Dehydration often goes undiagnosed and untreated in elderly nursing home patients. Fluid volume deficits can have devastating consequences such as causing kidney failure, seizures, swelling of the brain, hypovolemic shock, and increases a resident's susceptibility to urinary tract infections in females. Ultimately, dehydrated nursing home residents may develop sepsis resulting in death because their ability to fight infections has been compromised.
The standard of care for residents in nursing homes requires the nursing home staff to provide each resident with sufficient fluid intake to maintain proper hydration and health. Nursing homes should develop, implement and (when needed) revise care plans to protect residents from fluid volume deficits and water deprivation. Fortunately, the potentially fatal consequences of dehydration can be prevented if the nursing home staff takes preventative actions including recording daily food and fluid intake, monitoring body weight on a daily basis and implementing a hydration program that provides water during and between meals. The nursing home must carefully and thoroughly monitor fluid and nutritional support and initiate appropriate treatment when intake falls below adequate levels.
Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of dehydration/malnutrition, bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, medication error/prescription mistake, elder abuse or elder neglect.
]]>Careful monitoring of the patient's condition and review of their medical history is necessary to avoid an adverse drug reaction. Problems may occur when a patient's medication regimen is altered without careful review of current medications, or perhaps an older medication is continued when it is no longer needed. Sometimes old prescriptions are re-prescribed without being evaluated. It is also important that PRN ("as needed") orders are written with full instructions and that those instructions are followed.
When prescribing medication, the patient's age, weight, and gender should be considered. Older adults generally weigh less and have an increased sensitivity to drugs due to decreased liver and kidney function. Dosage should be altered accordingly.
Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of an adverse drug reaction, medication error or prescription mistake.
]]>Lawyers handling nursing home negligence cases must be sure to update their form discovery requests to make sure that certain types are electronic/computerized records are specifically requested or they risk exclusion of potentially helpful evidence of negligence.
For instance, in litigating bedsore cases (also known as pressure sores or decubitus ulcers), we have encountered situations with nursing homes that utilize a computer/kiosk record keeping system requiring the nursing home geriatric nursing assistants who provide care (including turning and repositioning) to the patient to make an entry in a computer kiosk each and every time the patient is turned and repositioned. In the event that such records do not document that the patient was turned and repositioned every two hours, this can be powerful evidence of negligence.
Unfortunately, these electronic records may not always physically make their way into a patient's chart. It is possible that nursing homes and their lawyers may try to read Plaintiffs' discovery requests narrowly to support a decision not to produce these records if they are not specifically requested.
Our firm therefore includes the following Request in Plaintiffs' Request for Production of Documents in bedsore/pressure sore/decubitus ulcer nursing home negligence cases:
A complete copy of all of Defendant's files regarding Plaintiff including but not limited to medical records, nursing home admission records, computer records, electronic records, kiosk records, log records or other documents containing written or computer entries regarding Plaintiff made by geriatric nursing assistants, certified nursing assistants or other nursing assistants that were/are maintained separately from Plaintiff's medical records at [insert name of nursing home].
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Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication administration error/prescription mistake, elder abuse or elder neglect.
]]>Many people have no idea what they are signing at this very stressful time in their lives when they are focused on ensuring that their family member or loved one receives all necessary medical care. As a result, family members may sign these arbitration agreements that have been carefully drafted by the nursing home's lawyers without even reading the documents and/or giving any thought whatsoever as to later ramifications.
On or about May 12, 2011, Senators Al Franken (Democrat-Minnesota), Richard Blumenthal (Democrat-Connecticut) and Representative Henry Johnson (Democrat-Georgia) introduced identical bills in the United States Senate and House of Representatives known as the "Arbitration Fairness Act of 2011" that, if enacted, would (among other things) ban forced arbitration clauses in nursing home admission contracts. The legislative process of this bill is still in the relatively early stages but given the present congressional make-up passage seems unlikely at least until the 2012 election cycle ends.
Executed nursing home arbitration agreements typically are not even a precondition to the patient receiving treatment or services. Hopefully, these forced arbitration clauses will be eliminated by Congress at some point in the future so that nursing home consumers and their surviving family members cannot be denied their day in Court.
In the meantime, however, families should be careful not to sign such arbitration agreements even though these clauses may be hidden in fine print and difficult to understand.
Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of nursing home neglect including bedsores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition or medication error/prescription mistakes.
