UCLA Study Finds Direct Correlation between Pressure Ulcers and Mortality

Experience shows many seniors that develop pressure ulcers begin a downward spiral in their health.  Without proper care, a pressure ulcer can develop into a mortal condition.  The wounds are painful and require surgery when large and infected.  Once the skin is compromised, it never regains its original integrity.  Broken skin presents a significant opportunity for infection, especially when a senior is using adult diapers.  
 
A recent article from UCLA Newsroom discusses the findings of a UCLA study of 51,000 randomly selected hospitalized Medicare beneficiaries.  The study basically confirms what most already know – that seniors who develop pressure ulcers “were more likely to die during their hospital stay, to have longer stays in the hospital, and to be readmitted to the hospital within 30 days of their discharge.”
 
It is paramount that when a person is immobile or sitting in a wheelchair all day that there is adequate staff to turn and reposition residents, and that the skin is kept clean and dry. 
 

Never Events, Pressure Ulcers and Hospital Safety

I just happened upon an excellent website (http://www.neverevents.org/), promoting the value of 11 years of “Never Events” as establishing safer practices in our hospitals. This site is authored by a physician and notes that another physician, Ken Kizer, MD, former CEO of the non-profit, National Quality Forum (NQF), first introduced this term in 2001. 

Since then, insurance companies, health organizations and later, the U.S. government, came on board – to support the notion that failing to protect the consumer public from preventable errors has devastating consequences for this nation. Topping the list on this site are preventable pressure ulcers.

New Study States That Antidepressants Increase the Risk of Falls in Nursing Home Patients with Dementia

A new study confirms that a large percentage of nursing home residents are prescribed anti-depressants, or selective serotonin reuptake inhibitors (SSRIs). While in most cases, anti-depressants are beneficial to the well being of the residents, in patients suffering from dementia, they can significantly increase the risk of falls - leading to serious injuries, and even death.

Researchers from the Netherlands recently reported that a study, which included 248 nursing homes, shows that anti-depressants were used on over 13,000 patients of which more than 650 sustained injuries. These falls occurred in 152 out of the 248 nursing homes included in the study. Additionally, 38 residents fell once during the time of the study, while 114 had multiple falls. Of those 650 falls, 220 resulted in serious injury, or even death.

It is imperative that these facilities conduct interdisciplinary care meetings to ensure that the proper protocols are followed, in order to reduce the risk of life-threatening accidents.

Simple Tools to Prevent Bed Sores Found to be Cost Effective

While nursing homes should always look to prevent bed sores – a painful and sometimes deadly condition – a recent study conducted revealed that the prevention of bed sores is also cost effective.

Foam mattresses which reduce pressure were found to be cost-effective 82% of the time as opposed to using standard mattresses. This simple change could save on average $115 per resident. Additionally, foam cleansers for incontinence were found to be cost-effective 94% of the time, as opposed to traditional soap and water, which results in an average savings of $179 per resident.

On average, roughly 10% of residents in long-term care facilities have a pressure ulcer. And for those residents, treatments are critical early on in order to prevent a serious, and even life-threatening condition. A better solution to this problem is prevention. Nursing homes and assisted living facilities can, and should, prevent these problems from happening rather than treating them after the fact. Most importantly, not only are these prevention techniques the right thing to do, but they also save money for the facility!

Triad Tangles with FDA on Recall

Earlier this year, I reported about the potential dangers posed to senior citizens (and others) who were potentially exposed to bacteria from antiseptic wipes. Reports indicate that a child may have died from such exposure and we are aware of seniors who appear to have potentially met the same fate.  Now, Federal regulators say that although Professional Disposables International (PDI) of Orangeburg, New York promised to recall the product this past June, it has since failed to launch that recall nearly four months later.

 

The U.S. Food and Drug Administration issued a second statement last Wednesday saying the agency was not backing down on its assertion that PDI failed to follow through on its promise to conduct a recall in June. A follow up story from the Journal Sentinel Online addresses some of the recent developments in the enforcement action.
 

A New Way to Combat "Never Events": Obama Administration May Penalize Nursing Homes That Unnecessarily Admit Patients to Hospitals

The Centers for Medicare and Medicaid Services (CMS) have recently designated certain injuries in hospitals “never events” – or injuries that should not happen. These injuries include Stage III and IV bed sores and falls with fractures. The penalty to hospitals when these injuries happen is that CMS will not pay for treatment rendered for these injuries. The result is that many hospitals are reporting the incidence of these events has gone down, and in some places tremendously.

