California Elder Law Attorney Blog

Surgical Treatment There are many different types of surgeries used to treat pressure sores, bed sores and decubitus ulcers.. Debridement is an option to surgically clean and remove any dead or infected skin and muscle. This debriding creates a larger wound, but the area is healthy and more likely to heal. In many cases a small amount of bone is also removed from the base of the wound to decrease recurrence of infection. In some cases, the hip joint will need to be removed along with a portion of the thigh bone.

Reconstructive surgery involves the removal of healthy tissue from one place on the body to cover a wound somewhere else. The skin and/or muscle (the flap) is usually taken from the back, buttocks or thigh. This flap tissue, which has a good blood supply, is repositioned to cover the wound and help nourish the tissue around the pressure sore. Once the pressure sore is covered, the area where the flap tissue was removed is closed. Sometimes skin grafts are used to close these areas.

Multiple Pressure Sores Some people have more than one pressure sore. It is not uncommon that surgery on these areas must be spread out over more than one surgery. If reconstruction can be accomplished with a single operation, it may require a more radical treatment option if there are multiple or very large wounds. In severe cases, a leg may be amputated to provide the necessary tissue for the reconstruction. For example, a total thigh flap requires amputation of the leg so the skin and muscle from the front of the thigh is used to fill the wound.

Postoperative Care After surgery, it is very important take care of the repaired area to reduce the risk for complication. Care starts with transferring from the operating table to the air-fluid bed. Patients are positioned flat in the air-fluid bed for 4 weeks. Movement is limited to prevent shearing and tension across the flap repair. After 4 weeks, patients can be wedged carefully into the semi-sitting position. Six weeks after surgery, patients can begin sitting for 10 minute intervals. After each interval, the flap area is examined for discoloration and wound edge separation. The sitting periods are increased at 10 minute intervals over 2 weeks and reaching up to 2 hours of sitting at a time. Pressure reliefs are needed for 10 seconds at least every 15 minute while sitting. Patients will need to continue using a pressure-reducing mattresses and turn in bed every 2 hours.

Individuals with SCI have other concerns. Involuntary muscle spasms must be well controlled to allow proper healing after surgery. Bacteria, which is the source of infection, is easily brought into the bladder with Intermittent Catheterization, Foley, and Suprapubic methods of bladder management. It is important to prevent infections, and antibiotic treatment is needed if bacteria are present in urinary cultures or urinalysis.

Special equipment is also needed to allow healing to progress normally. Because this is so important, all equipment are secured before surgery is scheduled. The equipment might include a pressure-reducing mattress (such as an air-fluidized bed or low air loss mattress) and a proper seat cushion for patients using wheelchairs. In addition, plans for recovery include setting up home health care or staying in a rehabilitation facility or assisted living center to recover.

In most cases the area of the pressure sore and reconstructive flap does not have sensation. It is also important to note that reconstruction cannot restore normal sensation. Wound disruption or delayed wound healing is possible, and some areas of the flap skin may heal abnormally or slowly.

Without these precautions, wound breakdown or pressure sore recurrence is extremely likely. Treatment may require frequent dressing changes or further surgery to remove the non-living tissue and an additional reconstructive procedure.

Risks of Flap Reconstruction
Every surgical procedure involves a certain amount of risk, and it is important that you understand the risks involved with the reconstruction of a pressure sore. An individual's choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience the following complications, you should discuss each of them with your surgeon to make sure you understand the risks, potential complications, and consequences of reconstruction with flap surgery.

Bleeding is possible during or after surgery. If bleeding occurs, it may require emergency treatment to drain accumulated blood (hematoma).

Infection can occur after surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary. If an infection does not respond to antibiotics, the reconstruction may to be opened. After the infection is treated, additional reconstruction may be needed.

Flap Failure is possible despite all best efforts. Failure sometimes occurs when a blockage or compression occurs at the point of blood flow to the flap.

Even though risks and complications occur infrequently, the risks cited above are the ones that are commonly associated with flap reconstruction surgery. Other complications and risks can occur but are uncommon. Should complications occur, additional surgery or other treatments may be necessary.

