California Elder Law Attorney Blog

The Peck Law Group, California's number one and soon to Be Arizona's premier Nursing Home Abuse and Neglect Lawyers are advocating for more oversight of nursing homes in California, Arizona, and all over the United States..

Recently we were advised of one patient at an nursing home facility that had maggots in her trachea and another patient that had maggots on an open bed sore also known as a pressure sore and decubitus ulcer.These type of cases are specific examples and unfortunately are not isolated incidents or unique to any particular nursing home. Rather, they are indicative of a statewide failures to provide quality nursing care at all times and to protect nursing facility residents from harm says Nursing Home Abuse and Neglect Lawyer Steven Peck.other incidents which we have litigated include, a skull fracture from a fall from wheelchair wherein the resident died three days later because of bleeding in the brain, another patient dying from injuries sustained in a fall from a wheelchair without foot pedals, and what seems like a typcial nursing home negelct problem of Elopement transpired when a resident was able to leave a nursing home facility and sat in a wheelchair on the side of the road and no staff members were disciplined.

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Low nurse staffing levels are considered the strongest predictor of poor nursing home quality leading to abuse and neglect says California Elder Abuse Attorney Steven Peck.

The 10 largest for-profit chains operate about 2,000 nursing homes in the United States, controlling approximately 13 percent of the country's nursing home beds.

In recent decades, nursing home chains have undergone a considerable expansion. A number of chains were publicly-traded companies until the early 2000s, when five of the country's largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses.

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share.

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing which lower staffing could lead to bed sores, malnutrition, dehydration, and infections.

Recent Medicare cuts in payment rates for nursing home residents - by 11 percent in October, 2011 - may further jeopardize the health and safety of residents if the chains respond by reducing staffing and wages, Harrington said.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse "staffing hours" than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, bed sores and decubitus ulcers, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents such as malnutrition and dehydration.

The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

The authors said that more study is needed on the subject. They also said that greater accountability and quality oversight mechanisms would help improve nursing home care, along with effective funding incentives and sanctions for low staffing and poor quality.

Source: UCSF

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Uninterrupted pressure exerted on the skin, soft tissue, muscle, and bone can lead to the development of localized ischemia, tissue inflammation, tissue anoxia, and necrosis. Pressure ulcers, Bed Sores also known as Decubitus Ulcers can result from these effects; about 3 million adults in the United States suffer from pressure ulcers, bed sores and decubitus ulcers. Estimates of the incidence of pressure ulcers vary according to the setting and range from 0.4 to 38.0 percent in acute-care hospitals, from 2.2 to 23.9 percent in long-term nursing facilities, and from 0 to 17 percent in the home-care setting.

Various systems have been used to assess the severity of pressure ulcers, but most use a four-stage categorization with higher numbers indicating higher severity.Healing rates of pressure ulcers vary considerably and are dependent on comorbidities, clinical interventions, and severity of the ulcer. This variability can add to the length of hospitalization and impede the return of patients to full functioning. Data on the costs of treatment for a pressure ulcer vary, but some estimates range between $37,800 and $70,000, with total annual costs in the United States as high as $11 billion.

Interventions to treat pressure ulcers are numerous and diverse and include strategies such as reducing pressure with various support surfaces, wound debridement and cleansing, surgical repair, and the use of various wound dressings, various biologic agents, and nutritional supplementation.In addition, various adjunctive therapies have been evaluated, including vacuum-assisted closure, ultrasound therapy, electrical stimulation, and hyperbaric oxygen therapy. The approach to treatment typically varies, depending on the stage of the wound and patient-related factors such as the existence of particular comorbidities says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

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There are a number of different warning signs that could suggest that a nursing home is not providing adequate health care. In many cases, these warning signs will go unnoticed until it is too late. In other cases, these warning signs are simply brushed off by family members and friends. And, in even more cases, these warning signs are hidden behind closed doors. Whatever the case, it is important to be on the lookout for any signs of nursing home abuse or neglect. Nursing homes are supposed to be a place of support and security; however, this is not always the case. If you notice any warning signs that a nursing home is not up to standard, then it is important to contact a Peck Law Group elder abuse attorney to toll free at 1.866.999.9085 immediately.

Physical Signs of Nursing Home Abuse
Physical signs can often be a great indicator of abuse. If your loved one is showing any of these symptoms, it could be a sign of neglect or abuse:

■Bed sores/ pressure sores
■Torn clothing or personal items
■Constant falls and traumas
■Excessive weight loss or weight gain
■Fecal/urine smells
■Pale complexion
■Lack of personal hygiene
■Presence of dirt, lice, fleas, etc.
■A change in personality
Keep in mind that abuse can also occur without any shred of physical symptoms. It is also important to remember that emotional abuse be just as common and devastating to the nursing home victim.

