California Elder Law Attorney Blog

Definition of Pressure Ulcer, Pressure Sore, Bed Sore or Decubitus Ulcer::

A pressure ulcer, pressure sore, bed sore or decubitus ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.

A pressure ulcer, pressure sore, bed sore, or decubitus ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head. says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Causes:

These factors increase the risk for pressure ulcers, pressure sores, bed sore or decubitus ulcers:

* Being bedridden or in a wheelchair
* Fragile skin
* Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow
* Inability to move certain parts of your body without assistance, such as after spinal or brain injury or if you have a neuromuscular disease (like multiple sclerosis)
* Malnourishment
* Mental disability from conditions such as Alzheimer's disease -- the patient may not be able to properly prevent or treat pressure ulcers
* Older age
* Urinary incontinence or bowel incontinence

Osteomyelitis
When instances of nursing home neglect and abuse lead to bed sores, pressure sores, and decubitus ulcers says California Nursing Home Abuse and neglect Attorney Steven C. Peck patients are placed at a greater risk of contracting bacterial infections.

One of the most common bacterial infections associated with nursing home neglect is osteomyelitis. Osteomyelitis is a bone infection caused by the bacteria which formed in the open wound of a bed sore. Symptoms of osteomyelitis include bone pain, high fevers, nausea, chills, excessive sweating, lower back pain, swelling of the ankles, feet and legs, and swelling, redness and warmth around the affected area.

Early detection and prompt treatment is crucial in the healing process of osteomyelitis. Testing should be conducted at the first sign of a possible infection. These tests may include blood cultures, bone lesion biopsies, bone scans, MRIs and needle aspirations of the area around the affected bone.

Once a patient has been diagnosed with osteomyelitis, antibiotics are commonly used in order to kill the bacteria that are causing the infection. If negligent care continues and the infection is not treated in a timely manner, the infection will spread. In these severe cases surgery may be needed to remove dead bone tissue. After surgery, the open space left by the removed bone tissue may be filled with a bone graft or packing material which will aid in the growth of new bone tissue.

With any surgical procedure that is preformed on a nursing home patient, there are risks of complications and additional injuries. If you or your loved one has had to have surgery as a result of negligent care received in a nursing home or hospital you should speak with one of our attorneys to learn what your legal rights and remedies may be.

Continue reading "Osteomyelitis Is a Bone Infection Caused By Bacteria Which Forms in the Open Wounds of Bed Sores, Pressure Sores, and Decubitus Ulcers" »

The terms decubitus ulcer and pressure sore often are used interchangeably in the medical community. Decubitus, from the Latin decumbere, means "to lie down." Decubitus ulcer, therefore, does not adequately describe ulceration that occurs in other positions, such as prolonged sitting (eg, the commonly encountered ischial tuberosity ulcer). Because the common denominator of all such ulcerations is pressure, pressure sore is the better term to describe this condition.

A study by Howard and Taylor found the incidence of pressure sores in nursing home residents in the southeastern United States to be higher in black patients than in white ones. The authors examined data from 113,869 nursing home residents, none of whom had pressure sores at nursing home admission. They determined that 4.7% of black residents developed postadmission ulcerations, compared with 3.4% of white residents. In addition, the racial differences in pressure sore incidence displayed a sex predilection based on patient characteristics. The variation in incidence between black and white males occurred in residents who were dependent in mobility, while in females, such variation occurred in black and white residents who were bedfast and living in nursing homes with fewer than 200 beds.1

History of the Procedure
Pressure sores have probably existed since the dawn of our infirm species. They have been noted in unearthed Egyptian mummies and addressed in scientific writings since the early 1800s. Presently, treatment of pressure sores in the United States is estimated to cost in excess of $1 billion annually.

Problem
Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath. These pressures are often in excess of capillary filling pressure, approximately 32 mm Hg. In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, conscious and unconscious, from the areas of compression leads individuals to change body position. These changes shift the pressure prior to any irreversible tissue damage.