Now, the Obama administration is doing a similar thing to nursing homes according to an article in Forbes magazine.

According to the article, a recent study showed that 25% of nursing home hospital admissions may be preventable. A further congressional review panel estimates that 14% of hospital patients sent back to nursing homes return to a hospital for a preventable condition. The Obama administration wants to penalize nursing homes that have unnecessarily high hospital admissions for preventable conditions by reducing their Medicare payments.

So, why are these residents being sent to the hospital to be paid for with your tax money? The author of the article documents that, “I’ve seen hospital emergency rooms filled with very frail seniors on Friday afternoons. Why? Because nursing homes know they won’t have enough weekend staff to care for their sickest residents, so they simply send them back to the hospital. The new rules could stop those practices.”

Perhaps hitting substandard nursing homes in the pocketbook will force them to take better care of their residents. 

Certain Bed Rails Dangerous to the Elderly Public Citizen Tells FDA

After an analysis of FDA records, the non-profit consumer advocacy group Public Citizen sent a petition to the FDA requesting that they recall two models of bed rails produced by Bed Handles, Inc.  Public Citizen claims that evidence shows that if a weak or frail elderly person – assumingly those whom would purchase the bed rails in the first place – falls in-between the bed rails and the mattress, they can suffocate to death. 

“Contrary to the manufacturer’s claim that the Bedside Assistant bed handles make any bed a safer bed, data previously provided to the FDA demonstrate that these devices can turn a bed into a death trap for patients who are physically weak or have physical or mental impairments,” said Dr. Michael Carome, deputy director of Public Citizen’s Health Research Group.

Public Citizen says documents show that this has happened, and believes that it has happened more than the document report because people don’t know to the bed rails are governed by the FDA and should be reported when there is a death.

The Public Citizen petition requested the ban on Bedside Assistant model numbers BA10W and BA10W-6.  The rails are not designed for hospital use, but

You can read the full Public Citizen’s findings and petition online here.

Staggering Costs of Medical Errors

A new study analyzed insurance claims from the past several years and noted that in 2008 alone, there were more than 1.5 million medical errors reported which accounted for over $19.5 billion. That averages out to roughly $13,000 per error.

The report states that medical errors led to more than 2,500 otherwise avoidable deaths and more than 10 million missed workdays. Five common medical errors accounted for 55% of the total amount of medical error costs in 2008:

  • Pressure ulcers - $3.86 billion ($10,288 total cost per error)
  • Postoperative infections - $3.66 billion ($14,548 per error)
  • Mechanical complications of devices, implants, or grafts - $1.13 billion ($18,771 per error)
  • Postlaminectomy syndrome - $1.12 billion ($9,863 per error)
  • Hemorrhages complicating a procedure - $960 million (12,272 per error)

Some of the other top ten medical errors include: infection following infusion, injection, transfusion, or vaccination; pneumothorax; infection due to central venous catheter; other complications of internal (biological) (synthetic) prosthetic device, implant, and graft; and ventral hernia without mention of obstruction or gangrene.

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Elderly Abuse in Nursing Homes: Physical and Financial

By now, most of us have heard of the tearful testimony of the great Mickey Rooney in Congress, on abuse and victimization of the elderly.  Here is yet another story on how abuse of nursing home residents is not only physical, but often financial. In this case, Tanya Fredrick, the business office manager at Golden Living Center, was fired after police revealed that she had been stealing thousands of dollars from the center and residents.

Mickey Rooney's testimony before Congress on Elder Abuse and Medical Malpractice Bill HR 5

With painfully shocking testimony, American Icon, Mickey Rooney, told a gripping story about how even he was the victim of elder abuse. It has become quite clear that the degree of this form of elder abuse is much more widespread than previously thought. We all need to be on the lookout for this abuse in our loved ones.
 
We have blogged before on the dangers of proposed HR 5 legislation, which in large part is designed to eliminate elder abuse claims.  Should this bill pass, our ability to prosecute such cases, uncover these horrors and protect the elderly will be severely limited.
 
Here is a link to the video of Mr. Rooney's testimony.  It is worth watching.
 

Protecting the Rights of Nursing Home Residents

Many of our cases involve terrible injuries and death as a result of neglect, negligence and abuse, such as bed sores, hip fractures and assaults. However, many of our clients and their families also complain about living in nursing homes that are just bad - a lousy building, freezing in the winter, hot in the summer, residents not being changed and bathed, broken plumbing, roaches and rodents, uncaring staff, or not enough nurses or CNAs. After receiving complaints, the nursing home promises to fix these problems and don’t. What can someone do in these circumstances? 