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In nursing home neglect/wrongful death cases involving pressure ulcers, however, graphic photographs of these wounds are powerful evidence, and nursing home defendants and their lawyers will factor such photographs into their evaluation of claims. If a family member or loved one has developed wounds/pressure sores/decubitus ulcers, it is therefore advisable to take photographs of the condition and to be able to state the dates of the photographs.
As the saying goes, a picture really is worth a thousand words.
Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores/pressure ulcers or decubitus ulcers.
When aspiration doesn't cause choking, it can create an infection in the lungs that is referred to as aspiration pneumonia. Pneumonia is the second most common infection among elderly residents of assisted living facilities, and is often deadly for these patients with compromised immune systems.
It is often difficult to tell when pneumonia is caused by aspiration, as the initial aspirating event is usually not witnessed. But it is important for caregivers to be aware of any potential warning signs, such as swallowing difficulties. Gurgling sounds or coughing during meals may be an indication a patient is aspirating. Patients should be monitored while eating and kept in an upright position. Studies show that tube feeding does not prevent the risk of aspiration and may actually increase it by weakening the lower esophageal sphincter.
Oral hygiene also plays an important part in the prevention of aspiration pneumonia. Healthy teeth are required to chew and process food. Studies show that patients who receive proper oral care have a significant reduction in pneumonia.
The following symptoms may be a sign of aspiration pneumonia:
• Fever
• Chills
• Cough
• Chest pain
• Fatigue
• Swallowing difficulty
Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of aspiration pneumonia, bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.
]]>Legionnaires' disease is not contagious and has a 2 to 14 day incubation period. Symptoms of the disease include fever, cough, headaches, muscle aches, nausea, vomiting and chills. Legionnaires' disease is treated with antibiotics and can be fatal especially in the elderly.
Legionella bacteria often develops and grows in warm water environments including hot water tanks, cooling towers, plumbing systems, air conditioning systems, and hot tubs.
Legionnaires' disease outbreaks may occur at long-term care facilities including nursing homes or assisted living facilities. The Howard County Health Department issued a Media Release dated November 8, 2011 reporting the recent death of an elderly male resident of the Lighthouse Senior Living Facility in Ellicott City, Maryland due to Legionnaires' disease.
According to the Howard County Health Officer Dr. Peter Beilenson, there does not appear to be any other cases among residents at this time. It is reported further that the Howard County Health Department is working in conjunction with the Maryland Department of Health and Mental Hygiene ("DHMH") and Lighthouse Senior Living to assure the safety of other residents at the facility and to ensure that appropriate remediation measures occur.
Please feel free to contact the lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if a family member or loved one has contracted Legionnaire's disease secondary to nursing home and/or assisted living facility exposure.
]]>In order to comply with the minimum standards of care, nursing homes must: (1) ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were unavoidable; and (2) ensure that a resident having pressure ulcers receives necessary treatment and services to promote healing, prevent infection and prevent new ulcers from developing. This includes turning and repositioning the resident at least every two hours while in bed.
Nursing home residents are often placed in chairs (including wheelchairs or Geri-chairs) for long time periods and even allowed to nap in these chairs for hours at a time. Sitting residents experience more pressure to their buttocks area than they would experience if lying down, preventing the blood from flowing into those points. Pressure must be relieved by turning or repositioning such residents more frequently than residents lying in bed.
The federal government has developed clinical practice guidelines requiring residents who are sitting to be repositioned at least every hour. According to Clinical Practice Guideline Number 15 for Treatment of Pressure Ulcers published by the United States Department of Health and Human Services in December of 1994:
While Sitting. Interface pressure may be particularly high over sitting surfaces. When a pressure ulcer has formed on such a surface, the individual should avoid sitting. If pressure on the ulcer can be totally relieved, the person can sit for a limited time. Proper postural alignment, distribution of weight, balance, stability, and continuous pressure relief are important positioning considerations for the sitting individual. A written plan for the use of positioning devices should be developed and implemented. An individually prescribed seat cushion should be used and donut-type devices should be avoided. Sitting individuals should be repositioned at least every hour and should shift their weight every 15 minutes if possible. If hourly repositioning is not feasible, the individual should be returned to bed.
(Emphasis added).
Unfortunately, in our cases, we have encountered situations where nursing home residents were allowed to sit for hours at a time without being repositioned and pressure sores developed. Once a bedsore/pressure ulcer/decubitis ulcer develops, it can be difficult to reverse, become infected and quickly progress to a stage 3 or stage 4 decubitus ulcer. A stage three ulcer involves full-thickness skin loss and damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia. The ulcer appears as a crater, with or without undermining of adjacent tissue. A stage four ulcer involves full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).
