California Nursing Home Abuse Lawyers Blog

Stage I and stage II pressure sores usually heal within several weeks to months with conservative care of the wound and with ongoing, appropriate general care that manages risk factors for pressure sores. Stage III and IV pressure sores are more difficult to treat. In a person who has a terminal illness or multiple chronic medical conditions, pressure sore treatment may focus primarily on managing pain rather than complete healing of a wound says California Nursing Home Abuse and Neglect Attorney Steven Peck.

Treatment team
Addressing the many aspects of wound care usually requires a multidisciplinary approach. Members of a care team may include:

* A primary care physician who oversees the treatment plan
* A physician specializing in wound care
* Nurses or medical assistants who provide both care and education for managing wounds
* A social worker who helps a person or family access appropriate resources and addresses emotional concerns related to long-term recovery
* A physical therapist who helps with improving mobility
* A dietitian who assesses nutritional needs and recommends an appropriate diet
* A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on whether surgery is required and what type of surgery is needed

Relieving pressure:
The first step in treating a sore at any stage is relieving the pressure that caused it. Strategies to reduce pressure include the following:

* Repositioning. A person with pressure sores needs to be repositioned regularly and placed in correct positions. People using a wheelchair should change position as much as possible on their own every 15 minutes and should have assistance with changes in position every hour. People confined to a bed should change positions every two hours. Lifting devices are often used to avoid friction during repositioning.
* Support surfaces. Special cushions, pads, mattresses and beds can help a person lie in an appropriate position, relieve pressure on an existing sore and protect vulnerable skin from damage. A variety of foam, air-filled or water-filled devices provide cushion for those sitting in wheelchairs. The type of devices used will depend on a person's condition, body type and mobility.

Removing damaged tissue:
To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing these tissues (debridement) is accomplished with a number of methods, depending on the severity of the wound, your overall condition and the treatment goals. Options include:

* Surgical debridement involves cutting away dead tissues.
* Mechanical debridement uses one of a number of methods to loosen and remove wound debris, such as a pressurized irrigation device, a whirlpool water bath or specialized dressings.
* Autolytic debridement, the body's natural process of recruiting enzymes to break down dead tissue, can be enhanced with an appropriate dressing that keeps the wound moist and clean.
* Enzymatic debridement is the use of chemical enzymes and appropriate dressings to break down dead tissues.

Cleaning and dressing wounds:
Care that promotes healing of the wound includes the following:

* Cleaning. It's essential to keep wounds clean to prevent infection. A stage I wound can be gently washed with water and mild soap, but open sores are cleaned with a saltwater (saline) solution each time the dressing is changed.
* Dressings. A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. A variety of dressings are available, including films, gauzes, gels, foams and various treated coverings. A combination of dressings may be used. Your doctor selects an appropriate dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of application and removal.

Other interventions:
Other interventions that may be used are:

* Pain management. Interventions that may reduce pain include the use of nonsteroidal anti-inflammatory drugs -- such as ibuprofen (Motrin, Advil, others) and naproxen (Aleve, others) -- particularly before and after repositioning, debridement procedures and dressing changes. Topical pain medications, such as a combination of lidocaine and prilocaine, also may be used during debridement and dressing changes.
* Antibiotics. Pressure sores that are infected and don't respond to other interventions may be treated with topical or oral antibiotics.
* Healthy diet. Appropriate nutrition and hydration promote wound healing. Your doctor may recommend an increase in calories and fluids, a high protein diet, and an increase in foods rich in vitamins and minerals. Your doctor may also prescribe dietary supplements, such as vitamin C and zinc.
* Muscle spasm relief. Muscle relaxants -- such as diazepam (Valium), tizanidine (Zanaflex), dantrolene (Dantrium) and baclofen -- may inhibit muscle spasms and enable the healing of sores that may have been caused or worsened by spasm-related friction or shearing.

Surgical repair:
Pressure sores that fail to heal may require surgical intervention. The goals of surgery include improving the hygiene and appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer.

The type of reconstruction that's best in any particular case depends mainly on the location of the wound and whether there's scar tissue from a previous operation. In general, though, most pressure wounds are repaired using a pad of the person's own muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).

Bedsores may sound like a minor inconvenience, but they are often very serious. These injuries frequently impact individuals living in nursing homes or assisted living facilities. In many cases, bedsores, also referred to as pressure ulcers, pressure sores and decubitus ulcers, can be prevented says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

How bedsores can develop:
If you have a loved one living in a California nursing home, you need to become familiar with bedsores and how they develop. These sores tend to occur when there is unrelieved pressure and/or restricted blood flow. Bedsores have also been linked to friction, when the skin rubs against another object, even something as soft as a bed sheet. The areas of the body that lack cushion from muscle or fat, such as the tailbone, shoulder blades or elbows, are especially vulnerable.

