California Nursing Home Abuse Lawyers Blog

Burdensome health care transitions in the last months of life are common and are associated with poor quality end-of-life care, according to a study published in the Sept. 29, 2011 issue of the New England Journal of Medicine.

Investigations were done concerning health care transitions among 474,829 nursing home residents with advanced cognitive and functional impairment 120 days before death says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Three types of transitions were classified as being burdensome: those occurring in the last three days of life, absence of nursing home continuity following hospitalization during the last 90 days of life, or multiple hospitalizations in the last 90 days of life.

The associations between regional rates of burdensome transitions and the likelihood of feeding-tube insertion, hospitalization in an intensive care unit (ICU) in the last month of life, the presence of a stage IV decubitus ulcer, and hospice enrollment in the last three days of life were assessed.

The investigators found that 19 percent of the patients had at least one burdensome transition, with variation across states (range, 2.1 to 37.5 percent). Blacks, Hispanics, and those without advance directives had an increased risk of burdensome transition. Compared to patients in the lowest category of burdensome transitions, those in the highest area had significantly increased rates of feeding-tube insertion (adjusted risk ratio [aRR], 3.38), ICU time in the last month of life , late hospice enrollment, and a stage IV decubitus ulcer.

Continue reading "Burdensome Health Care Transitions In the Last Months of Life Are Very Common" »

Recent front-page Sacramento Bee headlines about tragedies in California nursing homes should be glaring reminders about the reasons California pioneered the Adult Day Health Care (ADHC) alternative to nursing home care 40 years ago.

If you are old, or are planning to be - pay attention - because this system is about to vanish.

Facing severe budget pressures, the Department of Health Care Services (DHCS) is currently dismantling the ADHC program in California.

This proven cost-effective program that has worked well to keep Californians out of nursing homes for the past four decades has fallen victim to an annual game of "budget chicken."

How did this happen?

In response to well-documented stories of institutional abuse in long-term care facilities in the 1980s, California pioneered Adult Day Health Care, a community-based, integrated health and social services program designed to keep frail and disabled persons out of nursing homes.

Since that time, the ADHC daytime congregate care program has saved the state hundreds of millions in nursing home and emergency services costs by providing frail seniors with multiple complex medical conditions a safe daily care setting.

Over the past several years, California's continuing fiscal woes have seen Republican and Democratic Governors alike cutting this MediCal "optional" program. Each time, advocates sued, with the courts blocking the cuts. In fact, a suit to block the elimination of ADHC is pending now.

Gov. Jerry Brown proposed the elimination of the ADHC program in his 2011-12 budget.

Without support for revenue extensions, all Assembly Democrats voted for the governor's proposal, with the understanding that AB 96, legislation that provided for a "step-down" alternative ADHC program would take its place.

This new program, "Keeping Adults Free of Institutions" - or KAFI - was budgeted at $85 million, half of the current cost of ADHC.

The governor vetoed AB 96 unexpectedly at the end of July, throwing the ADHC community into confusion and chaos.

With a looming deadline of Dec. 1, 2011 for program elimination, DHCS has started to shift ADHC recipients to Medi-Cal managed care and is contracting with out-of-state corporations to provide less reliable and more costly services.

Thirty-seven of my colleagues, including 35 Assembly members and two state senators,

There is no doubt that the destruction of the ADHC program will result in increased 911 calls, hospital emergency room visits, nursing home placements, and investigations for abuse and neglect.

Demands for mental health care, and in-home supportive services will also rise--at a time when budgets for all of these programs are being slashed.

Without safe adult daycare, working family members will either have to quit their jobs to care for their loved ones or place their family members in less appropriate settings - often, nursing homes.

Both Gov. Brown and I are senior citizens. My hope is that you will become one, too.

With an exploding population of baby boomers, persons with autism and Alzheimer's, returning veterans with disabling conditions and traumatic brain injuries, along with increasing numbers of impoverished adults with multiple chronic conditions in our communities, is this the time to take a wrecking-ball to a proven, cost-effective program serving our state's most vulnerable?

Will the courts again provide relief at the expected November 8 hearing, three weeks before the Dec. 1 elimination date?

History will be the judge of my vote and the governor's veto. But unless we raise our voices now, we will all surely suffer the consequences.

The most common types of health record falsification include:

1)Covering up poor outcomes, such as when a patient dies or sustains an injury;
2)Staff members filling out paperwork without knowing whether treatments took place or if the information recorded is accurate; and
3) Inaccurate recordings of dispensed medications.