Individuals who are unable to avoid long periods of uninterrupted pressure over bony prominences--a group of patients that typically includes elderly individuals, persons who are neurologically impaired, and patients who are acutely hospitalized--are at increased risk for the development of necrosis and ulceration. These individuals cannot protect themselves from the pressure exerted on their body unless they consciously change position or have assistance in doing so. Even the most conscientious patient with an extensive support group and unlimited financial resources may develop ulceration resulting from a brief lapse in avoidance of the ill effects of pressure.

Frequency
Two thirds of pressure sores occur in patients older than 70 years. The prevalence rate in nursing homes is estimated to be 17-28%.

Among patients who are neurologically impaired, pressure sores occur with an annual incidence of 5-8%, with lifetime risk estimated to be 25-85%. Moreover, pressure sores are listed as the direct cause of death in 7-8% of all paraplegics.

Patients hospitalized with acute illness have a pressure sore incidence rate of 3-11%. In a study of 658 patients aged 65 years or older who underwent surgery for hip fracture, Baumgarten et al found that 36.1% developed an acquired pressure sore within 32 days after hospital admission.5 (The authors defined an acquired pressure sore as one that arose after hospital admission and had reached stage II or higher.) Although the 32-day period included time spent by patients in rehabilitation facilities and nursing homes, the highest incidence rate for pressure sores occurred during the patients' acute hospital stays.

Disturbingly, even with current medical and surgical therapies, patients who achieve a healed wound have recurrence rates of as high as 90%.

Etiology
Many factors contribute to the development of pressure sores, but pressure leading to ischemia is the final common pathway. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures slightly above capillary filling pressure initiates a downward spiral towards ulceration.6,7

Impaired mobility is an important contributing factor. Patients who are neurologically impaired, heavily sedated, restrained, or demented are incapable of assuming the responsibility of altering their position to relieve pressure. Moreover, this paralysis leads to muscle and soft-tissue atrophy, decreasing the bulk over which these bony prominences are supported.

Contractures and spasticity often contribute by repeatedly exposing tissues to pressure through flexion of a joint. Contractures rigidly hold a joint in flexion, while spasticity subjects tissues to considerable repeated friction and shear forces.

Sensory loss also contributes to ulceration, by removing one of the most important warning signals, pain.

Paralysis and insensibility also lead to atrophy of the skin with thinning of this protective barrier. The skin becomes more susceptible to minor traumatic forces, such as friction and shear forces, exerted during the moving of a patient. Trauma causing deepithelialization leads to transdermal water loss, creating maceration and adherence of the skin to clothing and bedding, which raises the coefficient of friction for further insult.

Malnutrition, hypoproteinemia, and anemia reflect the overall status of the patient and can contribute to vulnerability of tissue and delays in wound healing. Poor nutritional status certainly contributes to the chronicity often observed with these lesions. Anemia indicates poor oxygen-carrying capacity of the blood. Vascular disease also may impair blood flow to the region of ulceration.

Bacterial contamination from improper skin care or urinary or fecal incontinence, while not truly an etiological factor, is an important factor to consider in the treatment of pressure sores and can delay wound healing.

Pathophysiology
The inciting event for a pressure sore is compression of the tissues by an external force, such as a mattress, wheelchair pad, or bed rail. Other traumatic forces that may be present include shear forces and friction. These forces cause microcirculatory occlusion as pressures rise above capillary filling pressure, resulting in ischemia. Ischemia leads to inflammation and tissue anoxia. Tissue anoxia leads to cell death, necrosis, and ulceration.

Irreversible changes may occur after as little as 2 hours of uninterrupted pressure.

Presentation
Clinical presentation of pressure sores can be quite deceiving to the inexperienced observer. Soft tissues, muscle, and skin have a differential resistance to the effects of pressure. Generally, muscle is the least resistant and will necrose prior to skin breakdown. Also, pressure is not equally distributed from the bony surface to the overlying skin. Pressure is greatest at the bony prominence, decreasing gradually towards the periphery. Once a small area of skin breakdown has occurred, one may be viewing only the tip of the iceberg, with a large cavity and extensive undermining of the skin edges.

