California Nursing Home Abuse Lawyers Blog

A woman is suing HCR Manorcare after she claims her family member was neglected while he was a resident.

Manor Care, Inc.; HCR Manor Care Services, Inc.; Health Care and Retirement Corporation of America, LLC; Heartland Employment Services, LLC; Heartland of Beckley WV, LLC; HCR Manorcare West Virginia Properties, LLC; Jo Claire Hanshew; John Does 1 through 10; and Unidentified Entities 1 through 10 (as to Heartland of Beckley) were also named as defendants in the suit.

Arcel Rose was a resident of the defendants' nursing facility from 2006 through 2009, according to a complaint filed March 28 in Kanawha Circuit Court.

Angela Black claims Rose was neglected while living in the nursing home and died March 5, 2009.

Black claims the defendants caused Rose's accelerated health and physical condition deterioration beyond that caused by the normal aging process, which caused physical and emotional trauma, including dehydration, malnutrition, infections, pressure sores and death.

The defendants caused Rose to lose his personal dignity and extreme and unnecessary pain, degradation, anguish, otherwise unnecessary hospitalizations, disfigurement and emotional trauma, according to the suit.

Continue reading "Elder Suing Manorcare for Dehydration, Malnutrition, Infections, Pressure Sores and Wrongful Death says California Nursing Home Abuse and Neglect Lawyer Steven Peck" »

One in three hospitalized patients experiences a medical error during the course of their stay, a study published this month in the journal Health Affairs reported. One in seven hospitalized Medicare beneficiaries is harmed in the course of their care, indicates California Elder Abuse Attorney Steven Peck, and half of those errors are preventable. Each week, about 40 surgeries are performed on the wrong patient or the wrong site on the body, according to the Joint Commission, the accrediting agency for healthcare institutions.

When tackling common problems like hospital-acquired infections, efforts to share best practices among hospitals and make sure that the right procedures are followed every single time and a collaborative effort among 150 hospitals and nursing homes had reduced the incidence of pressure ulcers, or bedsores, by 70 percent. A similar effort to combat bloodstream infections caused by contamination of catheters, or tubes, that deliver medicine or blood to the body, led to reduction of 80 percent indicates Los Angeels Nursing Home Abuse Lawyer Steven Peck.

Continue reading "Medical Error Is Experienced By One in Three Long Term Care Patients" »

The degree of dehydration is graded according to signs and symptoms that reflect the amount of fluid lost indicates Van Nuys Nursing Home Abuse and neglect lawyer Steven Peck.

In the early stages of dehydration, there are no signs or symptoms.
Early features are difficult to detect but include dryness of mouth and thirst.

As dehydration increases, signs and symptoms develop. These include: thirst, restless or irritable behaviour, decreased skin turgor, dry mucous membranes, sunken eyes, sunken fontanelle (in infants), and absence of tears when crying vigorously.

Symptoms of early or mild dehydration include:flushed face
extreme thirst, more than normal or unable to drink
dry, warm skin
cannot pass urine or reduced amounts, dark, yellow
dizziness made worse when you are standing
weakness
cramping in the arms and legs
crying with few or no tears
sleepy or irritable
unwell
headaches
dry mouth, dry tongue; with thick saliva.

In severe dehydration, these effects become more pronounced and the patient may develop evidence of hypovolaemic shock, including: diminished consciousness, lack of urine output, cool moist extremities, a rapid and feeble pulse (the radial pulse may be undetectable), low or undetectable blood pressure, and peripheral cyanosis. Death follows soon if rehydration is not started quickly.

Symptoms of moderate to severe dehydration include:
low blood pressure
fainting
severe muscle contractions in the arms, legs, stomach, and back
convulsions
a bloated stomach
heart failure
sunken dry eyes, with few or no tears
skin loses its firmness and looks wrinkled
lack of elasticity of the skin (when a bit of skin lifted up stays folded and takes a long time to go back to its normal position)
rapid and deep breathing - faster than normal
fast, weak pulse

Continue reading "Certain Signs That Evidence Symptoms of Dehydration Indicate Nursing Home Abuse and neglect" »

Frail and vulnerable residents of nursing homes throughout California are being dosed with powerful anti-psychotic drugs, leading to painful spasms, tremors, lethargy, a higher risk of harmful falls, infections and even death. Making matters worse, the drugs often cause behavioral problems, leading to even more drugs says California Nursing Home Abuse and Neglect Lawyer Steven Peck

In many nursing homes, anti-psychotics are the drug of choice to subdue residents with dementia. More than 25,000 California nursing home residents -- one of every four residents -- are given these drugs each day. Many residents are drugged without their consent and without a legitimate medical reason for their use indicates Ventura County Elder Abuse Attorney Peck.

Consider what the Food and Drug Administration had to say in a 2009 alert:

1) Elderly patients with dementia-related psychosis treated with conventional or atypical anti-psychotic drugs are at an increased risk of death.
2)) Anti-psychotic drugs are not approved for the treatment of dementia-related psychosis. Furthermore, there is no approved drug for the treatment of dementia-related psychosis. Health care professionals should consider other management options.

The FDA has also issued its most dire warning -- known as a black-box warning -- that anti-psychotic drugs cause elders with dementia to die which can cause the family to file a civil lawsuit.

Make no mistake. Anti-psychotic drugs do not treat dementia. They are a treatment for schizophrenia, and other related issues.

Although some nursing homes and assisted living facilities use these drugs only as a last resort, others use them routinely to chemically restrain residents with dementia and so they do not have to devote extra time to their patients.

There is a better way. Caring for individuals who suffer from dementia is difficult, but progressive providers throughout the nation are demonstrating great success in addressing behavioral symptoms of dementia with very little or no use of anti-psychotic drugs.

These facilities use good nursing practices to identify and respond to untreated pain and infections that often go undetected in elders with dementia, because they are unable to communicate effectively, and common sense techniques to make their lives more comfortable. A little caring and compassion can go a long way.

As ombudsman, federal law requires us to speak up about any issue that affects residents in long-term care. This could be legislation, education or anything that affects their quality of life, including misuse of medications. Residents in nursing homes and their representatives have the right to know what medications they are receiving, to be informed of their side effects and to accept or refuse them.

All people in California nursing homes have a legal right to live in the least restrictive environment as possible, including freedom from chemical restraints. Please join us in making "least drugging" the norm, rather than the exception in California nursing homes.