So the question becomes, how do we properly track a patient's care without fear of caregivers falsifying information? The answer may be technology. As the Sacramento Bee found, "computerized record-keeping can prevent nursing home personnel from changing entries after the fact."

Continue reading "The Medical Records Can Be Easily Falsified in Long Term Health Facilities" »

Understaffing is being alleged in many cases based upon Nursing Home and Long Term Care and Neglect. The failure to adequately staff violates the Patients Bill of Rights, which includes the right to be in a facility that has sufficient staff to care for the needs of patients.

That bill of rights also lays out minimum state staffing requirements - including 3.2 nursing hours per day per patient - many long term care facilities violate the law concerning the nursing hours per day per patient.

California Nursing Home Abuse and Neglect Lawyer Steven Peck says that convalescent facilities received an extra $1 billion in reimbursements between 2004 and 2008, but failed to use that money to comply with the legal staffing requirements.

Peck says that nursing home staff commonly are underpaid and have no health benefits, and as a consequence there is high turnover.

Continue reading "Understaffing Is A Legal Concern Causing Nursing Home Abuse and Neglect" »

There is no accurate predictive value in pressure ulcer assessment scales. There is, in my opinion, says California Nursing Home Abuse and Neglect Lawyer Steven Peck, only one predictive factor that will determine whether at-risk patients will develop pressure ulcers: Who is caring for these patients. Like most risk assessment scales, the Braden Scale measures only the patient. It does not measure the staff. The incidence of pressure ulcers is related directly to the care, or lack thereof, given by the nursing staff.

Let us assume that there are 200 sets of identical twins with the lowest possible Braden Scale scores. One-half of the at-risk twins are admitted to an understaffed facility with poorly prepared personnel and no pressure-relieving beds. The other half are admitted to the finest facilities with well-prepared nurses, fully staffed shifts, pressure-relieving beds for each patient, and enough staff to turn each patient every 2 hours. It is my contention that the latter group will have dramatically fewer pressure ulcers than the former, despite identical Braden Scale scores.

At some time during the patient's course in the hospital or nursing home, the nursing staff fell down on the job, pure and simple should a pressure sore developed. The sicker and more at risk the patient, the harder hospital and nursing home staff must work to prevent decubitus ulcers.

It is obvious that the Hospitals and Nursing Homes are understaffed, overworked, have too many patients, too little money, and not enough specialty beds. No doubt that these are the problems and concerns. However, we need to acknowledge this and stop blaming patients because they have low Braden Scale scores. A patient develops a pressure ulcer because, at some point, he or she had inadequate pressure relief.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Develop Because of Understaffing and Lack of Care" »

Early this year, the Tennessee Supreme Court in a 12-page decision delivered a virtually complete victory to the family of a 57-year-old woman who died after a four-month stay at a Chattanooga nursing home.

The suit charged that Martha French, who had suffered a debilitating stroke, developed pressure sores or ulcers that, because of poor care, became infected, leading to her death from sepsis.

The decision reversed most of an unfavorable appeals court decision and concluded that French's family could pursue medical malpractice and negligence claims against Stratford House, a 127-bed nursing home. That meant that all of the family's claims would not be placed under the strict requirements of the state medical malpractice law.

In addition, the court ruled that the family could pursue negligence claims based on violations of state and federal regulations and under the state Adult Protection Act.

But even as lawyers assessed the victory, a move was afoot to undo it.

Despite protests from some legislators and advocates for the eldery, the nursing home provisions in the tort reform bill included a key provision that brings all claims against nursing homes under the strict limits of the medical malpractice law, eliminating separate claims for negligence and requiring plaintiffs to provide certification that the care provided did not meet local standards. Punitive damages also are limited to $500,000 or two times the pain and suffering claims. Claims under a protection from abuse also will be blocked.

Lawyers who regularly take nursing home negligence and malpractice cases say the new law completely reverses the French decision.

"I think it is going to effectively weaken protection for vulnerable adults. There will be much less accountability," says the Plaintiffs' bar.

Continue reading "Tennesse Limits Nursing Home Abuse and Neglect Awards" »

This is the story of a ninety-two-year old man who went to a skilled nursing facility after a hospital stay for shortness of breath. He died several days later from pressure ulcers on his heels that led to leg amputations and a raging bone infection.

Apparently nursing home staff had not repositioned him often enough. Court depositions showed that the nursing home administrator and a representative of the facility's corporate offices had ordered a nurse to alter the medical records to show that the resident had arrived at the facility with "softened heels." But the nurse admitted she had not seen the patient when he was admitted and had "no memory of him ever having softened heels." The nurse said a corporate representative had told her "to falsify the medical records because the current records did not 'look good' and he was worried about a lawsuit." says Nursing Home Abuse and Neglect Lawyer Steven Peck.