Many classification systems for staging pressure ulcers have been presented in the literature. The most widely accepted system is that of Shea, which has been modified to represent the present National Pressure Ulcer Advisory Panel classification system. This system consists of 4 stages of ulceration but is not intended to imply that all pressure sores follow a standard progression from stage I to stage IV. Nor does it imply that healing pressure sores follow a standard regression from stage IV, to stage I, to healed wound. Rather, it is a system designed to describe the depth of a pressure sore at the specific time of examination, in order to facilitate communication among the various disciplines involved in the study and care of such patients.

Stage I represents intact skin with signs of impending ulceration. Initially this would consist of blanchable erythema from reactive hyperemia that should resolve within 24 hours of the relief of pressure. Warmth and induration also may be present. Continued pressure creates erythema that does not blanch with pressure. This may be the first outward sign of tissue destruction. Finally, the skin may appear white from ischemia.

Stage II represents a partial-thickness loss of skin involving epidermis and possibly dermis. This lesion may present as an abrasion, blister, or superficial ulceration.

Stage III represents a full-thickness loss of skin with extension into subcutaneous tissue but not through the underlying fascia. This lesion presents as a crater with or without undermining of adjacent tissue.

Stage IV represents full-thickness loss of skin and subcutaneous tissue and extension into muscle, bone, tendon, or joint capsule. Osteomyelitis with bone destruction, dislocations, or pathologic fractures may be present. Sinus tracts and severe undermining commonly are present.

Other important characteristics of the wound should be noted in addition to depth. One should note the presence or absence of foul odors, wound drainage, eschar, necrotic material, and soilage from urinary or fecal incontinence. This provides information regarding the level of bacterial contamination and the need for débridement or diversionary procedures.

The overall state of health, comorbidities, nutritional status, mental status, and smoking history also should be noted. Presence or absence of contractures and spasticity also are important in the formulation of a treatment plan. One should note where the patient normally resides and the extent of his or her support structure. Examining the support surfaces present on the patient's bed or wheelchair also is important.

Relevant Anatomy
The hip and buttock regions account for 67% of all pressure sores, with ischial tuberosity, trochanteric, and sacral locations being most common. The lower extremities account for an additional 25% of all pressure sores, with malleolar, heel, patellar, and pretibial locations being most common.

The remaining 10% or so of pressure sores may occur in any location that experiences long periods of uninterrupted pressure. Nose, chin, forehead, occiput, chest, back, and elbow are among the more common of the infrequent sites for pressure ulceration. No surface of the body can be considered immune to the effects of pressure.

Continue reading "Decubitus Ulcers, Pressure Sores aka Bed Sores Cost over $ 1 Billion Annually To Treat " »

Pressure Ulcers and Infections
Pressure ulcers also known as Bed Sores and Decubitus Ulcers and infection are a serious risk to patients in long term nursing home facilities. Approximately one million people develop pressure ulcers, also known as bed sores and decubitis ulcers every year in America. At least sixty thousand lives are lost as a result of pressure ulcers and infections or other complications each year. Three of every four people who suffer pressure ulcers and infections are seventy years of age or older. In light of this fact, the prevention and treatment of pressure ulcers and infections are major issues in the nursing home industry.

Pressure ulcers and infections can affect patients who are bedridden, unconscious, unable to feel pain or sensation, or are immobile and use a wheelchair. Pressure ulcers develop after a period of prolonged pressure which cuts off circulation to the skin and causes it to die. When pressure ulcers develop, they begin as superficial irritations to the skin that appear as reddish or otherwise discolored patches of skin. If left untreated, deeper pressure sores and infections can develop.