Know your rights.
New Jersey, like many other states, gives nursing home residents specific rights by law. If nursing homes infringe these rights they can be punished. Resident rights must be in writing, posted, and given to each nursing home resident when admitted. These are important rights, and include the right to:

  • a safe and decent living environment
  • privacy
  • considerate and respectful care
  • expect and receive appropriate assessment, management, and treatment of pain
  • unrestricted communication at any reasonable hour
  • unaccompanied right to a telephone 
  • obtain assistance in writing and reading letters
  • retain personal property
  • to wear your own clothes
  • present grievances on behalf of himself or others to the nursing home administrator

Make sure you have a copy of the law. You can view the full text online. If the nursing home is not meeting these rights, demand that they start doing what the law requires.

Hospitals Prove Deadly for Some Medicare Patients

A government study released today states that roughly 15,000 Medicare patients die each month due in part to the care they receive at hospitals. The study focuses on understanding adverse events in hospitals, or more specifically, any medical care that causes harm to a patient.

The study included 780 Medicare patients who were discharged from a hospital in October 2008. Those patients suffered from problems such as bed sores, infections and excessive bleeding from blood-thinning drugs.  Of the 780 patients in the study, 12 died as a result of hospital care, five of which were related to blood-thinning medication. Additionally, two other medication-related deaths involved inadequate insulin management resulting in hypoglycemic coma and respiratory failure resulting from over-sedation.

This is simply devastating and completely unacceptable for the roughly 47 million Americans enrolled in Medicare across the country.

Pressure Ulcer Stages

Bed sores (also called pressure ulcers and decubitus ulcers) can develop into severe wounds that can be fatal.  Wounds can at times be so large that bones become exposed inviting infection.  It is not uncommon for a family member not to see the bed sore until it is serious.

While most people have heard the term bed sore before, very few have actual experience with them.  They are fortunate.  One person recently told me they thought a bed sore was akin to a bad rash, until she first saw one on her mom and almost passed out. 

A bed sore forms when a person is not moved.  Areas with constant pressure on the underlying tissue such as the tail bone (also called the sacral area), elbows, heels and head, and areas where there is a brace, prevent blood flow that can kill tissue.  This causes a bed sore.

Bed sores are categorized by Stages.  Basically they are 5 stages of bed sores or pressure ulcers:
 

Stage I - No skin breakage.  May look like a red rash.  
Stage II  - Superficial skin breakage.
Stage III  - Open skin wound.  Can see blood but no muscle or bone.
Stage IV  - Open skin wound.  Can see muscle or bone.
Unstageable  - Because of dead tissue covering the wound, these wounds cannot be staged.  Generally presumed to be a stage IV.

 

For more detailed descriptions, you can go to the National Pressure Ulcer Advisory Panel's website.

The good news about bed sores is that they are both preventable and treatable.  With good prevention measures and early intervention bed sores can be avoided or can heal.  Even people who suffer from large bed sores may heal with the right care.  Treatments vary for the different stages, so its important to understand the different stages when taking part in a care conference or talking to a doctor.  Armed with the proper facts, a person can become a better advocate for a loved one.

Many Health Insurance Companies No Longer Willing to Pay for Treatment Related to Hospital Acquired Bedsores and other avoidable mistakes.

I recently wrote an article for the New Jersey Law Journal about the new Medicare Guidelines for Hospitals and Never Events.  After some additional research, I have learned that many insurance companies agree that it is unfair for negligent hospitals to pass costs related to their mistakes along to others.
 
We first learned that after extensive studies by non-profit health related organizations, one of the best ways to improve the quality of care for patients was to prevent hospitals from passing the costs of their mistakes on to taxpayers.  So, Medicare now will not pay for treatment related to what are now called Never Events (injuries and mistakes which are never acceptable).
 
It seems that insurance companies agree....and many are joining in to follow Medicare's lead.  As this article from a leading insurance website notes:

Standing in the middle of Never Event messes are health insurance companies.  Just like Medicare, they’re tired of paying for Never Events and they want hospitals and doctors to be more accountable for their mistakes.

Independent Living Resident Dies After Unanswered Call for Help

The Milwuakee Wisconsin Journal Sentinel reported this disturbing story.  A woman died after bleeding to death when her emergency pull cord located in her “independent living” apartment went unanswered for four hours.  Apparently the nurse aide who was working at the time shut off the sound alarm, disregarded a phone call from another resident who heard the alarm, and went back to watching television while the woman was bleeding to death.