Continue reading "The Over Prescription of Anti-Psychotic Drugs To Residents of Nursing Homes May Constitute Elder Abuse" »

The U.S. Department of Health insurance and Human Services' Office of Inspector General investigated the number of individuals with criminal records working in nursing homes. To conduct the investigation, the OIG selected a stratified random sample of 260 nursing facilities from more than 15,000 Medicare-certified nursing facilities and performed Federal Bureau of Investigation background checks on the employees of those 260 nursing homes. Long-term care facilities like hospices weren't investigated, and contract workers at nursing facilities were also not considered.

Study Finds Most Nursing Homes Have Employees With Criminal Convictions says Los Angeles Nursing Home Abuse and Neglect Lawyer Steven Peck.

Based on a government report, a lot more than 90 percent of nursing facilities have employees with criminal records. The current patchwork system of criminal-background checks may bring about the high number of individuals with criminal convictions working in nursing homes, and it leaves vulnerable nursing-home residents at risk of harm.

Criminals in Nursing Homes
The analysis says, in 2009, 92 percent from the nursing homes employed at least one person with a criminal conviction. Further, almost 1 / 2 of the nursing homes employed five or even more people with criminal convictions.

At one facility with a total of 164 employees, 34 employees had a minumum of one conviction each, said Daniel R. Levinson, Inspector General from the U.S. Department of Health and Human Services.

Seven registered sex offenders were working at five different nursing homes, and 13 percent from the employees with criminal convictions were found guilty of crimes against people. The majority of the employees' convictions, 44 percent, were for crimes against property such as shoplifting, burglary or writing bad checks.

Medicare and Medicaid Regulations
Federal regulations report that nursing homes that receive Medicare and Medicaid payments cannot employ people convicted of "abusing, neglecting or mistreating" nursing-home residents and can't employ people entered in state nurse-aide registries for neglect, abuse or mistreatment of nursing-home residents, including theft of resident property.

The Centers for Medicare and Medicaid Services' guidelines suggest that nursing homes "must be thorough within their investigations of the past histories of people they are considering hiring." However, criminal-background checks are not required by federal law. Individual states may create their own background-check standards, but the insufficient centralized screening of nursing-home employees puts nursing-home residents at risk.

Patient Safety Risks
Currently, only ten states require pre-employment state and FBI criminal-background checks. Because only the FBI background check reports criminal convictions in multiple states, someone with a conviction in one state may find employment in a elderly care in a different state that does not use FBI criminal-background checks.

Senator Herb Kohl, D-Wisconsin, Chairman of the Senate Special Committee on Aging, said the current background-check system is "haphazard, inconsistent and full of gaping holes in many states. Predators can certainly evade detection throughout the hiring process, securing jobs that permit them to assault, abuse and steal from defenseless elders."

Additionally, AARP spokesman Jim Dau said, "There are still potentially-dangerous gaps in the system accustomed to determine who will be responsible for providing care for many people during vulnerable points within their lives."

Since nursing-home employees often work unsupervised in close connection with people who are less in a position to protect their property and defend themselves, a background-check system -- or lack thereof -- which allows people with criminal convictions to slip through the cracks puts family members at risk for theft and, even worse, maltreatment or nursing-home abuse.

National Criminal record check Program
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act. According to the OIG report, the Patient Protection and Affordable Care Act requires the Secretary of Health insurance and Human Services to implement a nationwide program for individual states to conduct both state and FBI background checks for nursing-home employees with immediate access to nursing-home residents.

Because criminal convictions are occasionally under different names, the National Background Check Program will work fingerprint-based searches of state and federal criminal-conviction records. However, FBI records generally do not indicate whether the victim of the crime was a nursing-home resident. Therefore, additional information on a potential nursing-home employee's criminal conviction is necessary.

Improvements to nursing-home employee screening ought to be made quickly so elderly and vulnerable residents are not harmed by people with criminal convictions. If you suspect that a relative or loved one in a nursing home might be suffering neglect, abuse or maltreatment from nursing-home employees, contact an experienced nursing home attorney in your area to discuss your legal options.

Continue reading "Most Nursing Homes have Employees With Criminal Backgrounds Indicates San Francisco Nursing Home Abuse and Neglect Attorney Steven Peck" »

A bedsore, also called a pressure ulcer, is an area of skin damaged after a two to three hour loss of blood supply, according to the University of Maryland Medical Center. The first sign is a reddened, painful area that later turns purple. Without treatment, the damaged skin breaks open and can become infected, eventually invading the deep tissue and muscle says San Deigo Nursing Home Abuse and Neglect Lawyer Steven Peck.

Patients who are unable to change position by themselves due to paralysis, loss of sensation, confusion, surgery, illness or advanced age are at highest risk for developing pressure ulcers indicates elder abuse attorney Peck.

Pressure

A healthy person unconsciously shifts her position many times during the day and night. Immobile patients, however, are unable to change position independently and may develop pressure ulcers at any point where the skin is trapped between bone and a surface such as a bed or wheelchair for two to three hours, elder law lawyer Peck. The pressure obstructs the blood flow to the skin in that area, causing damage to the skin and underlying tissue. Most commonly, this occurs at bony areas such as the hips, heels, elbows, shoulder blades, tailbone and spine, where there is less fat and muscle padding than in other areas of the body, according to MayoClinic.com.

Skin Trauma

Seemingly simple movements in bed or in a wheelchair can cause bedsores or make existing sores worse, according to Peck.. Moving a patient up in bed can create traction if the skin sticks to the bed linens. Turning the patient side to side or pulling him across the bed causes friction that wears away the top layers of the skin. When the patient slides down in bed, his skin moves in one direction and the underlying bone moves in another direction, causing a shearing force that damages the skin. Patients with circulatory problems, joint contractures or muscle spasms, as well as those who are elderly, are at highest risk for skin damage due to shearing, traction or friction.

Moisture

Prolonged exposure to moisture from urine, feces or perspiration increases the effects of friction and weakens the outer protective layer of skin, according to San Diego nursing home abuse and neglect attorney Steven Peck. The skin becomes macerated or softened and breaks down more easily. Enzymes in urine and feces promote the breakdown of tissue, and bacteria from fecal matter can cause serious infections in the wound as well as in the bloodstream.