When pressure ulcers are not prevented or treated, tissue deterioration can deepen to invade the tissues and underlying structures. When pressure ulcers become open wounds they are very vulnerable to infection. Infection occurs when bacteria enters the affected areas. Pressure ulcers and infections are characterized by pus discharge, foul odor, fever, and tenderness, heat, or redness around the pressure ulcer. Sweat, feces, urine, and other sources of moisture are all common causes of pressure ulcers and infections. Incontinent patients, those who are paralyzed, and other disabled patients are at a greater risk of developing pressure ulcers and infections says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

When patients suffer from pressure ulcers and infections it is vital that they be promptly and adequately treated to avoid life threatening complications. Nursing staff have a duty to administer antibiotics and pain medicine when appropriate, clean and bandage affected areas, and respond to all the needs of patients with pressure ulcers and infections. When pressure ulcers and infections are left uncared for serious complications can threaten the lives of these patients.

Pressure ulcers and infections can lead to a variety of serious complications. Infections can cause gangrene or tissue death. Osteomyelosis is a serious bone infection that occurs with advanced stages of pressure ulcers. A patient can develop scar carcinoma, or cancer in the scar tissue of a pressure ulcer. Sepsis is a serious infection that occurs when bacteria enters the blood stream via a pressure ulcer. Sepsis is fatal in fifty percent of all pressure ulcers and infections cases.

When nursing home patients develop pressure ulcers and infections it can be the result of nursing home abuse or negligence. Nursing care professionals have a legal duty to prevent patients from suffering from pressure ulcers and infections. If they fail to do so, they can be held liable for any injury or death that ensues.

Continue reading "Bedsores, Pressure Sores & Decubitus Ulcer Infections" »

What are Bed Sores, Pressure Sores also known as Decubitus Ulcers?

Bed sores are ulcers that occur on areas of the skin that are under extended periods of pressure. The pressure may be a result of lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Bed sores can occur when a person is bedridden, unconscious, unable to sense pain, or immobile. Bed sores are ulcers that occur on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time.

Bed sores are commonly found on the tail bone area, hips, back, elbows, heels and ankles. They can become deep, extending into the muscle.

Bed sores are also called Decubitus Ulcers and Pressure Sores. indicates Los Angeles Elder Abuse Lawyer Steven C. Peck.

Can Bed Sores be Treated?

Yes. It is important to treat bed sores as soon as they appear. If left untreated, the skin can break open and become infected. The treatment will depend on the severity of the sores and may include several methods. Treatment is more difficult if the skin is broken.

Common treatments of bed sores include:

•removing pressure on the affected area
•protecting the wound with medicated gauze
•keeping the wound clean
•medication (antibiotics and pain relievers)
•antibiotic ointments
•surgical removal of dead tissue
Can bed sores be prevented?

Yes. Some of the ways to prevent bed sores are:

•good nutrition
•clean and dry linens
•frequent turning and repositioning of immobilized individuals
•providing soft padding in wheelchairs and beds to reduce pressure
•keeping the skin clean and dry

Continue reading "What Are Bed Sores, Pressure Sores also known as Decubitus Ulcers?" »

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.

Anyone who is confined to bed for a long time is liable to develop bedsores, especially if movement is restricted or if sensation is impaired. The sores occur on those parts of the body that bear the weight of the body or rub constantly against the bedclothes. The most common sites are the elbows, knees, shoulder blades, spine and buttocks states California Nursing Home Abuse Attorney Steven C. Peck.

A bedsore begins as a patch of tender, reddened, inflamed skin. Later, it can become purple. Then it breaks down and an ulcer or sore develops. If any skin redness or inflammation occurs, consult the physician right away. The ulcers generally take a long time to heal and are quite uncomfortable and harmful to the patient's health.

Bedsores can be prevented. Someone confined to bed can still get a kind of exercise unless he or she is paralyzed or otherwise immobile. Every hour or so, a period of wriggling the toes, rotating the ankles, flexing the arms and legs, tightening and relaxing muscles, and stretching the whole body will both stimulate circulation and prevent joint contracture, or stiffening. indicates Los Angeles Elder Abuse and Neglect Attorney Steven C. Peck.