What is also remarkable about this story is that the woman lived in what was deemed an “independent living” building.  The same facility also included assisted living units and a nursing home.  The state Department of Health Services was asked if they were getting involved in the case.  Unfortunately, that agency does not oversee “independent living” apartments.  Since the District Attorney did not find any crime they could prosecute, it appears that the only one who can punish this facility is the family suing.

California nursing home fined for alleged neglect in resident's fatal fall and brain bleed

Just because a doctor orders something for a resident in a nursing home, it does not mean it gets done - sometimes with lethal consequences.  A California state investigator found that Pilgrim Haven Health Facility in Los Altos failed to install an electronic fall monitor as ordered by the resident's doctor, and failed to make sure the resident’s walker was in reach.   As a result, the man fell twice, and died from head trauma.  The nursing home was fined $100,000 by the state.

 

You can read more on the story online here.

Six Employees Arrested for Elderly Abuse at California Nursing Home

While resident abuse is shocking and disgraceful, there are times where behavior is simply unbelievable. Six employees were recently arrested at a facility where residents with dementia were covered from head to toe in ointment cream to make them slippery for the next shift as a practical joke.

It should be noted that when the elderly are dropped they can suffer fractured hips.  A fractured hip leads to disability and severe pain, and has a high mortality rate. The mortality rate is especially high in the first months after a fractured hip, and remains high for the first year. 

You can read more on this story online here.

Decubitus Ulcers: An Update on Staging and The Impact of Never Events on Hospital Litigation

David R. Cohen, Chair of Stark & Stark's Nursing Home Litigation Group, authored the article, Decubitus Ulcers: An Update on Staging and The Impact of Never Events on Hospital Litigation, for the June 21, 2010 edition of the New Jersey Law Journal.

 

The article features an update on the process of diagnosising and staging decubitus ulcers, as well as guidelines for proper care and prevention. The article also includes a discussion on the applicability of so-called “never events” and what effect they can have in litigation matters.

 

You can read the full article online here. (PDF)

Understaffing Causes Death in Nursing Home

An article out of Minneapolis, Minnesota last week reports of an 89-year old nursing home resident who, even with all of the proper precautions, died after a fatal fall. Despite a bed alarm, a motion sensor, a sound monitor and a perimeter mattress the resident fell in the middle of the night. Due to a severely understaffed wing, the resident died due to complications from the fall.

Profits of people and bedsores

Nursing home employees in New Jersey have launched a campaign informing the public about the rate of bed sores in patients residing at Omni nursing homes. The campaign includes TV ads, radio ads, Google ads, a mobile billboard and a website dedicated solely to informing people of the poor care provided at these homes.

In recent years, Omni nursing homes have been reported to have the worst bed sore rate in New Jersey, and one home in particular, 45% of short-stay residents had bed sores. Due to the severity and possibly deadly side effects of bed sores, this rate is simply unacceptable. Though the care provided is lacking, supplies are limited and homes are often times understaffed, the profits are not. In the past four years alone, Omni executive Avery Eisenreich has earned a personal fortune of roughly $33 million.

You can visit the website online here.

Preventing Crippling Contractures in Nursing Homes

I found an interesting article online which addresses the recent epidemic of contractures in nursing homes.Contractures are injuries, usually sustained by the elderly in nursing homes, which limit their mobility and range of motion. When residents enter nursing homes with preexisting medical conditions they often times do not receive the proper amount of physical exercise. This decrease in regular movement leads to degeneration and increased stiffness in the joints, and ultimately leads to contractures. The article discusses three common ways nursing home residents can prevent contractures from developing.

You can read the full article online here.
 

Fosamax Attorneys Investigate Possible Claims

We wanted to inform the readers of our blog that the Mass Tort Team of Stark & Stark is now reviewing possible claims against the popular osteoporosis drug, Fosamax. Patients who used Fosamax have reported serious side effects from the drug, including Osteonecrosis of the Jaw (also known as Fossy Jaw, Dead Jaw and Phossy Jaw), low-energy femur fractures and severe and painful injuries affecting bones, joints and muscles.

If you or a loved one have suffered a severe illness or injury after taking Fosamax, you can have an experienced Mass Tort attorney from our firm review your potential case.


 

Assault charges against Golden Living Employee

Here is an article outlining yet another example as to how poor hiring, training and supervision allow abuse to occur in nursing homes.   In this case, a Golden Living employee actually punched a nursing home resident in the face.  Thankfully, she is being prosecuted.