Every pressure sore, bed sore and decubitus ulcer is unique, and a great deal depends on individual circumstances. Ask your doctor to explain anything you do not understand. Also, you should also ask your doctor for educational information that specifically details the procedure you are considering for yourself.

Continue reading "Surgical Treatment of Bed Sores, Pressure Sores and Decubitus Ulcers Can Be Very Painful and Costly Says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Treating a pressure sore is much more difficult than preventing one. The main goals of treatment are to relieve pressure on the sores, keep them clean and free of infection, and provide adequate nutrition. Adequate nutrition is important in helping pressure sores heal and in preventing new sores from forming. A well-balanced, high-protein diet is recommended as well as a daily high-potency vitamin and mineral supplement. Supplemental vitamin C and zinc may help with healing as well. Electrical stimulation, heat therapy, massage therapy, and hyperbaric oxygen therapy have not proven helpful.

In the earliest stage, pressure sores usually heal by themselves once pressure is removed. When the skin is broken, a doctor or nurse considers the location and condition of the pressure sore when recommending a dressing. Film (see-through) dressings help protect early-stage pressure sores and allow them to heal more quickly. Hydrocolloid (oxygen- and moisture-retaining) patches protect, keep the skin appropriately moist, and provide a healthy environment for deep sores. Other types of dressings may be used for deeper sores, those that ooze a lot of fluids, and those that are infected.

If the sore appears infected or oozes, rinsing with saline and dabbing gently with a gauze pad are helpful. A doctor may need to remove (debride) dead tissue with a scalpel or a chemical solution. Removal of dead tissue is usually painless, because pain is not felt in dead tissue. Some pain may be felt because healthy tissue is nearby. Health care practitioners may flood (irrigate) the sore, particularly its deep crevices, with a sterile solution to help clean away hidden debris.

Sometimes a bed that circulates air (an air-fluidized bed) is used in hospitals and nursing homes. This special bed helps reduce or redistribute pressure on the body.

Deep pressure sores are difficult to treat. Sometimes they require skin and muscle flaps, in which healthy, thicker tissue with a good blood supply is surgically repositioned to cover the damaged area. This type of surgery is not always successful, however, especially for frail older people who are malnourished. Often, when infections develop deep within a sore, antibiotics are given. When bones beneath a sore become infected, the bone infection (osteomyelitis---see see Bone and Joint Infections: Osteomyelitis) is extremely difficult to cure and may spread through the bloodstream, requiring many weeks of treatment with an antibiotic.

Continue reading "The Treatment of Pressure Sores, Bed Sores and Decubitus Ulcers Is More Difficult Than Prevention says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

People are paying a bundle to keep a loved one in a nursing home these days. The average cost of an annual stay at a facility is $71,000 for a private room in the United States. What is appalling is that this estimate doesn't reflect the care and attention that patients deserve when submitted to these facilities. One of the reasons for this rise in substandard care is under-staffing. And Facilities that are understaffed usually have patients that suffer from nursing home abuse and neglect.

The majority of homes in the US are for-profit enterprises, usually operating with too few staff assigned to too many patients. The Department of Health and Human Services estimate that over 90 percent of nursing homes operating in the United States do not have enough staff to provide proper care. Staff also tends to be overworked and underpaid, which leads to a high turnover rate at most facilities. Replacement rates at some nursing homes approach 100 percent annually. With new staff coming and going, it is easy to see how a patient's particular needs might not receive the special care that they deserve.

Over several decades, many many states have tried to pass legislation to force the nursing home industry to provide better care. Unfortunately for victims of abuse and neglect, legislators are not trying hard enough. Ultimately it is up to the families and friends of the patient to bring about real change. One step you can take to prevent abuse is visiting your loved one often. If a patient doesn't receive a lot of visitors, staff forgets that the patients are real people. Another step you can take if you suspect abuse is to talk to The Peck Law Group Nursing Home Abuse and Neglect Lawyers.

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Nursing homes are understaffed, and the big problem seems to be workload. Only 41 percent of the facilities agreed that the facility had enough staff to handle residents' needs safely, and almost two-thirds agreed that staff had to hurry because there was too much work to do.

