Recently in In The News Category

Nursing homes may attempt to include arbitration agreements among the stack of paperwork that they have patients or their families sign at the time of admission to the facility.  These arbitration agreements attempt to prevent jury trials in the event of subsequent lawsuits alleging injuries or death resulting from nursing home negligence. Instead, such disputes would be decided by arbitrators who are often chosen by the nursing home and subject to rules and procedures dictated by the nursing home.

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.

 

Contact Our Firm
Your Name: Email Address: Phone Number:

According to Taber's Medical Dictionary, sepsis is defined as "the spread of an infection from its initial site to the bloodstream, initiating a systemic response that adversely affects blood flow to vital organs."  This condition can prove fatal and is a common cause of death in the elderly population including nursing home residents.

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.

Contact Our Firm
Your Name: Email Address: Phone Number:

A recent Clinical Research Study entitled "The Safety of Warfarin Therapy in the Nursing Home Setting" published in the American Journal of Medicine, Volume 120, No. 6 (June 2007) examined the preventability of adverse warfarin (also known as Coumadin) events in the nursing home setting.  This study concluded that the use of warfarin (Coumadin) "in the nursing home setting presents substantial safety concerns for patients.  Adverse events associated with warfarin therapy are common and often preventable in the nursing home setting.  Prevention strategies should target the prescribing and monitoring stages of warfarin management."   

Coumadin (generic name: warfarin) is an anticoagulant, or blood thinning medication, that is prescribed to many nursing home patients who are at risk for developing blood clots that could result in heart attacks or strokes.  It is a very powerful drug that is also still used as rat poison and requires careful monitoring in humans.  In our practice, we have seen the devastating results when nursing homes fail to take the proper steps to ensure that their residents receive proper administration and/or monitoring of their Coumadin therapy. 

Patients taking Coumadin require periodic blood samples to measure their clotting time, or INR (International Normalized Ratio), and may require periodic adjustments of their daily dosage of Coumadin in order to ensure that their blood remains within their predetermined therapeutic range.  The physician overseeing a patient's Coumadin therapy will set a target INR range usually between 2.0 to 3.0.  Patient's with mechanical heart valves may require target INR in the range of 2.5 to 3.5.    

If a patient takes too much Coumadin, they can suffer life-threatening complications due to excessive bleeding.  If a patient takes too little, their blood will clot and they can suffer a heart attack or stroke. 

The nursing home staff must ensure that the resident takes the appropriate dosage and receives regular INR testing.  The nursing home staff must also ensure that the doctor overseeing the care timely receives the testing results, and is immediately made aware of all significant changes in the patient's condition.  In the event that the physician cannot be reached, residents experiencing significant changes in condition should be transported to a hospital immediately.

The nursing home staff must also ensure that patients taking Coumadin are provided with the appropriate diet because some foods interact with the drug.  Many commonly used medications such as antibiotics also interact with Coumadin.  Additionally, the nursing home staff must institute and implement fall precautions because residents taking Coumadin may have increased bleeding risk.

Ultimately, Coumadin administration and/or monitoring errors may be avoidable so long as nursing homes develop and implement policies and protocols aimed at: (1) ensuring that the resident receives proper INR testing, and that the results are timely analyzed and acted upon; and (2) ensuring there is a clear flow of information provided to all health care providers (especially the prescribing doctor) who interact with the resident.

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 Coumadin administration and/or monitoring errors, bed sores (also known as pressure sores or decubitus ulcers), dehydration/malnutrition, nursing home falls, elder abuse or elder neglect.

Contact Our Firm
Your Name: Email Address: Phone Number:

I just read a disturbing article in the October 1, 2009 online edition of the Chicago Tribune entitled "Nursing Homes a Risky Business - Dozens of Mentally Ill Felons Are Housed in Facilities Tied to 2 Executives."  This article discusses the practice of nursing homes admitting mentally ill criminals (often in order to receive Medicaid reimbursement) who go on to harm other residents.  The incidents cited in the article include allegations of physical assault and rape.

As if families forced to put their loved ones into nursing homes didn't already have enough to worry about, they must now consider the possibility that dangerous, mentally ill fellow nursing home residents may harm their loved one.

Ultimately, a nursing home may be responsible for injuries caused by fellow nursing home residents as the nursing home must institute appropriate protocols and policies that protect the safety and welfare of their residents.