Click here to read the full article.(PDF)

 

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Never Events: Pressure Sores, Medical Mistakes and Treatment Failures

 
Medicare recently announced an expansion of it's never events list.  Importantly, pressure ulcers (bedsores) in the acute care setting are formally characterized as "reasonably preventable."  To the extent that hospitals injure patients for events which never should occur, Medicare will not pay them.  Beyond that - Medicare will no longer pay hospitals for the treatment needed for the fallout of never events.
 
Most observers believe that the never event policy will soon find it's way into long term care (ie. nursing homes).  This would be consistent with the regulations already in existence regarding the mandate that avoidable pressure ulcers should never develop in nursing homes.
 
You can click on this hyperlink for more information: 

http://www.medicalnewstoday.com/articles/126375.php

 

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Signs and Forms of Abuse

Here is a very good website on recognizing the signs and forms of abuse and neglect that commonly occur at nursing homes across the country. The website also offers advice and tips on choosing the right nursing home. If you have a loved one in a nursing home or are considering making such a move, I'd recommend you take the time to review this website.

Click Here to view the website.

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Woodbury Nursing Home

Nursing Aide strikes an 89-year-old patient with his soiled diaper at a Woodbury Nursing Home.

To read the full article click here.

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3 Patients Found Dead in Brooklyn Nursing Home

Early this morning 3 patients were found dead at Carlton Nursing Homes located in the Fort Greene section of Brooklyn, NY. The 3 patients were on the same floor and died within an hour of each other. The men- ages 77, 72, and 61 were found unconscious and unresponsive in their separate bedrooms on the third floor. The medical director Lawrence Diamond of Carlton Homes located on 405 Carlton Avenue was quoted saying “ There’s nothing usual about old people dying”. Police are currently investigating these mysterious deaths.

Click here to read more at MSNBC and The Daily News.

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Nursing Home Neglect Can Happen Anywhere

I recently met with the daughter of an 80-year-old woman who was left alone in blistering heat without water and wearing a fleece coat. It is uncertain how long the woman had been left unattended but it was long enough to make her pass out and suffer from severe dehydration. The facility at which this took place is a well regarded, pleasant looking facility. It charges residents $6,000 a month. The daughter, who visited her mother regularly, was shocked. She thought that type of thing only happened at the less well-to-do facilities. Sadly, she was wrong.
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Fourth Annual Patient Safety In America Hospitals Study

The fourth annual Patient Safety in American Hospitals Study was released recently, and contains very insightful information for patients and their families when choosing a hospital. Safety in hospitals has recently become an overwhelming concern due to the rise of injuries suffered to patients during their hospital stays.


Often times this process can be quite daunting and somewhat confusing if you are not familiar with the all of the available resources provided to assist you. The study provides patient safety incident rates and associated mortality among Medicare beneficiaries, gives an overall patient safety indicator hospital performance assessment, and provides a list of the best-performing hospitals for overall patient safety across the country.

You can read the full April 2007 report here.


Assisted Living Facilities vs. Nursing Homes

Assisted Living Facilities and Nursing Homes cannot offer the same level of care. Assisted Living Facilities do not offer specialty care. They have fewer nurses, fewer CNAs, and less overall oversight of the individual resident. Thus, Assisted Living Facilities generally have residents who are more independent. However, due to desire to fill beds and generate more revenue, Assisted Living administrators sometimes take residents they cannot necessarily care for. Such is the case with a matter our firm is currently handling. In this particular case, the resident was brought into an Assisted Living Facility even though there was documentation that showing the resident had fallen thirty seven times at a previous nursing home. This resident was clearly a high risk for falls. Assisted Living Facilities are simply not equipped to provide the kind of care that this individual needed. Consequently, within three days after being admitted to the Assisted Living Facility, this resident fell and severely fractured her wrist.

Prevention of Bedsores, Pressure Ulcers and Decubitus Ulcers

Prevention is the key when dealing with bedsores, pressure ulcers and decubitus ulcers. Repositioning is crucial to staving off the development and/or further deterioration of decubitus ulcers (a.k.a. “bedsores”). This entails the simple act of shifting the residences body to alleviate pressure on certain parts of the body in order to avoid skin breakdown. Federal and state regulations for nursing homes require residence at risk of developing decubitus ulcers, and those who already have the ulcers, be turned at least every two hours. Due to staff shortages and/or staff incompetence repositioning often does not occur within the two hour time period. The consequences of this failure can be horrific. A small ulcer resembling a minor abrasion can quickly deteriorated into a very painful gaping wound that requires surgery.
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