Size matters -- a lot, though it's not clear why. In nursing homes with 49 or fewer beds, 77 percent of staff awarded their facility high safety ratings overall. In facilities with more than 100 beds, only 59 percent would.

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A federal agency has released health quality data that show troubling statistics about nursing home care in California. The data show almost one in 10 long-term nursing home patients was physically restrained in 2008.

The state snapshot also said that some 27 percent of short-stay nursing home residents had bed sores that same year. In these areas, California ranked last among the states.

Bill Freeman of the Agency for Healthcare Research and Quality said he hopes the numbers are useful to lawmakers. The agency found the state was 'average' in overall quality of care.

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Continue reading "Nursing Home Care Is Very Troublesome In the State of California" »

Clinical Conditions that may evidence the risk of Dehydration and / or electrolyte chemical inbalance are as follows indicates Los Angeles Nursing Home Abuse and Negelct Attorney Steven Peck:

Dementia or cognitive impairment
Fever (including low-grade fever)
Diarrhea
Vomiting
Dependence on staff for eating and drinking
Use of medications that can cause dehydration (e.g., diuretics, phenytoin, lithium, laxatives)
Draining wounds or pressure ulcers
Excessive sweating
Rapid breathing
Gastrointestinal bleeding
Previous episodes of dehydration
Difficult or painful swallowing
Depression
Small amount of dark or concentrated urine
Excessive urination
Nothing-by-mouth or fluid-restriction orders
Chronic comorbidities (e.g. stroke, diabetes, congestive heart failure)
Infection
Dizziness
Environmental Factors

Tube feeding
Use of specialty beds
Lack of social or family support
Inadequate staffing
Language barriers
Isolation
Restraints
Facility-specific factors that may expose patients to excessive heat (e.g. malfunctioning air conditioners)

Risk Reduction. A facility-wide hydration program can contribute significantly to decreasing the risk of dehydration. The certified nursing assistant (CNA) can be a major resource for this program. Regular rounds for fluid distribution, one-on-one help with consuming fluids, records of fluid intake and output if indicated, and reporting of warning signs that caregivers have been trained to recognize all play a part in a facility-wide effort to reduce the risk of hydration problems.

Hydration should be considered part of everyone's job. Every staff member should be trained to help manage hydration and to offer fluids as appropriate, and all staff should be involved in managing hydration. All caregiving staff should pay attention to such issues as why a patient may not be consuming fluids that are offered and ensuring that a patient's liquid preferences are identified. Questions about these issues should be asked of patients or of their family members or other advocates when patients are unable to respond.

Continue reading "Conditions and Factors That May Increase Risk for Dehydration or Fluid/Electrolyte Imbalance" »

Some of the factors to consider when encountering an individual who is paraplegic says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck:

Where his skin breakdown problems are--and are they healed or open right now
How is his nutrition?
Does he have a problem with moisture (incontinence or sweating)
Does he use a hospital bed, regular bed or adjustable bed, and what size
Does he turn and is he able to do this himself
What positions does he use for sleep
How does he transfer
What ADLs does he do in bed

Continue reading "Pressure Sores, Bed Sores and Decubitus Ulcers In Paraplegics: Some Factors to Consider says California Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Signs of VRSA

VRSA is vancomycin-resistant Staphylococcus aureus. VRSA can result from treatment of MRSA with vancomycin and teicoplanin. The patient may become resistant to the original infection, as well as the drug being used to stop the infection from spreading. This particular bacterium is rarer than MRSA, but it does occur with increasing regularity. The bacteria will thicken the cell walls depleting the amount of vancomycin that enters the blood stream and kills the bacteria. Patients with this infection must be isolated to avoid spreading it throughout the rest of the SNF. They may also have to be placed on a pump to clean out their system of the vancomycin before trying another drug. The bacterium has to be isolated in the body to help eradicate it.

Looking for Risk Factors

VRSA and MRSA are just two inflectional bacterium found in SNFs that you should look for before placing a loved one. To keep residents at SNFs free of this inflectional bacterium the staff must provide proper housekeeping, hygiene, and keep to federal and state regulations regarding care facilities.