Signs of Nursing Home Neglect or Inadequate Care
There are a number of cases where the neglect or abuse is not as easy to recognize as the physical signs. One of the best ways to understand if a nursing home is providing adequate care is to understand the Minnesota Nursing Home Resident Bill of Rights. Some of the signs that neglect or abuse is taking place may include:

■Lack of staff members and lack of service provided
■Rudeness of staff members
■Lack of entertainment facilities
■Lack of patient morale
■Lack of proper diet, nutrition and lifestyle facilities
■Lack of proper heating or cooling
■Lack of proper hygienic cleaning
If you notice any of the following, then it is important to discuss your concerns with your loved one as well as with an experienced Peck Law Group nursing home abuse lawyer.

A lawsuit filed May 25, 2011 in Galveston County Court at Law No. 2 argues that the facility, doing business as Heartstone at Texas City, and one of its physicians failed to provide the decedent adequate care and treatment for his wounds and thus contributed to his death last September.

Dr. Folasade M. Ojo, Heartstone Management Inc. and IPH Health Care Services Inc. are also defendants in the case.

The original petition shows Christopher Murphy was admitted for residency requiring minimal assistance on May 8, 2010.

An apparent fall three weeks later caused him to be taken to nearby Mainland Medical Center for observation.

According to the suit, doctors diagnosed Christopher Murphy with "infected wounds to the buttocks, feet and legs" and "acute renal failure."

They reported to his family "that he did not have injuries related to a fall," it says.

Christopher Murphy died on Sept. 3, 2010.

The report from his subsequent autopsy revealed the cause of death to be sepsis from pseudo membranous colitis, severe sacral decubitus ulcer and urinary tract infection.

Continue reading "Texas Facility Accused of Nursing Home Abuse and Neglect Due To Sepsis, Bed Sores and Urinary Tract Infection" »

The State of California has issued 15 citations, accusing an Oroville nursing home of illegally moving 14 residents out of the facility last year.
Olive Ridge Post Acute Care was ordered to pay $15,000 in fines because of the citations, which were issued in February of 2011 indicates California Elder Abuse Lawyer Steven Peck.

In early 2010, the nursing home staff told residents of a locked unit that they would have to move out, according to the California Department of Public Health. Olive Ridge administrators began finding other nursing homes around the north state that would take these residents.

A Department of Public Health document said the state was told the locked unit, which was for residents with Alzheimer's, dementia, psychosis and other ailments, was being phased out and would be converted to an unlocked unit.

Originally, there were 25 residents in the locked unit. By late February of 2010, 14 of them had been moved to other nursing homes. Another six were waiting to be transferred, and five were going to stay at Olive Ridge and be put in with the general population of residents.

A summary of the state's action against Olive Ridge was posted on the Internet by the watchdog group California Advocates for Nursing Home Reform.

It stated Olive Ridge was cited for breaking a number of laws, including those requiring that residents receive ample advance notice and that nursing homes file a relocation plan with the state.

According to federal law, the only valid reasons for moving a resident to another nursing home are that the move is necessary for the resident's health, the resident has gotten better and no longer needs the facility's care, the safety or health of the residents are endangered, the resident has failed to pay for staying in the facility, or the facility goes out of business.

In its summary, the reform group charged that by closing its locked unit, Olive Ridge appeared to be "following an increasingly popular model of nursing home care (of) moving out long-term residents who were perceived as difficult to manage to increase the available beds for short-term rehabilitation residents who pay more for their care."

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Understaffing affects nursing home employees by causing high turnover, low morale, fatigue and physical injuries. Poorly paid nursing assistants provide the most direct care, and demands placed upon them are often impossible to meet says San Diego Nursing Home Abuse and Neglect Attorney Steven Peck,

Profit-driven multi million dollar corporations that own these institutions must be held accountable. The private-pay charge for a nursing home room is more than $5,000 a month. The charge for Medicaid residents is lower but still substantial. Yet, these facilities continue to be understaffed which causes our elder and dependant adults to be seriously neglected.

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North Carolina will be observing Vulnerable Adult and Elder Abuse Awareness Month from May 6th - June 20th 2011, according to North Carolina Division of Aging and Adult Services.

Nursing home abuse and neglect attorneys want to remind everyone to wear a purple ribbon in honor of keeping our elders safe and to watch out for the common forms of abuse that take place in nursing homes and what signs to look for if you have an elderly loved one residing in an elder care facility.

There are several types of nursing home abuse in Carolina and throughout the country. Physical abuse is the most apparent to the human eye. You may see signs of bruising, cuts, bed sores or other injuries, failure to maintain hygiene or unsanitary living conditions.