Please feel free to contact the 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 injuries inflicted by a fellow nursing home resident. 

Contact Our Firm
Your Name: Email Address: Phone Number:

Nursing homes patients are typically at risk for falling as a result of numerous factors including physical and/or cognitive disabilities, muscle weakness, or side effects of medications.  In our nursing home neglect and abuse cases, we have encountered many situations where nursing home residents have experienced falls during transfers from or to beds, wheelchairs or Geri-chairs, and during physical therapy or occupational therapy treatments.  These falls may be the result of improper and/or inadequate supervision or staffing by the nursing home.

According to the United States Centers for Disease Control and Prevention ("CDC"), the average nursing home resident experienced 2.6 falls per year.   The CDC reports further that approximately 10% to 20% of nursing home falls result in serious injuries, and approximately 1,800 nursing home residents die each year as a result of falls.

In our practice, we have seen many situations where a nursing home resident's fall results in significant disability, functional decline, reduced quality of life and even death.  Of particular concern, are traumatic head and brain injuries resulting from nursing home falls that too often do not receive immediate medical attention and treatment. 

Traumatic brain injury (also called intracranial injury) occurs when an outside force traumatically injures the brain and may result when the head suddenly and violently hits an object following a fall.  The severity of traumatic brain injury ranges from mild (a brief change in consciousness or mental status) to severe (extended period of unconsciousness or loss of memory) based upon a scale called Glasgow coma scale.  According to the CDC, approximately 1.4 million people sustain traumatic brain injuries each year resulting in 50,000 deaths and 235,000 hospitalizations.  

The United States National Institute of Health ("NIH") has reported that approximately half of severely injured patients will need surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue).  Even if the fall victim has no visible signs of brain injury, brain bleeding or swelling may begin slowly and result in pressure on the brain as the blood has nowhere to escape.  As the pressure increases, brain cells begin to die with devastating results.   In our experience, nursing home fall victims may not receive the necessary CT scan testing and other medical attention following head trauma with tragic and potentially fatal results. 

A CT scan of the head will quickly reveal blood clots, bleeding or skull fractures that may require immediate medical care and surgical intervention.  As alluded to above, a complicating factor is that head trauma victims may appear awake with no visible symptoms as swelling and bleeding can start slowly giving the nursing home staff a false sense of security regarding the fall victim's condition.  The recent tragic death of actress Natasha Richardson as a result of a blunt impact to her head secondary to a minor skiing accident on a beginner's slope attracted substantial media attention and can be instructive.  Immediately following her fall, Ms. Richardson seemed fine and was reportedly even joking about her fall.  Approximately one hour later she developed a headache and didn't feel well resulting in a significant delay before she was finally transported to the hospital.  Unfortunately, by the time she arrived at the hospital it was too late and she died.        

It is therefore critical to prevent falls in nursing home residents through the use of proper preventative measures and precautions, and carefully monitoring of nursing home residents by the nursing home staff.  In the event that head trauma results from a fall, the nursing home staff must take immediate steps to ensure that the injury is immediately evaluated by the patient's doctor or an outside hospital.  Traumatic brain injury may be a very treatable condition if the nursing home staff merely takes proper actions to quickly transfer the resident to a hospital.  In this regard, it is better to be safe than sorry, and good practice requires nursing home fall victims with head trauma to be seen by a doctor immediately.  

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 a nursing home fall, bedsores (also known as pressure sores or decubitus ulcers), medication error/prescription mistake, dehydration, malnutrition, elder abuse or elder neglect. 

Contact Our Firm
Your Name: Email Address: Phone Number:

Patients residing in nursing homes may be at risk of developing bed sores (also known as pressure sores or decubitus ulcers) as a result of their underlying health problems and immobility issues.  A pressure sore/decubitus 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.

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."  This paper contained the following key findings and conclusions that are worth repeating.

-Overall, about 159,000 United States nursing home residents, or 11% of nursing home residents, had pressure ulcers in 2004.  

-Various demographic and clinical factors were related to having a pressure ulcer in a nursing home.  Residents who had been in a nursing home for one year or less or who had recent weight loss, or who had high immobility had the highest prevalence of pressure sores.  Nursing home residents aged 64 and under were more likely than older residents to have pressure sores.  One-fifth of nursing home residents with a recent weight loss had pressure sores. 