Continue reading "VRSA Can Be Deadly In Nursing Homes And Can lead To Death Says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck" »

Under federal guidelines, each nursing facility must develop and implement written policies and procedures prohibiting mistreatment, neglect, or abuse of residents. A resident in such a nursing facility is entitled to receive verbal and written notice of the rights and services to which he or she is entitled during his/her stay in the facility. This notice must be give prior to or upon admission, and periodically throughout the resident's stay, in a language the resident understands. The resident must acknowledge his or her receipt of such notice in writing.

* Nursing home residents have the right to see family members, ombudspersons or other resident advocates, physicians, service providers, and representatives of the state and federal government.
* Residents may keep and use their personal possessions and clothing unless doing so would endanger health and safety.
* Residents have the right to apply for and receive Medicare and Medicaid benefits and cannot be asked to leave a home because they receive such benefits.
* A nursing home must treat all individuals the same, regardless of whether they are private payers or Medicare or Medicaid recipients.
* Residents have the right to keep their clinical and personal records confidential.
* Residents are entitled to lists of what services are paid by Medicare and Medicaid and the additional services for which the residents will be charged, plus the fees for those services.
* Nursing home residents have the right to choose their own personal physician.
* Residents have the right to be fully informed about their medical care.
* Residents have the right to participate in the planning of their care and treatment.
* Nursing home residents have the right to refuse treatment.
* Residents have the right to be free from mental and physical abuse.
* Nursing home residents cannot be kept apart from other residents against their will.
* Residents cannot be tied down or given drugs to restrain them if restraint is not necessary to treat their medical symptoms.
* Residents have the right to raise grievances and have them resolved quickly.
* Residents may participate in social, religious, and community activities to the extent that they do not interfere with the rights of other residents.
* Residents cannot be required to deposit their personal funds with the nursing home, and if they request that the home manage their funds, the home must do so according to state and federal record-keeping requirements.
* Residents have the right to privacy, including in their rooms, medical treatment, communications, visits, and meetings with family and resident groups.
* Residents have the right to review their medical records within twenty-four hours of making a request.
* Nursing home residents have the right to review the most recent state inspection report relating to the home.
* Residents must be given notice before their room or roommate is changed, and residents can refuse the transfer if the purpose is to move them from a Medicare bed to a Medicaid bed or vice versa.
* Residents have the right to stay in the nursing home and can only be removed if it is necessary for the resident's welfare, the resident no longer needs the facility's services, it is necessary to prevent harm to the health or safety of others in the facility, the resident fails to pay after reasonable notice, or the facility ceases to operate.
* Nursing home residents and their representatives have the right to thirty days' notice of a proposed transfer or discharge, and they have the right to appeal.
* Before transferring residents for hospitalization or therapy, the nursing home must inform them of the length of time that their beds will be held open for their return, called the "bedhold period."
* Nursing home residents returning from a hospital or therapeutic leave after expiration of the bedhold period have the right to be readmitted as soon as the first semi-private bed becomes available.
* Residents must be informed of their rights upon admission, and must be given their rights in writing if so requested.

Continue reading "Federal Guidelines Determine The Policies Governing Nursing Home Abuse and Neglect States Los Angeles Nursing Home Abuse and Neglect Attorney Steven C. Peck" »

Nursing home abuse lawsuits are getting to be far more regular annually says San Francisco Nursing Home Abuse and Neglect Attorney Steven Peck.

It truly is tough to think that the workers of a nursing home abuse attorney would be negligent towards their elderly patients, however, many health conditions are at-risk of getting overlooked in a very substandard care setting. It is necessary for loved ones of citizens to continue to be alert for any indications that abuse might be occurring. The failure of a nursing home's workers to identify and deal with a affected person suffering from dehydration is a single normal shortcoming. and should be closely monitored.

The staff of a live-in care facility is accountable for making certain that patients obtain sufficient liquid to continue being adequately hydrated. At any age brain injury claim could cause considerable sickness, but dehydration inside the elderly could cause considerably more severe conditions. For minor dehydration, headaches and dizziness may perhaps happen. Increased dehydration may possibly bring a dangerous fluctuation in entire body temperature, a weakened immune program, and dangerously reduced blood strain.

