaction.

Medicare spokeswoman Mary Kahn says a one-star nursing home is not necessarily a terrible facility. Even the lowest-rated homes must still meet baseline Medicare conditions, she says.

The newspaper's analysis found the lowest-rated homes had an average of 14 deficiencies per facility, which can include quality-of-life measures and safety violations.

"Families can show (a home's rating) to a hospital discharge planner and say, 'I'm not going to send my mother to a home with one or two stars,' " says Janet Wells, public policy director of NCCNHR, formerly the National Citizens' Coalition for Nursing Home Reform.

"If homes are not motivated to get better, chances are they won't, and you'll wind up in homes in poor-quality purgatory," Minnix says. "There should be two types of homes: the excellent and the non-existent."

Continue reading "One in Five Nursing Homes in the United States Receive Poor Ratings" »

Los Angeles County Supervisor Michael Antonovich is hailing the signing of Assembly Bill 215, which will require that state nursing homes post assigned grades reflecting their quality ratings. The nursing home grading system was kicked off by Antonovich at the LA County level, and recent legislation by Santa Clarita's Assemblyman Cameron Smyth and Assemblyman Mike Feuer has made it law, beginning January 1, 2011.

"In reflecting on this past year, one bright light that shines across our County and State and will enhance the quality of care for our senior citizens was the state law I initiated requiring nursing homes to publicly display their five-star rating issued by the Federal Government's Centers for Medicare and Medicaid Service," said Supervisor Michael D. Antonovich, who also led the charge in establishing the County's successful restaurant grading system in 1997. "This posting system provides vital information for families to make informed decisions about the care for their loved ones and provides incentives for nursing homes operators to establish and maintain high-quality standards of care and compliance."

The rating system covers quality of medical care, staffing levels, food services, sanitation, bedsore mitigation and the results of licensing inspections. The system designates five stars for the highest rated facilities, down to one star for the poorest.

The ratings have already been designated, however until this law goes into effect, nursing homes will not be required to post them says California Elder Abuse and Neglect Attorney Steven C. Peck who can be contacted toll free at 1.866.999.9085 or on-line at www.premierlegal.org.

While the nursing home grade posting system program does not go into effect until 2011, Antonovich has made the Nursing Home Compare Tool accessible now at www.antonovich.com.

Self-Help for the Elderly and the Congress of California Seniors announced Tuesday (Dec. 8) that they have received $150,000 from the Verizon Foundation, the philanthropic arm of Verizon, to continue an elder-abuse awareness program for senior citizens in Santa Clara and Ventura counties.

Including this contribution, Verizon has awarded a total of $300,000 to the organizations for the Commitment to End Abuse of Seniors and Elders program (CEASE).

Through the program, Self-Help for the Elderly and the Congress of California Seniors have partnered with local senior service providers and domestic violence prevention groups to implement an education and outreach campaign, publish multilingual education materials, and direct information about local resources available to victims and family members.

"Our seniors are very vulnerable and we must make every effort to protect them," said Anni Chung, president and CEO of Self-Help for the Elderly. "I look forward to working with the Congress of California Seniors and Verizon to educate the public and families about the effects and consequences of elder abuse."

Hank Lacayo, president of the Congress of California Seniors, said, "In recent years, financial abuse, physical assault and family-related violence have increased while public resources to identify abuse and to protect victims have been cut back, creating a budget crisis for agencies fighting abuse. The continued funding from Verizon will help us prevent ongoing abuse and raise awareness of this critical issue through advocacy, education, training, public awareness and coordination of services."

State Sen. Leland Yee said, "While our resources are shrinking, the need for these types of programs is growing. As a result, this help is more important than ever. It is these community partnerships that are truly making a difference."

Every year, nearly a quarter of a million Californians are victims of elder abuse and dependent adult abuse. It is estimated that one of every 20 California elders is a victim of neglect or physical, psychological or financial abuse, according to the California Department of Justice, yet only one in five of these cases is reported.

Raising awareness of domestic violence and aiding in its prevention is a key social issue for the Verizon Foundation.

"Our senior citizen population is among the most vulnerable when it comes to the issue of abuse," said Elva Lima, Verizon vice president, strategic programs. "This partnership allows Verizon to continue to use our resources to support an organization that has a proven record of creating positive change in the lives of our seniors."

About Self-Help for the Elderly
Originally created as a "War On Poverty" program, Self-Help for the Elderly began serving seniors in San Francisco's Chinatown community in 1966. It provided social services and hot meals to low-income and isolated elderly. Today, Self-Help for the Elderly serves over 25,000 seniors each year in San Francisco, San Mateo, Santa Clara and Alameda counties. It is a multi-service organization providing programs along a wellness continuum ranging from employment/training and social activities for those who are more independent to in-home assistance and residential board and care to those who are frailer.