Poor Nutrition

Poor nutrition is a common problem among the elderly and patients confined to bed rest. Since underweight patients lack the natural padding of body fat and muscle between the skin and bones that helps to prevent pressure ulcers, their risk of skin damage from even minor pressure is higher than for those of normal weights. A diet deficient in protein, zinc or vitamin C also increases the risk of developing pressure ulcers and prolongs wound healing.

Bed sores also go by the identify of decubitus ulcers and they are ulcers of the skin that appear due to prolonged pressure. Bed sores are easier to prevent than to treat and this short report will share preventative measures you can take and information about the medical symptoms, causes and treatments available if bed sores are already present says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck.

Bed Sores:

Indications of bed sores start as an region of red skin, which is usually over a bony prominence.

If a particular person is confined to bed rest, the prevalence of these sores could be greater overlying the hips, spine, lower back, shoulder blades, elbows and heels.

If a particular person is in a wheelchair, bed sores also known as pressure sores and decubitus ulcers, may be noticed on the buttocks or tailbone, lower back, lower limbs, heels and feet.

If the pressure is not eliminated from these red areas an ulcer can develop. This ulcer could have a foul odor, tenderness, be warm to touch and feasibly drain fluid.

The blistered sores are normally allowed to advance due to the fact most persons who succumb to decubitus ulcers are chronically ill, bed ridden, and/or possess very poor circulation or sensation. These elements make the individual not aware of the increasing ulcer.

For avoidance of bed sores it is crucial to frequently change the position of the individual. A bed sore can begin to form in just a few hrs of immobility. It's ideal to have the individual adjust positions each 15 mins particularly if they are in a wheelchair and just about every 2 hrs if they are bed ridden, even throughout the night.

Other bed sores avoidance steps involve:

Lying on your side at a 30 degree angle to stay away from direct pressure on the hipbones

Inserting a foam pad or cushion beneath the legs from the mid-calf to the ankle (not behind the knees in which it can restrict blood movement) when lying on your back

Utilizing a small pillow or pad to stop knees and ankles from touching

Maintaining an incline bed at less than 30 degrees to stop possible friction from slipping down.

Employing a mattress specially developed to lessen pressure. Examine your choices with your doctor.

As for treatment, considering the impacted particular person may already have bad blood flow to the spot of the ulcer, healing could be slow. It is quite crucial to minimize any further pressure on the damaged place. This can be achieved in bed ridden persons by repositioning each and every 1-2 hours. Wheel chair individuals could additionally be repositioned frequently. A prescription ointment can be applied through the day and anti-biotics can help combat any infection.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Are Easier To Prevent Than to Treat Says San Francisco Nursing Home Abuse and Neglect Lawyer Steven Peck" »

If your loved one has a bed sore and is later diagnosed with sepsis then there is a strong likelihood that the sepsis is due to the bed sore or open wound. Sepsis is an illness caused by infection in the bloodstream by bacteria says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Sepsis must be identified and treated as early on as possible in order to provide the best chances of survival. If left undiagnosed and untreated, sepsis can be fatal. In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Symptoms of sepsis include:
•Fever
•Low body temperature (hypothermia)
•Loss of ability to appreciate surroundings
•Cool hands and feet
•Anxiety
•Shaking
•Organ dysfunction

Frequently, people use the term sepsis to describe 'severe sepsis' and 'septic shock.' Severe sepsis is used to describe people who have organ dysfunction following a diagnosis of sepsis. People diagnosed with septic shock have sepsis with hypo-tension (abnormally low blood pressure).

Sepsis is a common medical condition; it accounts for:

•1-2% of all hospitalizations
•25% of all intensive care visits
•100,000 deaths per year
•The most common cause of death in intensive care units
In order for treatment to be most effective, it must be implemented as soon as the diagnosis is made. Generally, treatment consists of antibiotics and surgical drainage. Nutritional supplements are also suggested as treatment for sepsis.

Continue reading "Is Sepsis Related to Bed Sores?" »

Bedsores, also called decubitus ulcers, pressure ulcers, or pressure sores, begin as tender, inflamed patches that develop when a person's weight rests against a hard surface, exerting pressure on the skin and soft tissue over bony parts of the body. For example, skin covering a weight-bearing part of the body, such as a knee or hip, is pressed between a bone and a bed, chair, another body part, splint, or other hard object says California Nursing Home Abuse and Neglect Attorney Steven Peck.

This is most likely to happen when the person is confined to a bed or wheelchair for long periods of time and is relatively immobile. Usually, mobile individuals, when either conscious or unconscious, will receive nerve signals from the compressed part of the body and will automatically move to relieve the pressure. Pressure sores do not usually develop in people with normal mobility and mental alertness. However, people compromised through acute illness, heavy sedation, unconsciousness, or diminished mental functioning, may not receive signals to move, and as a result of the constant pressure, tissue damage may progress to bedsores in these individuals.

Each year, about one million people in the United States develop bedsores at a treatment cost of $1 billion. Pressure sores are most often found in elderly patients; records show that two thirds of all bedsores occur in people over age 70. People who are neurologically impaired, such as those with spinal injuries or paralysis, are also at high risk. Pressure sores have been noted as a direct cause of death in about 8% of paraplegics.

Continue reading "Bed Sores Caused By Immobility Will Result In Death To Compromised Elders" »

The distraught family of a grandmother who died after suffering horrific pressure sores in a care home said today the tragedy must never be repeated.

The Elder died from blood poisoning due to infected sores on her feet says California Nursing Home Abuse and Neglect Attorney Steven Peck. The Bed Sores, Pressure Sores also known as Decubitus Ulcers had become so severe her skin had worn through to the bone.

The Pathologist who carried out the post-mortem examination, said the sores on her left foot were the worst grade they could be, and penetrated so deeply they reached the bone causing the infection. The elder was also suffering severe dehydration and renal failure and died. The cause of death was sepsis - an infection of the blood due to pressure sores.