If a stroke patient cannot move or is very weak, gently bend and straighten the joints manually at least once a day. Also, change his or her position as often as you can at least every two to three hours, but more often if possible so that the pressure of the body on any particular area is relieved. This is most easily done, especially if the sick person is a great deal heavier than you, by using a draw sheet or by rolling the person from side to side. Otherwise, lift the person into a new position (enlisting someone else's help if necessary).

Dragging the person may damage the skin and increase the chances of bedsores. Use a bed or foot cradle (frames that raise the covers) to keep the weight of the bed clothes off the sick person's legs and feet.

If the person is lying permanently on his or her side, support the upper arms and thighs with soft pillows to keep the elbows and knees apart, and put a pillow between the ankles to keep them from rubbing against each other. The person will still have to be turned frequently to prevent bedsores.

Make sure that the sheets are always clean, dry, crumb free, and pulled as tight as possible to prevent wrinkling. If the stroke or disabled person is likely to be bed ridden for a long time, you may want to get a fluffy sheepskin (preferably a synthetic, washable one) for the person to lie on, to help cushion the whole body. Sheep skin bootees can be bought also, to protect the heels and ankles.

Also, wash the patient frequently and keep the skin on places that are vulnerable to bedsores particularly clean and dry. If you notice any reddening, keep pressure off that area and let the physician know that a bedsore is beginning to form.

Continue reading "Confinement To A Bed For A Long Time Is a Cause of Decubitus Ulcers, Bed Sores & Pressure Sores" »

A decubitus ulcer also known as a Bed Sore or Pressure Sore is essentially a hole caused by tissue death. Generally, we move when an area on our body in uncomfortable. In a person that cannot move or has decreased sensation, then they are not relieving pressure on the skin. When you press down on your skin, you see a lightening of the skin. This is caused by less oxygen enriched blood in that area, the blood was displaced by pressure. This will cause cell and tissue death. This is very very painful for the person says California Nursing Home Abuse and Neglect Lawyer Steven C. Peck who may be reached toll free at 1.866.999.9085.

When the tissue dies, it leaves behind a hole. The size depends on the pressure point involved. The depth (through different layers of skin) is classified as stages... dermis, epidermis, etc. This mostly depends on time. The longer the pressure was left unreleased, the deeper. However, there are cases that I have seen that within just a couple hours the sore was all the way to the bone indicates Los Angeles Elder Abuse Attorney Steven C. Peck.

Decubitus ulcer formation is even quicker when the body is running at a high speed. Times like fever cause an increase in heat production- which then is an increase in energy production- which then leads to a greater demand for oxygen (just like when you are running) Here, each cell is almost "running" and they wear out quickly. Add to that the inability for new blood to reach it... and you know the rest.

Treatment varies GREATLY. Some wounds are packed with saline soaked gauze and then sealed with a clear bandage. These wet dressings tend to do great for larger and deeper areas. This is one of hundreds of treatments. Treatments are based on past evidence, and each individual detail about each wound, as well as the patients history.

Prevention is the single most effective treatment.

If you or a loved one has developed bedsores in a facility, the facility by federal and most state regulations must prove that the sores were unavoidable and that the staff provided effective care.

Why do bedsores develop? In a number of cases, nurses fail to give proper care. In additional cases, a pervasive culture of abuse and neglect by the heatlh care facility might be to blame. For instance, as outrageous as it sounds, in a number of nursing homes, lazy staff have restrained patients to avoid having to care for them. These patients literally become prisoners inside in their beds and as a result thereof they incur horrific Decubitus Ulcers also known as Bed Sores and Pressure Sores, which become infected and in many many instances cause wrongful death.

Continue reading "Federal and State Laws Regulate The Development of Bed Sores in Health Care Facilities" »

The chairman of a state House committee Tuesday called the results of inspections in two state-run nursing homes for veterans "shocking, unsettling and inexcusable."