About Congress of California Seniors
The Congress of California Seniors (CCS), founded in 1977, is a statewide nonprofit advocacy organization and is registered with the IRS as a 501(c)(4) California corporation. Our board of directors is comprised of senior leaders and advocates from among the Congress of California Seniors' 105 affiliated organizations. The organization is funded through membership dues, contributions from affiliated organizations, individual donations and corporations.

Continue reading "Verizon Sponsors Elder Abuse Awareness Programs" »

A Ventura nursing home called Fillmore Convalescent Center, its owner, and one of its employees were hit with a $7.75 million verdict yesterday after a jury found them liable for elder abuse. It has to be one of the largest verdicts in California in a case involving nursing home abuse or neglect.

The facts are egregious. In 2006, the family of 71-year-old Maria Arellano, a stroke victim who was also non-verbal, began to notice suspicious bruising. They complained to the nursing home administration, but it failed to look into it. The family then placed a hidden camera in Ms. Arellano's room, which caught caregiver Monica Garcia slapping Arellano, pulling her hair, bending her fingers, and treating her violently. When the tape was revealed, Garcia was charged with criminal acts, and the family brought an elder abuse lawsuit against the nursing home.

The lawyer for Arellano, must have done an excellent job. He told the Ventura County Star that he offered to settle the case for $500,000, but was rebuffed. The nursing home, through its attorney Tom Beach, never offered a dime to resolve the case.

Ironically, Fillmore Convalescent received a five-star rating, the highest, from the Nursing Home Compare system, operated by the Centers for Medicare and Medicaid Services.

Continue reading "Ventura Nursing Home Found Liable for Elder Abuse in the Amount of $7.75 Million" »

The California State Senate has approved Assembly Bill 392 (Feuer) with strong bipartisan support on a vote of 33-3. AB 392 would immediately provide $1.6 million for local Long-Term Care Ombudsman programs over the next year, ensuring protection from abuse and neglect for California´s vulnerable and elderly residents of nursing care and assisted living facilities.

"We need to take every step we can to protect seniors who may be at serious risk of abuse or exploitation," said Assembly member Mike Feuer (D-Los Angeles). "The funds provided to Ombudsman programs in AB 392 fill this important need during the next year. Isolated and vulnerable residents of nursing homes and assisted living facilities have nowhere else to turn, and their lives depend upon these programs being restored immediately."

Last year, Governor Schwarzenegger vetoed $3.8 million in funding for local Ombudsman programs, representing about half their funding. As a result of the cuts, the programs have been forced to lay off staff and drastically reduce services, compromising their abilities to investigate complaints and monitor facilities. Since these cuts have taken effect, residents have suffered the dire consequences of unchecked poor treatment.

In late June 2009, a Northern California facility owner and one care giver were arrested on suspicion of criminal abuse and neglect of a resident whose untreated pressure sores were so severe that they resulted in fatal sepsis. After the arrest, the two suspects posted bail and continued to collect payment to provide care for the six other facility residents. Unfortunately, without the funds provided by AB 392, the local Ombudsman cannot investigate how well the remaining patients are being cared for.

Local Ombudsman programs conduct frequent unannounced monitor visits to facilities, and they provide timely response to reports of suspected abuse and neglect. They investigate thousands of abuse cases each year. Without the scrutiny of the Ombudsman programs, the facilities are reviewed just once a year (or less) by government agency inspectors. Because no other program duplicates this critical advocacy service, the passage of AB 392 is especially important for residents´ quality of life and quality of care.
Contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced elder abuse and neglect attorney.

A live-in caregiver arrested in connection with the heat-related death of a 90-year-old man and the hospitalization of his wife in eastern Contra Costa County has been released, authorities said today.

Laarni Dime, 57, was arrested on suspicion of elder abuse after she failed to turn on the air conditioner in the Discovery Bay home of George Brim.

Brim was found dead in his bedroom and his 85-year-old wife was suffering from heat-related injuries at about 11:15 p.m. on Saturday July 18, 2009, Lee said. The high in Discovery Bay that day topped 100 degrees.

Dime was released late Monday while the investigation continues.

Should you ever suspect the elder abuse and neglect of a loved one, immediately contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced nursing home abuse and neglect attorney.

Physical, mental and sexual abuse are certainly forms of abuse encountered by nursing home residents across the country. Remember, you know your loved one better than anyone else. If you suspect mistreatment or elder abuse immediately report the situation to local police and/or ombudsmen. The reality is that most episodes of elder abuse go unreported.