Fraudulent charting is often the result of understaffing: "public documents reveal tales of chaotic shifts on which certified nurse assistants are scrambling to provide care." Since nursing staff is a facility's biggest cost, it's easy to see how fewer nurses makes good business sense, especially when doctoring the records appears so easy.

Continue reading "Nursing Homes Are Chronically Understaffed leading to the Falsifying of Medical Records" »

A thorough evaluation should done upon admission to any hospital, skilled nursing facility, and long term care organization so that patients are assessed daily for red or open areas which could lead to devastating Pressure Sores also known as Bed Sores and Decubitus Ulcers.

A Braden scale is used to assess each patient. If a patient's score is lower than normal, a facility should implement even more rigorous ways to reposition the patient. Mobility is the first thing they try, but the facilities also should have special mattresses for pressure ulcers.

Educating the public about Bed Sores is important so that they do not lead to needless infections and possible death.

Continue reading "Thorough Evaluations Should Be Done In All Long Term Care Facilities To Halt Any Bed Sore Development" »

Pressure ulcers, also known as bed sores, are a devastating complication for many of those who are elderly, ill or immobile.

They are areas of breakdown in the skin. This is usually caused by lying or sitting in one position for too long. The pressure on the skin leads to tissue damage caused by a lack of blood flow. Over time the skin will have an open ulcer that is difficult to heal.

These sores are often overlooked by some and can turn into a deadly sore down the road. Infections can get bad very quickly.

Caregivers who care for people in-home need to be especially aware of pressure ulcers.

Pressure ulcer development is most often the result of three factors: pressure that impairs blood flow, friction and shear. Pressure occurs as a result of an outside surface (bed, chair, cast) compressing tissue layers against a deep bony prominence resulting in distortion and blockage of vessels. The most commonly affected areas include the tail bone area, heels, buttocks and hips.

Sores can be treated first by relieving any pressure. Patients should avoid lying directly on the affected area. It is important to change position frequently, often every two hours unless the ulcer is further advanced, then every hour is recommended.

Living a healthy lifestyle is the best prevention to avoiding pressure ulcers. Exercise and mobility are important to avoid too much pressure on any one area.

Continue reading "Pressure Ulcers, also known as Bed Sores, and Decubitus Ulcers are a devastating complication " »

About 11,000 people suffer spinal cord injuries every year in the USA, and more than 250,000 people are living with this type of injury.

More than one-third of people with spinal cord injuries develop bed sores, also known as pressure sores or pressure ulcers, says Steven Peck, a California Nursing Home Abuse and Neglect Lawyer. Complications from such sores kill 60,000 Americans a year. That's twice the number who die from prostate cancer. About 8% of those with spinal cord injuries die from pressure sores. The sores can be difficult to prevent, Peck says, even for patients who receive the best care.

Bed sores, also known as pressure sores or pressure ulcers,can be caused by friction, when a paralyzed person slides down in bed, or when the body presses on a vulnerable area and cuts off the blood supply. Tissue can die within hours. If bacteria from infected bed sores spread to the blood, patients can develop an infection called sepsis, which can be fatal.

Although pressure ulcers cannot always be prevented, experts say good nutrition and diets with adequate protein reduce the risk. So do "pressure releases," in which patients shift their weight in wheelchairs. Chairs and beds for quadriplegics also have been specially designed to relieve pressure. A vacuum device can stimulate wounds to close and clean out bacteria. In serious cases, doctors may operate to cut away dead tissue.

But treating bed sores -- which sometimes take more than a year to heal -- can be both daunting and disruptive. Patients may have to stay in bed for weeks or even months. Pressure sores can leave paralyzed people further disabled and isolated, . "It stops your life," Peck says.

Continue reading "People With Spinal Cords Injuries Are Candidates For Bed Sores, Pressure Sores and Decubitus Ulcers " »

There are some individuals in which pressure ulcer development is unavoidable.
a. Conditions were identified that may lead to unavoidable
pressure ulcers (eg, hemodynamic instability
and impaired perfusion); however, these conditions
do not make pressure ulcers inevitable. The duty to provide preventive care remains.
b. There are situations and conditions that limit preventive
interventions.
2. Skin failure at end-of-life is not the same as pressure
ulcers.