Bedsores can be avoided:
When an elderly loved one is immobile and is forced to rely on the assistance of a nursing home or other facility, the risk of bedsores is high. It is crucial that certain measures be taken by the nursing staff to prevent pressure sores, including:

* Turning the patient on a regular basis
* Ensuring proper nutrition and hydration of the patient
* Helping the patient maintain good hygiene
* Removing pressure to avoid further injury

Steps also need to be taken to improve healing and avoid infection. For example, the affected area must be kept clean and dead tissue needs to be removed.

Sepsis describes a bacterial infection of the blood which can become fatal without treatment. The elderly often present a high risk for developing sepsis due to having weak immune systems especially if they have also pre-existing medical conditions. Improper or neglectful nursing home care of residents with bed sores, surgical or slow healing wounds, or using intravenous lines or catheters can result in a septic infection says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Cause of Sepsis::
Sepsis is caused by bacterial infection which spreads from any vulnerable point of the body into the bloodstream. Some symptoms of sepsis include irregular body temperature, and respiration, nausea, vomiting, seizures and body pains.

Bed Sores and Skin Ulcers:
Bed ridden or incapacitated residents are vulnerable to skin ulcers or bed sores. Some treatments include relieving pressure in affect areas, antibiotics, and cleaning and covering of wounds. Without treatment these wounds can blister, break open, and become infected. The infection can eventually develop into sepsis indicates Elder Abuse Attorney Peck.

Surgical and Slow Healing Wounds::
Residents recovering from surgical or slow healing wounds may require antibiotics, regular cleaning and changing of bandages to help reduce possibility of infection. Improper or neglectful attention, to these residents, can increase potential for a bacterial infection which can spread from the wound to surrounding tissue and into the bloodstream causing sepsis.

Intravenous Lines (IV Lines)::
Intravenous treatments carry a risk of infection due to direct contact into the blood stream through the vein. It is an aseptic procedure which requires regular changing and cleaning of the insertion site. However, improper care can lead to bacterial infection from foreign objects within the line and contaminated equipment. Accumulation of moisture, around the insertion site, can also result in an infection which can grow into sepsis.

Treatment:
Treatment for sepsis includes aggressive intravenous antibiotics to kill the infection. A more severe case may require ventilation for respiratory failure, vasopressor treatment to stabilize blood pressure, painkillers, and medications to control blood sugar and immune response. Invasive surgical procedures may also be required to drain or remove the source of infection.

Prevention:
Nursing home attendants can help reduce risk of sepsis through regular bathing of incapacitated residents, proper attention and cleaning of surgical wounds and bed sores, and regular changing of IV lines.

Continue reading "Sepsis and Septic Shock Is Caused By Nursing Home Abuse and Neglect" »

Lawmakers Introduce Bills To Crack Down on Elder Abuse says California Nursing Home Abuse and Neglect Attorney Steven C. Peck

California lawmakers have introduced legislation aimed at improving elder abuse reporting and making it easier to obtain convictions. Assembly member Mariko Yamada (D-Davis) introduced a bill (AB 40) that would require mandated reporters -- such as nursing employees and social, health and law enforcement employees -- to inform both an ombudsman and local law enforcement of suspected elder abuse. Currently, mandated reporters only are required to report cases to one of the two agencies. Meanwhile, Sen. Joe Simitian (D-Palo Alto) introduced a bill (SB 558) that would lower the burden of proof in elder abuse cases from "clear and convincing evidence" to a "preponderance of evidence."

Plaintiffs' lawyers have been fighting for many years to have the stiffer burden of clear and convincing evidence lowered to the preponderance of the evidence standard that was needed to prove elder abuse cases. Should the legislation pass, the new burden will conform with the burden of other personal injury matters, and give Elders and Dependent Adults an even playing field.

Continue reading "New Legislation Introduced in California Regarding Elder Abuse Reporting and Burden of Proving Elder Abuse says California Elder Abuse Lawyer Steven Peck" »

the California Court of Appeal (Second Appellate District, Division Five) permits a plaintiff in an employment case to seek punitive damages from her employer.