Members of the family and cherished ones might identify the situation by observing that a patient's eyes appear to be sunken, or probably by noticing a slight modify in character. Confusion is usually a signal that a medical injury claims illness is occurring as a result of the lack of needed liquids within the physique.

Although they cannot reverse the sad conditions which have resulted from nursing home abuse claim, a nursing Home abuse and neglect legal professional may well be able to help in holding a negligent / neglectful facility accountable for the harm it has accomplished. If reported, the events at fault could be heavily fined or even drop their license says Van Nuys, California Elder Abuse Attorney Steven Peck.

Continue reading "Dehydration In the Elderly In Long Term Care Facilities Is Very Common Says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck" »

The final element to prove in any elder abuse case in the State of California is that a managing agent knew of, ratified, or is personally guilty of the reckless conduct indicates Los Angeles Nursing Home Abuse and Neglect Attorney Steven C. Peck.

In an acute care facility, look to who created the policies and procedures, who was responsible for insuring that the nursing staff knew, understood, and applied the policies and procedures, who decided the staffing levels for the units on which your client was a patient, who trained the staff on the proper use of beds and mattresses, etc.

Helpfully, the only published opinion that discusses the element of managing agent in an elder abuse case is regarding elder abuse in an acute care facility. See Marron, supra, 108 Cal.App. 4th 1049. The court in Marron found that a nursing supervisor in a hospital is a managing agent.

Continue reading "Managing Agent in an Acute Care Facility" »

The application of the Elder Abuse Act against acute care facilities fits squarely under the existing case law, statutory language, and jury instructions. Indeed, the Elder Abuse Act itself includes a broad list of facilities to which the Act applies, making no distinction between skilled nursing facilities and acute care facilities. Welfare and Institutions Code Section 15610.17 states in part:
"Care custodian" means an administrator or an employee of any of the following public or private facilities or agencies, or persons providing care or services for elders or dependent adults, including members of the support staff and maintenance staff:

(a) Twenty-four-hour health facilities, as defined in Sections 1250, 1250.2, and 1250.3 of the Health and Safety Code.
Health and Safety Code Section 1250 includes "general acute care hospital," as well as "skilled nursing facility," providing a solid basis for the argument that the Elder Abuse Act applies equally to the acute care setting.
Similarly, the CACI Jury Instructions on Elder Abuse make no distinction between elder abuse in a skilled nursing facility and elder abuse in the acute care setting. Notably, CACI 3103 specifically provides for a cause of action against a health care provider for custodial neglect without regard to the type of facility:

Continue reading "The Elder Abuse Act AppliesTo Long Term Care Facilities says Los Angeles Elder Abuse Attorney Steven C. Peck" »

Elder abuse in nursing homes is an unfortunate occurrence. This type of abuse encompasses the physical and mental abuse of individuals who reside in nursing home as well as the neglect of these individuals for the negligent failure to provide medical services says Van Nuys, California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

There are various federal and state laws which are aimed at preventing nursing home and elder abuse. While some of the laws seek to ensure a safe environment by establishing monetary fines for failure to maintain a proper environment, other laws are criminal in nature.

Federal Laws:

1. There is a substantial federal law which attempts to ensure the quality of nursing homes and prevent elderly abuse. The act is known as the Omnibus Budget Reconciliation Act (OBRA) of 1987. In addition, the act is sometimes referred to as the Nursing Home Reform Act. This act contains provisions specifically aimed at nursing homes which participate in Medicare and Medicaid and receive payment from these programs. The act has companion regulations, contained in the Code of Federal Regulations (CFR). These regulations establish the specific duties of a nursing home, which include having adequate staff, developing comprehensive care plans for nursing home residents, assisting with the daily life activities of the residents, taking preventative measures to prevent bed sores and other types of infections, providing appropriate skilled nursing and non-skilled nursing services to residents, giving medications to patients as needed, ensuring patients' privacy and maintaining updated records for each patient.