With stage 3 or 4 pressure ulcers, the extent of the disease may not be evident because of covering necrotic material. To establish the extent of the disease and promote healing, the necrotic material needs to be removed and surgical consultation may be required. When ulcers develop over bony prominences, osteomyelitis is a potential complication. Pressure ulcers are chronically contaminated wounds and the combination of bacteremia and pressure sores can result in sepsis and death.
Please feel free to contact the lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury as a result of bedsores/pressure sores/decubitus ulcers or elderly abuse or neglect
]]>Under Maryland's nursing home regulations, nursing homes are required to file a signed copy of the agreement between the Nursing Home Administrator and the Director of Nursing that, among other things, specifies the duties of the Director of Nursing. This information can be obtained from the State via public information request and we routinely obtain this information in our cases.
Most qualified medical experts would agree that the standard of care applicable to nursing homes requires the nursing home staff to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable. The nursing home staff must also ensure that a resident having pressure ulcers receives necessary and proper wound care treatment and services to promote healing, prevent infection and prevent new ulcers from developing. The nursing home staff must relieve pressure by turning and repositioning the resident at least every two hours while in bed and every hour while in a Geri-chair or wheelchair, maintain adequate nutrition and hydration, and prevent contractures of the extremities.
Unfortunately, once a bedsore has progressed to stage 3 and stage 4, it can be difficult to achieve healing and avoid painful and life-threatening complications such as osteomyelitis (infection of the bone) and sepsis (blood infection).
Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.
]]>The standard of care applicable to nursing homes requires the nursing home staff to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable. The nursing home staff must also ensure that a resident having pressure ulcers receives necessary and proper wound care treatment and services to promote healing, prevent infection and prevent new ulcers from developing. The nursing home staff must relieve pressure by turning and repositioning the resident at least every two hours while in bed and every hour while in a Geri-chair or wheelchair, maintain adequate nutrition and hydration, and prevent contractures of the extremities.
Nursing homes oftentimes have pre-printed turning and repositioning forms that are filled out/checked at the end of every shift by nurses who may not personally do the actual turning and repositioning of the patient. In these circumstances, the nursing home's lawyers may then try to use these forms to support their contention that the patient was turned and repositioned every two hours as ordered by the physician.
In litigating nursing home negligence cases, we have learned that many nursing homes utilize a computer/kiosk record keeping system requiring the nursing home geriatric nursing assistants who provides care (including turning and repositioning) to the patient to make an entry in a computer kiosk each and every time they turned and repositioned a patient. These computer entries may be even used by registered nurses when they submit monthly MDS (Minimum Data Set) records to the State, but these records may not physically make their way into a patient's chart. We have encountered situations where the nursing home and their lawyers do not produce these records unless Plaintiffs' counsel propounds discovery requests specifically requesting these computer/kiosk records. In the event that the nursing home is not subsequently able to produce computer/kiosk records showing that the patient was turned and repositioned every two hours, this will be very powerful evidence of negligence.
It is therefore advisable to include the following Request in Plaintiffs' Request for Production of Documents in a bedsore/pressure sore/decubitus ulcer nursing home negligence case:
A complete copy of all of Defendant's files regarding Plaintiff including but not limited to medical records, nursing home admission records, computer records, kiosk records, log records or other documents containing written or computer entries regarding Plaintiff made by geriatric nursing assistants, certified nursing assistants or other nursing assistants that were/are maintained separately from Plaintiff's medical records at [insert name of nursing home].
* * *
Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication administration error/prescription mistake, elder abuse or elder neglect.
]]>Many people have no idea what they are signing at this very stressful time of their lives as they are focusing on ensuring that their family member or loved one gets necessary medical care. As a result, it is common for family members to sign these arbitration agreements without reading the documents and/or giving any thought whatsoever as to later ramifications.
Under Maryland law, if a mentally competent patient signs such an arbitration agreement at the time of admission to a nursing home, he or she will likely be bound by its terms down the road.