Continue reading "There Are Very Few Instances In Which Bed Sores, Pressure Sores and Decubitus Ulcers Are Unavoidable" »

Some nursing homes in California have altered patients' health records and provided false information in medical charts, the Sacramento Bee reports.

Elder abuse attorneys who sue nursing homes for civil damages have said they encounter some form of suspect record-keeping in nearly every case they investigate.

Background

From 1990 to 1999, California issued 180 citations for "willful material falsification" against long-term care facilities. That number dropped to 29 citations between 2000 and 2010.

Falsifying health records is a misdemeanor in California, but workers rarely are charged criminally for the offense.

Health record falsification is the least common citation the California Department of Public Health issues to nursing homes (Lundstrom, Sacramento Bee, 9/18).

Attorneys who sue nursing homes say patient record falsifications are common but infrequently pursued by authorities (Lundstrom, Sacramento Bee, 9/19).

Details of the Trend

According to an analysis of record falsification cases conducted by the Bee, some nursing home administrators have been driven to re-create medical records to hide negligence in care and to try to avoid costly lawsuits.

The most common types of health record falsification include:

Covering up poor outcomes, such as when a patient dies or sustains an injury;
Staff members filling out paperwork without knowing whether treatments took place or if the information recorded is accurate; and
Inaccurate recordings of dispensed medications.

Nursing Homes' Response

Nursing home industry representatives contend that falsification of health records is not widespread and is not a matter of great concern.

Deborah Pacyna -- a spokesperson for the California Association of Health Facilities, which represents more than 1,250 facilities -- said she has not heard of record falsification being an issue during her two years with the association.

Mark Reagan, an attorney for the association, said that the association does not condone fraudulent record-keeping but that "it's never been my experience that there's a pervasive problem with it" (Sacramento Bee, 9/18).

Industry representatives also have said fraud allegations are unjustified especially considering the amount of paperwork facilities have to produce to comply with Medicare and other regulatory requirements (Sacramento Bee, 9/19).

Read more: http://www.californiahealthline.org/articles/2011/9/19/california-faces-issue-of-record-falsification-at-some-nursing-homes.aspx#ixzz1YRELsxdd

Continue reading "California Faces Issue of Record Falsification In Nursing Homes" »

Pass The Nursing Home Patient Protection and Standards Act of 2011. Assure that nursing home residents are properly cared for, and that facility owners and administrators are accountable for the care of these residents.

Millions of Americans - those who are elderly, ill and frail - currently reside in nursing homes. The decision to move into a nursing home is often emotionally painful, as individuals must accept their lack of independence and unfamiliar surroundings because they are no longer able to care for themselves. However, these most vulnerable Americans are often abused and neglected in the very facilities that are intended to provide care. These individuals must be protected through our legislative process.

House Bill 2522 was recently referred to the House Subcommittee on Health and Human Services. Passage of this legislation would amend sections of the Social Security Act to allow for improved oversight of nursing home care provided under Medicaid and Medicare programs. In addition, protection against retaliation for whistleblowers - employees who report inappropriate treatment or conditions in nursing homes - would be put in place.

The process of checking into a nursing care facility does not include relinquishing one's rights to dignity and proper care. In fact, these rights are included in many existing federal and state statutes. Some of these rights include treatment with respect, consideration and personal dignity which is adequate and appropriate, given the resident's condition, and freedom from mental and physical abuse. However, existing statutes do not go far enough and do not include sufficient punitive measures for caregivers, administrators, and facility owners to assure that proper conditions exist. Sadly, the elderly and infirm in American society are viewed as a nuisance. This lack of respect, coupled with the greed in the nursing home industry, leads to cutting corners, inappropriate staffing and resident neglect.

Please urge Congress to enact nursing home reforms so that elderly and ill residents are protected from undue suffering and humiliation.

Continue reading "We Must Pass The Nursing Home Patient Protection and Standards Act of 2011. " »

Clostridium difficile infection (CDI) caused by an anaerobic, gram-positive, spore-forming bacillus organism, is the most common cause of healthcare-associated infectious diarrhea in healthcare facilities and has the potential to cause outbreaks in hospitals and other settings. Exacerbated by the use of antimicrobial agents in the majority of cases, this disease has caused illness in all ages; however, the elderly (individuals 65 years of age or older) are at particular risk for this infection and of concern is the notable increase in morbidity and mortality in this population. This article discusses CDI with emphasis on the challenges of this disease and infection prevention measures in the nursing home setting. The term "nursing home" is defined by Webster's New World Medical Dictionary "as a residential facility for persons with chronic illness or disability, particularly older people who have mobility and eating problems." Nursing homes are also referred to as convalescent homes or long-term care (LTC) facilities. The terms nursing home and LTC facility are used interchangeably.