Continue reading "Tragic Death From Horrific Bed Sores Were Casued By Infection Down to The Bone Says San Francisco Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Signs and symptoms of specific types of abuse
Physical abuse

* Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body
* Broken bones, sprains, or dislocations
* Report of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
* Broken eyeglasses or frames
* Signs of being restrained, such as rope marks on wrists
* Caregiver's refusal to allow you to see the elder alone

Emotional abuse

In addition to the general signs above, indications of emotional elder abuse include

* Threatening, belittling, or controlling caregiver behavior that you witness
* Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to oneself

Sexual abuse

* Bruises around breasts or genitals
* Unexplained venereal disease or genital infections
* Unexplained vaginal or anal bleeding
* Torn, stained, or bloody underclothing

Neglect by caregivers or self-neglect

* Unusual weight loss, malnutrition, dehydration
* Untreated physical problems, such as bed sores
* Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
* Being left dirty or unbathed
* Unsuitable clothing or covering for the weather
* Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
* Desertion of the elder at a public place

Financial exploitation

* Significant withdrawals from the elder's accounts
* Sudden changes in the elder's financial condition
* Items or cash missing from the senior's household
* Suspicious changes in wills, power of attorney, titles, and policies
* Addition of names to the senior's signature card
* Unpaid bills or lack of medical care, although the elder has enough money to pay for them
* Financial activity the senior couldn't have done, such as an ATM withdrawal when the account holder is bedridden
* Unnecessary services, goods, or subscriptions

Healthcare fraud and abuse

* Duplicate billings for the same medical service or device
* Evidence of overmedication or undermedication
* Evidence of inadequate care when bills are paid in full
* Problems with the care facility:
- Poorly trained, poorly paid, or insufficient staff
- Crowding
- Inadequate responses to questions about care

Risk factors for elder abuse

It's difficult to take care of a senior when he or she has many different needs, and it's difficult to be elderly when age brings with it infirmities and dependence. Both the demands of caregiving and the needs of the elder can create situations in which abuse is more likely to occur.
Risk factors among caregivers

Many nonprofessional caregivers -- spouses, adult children, other relatives and friends -- find taking care of an elder to be satisfying and enriching. But the responsibilities and demands of elder caregiving, which escalate as the elder's condition deteriorates, can also be extremely stressful. The stress of elder care can lead to mental and physical health problems that make caregivers burned out, impatient, and unable to keep from lashing out against elders in their care.

Among caregivers, significant risk factors for elder abuse are

* inability to cope with stress (lack of resilience)
* depression, which is common among caregivers
* lack of support from other potential caregivers
* the caregiver's perception that taking care of the elder is burdensome and without psychological reward
* substance abuse

Even caregivers in institutional settings can experience stress at levels that lead to elder abuse. Nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities, are unsuited to caregiving, or work under poor conditions.
The elder's condition and history

Several factors concerning elders themselves, while they don't excuse abuse, influence whether they are at greater risk for abuse:

* The intensity of an elderly person's illness or dementia
* Social isolation; i.e., the elder and caregiver are alone together almost all the time
* The elder's role, at an earlier time, as an abusive parent or spouse
* A history of domestic violence in the home
* The elder's own tendency toward verbal or physical aggression

Continue reading "What Are The Signs of Elder Abuse?" »

A wrongful death case is a civil case that is brought against another individual, a hospital, nursing home, because their negligence or willful act caused the death of a loved one. In most states, the deceased must be a close family member or a life partner, and the family member must suffer some emotional or financial trauma as a result. Types of cases include accidental deaths, occupational hazards, medical malpractice, Nursing Home Abuse and Neglect or even criminal acts says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Because laws in a wrongful death case might differ from state to state, family members need to pay attention and contact a lawyer immediately.

In California, the Statute of Limitations against a health care provider is one year from the date of death pursuant to Code of Civil Procedure 340.5 and against a non-health care provider two years from the date of death pursuant to Code of Civil Procedure 335.1. Time is critical due to statues of limitations, which if missed can result in losing the legal right to sue.

Continue reading "Wrongful Death Claims Must Be Filed Within The Pertinent Statute of Limitations says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck" »

We know that one of the high-risk groups for carriage of methicillin-resistant Staphylococcus aureus (MRSA) are patients who come into our hospitals from long-term care facilities. Previous studies have shown a prevalence rate of anywhere from 5%-40% in this patient population. Recently, a study by Reynolds and colleagues, published in Infection Control and Hospital Epidemiology, looked at not just residents of 1 nursing home, but in all of the nursing homes in Orange County, California. This included 10 different nursing homes. Between October 2008 and November 2009, they sampled the nares of over 500 admissions and 1000 patients in a point-prevalence survey. MRSA on admission ranged from 8%-31%. The MRSA prevalence ranged from 7%-52%. When you subtracted from the point-prevalence survey those who had MRSA on admission, it ranged from 5%-22%.

Overall, point prevalence was 31% of patients having MRSA. These data show that at least these nursing homes in Orange County, California -- and there's no reason to believe that their nursing homes are any different than many other nursing homes -- have a very high prevalence of MRSA says California Nursing Home Abuse and Neglect Attorney Steven Peck.

We know that infection control practices at such nursing homes tend to be worse than at acute care facilities, and it facilitates the spread of MRSA from patient to patient. So it's not surprising then that these nursing home patients serve as a major reservoir for MRSA when they come into our acute care facilities. For that reason, nursing home patients should be at least one of the groups that is targeted if you're limiting your screening to high-risk patients

Continue reading "Nursing Home Residents Are At a Very High Risk of Carrying MRSA Into Hospitals Says California Nursing Home and Abuse Attorney Steven Peck" »

During your research of proper skilled nursing facilities for your elderly or disabled family member, you may have learned about nursing home abuse. One issue that results from abuse and neglect is infections. Infections can occur through lack of proper hygiene, improper food safety, and building safety. There are two highly common infections that are seen in nursing homes: MRSA and VSRA. These are not the only two infections and health problems. Focus are on these two because they are the more common issues.
MRSA stands for Methicillin-resistant Staphylococcus aureus. It is a bacterium that is highly difficult to treat once a patient is infected. It is known by other names like Oxacillin-resistant Staphylococcus aureus and multidrug-resistant Staphylococcus aureus. By definition it means the strain is resistant to antibiotics like penicillin. It is found in hospitals and skilled nursing facilities (SNFs) because these individuals may have open wounds or susceptible immune systems.

Signs of MRSA:

Signs of MRSA include respiratory issues, infections around open wounds, and urinary tract issues. To discover if a resident has this bacterium a swab of the nostrils and a microscope examination for the bacterium is needed. It does not take long for MRSA to worsen. Usually the initial symptoms appear in 24 to 48 hours, and after 72 hours it is resistant to treatment. MRSA can be prevented with proper cleaning and care of patients. Treatment is through vancomycin or teicoplanin and if used early enough can stop the infection before death can occur.