-Only 35% of those nursing home residents with stage 2 (or higher) pressure sores, received special wound care services.  According to the CDC, this suggests that a minority of nursing home residents with stage 2 (or higher) pressure sores received proper wound care in accordance with clinical practice guidelines.    

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.

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).

Unfortunately, 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.

The good news is that pressure ulcers are entirely avoidable so long as proper care and preventative measures are instituted and implemented by the nursing home.  Under new Medicare guidelines, hospitals are no longer even reimbursed for additional care resulting from bed sores as the government has determined that development of bed sores at a hospital is a so-called "never event."

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.

Contact Our Firm
Your Name: Email Address: Phone Number:
According to the Center for Disease Control and Prevention ("CDC"), each year an average nursing home with 100 beds reports 100 to 200 resident falls, and many falls go unreported.  Many nursing home residents fall more than once and the average resident experiences 2.6 falls per year.   The CDC reports further that: (1) approximately 35% of fall injuries involve nursing home residents who cannot walk; (2) approximately 10% to 20% of these falls result in serious injuries; (3) approximately 2% to 6% of these falls result in fractures; and (4) approximately 1,800 nursing home residents die each year as a result of falls.

Nursing home residents are often at risk for falling as a result of cognitive and physical disabilities and muscle weakness, as well as the side effects of medications.  Many falls also occur during transfers of immobile patients from or to beds, wheelchairs or Geri-chairs.  Nursing home residents also experience falls during physical therapy or occupational therapy treatments.

In our law practice, we have seen too many situations where a nursing home resident's fall results in significant disability, functional decline, reduced quality of life and even death.  Of particular concern, are hip (or femoral) fractures resulting from falls.  These injuries may require surgical intervention including the placement of plates and bone grafts.  There are significant risks for post-operative complications including infection, pneumonia, blood clots, blood loss, and hip dislocation.  Sadly, many of these nursing home fall victims ultimately die as a result of these life-threatening complications.  As reported by the Star Phoenix, according to a study published online on August 4, 2009 in the Canadian Medical Association Journal, nearly 25% of all Canadians who break their hip die within five years of being diagnosed.  This percentage is likely even higher with nursing home residents.

It is therefore critical to prevent falls in nursing home residents through the use of proper preventative measures and precautions, and carefully monitoring of nursing home residents by the nursing home staff.  

Please feel free to contact the nursing home 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 as a result of a nursing home fall, bedsores (also known as pressure sores or decubitus ulcers), medication error, elder abuse or elder neglect.  
Contact Our Firm
Your Name: Email Address: Phone Number:
Patients residing at nursing homes are often at risk of developing pressure sores/decubitus ulcers as a result of their underlying health problems and immobility issues.  A pressure sore/decubitis ulcer is a bedsore that comes from lying in the same position too long and is associated with pain.  "Decubitus" is the Latin-phrase for "lying down."

Most physicians would agree that the minimal standards of care applicable to such nursing homes is: (1) to ensure that a resident entering the facility without pressure ulcers ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically 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 and every hour while in a chair, the maintenance of adequate nutrition and hydration, and the prevention of contractures of the extremities.

Nursing home patients experience pressure from the 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.

Pressure is a primary contributing factor to the development of pressure ulcers.  Since the development of pressure ulcers depends on the length of time pressure is applied, immobility is the major risk factor.  Pressure must be relieved.  Malnutrition and adequate hydration have been linked to the development of pressure ulcers.

A stage one ulcer presents as redness of the skin and represents tissue injury and heralds skin ulceration.  A stage one 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 s stage one pressure ulcer.

A stage two ulcer is characterized by partial-thickness skin loss, that is, the epidermis is interrupted as an abrasion, blister or shallow crater.

A stage three 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 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 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.

Ultimately, pressure ulcers are avoidable so long as proper care and preventative measures are instituted and implemented by the nursing home.  In fact, under new Medicare guidelines, hospitals are no longer reimbursed for additional care resulting from bed sores and several other "reasonably preventable" errors including objects left in the body after surgery. The government has determined that development of bedsores at a hospital is a so-called "never event."
Contact Our Firm
Your Name: Email Address: Phone Number:

About this Archive

This page is an archive of recent entries in the In The News category.

General Information is the previous category.

Injuries Caused By Fellow Residents is the next category.

Find recent content on the main index or look in the archives to find all content.