In addition to abuse, caregivers at nursing home facilities can be guilty of neglecting residents. Most types of neglect are not as easily detected. Nurses may neglect a resident in the following manners: failure to feed or provide water, connect and interact emotionally with the resident or refrain from giving correct doses of medication in time-sensitive situations or needed medical care.

Victims of abuse at nursing home or assisted living facilities are often afraid to speak up. If you have a loved one at an elder care facility, it is your responsibility to make sure they are being treated appropriately. The following are some suggestions to help make sure proper care is being given:

-Maintain a close connection by participating in as many activities as possible with your loved one.

-Interact with other residents to see if you can detect signs of abuse or neglect in them.

-Check your loved one's medication records to make sure doses are properly maintained.

-Periodically check in with nurses or caregivers regarding the current physical and mental condition of your loved one.

-If abuse or neglect is detected - take action. Contact a Peck Law Group lawyer toll free at 1.866.999.9085 to discuss your rights immediately.

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Septic sores, or infections involving a loved one in a nursing home.

Any occurrence involving broken bones, especially a fractured hip, a broken arm, or broken leg.

Any type injury or death occurring during or shortly after an occurrence of wandering (including outside the facility) when the staff is not aware that the resident is missing for some period of time

Resident is frequently ill, and the illnesses are not promptly reported to the physician, and or the family

Serious injuries requiring emergency treatment or hospitalization of a loved one

Rapid weight loss, or weight gain without physician or family notification, and a change in treatment being provided

Unexplained or unexpected death of the resident

One nursing home resident injures another resident

Heavy medication or sedation of a parent or a loved one in a nursing home

Continue reading "Symptoms of Nursing Home Abuse and Neglect Occur Regularly says Los Angeles Elder Abuse Attorney Steven C. Peck" »

Nursing home patients have been dragged down hallways, doused with ice water, sexually assaulted and beaten in their beds, yet few prosecutions result says Los Angeles Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Many physical and sexual abuse cases in nursing homes are not treated the same as similar crimes elsewhere, Peck states.

Recently, a case of abuse and sexual assault was described as choking, breaking the elder's neck, and her wrist bones and her hand.

This elder unfortunately died two days later from the trauma. The Facility staff member eventually pleaded no-contest and served a year in prison. The incident was not reported to a state official who was in the nursing home at the time of the beating, he said.

This particular investigation found that nursing homes rarely call police for attacks that would bring an instant response if they occurred elsewhere says California Elder Law Attorney Steven Peck.

Over two million Americans are cared for in 20,000 nursing homes. The homes received $100 billion in reimbursements from Medicare and Medicaid in 2010.

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Northern Nevada nursing homes are regularly inspected by state agencies and cited for violations of care standards, but fines and other serious sanctions are rarely imposed-- even when a patient dies as a result of neglect or mistreatment, according to a Reno Gazette-Journal investigation into government inspections of nursing homes.

Some states, including California and Washington, can fine nursing homes for violating regulations, but Nevada law mirrors federal Medicare procedures. Medicare's "nonpunitive" system allows nursing homes to correct problems found during inspections instead of being fined for violations.

In Nevada, nursing homes can be cited for the same kinds of violations year after year. It's only when they fail to correct the problems after multiple inspections that fines are levied. Eight Northern Nevada nursing homes have been fined in the past three years.

Examples the Reno Gazette-Journal found of deficient care in Northern Nevada nursing homes during the past three years that didn't result in fines or serious sanctions included:

» A patient who had been left without care for 81 hours became severely dehydrated and died after being rushed to a hospital.

» Physical abuse by nursing home staff members against patients.

» Many documented cases of avoidable bedsores caused by patients left in the same position for many hours. In some cases, severe bedsores went unnoticed by staff members, and in other cases, infections went untreated for long periods.

» Patients given the wrong drugs, and some who overdosed on the medications.

"It's very sad we're doing this to our elderly people," said LaVonne Schfler of Reno, whose mother has spent time in nursing homes for rehabilitation and who does volunteer work with the Special Advocates for Elders program at the University of Nevada, Reno.

"They spend their lives working hard, contributing to society, and then when they can't care for themselves, their children have a choice between their survival or their parents' survival. (The children) can't do 24-hour care and work at the same time, so they wind up in nursing homes where they may be mistreated or neglected. It's not right."

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Neglect levels in California's long term care facilities as well as facilities all over the United States are "scandalous". Thousands of residents have died of dehydration, malnutrition, infected bed sores, Clostridium difficile and MRSA says Los Angeles Nursing Home and Neglect Attorney Steven C. Peck.

It is also feared the totals may be higher because care home residents who die in hospital are not included in the statistics.

The fact that people are dying from these sorts of causes is absolutely shocking in the 21st century.

These people in our care homes will have seen a lot in their lifetime. For them to be treated in that way is nothing sort of scandalous.

Figures suggest that more than 20,000 people have to sell their homes in California every year in order pay for residential long term care fees.