Continue reading "MRSA Infections Are Caused By Nursing Home Abuse And Neglect" »

When somebody is bed-bound, it is needed for them to change position periodically to stop bed sores. Bedsores happen when a patient lies motionless for an extended period of time. Constant pressure on spots on that person\'s body can trigger the skin underneath the contact point to die, making a hole in the person\'s skin. If they are caught early, bedsores can be treated simply. But if they are overlooked, they can lead to massive infections and death says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck.

Any spot the patient\'s body that experiences pressure whilst that person is motionless can develop a bed sore if the conditions are proper. For example, if the person is lying in a position where component of the bed's frame is in constant contact with the person's knee, the sustained pressure of the frame on the leg can cut off blood supply to that tiny area of skin. If blood flow is cut off for too lengthy, the skin underneath the contact point will die.

Sadly bed sores are specially frequent in nursing homes. Nursing houses are designed to care for patients who can not take care of themselves, and patients typically live there for years. A substantial portion of nursing home patients might be unable to leave their beds. Nurses are expected to frequently help patients reorient their bodies and to check for bedsores, but some facilities fail to safeguard their patients indicates California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Early-stage bedsores, if they are detected, only trigger damage to the upper layers of skin. Over time, the tissue death proceeds deeper and deeper. Beyond a certain point, the body can't recover on its own. Treating a bed sore demands surgically removing the dead tissue and applying anti-microbial dressings to maintain it covered. Severe wounds call for skin grafts or comparable surgery, as the body can not close the hole on its own.

The causes, nature, and effects of bedsores are well known. Nursing homes, hospitals, and other care facilities have an obligation to ensure that bed-bound patients do not develop bedsores. If their negligence causes a patient wonderful suffering, that individual and their loved ones have the appropriate to seek compensation for their suffering.

Continue reading "Bed Sores And Nursing Home Abuse And Neglect" »

Three workers at the Quadrangle nursing home in Haverford, Pennsylvania who were caught on camera abusing an elderly woman with dementia have been arrested. The family of the victim installed a hidden camera in the woman's room after they suspected nursing home abuse.

Video from the hidden camera shows one worker hitting the elderly woman in the face and head while trying to pull a shirt over her head. Video also shows the dementia patient without a shirt on, trying to cover herself as the three workers taunted her and pull at her ears, which were very sensitive without her hearing aids. The victim is also shown trying to leave the room repeatedly but being pulled back by the workers.

Among the charges against the workers are aggravated assault, simple assault, criminal conspiracy, harassment, and neglect of a care-dependent person.

The family of the victim, who has noticed bruises on the elderly woman in the past, say she has suffered lasting physical issues from the abuse.

Continue reading "Nursing Home Abuse and Neglect Caught on Camera" »

A Sacramento court has decided accusations of elder abuse at a Fair Oaks care facility warrant a trial.

Dennis Lee Haney brought the civil suit against Eskaton Properties, Inc. after his mother, Dorris Hilton died after spending three months there.

Hilton, 78, died in November 2006 after suffering from a urinary tract infection. Haney claims Eskaton Care Center in Fair Oaks neglected his mother's condition and failed to administer her prescribed medication until she became severely ill. Two days before her death Hilton was transferred to a hospital, where she died.

"She was neglected and without care or attention, without assistance in feeding or toileting, and was left without medication for a diagnosed urinary infection until she became confused and incoherent," Haney's complaint states. "During this time, her cries of pain and for assistance prompted no response from defendants, who had allocated knowingly inadequate resources to provide proper staffing to care for Doris Hilton."

The complaint states that Hilton was subjected to a humiliating death due to her treatment at the facility.

"The conduct of defendants was outrageous. Doris Hilton was forced to endure great pain, mental anguish, humiliation, feelings of helplessness and desperation due to their acts and omissions of deliberate indifference."

Eskaton Properties provided proper care to Hilton and the allegations are unfounded, said Stuart Greenbaum, a company spokesman.

"Eskaton maintains that this individual was provided the same highest level of care that each of the 3,500 people we serve each day receives," Greenbaum said in an email. "Because the case is still being litigated, we cannot respond further on the details. Except to add that this unique allegation is incredibly disconcerting to the 1,700 dedicated and compassionate professionals who work for Eskaton."

Eskaton Properties operates a chain of care facilities for seniors, including three in the Sacramento Area.

There have been several complaints of elder abuse filed against Eskaton's Sacramento properties over the past few years. Neither Greenbaum or Haney's attorney Lawrence Hensley could say whether the number of complaints is common in the long-term care industry. However, Hensley said since filing the complaint, he has received calls from people saying their family members were mistreated at the facility.

In another case, 87-year-old Viola Wiesser died at the facility in January 2010 after suffering from bedsores, pneumonia, clostridium, malnutrition and dehydration, according to a complaint. The woman's children believe her death was caused by neglect.

According to the most recent data available through the Administration on Aging, 54,032 complaints of elder abuse were reported at residential care facilities in California in 2008. While California received more complaints of elder abuse at residential care facilities than any other state, it is home to 9,025 facilities and 289,891 beds - more than any other state. Despite a large number of complaints, the rate of complaints in California is no higher than other state says San Diego Nursing Home Abuse and Neglect Attorney Steven Peck.

However, much of the abuse may go unreported. Only one in 14 cases of elder abuse is reported to the authorities, according to the National Center on Elder Abuse.

California spends more than $11.5 million conducting inspections of residential care facilities and investigating complaints, according to the Administration on Aging.

Continue reading "Elder Abuse Allegations Against Sacramento Assisted Living Facility Shall Proceed to Trial Says California Nursing Home Abuse and Neglect Attorney Steven Peck" »

As we grow older, our skin becomes thinner, more dry and less elastic. This makes aging skin more susceptible to physical injury from pressure, friction or shear on the body.

When pressure is applied to an area of the body continuously for anytime from 30 - 60 minutes, it reduces blood circulation to that part. This causes a gradual slowing down of the skin cells in that area. If the pressure is not removed, these cells eventually wear down and die.

This process leads to a breakdown of the skin structure, forming sores. These sores, if unchecked, can become infected and start a series of deadly, unwanted events.

The sores are called pressure sores, decubitus sores or bed sores.

Aging seniors happen to be among the highly 'at risk' category for pressure sores.