It is often the case, however, that a family member or loved one signs the admitting nursing home paperwork. Executed nursing home arbitration agreements typically are not even a precondition to the patient receiving treatment or services. In situations where someone other than the resident signs the arbitration agreement and the patient may receive health care without signing the arbitration agreement, the Court will focus its analysis as to whether the arbitration agreement is binding upon whether the individual who signed the arbitration agreement was authorized to waive the resident's access to the courts and right to a trial by jury. See Dickerson v. Longoria, 995 A.2d 721 (Md. 2010). Importantly, evidence of authority to make health care decisions and financial decisions are not relevant to this analysis. Instead, there must be evidence that the resident authorized decisions to be made on their behalf regarding access to courts and right to jury trial.
Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.
]]>This regulation requires assisted living facilities to request and obtain a resident specific waiver of care for a resident who sustains a stage 3 or stage 4 pressure ulcer while in the facility.
A pressure ulcer is a bed sore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain. Assisted living residents may experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points. Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection.
Unfortunately, once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and life-threatening complications. These patients may develop osteomyelitis (infection of the bone) and sepsis ultimately resulting in death.
Please feel free to contact the nursing home/assisted living neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.
]]>Sepsis can result from numerous conditions including bedsores (also known as pressure ulcers or decubitus ulcers). A pressure ulcer is a bed sore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain. Nursing home patients experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points. Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection.
Nursing home residents may be at risk for bedsores as a result of their underlying health problems and/or immobility issues. The United States Centers for Disease Control and Prevention ("CDC") published a paper in February of 2009 entitled "Pressure Ulcers Among Nursing Home Residents: United States, 2004" concluding that "pressure ulcers are serious and common medical conditions in U.S. nursing homes, and remain an important public health problem."
The standard of care applicable to nursing homes requires the nursing home staff to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable. The nursing home staff must also ensure that a resident having pressure ulcers receives necessary and proper wound care treatment and services to promote healing, prevent infection and prevent new ulcers from developing. The nursing home staff must relieve pressure by turning and repositioning the resident at least every two hours while in bed and every hour while in a Geri-chair or wheelchair, maintain adequate nutrition and hydration, and prevent contractures of the extremities.
Unfortunately, once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and life-threatening complications. These patients may develop osteomyelitis (infection of the bone) and sepsis (blood infection) ultimately resulting in death.
Oftentimes, the death certificate will list sepsis as the primary cause of death and include osteomyelitis and/or decubitus ulcers as contributing death factors. In these circumstances, it may be advisable to consult with an attorney if you have reason to believe that the bedsores developed at the nursing home and were not timely diagnosed and/or treated.
Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.
]]>While there has been discussion about extending this policy to include long term care facilities including nursing homes and assisted living centers, nursing homes are not presently subject to these guidelines. Nursing homes are therefore presently permitted to receive payment for care and treatment related to bedsores that develop in their facilities, while hospitals cannot. This writer firmly believes that these Medicare "never events" guidelines should be extended to include nursing homes and other long term care facilities so that these facilities will have the same financial incentive as hospitals do to improve patient safety measures relating to preventing the development of bedsores.
Like hospital patients, nursing home residents are often at risk for developing bedsores as a result of their underlying medical problems and/or mobility issues.
A pressure sore/decubitus ulcer is a bedsore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain. Patients experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points. Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection.
A stage 1 ulcer presents as redness of the skin without a break in the skin and represents tissue injury that does not disappear when pressure is relieved. A stage 1 ulcer is classified as nonblanchable erythema with intact skin. Erythema is redness of the skin produced by congestion of the capillaries. Erythema is the initial reactive hyperemia caused by pressure, and nonblanchable erythemia represents stage 1 pressure ulcer.
A stage 2 ulcer is characterized by partial-thickness skin loss, that is, the epidermis is interrupted as an abrasion, blister or shallow crater.
A stage 3 ulcer features full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia. The ulcer appears as a deep crater, with or without undermining of adjacent tissue.
A stage 4 ulcer involves full-thickness skin loss (exposing bone or muscle) with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).
Once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and potentially fatal complications. With stage 3 or stage 4 pressure sores, the extent of the disease may not be evident because of covering necrotic material or eschar. To establish the extent of the disease and promote healing, the necrotic material needs to be removed and surgical consultation may be required. When ulcers develop over bony prominences, osteomyelitis is a potential complication. Pressure ulcers are chronically contaminated wounds and the combination of bacteremia and pressure sores can be painful and life threatening.
Fortunately, as reflected by Medicare's "never event" guidelines, pressure ulcers may be entirely avoidable so long as proper care and preventative measures are instituted and implemented by the health care provider. The time is right to extend these "never event" guidelines to include nursing homes and other long term care facilities.
Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.
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