"The scenarios mentioned in the report would be horrendous at any nursing home or long-term care facility, but the fact that they occurred at state-run veterans homes -- that our veterans suffered these abuses -- is particularly troubling," said Rep. Anthony J. Melio, chairman of the House Veterans Affairs Committee.

Melio, a Bucks County Democrat, responded to a Tribune-Review story detailing state Health Department inspections that uncovered serious deficiencies at facilities in Scranton and Hollidaysburg. The department placed the Hollidaysburg home's license on probationary status for five months last year.

An inspection report on the Hollidaysburg home described a veteran kicking and screaming while four staffers held him down for routine treatment. Inspectors cited the Scranton home for a scabies outbreak and lack of preventative care for serious bed sores.

The facilities are part of a statewide, 1,632-bed system the Department of Military and Veterans Affairs runs. Agency officials said deficiencies cited in the reports were corrected and the homes are fully licensed. The department's other homes are in Pittsburgh, Erie and the Philadelphia region.

"We've taken note of each of the findings and taken steps to correct them," department spokeswoman Joan Nissley said. "We take a proactive approach and strive to provide the best care to veterans."

Melio said a "heightened level of monitoring" would be needed "to prevent this terrible treatment from occurring again."

Frank Mills of Huntingdon, statewide commander of the Pennsylvania Veterans of Foreign Wars, said concerns about care in the veterans homes would be the subject of upcoming meetings of Pennsylvania War Veterans Council and the State Veterans Commission.

"Our veterans might have seen or heard stories of soldiers lying on the battlefield, facing bad medical conditions, but they should not have to worry about disturbing and preventable treatment problems in our state veterans homes where they receive daily care," Mills said.

He said "budget cuts, bad implementation of proper policies and substandard staff performances that may cause our veterans to suffer cannot be tolerated."

State Sen. Kim Ward, a member of the Senate Veterans Affairs Committee, said agency officials this week assured her deficiencies were corrected. The Hempfield Republican said it is "vital that inspectors and administrators remain vigilant" and said she plans to tour the facilities in coming weeks.

Contact Steven Peck's Premier Legal toll free at 1.866.999.9085 to talk to an experienced California Nursing Home Abuse and Neglect Attorney and visit us on-line at www.premierlegal.org.

In New Jersey, if you are a firefighter, an EMT, a nurse, an optician, a podiatrist, a dentist, or any licensed health professional, you are now required to report suspected abuse, neglect or exploitation of persons over age 18 years to Adult Protective Services.

Every county in New Jersey has an agency that receives these reports and investigates.

Often times, these reports require many visits to determine the facts and to address the needs of the victims.

This law now identifies new legal responsibilities for first responders and health care professionals. More than 18 different health care professions are now required by this law to report abuse, neglect or exploitation of a vulnerable adult. These groups included acupuncturists, chiropractors, social workers, occupational therapists, audiology and speech therapists, to name just a few.

Grace Egan, the executive director of the NJ Foundation for Aging noted, "This law creates a new focus on the silent victimization of vulnerable adults. Now, professionals who work with seniors are required to report which is the first step to ending this cycle of violence. National statistics indicate that only 1 in 20 incidences of abuse or neglect is reported. While this law does not go far enough to provide financial support for more needed services, it does create a legal requirement for professionals to report."

This law requires reporting of abuse against a vulnerable person who is living in the community. A "vulnerable adult means a person 18 years of age or older who resides in a community setting and who, because of a physical or mental illness, disability or deficiency, lacks sufficient understanding or capacity to make, communicate, or carry out decisions concerning his [or her] well-being and is the subject of abuse, neglect or exploitation." .

Reports of abuse against institutionalized persons are investigated by the Ombudsman for the Institutionalized Elderly. This office investigates and responds to complaints of abuse, neglect and exploitation of individuals 60 years of age and older who reside in licensed facilities within the State, both public and private.

Continue reading "New Jersey Law Now Requires Mandatory Reporting of Elder Abuse, Neglect, and Exploitation" »

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" »

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