A lot of factors add together to make older seniors more at risk to pressure sores. These include poor nutrition, anemia, recurrent infection and poor circulation.

To better protect our elderly, aging seniors from the devastating effects of pressure sores, it is quite important to understand the following:

• Exactly how the aging process places the elderly at high risk of pressure sores
• What to do to greatly improve their chances of not developing a pressure sore

How the Aging Process Places the Elderly at High Risk of Pressure Sores

1. Changes to the Skin - Aging skin becomes thinner and weaker, with less fat and muscle which helps absorb pressure. This increases the fragility of the skin.

2. Chronic Conditions - The elderly are more prone to diabetes, vascular diseases and other medical conditions. These prevent areas of the body from receiving proper blood flow. With reduced blood flow, pressure sores will form more quickly at the slightest pressure.

3. Poor Mobility - The older persons' inability to move certain parts of the body without assistance - probably as a result of neuromuscular disorders such as multiple sclerosis - is another factor to consider. As we grow older, we also tend to sleep a lot more. Excessive sleepiness causes older people to change positions less often.

4. Malnourishment - Older people usually eat less and less. And sometimes totally forget to eat! This means that they are missing out on those important nutrients that come from a wide food selection.

5. Reduced Blood Circulatory Functions - As we get older our circulation becomes less efficient. This negatively affects blood supply, carrying all the essential nourishing and healing nutrients to the body cells.

6. Older Age Urinary Incontinence or Bowel Incontinence - Wetness is another major cause of pressure sore. As incontinence increases with advancing age, and the elderly stays soiled for long, irritations and pressure sores are bound to develop on the skin area.

7. Reduced Awareness - Forgetfullness is another condition that comes with age. Especially when it is as a result of a disorder such as dementia. It causes a reduced awareness of what is happening in and around the affected elderly, including their own pain and discomfort.

To protect the elderly from pressure sores, you need to pay close attention to prevention - now more than ever before. From all we have noted earlier on, there are so many factors that puts our elderly at risk indicates San Diego Nursing Home Abuse and Neglect Lawyer Steven Peck.

It is most important to place barriers such as sheepskin, fleece and pressure cushions between them and every perceived source of pressure. You can't be too careful here!

Keep the skin clean, dry and well moisturized. Encourage them to eat more. And to take their medications on time.

Continue reading "Elders Are At A Very High Risk for Bed Sores, Pressure Sores and Decubitus Ulcers Says California Nursing Home Abuse and Neglect Attorney Steven Peck" »

A UTI is an infection of one or more components of the urinary tract. The urinary tract consists of two kidneys, two ureters, a bladder, and a urethra. The kidneys are bean-shaped organs found in the lower back below the ribcage. They filter waste out of the blood and produce urine to carry the wastes and excess water out of the body. The urine is carried from the kidneys, through the ureters, and into the bladder. The bladder is a hollow muscular organ that stores urine for a short period. The bladder stretches as urine accumulates and, at a certain point, it signals the body to relieve the growing pressure. A muscular sphincter valve at the opening of the bladder is relaxed and the bladder contracts to send urine through the urethra and out of the body.

The blanket term UTI is frequently used, but a urinary tract infection may also be identified by the part of the urinary tract affected. Urethritis is an inflammation and/or infection of the urethra. Bladder involvement is called cystitis, and when one or more of the kidneys are inflamed or infected, it is called pyelonephritis.

Urine does not normally contain microorganisms, but if it is obstructed leaving the body or retained in the bladder, it provides a good environment for bacteria to grow. Most urinary tract infections are due to bacteria that are introduced into the opening of the urethra. They stick to the walls of the urethra, multiplying and moving up the urethra to the bladder. Most UTIs remain in the lower urinary tract (urethra or bladder), where they cause symptoms such as urinary urgency and a burning sensation during urination. Most of these infections are considered uncomplicated and are easily treated, but if they are not addressed, the infection may spread up through the ureters and into the kidneys. A kidney infection is more dangerous and can lead to permanent kidney damage. In some cases, a urinary tract infection may lead to an infection in the bloodstream (sepsis, septicemia) that can be life-threatening. says Los Angeles Nursing Home Abuse and Neglect lawyer Steven Peck.

Although a variety of bacteria can cause UTIs, most are due to Escherichia coli, a bacterium that is common in the gastrointestinal tract and is routinely found in stool. Other bacteria that may cause UTIs include species of: Proteus, Klebsiella, Enterococcus and Staphylococcus. Occasionally, a UTI may be due to a yeast, such as Candida albicans; urethritis is often due to a sexually transmitted disease such as herpes, chlamydia, or gonorrhea.

Urinary tract infections are common. According to the American Urological Association Foundation, UTIs result in more than 7 million visits to doctor's offices a year. Although they can affect anyone at any age, women are much more likely than men to have a UTI with about 40% of women and 12% of men having at least one in their lifetime. It is thought that a woman's increased susceptibility is partly anatomical, because the woman's urethra is shorter and because their anus and vagina are relatively close to the urethra. Anything that slows down the passage of the urine, blocks it, or introduces bacteria into the urinary tract can raise a person's risk of having a UTI. Conditions that cause an increased risk for developing a UTI include:

* Anatomical problems, such as narrowing of the urethra or ureters
* Urine retention (the bladder does not empty completely)
* Vesicoureteral reflux (the abnormal flow of urine from the bladder back to the ureters)
* Kidney stones
* Bladder catheterization, especially long term
* Spinal cord injuries
* Diabetes - it causes changes to the immune system, damage to the kidneys, and often results in sugar in the urine, promoting the growth of bacteria
* Kidney disease
* Kidney transplant
* Any condition that suppresses the immune system
* In men, an enlarged prostate may inhibit the flow of urine.

Continue reading "Urinary Tract Infections Can lead to Sepsis / Septicema and Death Says California Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Decubitus ulcers are also known as bedsores and pressure ulcers transpire due to continuous contact of the body with a hard surface, like a bed or a wheelchair. The bedsore is a pressure ulcer and there are common places where these sores can occur, due to the bone pressure against the skin, when the body is on a hard surface for an extended amount of time says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck.

Bedridden nursing home patients and parapeligecs that are not repositioned on a regular basis, which is usually every two hours according to protocol of most Nursing Homes and long term care facilities, are at a high risk to develop bedsores, pressure sores or decubitus ulcers, or for them to become worse.