The plaintiff, a drug store employee, accused her supervisor of sexual harassment. She sued her employer for compensatory and punitive damages, but the trial court granted the defendant's motion for summary adjudication on the issue of punitive damages. The court ruled that the plaintiff presented no evidence that her supervisor's misconduct was was approved by a corporate "managing agent," as required to obtain punitive damages against a corporation under California Civil Code section 3294 says California Nursing Home Abuse and Neglect Attorney Steven Peck.

The Court of Appeal disagreed. It said the plaintiff presented evidence that she complained to the defendant's regional manager, who was responsible for managing every aspect of the day-to-day operations at approximately 25 stores. The court said this evidence demonstrated a sufficient level of independent discretionary authority to support a finding that the regional manager was a managing agent. Curiously, the court did not cite Roby v. McKesson, the California Supreme Court's latest decision on the requirements for establishing managing agent status.

Continue reading "In Order To Receive Punitive Damages In an Elder Abuse Case in California the Plaintiff Must Prove That The Conduct Was Authorized and / or Ratified by a Managing Agent" »

While one sign does not necessarily indicate abuse, some tell-tale signs that there could be a problem are:

* Bruises, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.

* Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.

* Bruises around the breasts or genital area can occur from sexual abuse.

* Sudden changes in financial situations may be the result of exploitation.

* Bedsores, unattended medical needs, poor hygiene, dehydration, malnutrition, and unusual weight loss are indicators of possible neglect.

* Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.

* Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs.

Continue reading "Elder Abuse Signs Are Disturbing and Very Very Common Says California Elder Abuse Attorney Steven Peck" »

Pressure ulcers

Pressure ulcers are also referred to as pressure sores, bedsores, and decubitus ulcers. A pressure ulcer can range from a very mild pink coloration to the skin which disappears in a few hours after the pressure is relieved, to a very deep wound extending to and sometimes through a bone into internal organs.

All pressure ulcers have a course of injury similar to a burn wound. This can be a mild redness of the skin and/or blistering such as a first degree burn to a deep open wound with a lot of blackened tissue in it such as a third or fourth degree burn. This black tissue is called eschar.

The primary cause of pressure ulcers is unrelieved pressure. It can also occur from friction by rubbing against something such as a bed sheet, cast, brace, etc. or from prolonged exposure to cold. Any area of tissue that lies just over a bone is more likely to form a pressure ulcer. These areas include the spine, coccyx or "tailbone", hips, heels, and elbows. Other contributing factors to the development of pressure ulcers is poor nutrition, weight loss, diabetes, poor hygiene, and dehydration.

Prevention, is the most important component of pressure ulcer management. Removing all pressure from the involved areas to prevent further decay of tissue and promote healing is the primary method of treatment. Frequent turning is mandatory to alleviate pressure on the wound and to promote healing. The individual must have increased nutrition to allow for proper healing of the wounds.

Another key aspect of treatment is keeping the area clean and removing dead or necrotic tissue which can form a breeding ground for infection. Some deep wounds require surgical removal, called debridement, of dead tissue.

Without all of these elements being in place the wounds will not heal properly and will very likely worsen.

The development of pressure ulcers may be an indication of potential problems in the care being delivered to the nursing home resident. Even in good nursing homes, small wounds may develop, but with quick attention, these wounds will heal and not progress to massive wounds. According to federal law, in most situations there is no medically valid reason for a pressure ulcer to progress to a Stage IV situation (a massive deep open wound).

Continue reading "Bed Sores and Pressure Ulcers Are a Distinct Sign of Nursing Home Abuse and Neglect" »

What Are Bed (pressure) Sores?
When a nursing home patient is either bed or wheelchair bound, the skin on parts of their body that comes into contact with a mattress or wheelchair seat is compressed. This compression causes the blood vessels under the compressed skin to constrict, causing the skin and the underlying tissue to breakdown and die. This result of this breakdown are bed (pressure) sores.
The most common areas for bed sores are the buttocks, the hips, the heels, and the shoulders.

Recognizing the Stages of Skin Breakdown.
There are four stages of bed (pressure) sores:
Stage I : Appears as a red mark on the skin
Stage II : Appears as a blister or break in the skin
Stage III: Appears as a wound going deep into the underlying flesh
Stage IV : Appears as a wound going deeper into the flesh down to the bone.

Early Recognition and Treatment
Stages I and II are easily cured by relieving the pressure at least every two hours.
Stages III and IV require special wound care by a physician or wound care nurse.
Frequent turning and repositioning of a bed or wheel chair bound patient can avoid this terrible condition.

Continue reading "Bed Sores Are A Sign of Nursing Home Abuse and Neglect" »