The following situations certainly warrant further investigation:

Unexplained bruises, cuts, burns, sprains, or fractures. Bed sores. Frozen joints. Unexplained venereal disease or genital infections, vaginal or anal bleeding. Bloody clothing. Sudden changes in behavior. Staff refusing to allow visitors to see resident or delays in allowing visitors to see resident. Staff not allowing resident to be alone with visitor. Resident being kept in an over-medicated state. Loss of resident's possessions.
Sudden large withdrawals from bank accounts or changes in banking practices.
Sudden loss of appetite.

Q. Are bedsores an unavoidable part of living in a nursing home?

A. No! Bedsores, also called pressure sores or decubitus ulcers, are preventable -- with proper screening, early detection, and staff involvement. Bedsores are a widespread problem in nursing homes and hospitals. The development of bedsores in nursing home patients is really a reflection of poor nursing care than an inevitable part of of the aging process.

Bedsores likely will develop if the nursing home and its staff do not make bedsore prevention a top priority. Nursing homes must do a thorough assessment of residents on admission and on a regular basis during their stay. Following the assessment, the nursing home should develop a comprehensive care plan that specifies what precautionary measures should be in place.

The nursing home plan should include considerations to monitor each resident's hydration, nutrition, and hygiene. Early signs of bedsores should be identified by the nursing home staff and treatments should implemented. Unattended, bedsores can quickly become infected leading to sepsis, limb amputation and even death.

As part of nursing home's system of bedsore prevention, nursing home residents (particularly the bed-bound) should be repositioned every two hours and ensuring proper hygiene. Pressure relieving mattresses should be implemented as a preventative measure. While bedsore prevention plans are great in theory, the most important part of bedsore prevention and treatment ultimately relies on the skill and dedication of the staff. Do not let a nursing home or hospital tell you your loved one's bedsore was unpreventable!

Q: What should relatives do if they suspect their loved one in a nursing home has been abused?

A: Contact police, because police are the ones qualified to do criminal investigation. Listen closely to what loved ones say. Look for physical signs.Counseling should take place if needed. One of the worst things to do is to pretend nothing happened.

Q. What should families do to prove mistreatment?

A.When you become aware of mistreatment ... it is important to get your loved one the medical treatment they need and then get into "fact-collection mode." ... Collect information about the incident, acts of the nursing home staff and medical condition of your loved one.

Don"t assume you will remember all facts regarding the incident. As time goes on, your memory will begin to fade.The following information will prove to be valuable:
Photographs of the physical injuries themselves, the area where the incident took place and if possible, the people involved.
Write down as much information about the incident or events as you can remember. Write some more. Details can be particularly helpful ... Concentrate on: names, dates, room numbers, names of facilities and medication dosages (if relevant).
The medical chart from a nursing home and / or hospital is crucial to determining what a facility may have done or failed to do that resulted in injury or death.
Chronology: It is important get the correct names and general dates of admission at health-care facilities. The names of doctors who provided medical can be helpful as well.
Other Relevant documents: Health-care power of attorney, wills, death certificates, preinjury photographs, autopsy reports and nursing home inspection reports all can be helpful.
Q. Who regulates nursing homes?

A. In most states, nursing homes are regulated by a combination of state (Department of Health) and federal authorities (U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services). Each agency has its own regulations that control all aspects of the nursing home including: resident care, staffing, policies and procedures and medical equipment.

Because nursing homes are responsible for complying with state and federal regulations, agents from either agency conduct inspections of the facility to assure compliance with the regulations. These inspections are called 'surveys' and are generally done unannounced at least one time per year. Surveys may be conducted more frequently at facilities with a history of prior violations or in response to a complaint regarding resident care.

After each survey a report is completed regarding the facilities compliance with applicable regulations. If the findings do not immediately threaten patient safety, nursing home administrators will have an opportunity to review the survey findings and propose a 'plan of correction'. If however, surveyors find conditions that pose a threat to patient safety, they have the ability to impose a variety of penalties including: fines, appointed facility supervisors, suspension of new resident admissions or license suspension.
Steven Peck, an experienced California nursing home abuse and neglect attorney, may be contacted toll free at 1-866-999-9085 and at www.premierlegal.org

"It's the same old see-saw -- as the local economy sinks, reports of elder fraud and abuse are on the rise", says California Elder Abuse and Neglect attorney Steven C. Peck

"The number of elder abuse cases seen by my office has increased dramatically in the last few years", says attorney Peck.

"How high the case load my office inherits this year is unforseen. Elders and vulnerable adults are prime targets of all kinds of abuse both medical, ohysical, and financial."