Immobility places the patient at risk and without proper repositioning the risk triples, especially if the bedding is not kept clean of urine or if they have been soiled, which will add to the stress on the tissue. Doctor's orders and nursing home rules order proper repositioning to redistribute the weight, to keep proper blood flow supplied to the tissue. This prevents or minimizes bedsores in patients that are bedriddenand those completely unable to reposition themselves without the help of others.

Continue reading "The Bedridden and Paraplegics Are At A High Risk To Develop Bed Sores, Pressure Sores and Decubitus Ulcers Indicates California Nursing Home Abuse and Neglect Attorney Steven Peck" »

Bedsores, also known as pressure sores or pressure ulcers, are parts of the skin and tissue that are damaged. Bedsores are a concern for people confined to a bed. Oftentimes, sleeping in the same position causes bedsores, as does moisture in the bed and resting on joints. If you are looking for ways to prevent bedsores, either for yourself, a loved one or a patient, consider the following suggestions.

Avoid bedsores by changing lying positions every couple of hours. Repositioning someone who is unable to move can be made easier by using bed linens. With this method, you can roll someone gently to a side position from a back position, or vice versa, without causing any friction to the skin.

Consider investing in a special mattress if you are caring for a person confined to a bed on a full-time basis. Check with the doctor for a recommendation on whether you should opt for an air, water, foam or some other type mattress. There are also cushions you can purchase specifically designed to prop a person in different positions.

Be sure to avoid pressure sores by not positioning the body on a bony area. You can make good use of pillows or special cushions to position the body at an angle or float areas between the legs. Keep the body straight, and avoid certain areas being aggravated by joints.

Incorporate as much activity as possible for bedridden people, the extent of which is dependent on what the person is capable of. Exercise keeps the blood flowing and maintains muscle. Additionally, keeping active rouses the appetite. All of this leads to healthy skin, and healthy skin is less prone to bedsores.

Inspect the skin all over the body for sore areas on a daily basis. If you find some, treat the area to prevent it from getting worse. Maintaining healthy skin means bathing it gently and applying a little lotion to dry areas. If the person can check the skin with a mirror, have him do it regularly, especially areas that feel uncomfortable. If the bedridden person uses diapers, change diapers regularly to avoid moisture irritating the skin.

Maintain healthy skin by incorporating a nutritional diet that will improve the skin and protect against bedsores. Focus on fruits, vegetables, proteins and dairy. Cut out fats and sugar. Ask the doctor about supplemental vitamins and minerals that the bedridden person may be lacking.

Make sure that the bedridden person increases fluid intake, specifically water. Hydration is necessary for healthy skin, and healthy skin is less likely to get agitated with bedsores.

Cut out or cut back on alcohol, cigarettes and caffeine. All of these habits are bad for your skin, which will make it vulnerable to pressure sores.

Continue reading "Bed Sores, Pressure Sores aka Decubitus Ulcers Can Be Prevented With Proper Care" »

MRSA stands for methicillin-resistant Staphylococcus aureus, a type of infectious bacterium resistant to the antibiotic methicillin and other related antibiotics of the penicillin class. MRSA infections are a particular problem in hospitals. Some patients have MRSA on their skin or nose without it doing them any harm (colonised patients). However, these patients may develop infections if the MRSA spreads from the colonised skin area to an open wound says Los Angeles Nursing Home Abuse and Neglect Lawyer Stevenh Peck.

MRSA mostly affects hospital patients and can be a serious, even fatal, infection. MRSA-related deaths are commoner among the elderly and people with damaged or depressed immune systems, either from chronic disease, such as HIV, or those undergoing chemotherapy, which represses the activity of the immune system.

MRSA can cause fatal blood infections, such as septicaemia, that are hard to treat due to the bacteria's resistance to many antibiotics Peck says.

The history of MRSA
MRSA belongs to the Staphylococcus aureus (S. aureus, staph or SA) family of bacteria, which is a common cause of wound and blood stream infections.

SA infections were serious and often fatal before penicillin (an antibiotic) was introduced in the 1940s.

More and more strains of SA became resistant to penicillin and by the end of the 1950s the bacteria evolved the ability to develop an enzyme to destroy penicillin's antibacterial activity.

In the early 1960s, however, a more powerful type of antibiotic, methicillin, was developed for use in penicillin-resistant SA infections. Within a short time, however, some SA strains had again started to adapt to become methicillin resistant too.

Despite being relatively uncommon during the 1960s, 1970s and 1980s, MRSA infection grew dramatically in the mid-1990s, when new strains that were easily transmitted from person to person became established in hospitals across the UK, causing an increasing number of cases.

Health Protection Agency figures on MRSA blood stream infections reveal there were 1,087 cases reported in England during the fourth quarter of 2007, or a 0.6 per cent increase on the previous quarter when 1,080 reports were received (1).

How is MRSA transmitted?
Around 30 per cent (2) of people are colonised by SA naturally, which means bacteria live normally in the nose and throat, and on the surface of the skin, particularly in areas where there are folds, such as the armpit or the groin - without it causing any problems.

When SA bacteria get into the body through a wound, they can cause skin infections, such as boils or abscesses. If they get into the blood stream, they can cause potentially fatal infections, such as septicaemia.

Many SA infections can be treated with common antibiotics, but if you become infected with an MRSA strain, clearing up the infection becomes far more difficult, as the availability of drugs that can treat it is limited.

Hospital patients are usually the most likely to develop MRSA since some may have pressure sores, for instance, or surgical wounds after having operations, such as hip replacements or heart surgery, or are being treated with intravenous drips or urinary catheter - all of which offer opportunities for bacteria to enter the body and cause infection.

How do you get infected with MRSA?
Exogenous infection
You can catch MRSA if you have had contact with someone who either has the infection or who is colonised with MRSA bacteria, or by having contact with something that has been contaminated with MRSA bacteria, such as sheets, clothing, sinks, towels and even door handles.
Endogenous infection
You can infect yourself, if you are colonised by MRSA and suffer a cut, wound or other type of break in your skin where the bacteria can invade your body.
What are the symptoms of MRSA?
The majority of MRSA infections start as skin infections, such as a wound that does not heal and develops into a boil or an abscess. Ulcers, such as pressure sores, varicose ulcers and diabetic ulcers can often be colonised by MRSA infection.