While there are excellent homes it is simply unacceptable that people still die undignified deaths from wholly avoidable causes says Van Nuys, California Elder Abuse Attorney Steven Peck.

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A recent report issued by the Department of Health and Human Services (DHHS) has found that nearly all nursing homes in the U.S. have received citations for health and safety violations in 2009. The inspector general of DHHS, federal investigators inspected and evaluated complaints from the nation's 15,000 nursing homes.

Of these facilities, roughly 67 percent are "for-profit" homes, 27 percent are nonprofit companies and 6 percent are owned by the government.

The results of this nationwide inspection found that 94 percent of for-profit facilities and 88 percent of nonprofit organizations received citations for non-compliance last year says Los Angeles Nursing Home Abuse and Neglect Attorney Steven C. Peck.

In addition to calculating the percentage of homes violating federal standards, this investigation also looked into the amounts and types of violations occurring at particular homes.

These analyses found that:

• On average, 8 violations occurred at each non-compliant for-profit facility in 2009.
• About 6 violations occurred at each non-compliant nonprofit and government home in 2009.

In most cases, violations cited by federal inspectors consisted of any combination of:

• Infected bed sores
• Malnutrition
• Medication mishaps
• Patient abuse (either psychological or physical)
• Patient neglect

DHHS investigators contend that lack of adequately trained nursing home staff is primarily responsible for such rampant and disturbing nursing home violations. This contention is supported by the fact that independent researchers have found that having a higher ratio of staff to patients typically results in better care for the patients indicates San diego Nursing Home Abuse and neglect lawyer Steven C. Peck.

Medicare Violations at Nursing Homes

Along with finding such inhumane abuses, the DHHS report also uncovered the fact that some nursing homes were guilty of stealing funds from Medicare and Medicaid - as the facilities were billing these programs for services they didn't provide or provided extremely deficiently.

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Shortly after his grandmother moved into a residential care home in Fair Oaks, Sean Suh installed a small camera beside her bed to make sure the staff knew someone was watching.

But often when he visited, he said, he would find the "Grannycam" unplugged.

Suh decided to find a new place for Kyong Hui Duncan, a Korean immigrant and beloved matriarch who had become too frail to live on her own. But by the time he found one, Duncan, 73, was dead from a constellation of problems that her grandson said were inflicted upon her at Fair Oaks Residential Elderly Care.

A short video clip captured by Suh's "Grannycam" that shows a staffer violently shaking Duncan in her wheelchair now plays a key role in the state's decision to shut down the care home. The clip, which Suh discovered only after Duncan's death, is also at the center of a civil lawsuit the family filed Thursday that charges abuse, neglect and wrongful death.

Following an investigation spurred by Suh's complaint, the California Department of Social Services on January 13, 2011 ordered the care home's operators, Myung S. Kim and Jay J. Kim, to cease operations by the end of the business day. The state is moving to permanently revoke the home's license.

The state's suspension order accuses the home of violating the personal rights of residents. One of the concerns the state cites stems from the "Grannycam" clip, which shows staff members moving Duncan from the floor to her wheelchair, then dumping the chair backward with Duncan in it and shaking it. Among other allegations: that staff members improperly restrained Duncan and failed to quickly attend to her after she had fallen.

Once, the state alleges, family members arrived to find Duncan, crying and unattended, positioned upside down in her wheelchair. The order also cites instances in which Duncan suffered mysterious bruises and infections that went untreated.

Duncan's autopsy report showed potentially toxic levels of narcotics in her system, at least one of which her doctor had never prescribed, according to the document. The lawsuit charges that she suffered injuries, infection and "lethal doses of drugs," all of which contributed to her death.

The state also accuses the home of fire code violations, failing to dispose of contaminated needles, using prescription medicines that had expired and forging prescriptions.

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Despite greater awareness, nursing home abuse is still running rampant in the United States. Our elderly family, friends, and neighbors are still being abused neglected to the point where serious harm can come to them. And many of them are being forced to try to survive in absolutely terrible living conditions says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Neglect or physical abuse is any failure or any action that can cause unreasonable misery, suffering, harm, or injury to the resident of a nursing home that is caused by a care custodian and / or healthcare provider.

Financial abuse includes misusing the resident's funds to pay for services that have already been paid by a federal or state program. It could also be the misuse of nursing home resident's funds that weren't authorized by the resident, the trustee, the guardian, or the administrator of the resident.

Physical abuse includes sexually assaulting the resident, striking the resident, and/or withholding adequate or necessary physical care, food, or medical attention.

Reports signify that there was nursing home abuse in over 10,000 residences that are responsible for the well being of some of our elderly population.

The abuses that were reported include bed sores, dehydration, malnutrition, sexual abuse, physical abuse, verbal abuse, and more.

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