State Laws:

2. Every state has laws relating to abuse in nursing homes and health care facilities where the elderly reside. These may include statutes which prohibit the use of restraints without an independent medical review of up to two doctors, establish a freedom from physical or mental abuse, as well as the right to be treated with dignity, to be involved in one's own care and care plan, to have regular visiting hours, to receive mail and to manage one's own affairs. There are other types of laws which may apply, but these are the most common provisions. Usually, with these types of state laws, the penalties are civil in nature; in other words, a violation of the law may result in a fine. In California the Nursing Home State laws are encompassed in Title 22 of the California Code of Regulations.

Criminal Laws:

3. Since elder abuse encompasses physical acts and neglect, there are criminal laws which apply to elder abuse. Rape, battery and assault are all covered by criminal law statues of the state in which the nursing home is located. Furthermore, more serious criminal acts, such as manslaughter and murder are all possible charges against individuals who commit crimes against nursing home residents. In California see California Penal Code Section 368.

The federal law discussed above, known as the Omnibus Budget Reconciliation Act of 1987 or the Nursing Home Reform Act, requires that an ombudsman program be maintained by every state. An ombudsman is a person who serves as an advocate for nursing home residents. The person may assist in the disposition of concerns or problems, or intervene to assist in claims of elder abuse. The goal of the program is to ensure that nursing home residents have the ability to receive quality care and ultimately reduce elder abuse.

Continue reading "Federal and State Laws Are Aimed at Preventing Nursing Home Abuse and Neglect Says Van Nuys, California Elder Abuse Attorney Steven C. Peck" »

Most reported nursing home abuse falls into the category of neglect, such as bed sores, pressure sores, decubitus ulcers, or not maintaining proper sanitation. However, there are many other types of nursing home abuse, and the practice is not rare. According to the online Elder and Nursing Home Abuse Legal Guide, experts estimate that for every reported case of nursing abuse, about five more go unreported says Los Angeles Nursing Home Abuse and neglect Attorney Steven C. Peck.
Physical

1. Nursing home employees can physically abuse residents by hitting, kicking, slapping or any other harmful physical action.

Sexual

2. Sexual abuse also occurs, and is identified as any kind of sexual activity that occurs without the consent of the resident.

Punishment

3. Some nursing home employees punish residents in harsh ways, such as isolating them or subjecting them to painful restraints.

Emotional

4. Insulting residents, threatening or frightening them, or depriving them of their belongings, are examples of another type of nursing home abuse, defined as emotional or psychological abuse.

Neglect

5. Neglect is the most common type of abuse, including not maintaining clean living quarters or personal hygiene, not dispensing medication, or depriving residents of food and water, and the negligent failure to provide medical services.

Continue reading "Los Angeles Nursing Home Abuse and Neglect Attorney Steve Peck Comments About Elder Abuse" »

Nursing home neglect is a general term that encompasses many different situations that commonly result in patient injury or even death.

The duration of the neglect can occur over any period of time- days, weeks, months -- even years. Many situations involving nursing home neglect are reflective of a systematic problem at the facility, where shift-after-shift of nursing home employees fails to provide necessary care to patients in need.

Medical complications such as malnutrition, dehydration and bed sores are common consequences of nursing home neglect. In some situations, the aforementioned conditions of malnutrition and dehydration may contribute to the development of bed sores.

* Incontinence - Failure to keep patient clean, change soiled linens after an episode of incontinence, and re-position patients on a regular internals may contribute to the development of bed sores (similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers).

* Dehydration - An inability to perceive thirst or anxiety over going to the toilet are some of the common factors that contribute to dehydration of nursing home patients. Staff must keep track of patients fluid intake and output.

* Malnutrition - We all know food is a basic requirement to keep our bodies functioning properly. Yet, when inappropriate foods (solid foods given to an are given to patients who can not eat them) or no staff assistance is provided to patients who are unable to feed themselves serious health problems may develop.

Nursing Home Liability for Neglect of Patients:

It is not necessary to distinguish the type of neglect nor establish actual intent on the part of the facility to pursue a cause of action premised on neglect. Rather, if your loved one suffered a bed sore or other type of injury due to inaction on the part of a caretaker, you may be entitled to pursue a claim for the resulting damages.

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