In 20010, patients aged 65 years or older had the highest rate of CDI with 19.3 cases per 1,000 hospitalizations, and this variable has prevailed since 1995. Data on the elderly has been consistent with national reports on CDI hospitalization rates

Continue reading "Clostridium Difficile (CDI) Causes Severe Problems In Nursing Home and Long Term Care Facilities" »

Pressure sores are areas of damaged skin caused by staying in one position for too long. They commonly form where your bones are close to your skin, such as your ankles, back, elbows, heels and hips. You are at risk if you are bedridden, use a wheelchair, or are unable to change your position. Pressure sores can cause serious infections, some of which are life-threatening. They can be a problem for people in nursing homes.

You can prevent the sores by

Keeping skin clean and dry
Changing position every two hours
Using pillows and products that relieve pressure

Pressure sores have a variety of treatments. Advanced sores are slow to heal, so early treatment is best.

Continue reading "Pressure Sores Also called: Bed Sores, Decubitus Ulcers, Pressure Ulcers " »

In the case of Scampone v. Grane Healthcare Company, the Pennsylvania Superior Court unanimously ruled that nursing homes can be held liable under a corporate negligence theory. Scampone v. Grane Healthcare Company, 210 PA. Super 124, 11 A.3d 967 (Pa. Super. July 15, 2010). For years, there have been nursing homes that have made decisions, including the number of staff to employ, based solely on monetary motivation instead of patient needs. A large majority of nursing homes are dangerously understaffed which directly affects patient care. In Scampone, former employees testified that not only was the nursing home chronically understaffed despite complaints but that the nursing home would increase staffing levels in anticipation of state inspections and then return to its inadequate levels immediately following inspection. Scampone v. Grane Healthcare Company, 210 PA. Super 124, 11 A.3d 967 (Pa. Super. July 15, 2010). Former employees also testified that medical records were regularly altered to hide substandard care. Scampone v. Grane Healthcare Company, 210 PA. Super 124, 11 A.3d 967, 2010 (Pa. Super. July 15, 2010).

It is undeniable that corporate decisions such as staffing levels, standards of care and training are inexorably linked to the care and treatment that nursing home residents receive on a daily basis. Understaffing, lack of adequate training and hiring unskilled employees are all key elements that greatly determine the care a resident will receive. Nursing homes are a business and the majority of them are run for profit. However, when families admit their loved ones they are told that the nursing home will care for both their emotional and medical needs. At the same time as these promises are being made, nursing home companies are determining how to utilize the least amount of staff as possible to keep costs down. Those decisions are not taking your loved ones care into account.

The ability to hold a corporation liable for making a choice to put profits ahead of patients is of the utmost importance. Allowing a corporation to run a nursing home with inadequate staff and training in exchange for the nursing home making larger profits is unacceptable.

Continue reading "Nursing Homes All Around The United States Are Dangerously Understaffed" »

Risk factors that lead to sepsis can be reduced by many methods. Perhaps the most important way to reduce the chance for sepsis is to first prevent any infections. Vaccines, good hygiene, hand washing, and avoiding sources of infection are excellent preventive methods. If infection occurs, immediate treatment of any infection before it has a chance to spread into the blood is likely to prevent sepsis. This is especially important in patients that are at greater risk for infection such as those who have suppressed immune systems, those with cancer, people with diabetes, or elderly patients.

Continue reading "How Can Sepsis Infection (blood poisoning) be prevented?" »

Dehydration occurs when ones body does not have as much water and fluids as it should. Dehydration can be caused by losing too much fluid, not drinking enough water or fluids, or both. Diarrhea and vomiting are two of the most common causes. Malnutrition is the condition that occurs when your body does not get enough nutrients. Dehydration and Malnutrition have become huge problems in nursing homes, due to high susceptibility of the elderly.

Physiologic changes related to aging make an elderly adult more prone to dehydration. They have about 1/10 less body fluid than a younger adult. The sense of taste diminishes with age, food may become unappetizing. Consequently, they may eat less and use more salt, raising the body's need for water. At the same time, however, their thirst response may diminish, so they may not recognize the need to drink more. For these reasons, an elderly adult may become severely dehydrated very quickly, before they feel thirsty or anyone notices symptoms.

Continue reading "Dehydration and Malnutrition Pose Huge Problems In Nursing Homes" »