"The term "abuse" is an all-inclusive term." Peck said, " it can range from self neglect, neglect by others, physical abuse, psychological, emotional, sexual abuse and exploitation of financial or personal assets.
Contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced elder law, abuse and neglect attorney.

A California nursing home in Encinitas, California has become the latest facility to get a $100,000 fine for conditions that led to a patient's death. State officials concede collecting these fines can take years.

State regulators reserve the $100,000, or AA fine for the most severe violations of health and safety codes.

Nursing homes have the right to appeal the fine and most of them do so.

In 2007, the state issued more than $2 million worth of AA fines. To date, the state has collected less than ten percent.

Evidently, the California Department of Health Services doesn't have enough attorneys, their appeal system is broken down,and they don't even have enough administrative law judges to process the appeals and collect the fines imposed.

State officials say a nursing home can lose its license if it gets two AA fines within a 24-month period.

Should you suspect that a loved one has been neglected or abused in a california nursing home or long term facility, contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced california elder abuse and neglect lawyer.

The image is not pretty, the examples may make one feel uncomfortable, and some victims may not realize they need help. Elder abuse can take many forms and can sometimes be difficult to recognize.

These are some of the reasons that each June, World Elder Abuse Awareness Day is recognized. This year's observance was Monday June 15, 2009, but it's a problem that must be addressed every day.

Each year, more than two million vulnerable adults and older adults fall prey to elder abuse in the United States.

Protecting our vulnerable and older adults from abuse, neglect and exploitation is the responsibility of all our citizens. Learning to recognize the signs of abuse and neglect are important factors to ensuring that our seniors and vulnerable adults live their lives in safe environments with dignity and respect.

Research shows that older adults who are abused, neglected and exploited are three times more likely to die within 10 years than those who are not.

According to national statistics, elder abuse is grossly underreported because vulnerable and older adults who are being abused find it difficult to tell anyone due to shame and fear. Elder abuse affects men and women of all ethnic backgrounds and social status; it occurs in private residences and in facilities.

Elder abuse in California most often happens to adults over the age of 59 who live alone or with family members (85%), while the remainder happens in facilities or shelters. The most common form of mistreatment is neglect, with 69% of the cases involving self-neglect, where victims are unable to care for themselves adequately.

Anyone who suspects that a vulnerable or older adult is in need of protection is required by California law to report this information to the adult protective services intake unit at the department of social services in the county where the adult resides.

Some of the signs of elder abuse may include:

· Bruises, burns, cuts, scratches
· Malnutrition
· Untreated medical condition(s)
· Unsafe or unsanitary housing
· Mental anguish and distress
· Mistrust toward others
· Mismanaged property or savings
· Inability to provide needed care
What can you do to help raise awareness about elder abuse?
· Don't ignore this problem. It's not going away.
Should you suspect elder abuse or have suspicions as to nursing home abuse and neglect in an institution, immediately contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced elder law attorney.

A nursing home west of downtown Los Angeles has been fined $100,000 after state officials concluded that poor care led to the injury and death of an elderly resident who fell and hurt his head.

The penalty, levied on Lakewood Manor North Nursing Home in Westlake, just south of MacArthur Park, is the state's most severe, officials said.

The case involved an 83-year-old man, who on the morning of Jan. 4, 2007, lost his balance and struck his head on a bed rail when he was being moved from his bed to a wheelchair. The man had a short-term memory problem and had impaired cognitive skills, and relied on nursing staff for dressing; state officials said the facility failed to provide adequate support for the resident as he was transferred to his wheelchair.

At 8:30 a.m., about half an hour after the blow to the head, nurses' notes documented the man had a bluish discoloration on the left side of his head. Staff monitored the patient's condition as the attending physician was paged at 8:45 a.m. and 12:30 p.m., but the doctor did not return the call.

His condition continued to deteriorate throughout the day; he refused lunch and dinner and complained of not feeling well. At 8:30 p.m., he was observed as lethargic. Finally, at an unspecified time, an attending physician was reached, and the patient was transferred to a hospital at 9:30 p.m.--more than 13 hours after he had struck his head. The patient had suffered bleeding in the brain and died five days later.

Investigators said the licensed nurses should have called either an alternate physician or the medical director when the attending physician did not respond to pages, or call 911 in an emergency.

"Failure of the facility staff to immediately notify the physician and to provide the necessary care and services to Resident 1 [the patient] ... presented a substantial probability that serious harm would result, and did result to Resident 1 [the patient's] death," the report said.

Should you ever suspect nursing home abuse and neglect contact Steven Peck's Premier Legal toll free at 1-866-999-9085 to talk to an experienced attorney.