MRSA is far more serious when it enters the blood stream, causing septicaemia, septic shock, septic arthritis, deep (or internal) abscesses, meningitis, pneumonia, osteomyelitis (bone infection) and endocarditis (infection of the heart lining) (3).

Deeper abscesses can affect parts of the body, such as the kidneys, liver and spleen, causing low blood pressure, shivers, weight loss and organ failure (4).

Septicaemia, which is the type of MRSA infection that has the highest death rate, includes severe symptoms such as high body temperature, shaking and organ failure.

How is MRSA treated?
MRSA infection is detected by a blood or urine test. Also, sometimes a wound swab can check for the presence of MRSA bacteria. If the diagnosis is confirmed, you may need further tests to check to which types of antibiotics the bacteria are resistant.

Certain antibiotics, such as vancomycin, teicoplanin or linezolid, are still effective in treating MRSA. These drugs are usually injected directly into a vein or fed into the blood stream via a drip. The doses are much higher than those given for other types of infection and you may need several weeks' worth of hospital-based treatment.

Can MRSA be prevented?
Steps are being taken in hospitals around the country to control and minimise the spread of MRSA in patients.

For example, hospital workers are expected to wash their hands thoroughly before and after having contact with patients. Visitors also are encouraged to wash their hands before entering the wards and on their way out too.

If you are going to visit somebody in hospital, there should be antibacterial gels in dispensers near patients' beds, as well as next to main and ward doors.

If you see antibacterial gel dispensers on a ward or hospital door use them.

If you are going into hospital for treatment, a few sensible measures may reduce your risk. Make sure your hands are clean at all times. Keep a pack of antibacterial hand wipes by your bed and use them each time you come into contact with anyone or anything that could possibly be contaminated with bacteria (after using the toilet, for instance), as well as before and after having a meal.

Make sure anyone who visits you washes their hands thoroughly too, when they first arrive and before they leave.

Many hospitals also routinely test new patients for MRSA colonisation, and you may have swabs taken from your skin and nose, as well as being required to give urine and blood samples before you can receive any treatment.

If you test positive, you will be given an antibiotic skin cream and antiseptic shampoo and soap to get rid of the bacteria, so that you are clear before you are admitted.

Continue reading "MRSA stands for Methicillin-Resistant Staphylococcus Aureus, and can be fatal and deadly for elder Hospital Patients" »

High-quality nursing homes get sued almost as often as low-quality nursing homes, a new study shows.

Researchers say the finding illustrates that litigation, or the threat of litigation, doesn't lead to improvements in patient care. Nor does it appear that better nursing homes are rewarded for superior care in terms of fewer lawsuits.

"Nursing homes that are at the very top of the heap in terms of quality don't experience that much less litigation than nursing homes that are at the bottom of the heap," said lead study author David Studdert, a law professor at the University of Melbourne in Australia. "It's not clear that by improving your quality dramatically you will lessen your risk of being sued."

That's a problem, said study co-author David Stevenson, an associate professor of health care policy at Harvard Medical School, because one objective of litigation, other than compensating victims of medical malpractice, is encouraging high-quality care.

In other words, if a nursing home is good, it ought to face less of a threat of lawsuits than one that's sub-standard. But the research didn't bear that out.

"The results are sobering," Stevenson said. "One of the fundamental things that the risk of a malpractice claim is supposed to spur is deterring poor quality care. What we found was that the return on being a high-quality facility relative to a low-quality facility isn't great."

The study is published in the March 31 issue of the New England Journal of Medicine.

Five large U.S. nursing home chains provided the researchers with information on lawsuits brought against them between 1998 and 2006. Researchers looked at the alleged reason for the suit and the outcome, not whether the lawsuits had merit or not.

During that period, plaintiffs filed 4,716 claims against 1,465 nursing homes. On average, each nursing home was sued once every two years.

The most common harms alleged were fall-related injuries (27 percent) and pressure ulcers or bedsores (16 percent). Other claims were for dehydration, malnutrition and excessive weight loss, physical or verbal abuse and medication errors says California Nursing Home Abuse and Neglect Attorney Steven Peck.

Sixty-one percent of the claims resulted in a payment, which averaged nearly $200,000.

Researchers then analyzed the likelihood of a nursing home being sued based on 10 measures of quality gleaned from two national databases, including one that tracks the health of nursing home residents on a monthly basis.

Nursing homes that did the best on quality measures were only a little less likely to be sued. In any given year, nursing homes with the best records (the top 10 percent) had a 40 percent risk of being sued, while the worst 10 percent of nursing homes had a 47 percent chance of being sued.

Nursing homes that had the most nurse's aide hours per resident-day -- a measure of how well staffed a nursing home is -- were also slightly less likely to get sued, but again, not by much -- 45 percent compared to 41 percent annually for those with the lowest staffing levels.

One measure for which there was a significant difference in the likelihood of lawsuits was pressure ulcers or bedsores. Nursing homes with the lowest pressure ulcer rates had a 6 percent chance of being sued in a given year because of bedsore-related complaints compared to 11 percent for the worst-performing nursing homes.

Overall, for half of the 10 measures of quality, top nursing homes were slightly less likely to be sued than the worst nursing homes, but for five of the measures there was no significant connection.

Concluding that lawsuits have little effect on quality of care, the authors say that other long-term efforts, such as public reporting of nursing home conditions and performance-based reimbursement schedules, may be needed to encourage improvements.

The authors said their study doesn't specifically address tort reform, and their research shows that even in regions where there is less litigation -- one of the aims of tort reform -- there is no strong connection between a high-quality versus a low-quality nursing home's likelihood of being sued.

"The tort system is not working well in terms of deterrence, and it's not looking like you can fix that by any tweak to the system," Studdert said. "It looks fundamental."

But industry representatives said the study underscores the need for medical liability reform.

"The report's findings that a facility's quality of care does not affect the frequency of litigation demonstrates that comprehensive tort reform is essential," said Teresa Cagnolatti, director of government relations for the American Health Care Association, a Washington, D.C-based nursing home industry group.

"These legal distractions demoralize providers and employees, threaten staffing ratios and most importantly diminish resources from facilities providing good quality of care," Cagnolatti said.

Stevenson said the lawsuits likely added to the cost of housing the frail and elderly, although the study did not determine how much.

And although the study was in nursing homes, "it's very reasonable to assume there is a similar situation happening in the acute care sector, with hospitals and doctors," Studdert said.

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