California Nursing Home Abuse Lawyers Blog

Bed Sores, Pressure Sores and Decubitus Ulcers were again the most common medical errors found in the year 2010 closely followed by foreign objects left inside patients after surgeries says Nursing Home Abuse and Neglect Lawyer Steven Peck.
The Department of Health released its 2010 Medical Error Report on It cited numerous stage three or stage four bed sores after hospital admissions--the most common problem in four of the last five years--and secondly foreign objects left behind in residents after surgeries.

Other common mistakes were falls resulting in deaths or disabilities and surgeries on the wrong body parts.

Medication errors resulting in deaths or disabilities have also been a major problem.

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Nursing Homes may be at unique risk for outbreaks of gastrointestinal disease. Multiple chronic diseases and functional impairments, as well as common air, food, water, and medical care, heighten the potential for an outbreak, as do prolonged lengths of stay, limited diagnostic facilities, and poorly developed infection-control programs.[

Among epidemic illnesses, outbreaks of gastrointestinal disease may be particularly severe. A variety of characteristics of the nursing home and its residents predispose to serious gastrointestinal infection. One review of such outbreaks identified a variety of factors placing this population at risk. Age-related (or medication-induced) achlorhydria and high rates of antibiotic usage, which alter the normal protective gastrointestinal flora, increase rates of infection and colonization. Additionally, dementia, incontinence, and psychosis, present in high rates in long-term care facilities, as well as crowded communal living conditions, facilitate behavioral patterns that allow person-to-person transmission of gastrointestinal pathogens. These risk factors create the potential for the occurrence of severe outbreaks, including wrongful death.

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Effective prevention and treatment measures depend on a comprehensive care plan that includes scheduled turning and body repositioning in order to stop the incidence of Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Attorney Steven Peck. There is evidence that the frequency and intervals between turnings may be more critical than pressure in the production of pressure ulcers. Tthe practice of turning patients every 2 hours, and this procedure remains the mainstay of prevention strategies. Various other factors clearly contribute to the development of pressure ulcers. However, the best advice still is to establish a regimen in which pressure is completely relieved on all areas of the body at regular intervals.

Providers working with persons at risk need to be able to recognize skin changes that might indicate an impending breakdown. This is particularly true in elderly patients or in patients who are immunocompromised because the signs of impending or fulminating infection are frequently absent in these patients. Systemic signs of infection that mark the need to culture wounds include drainage, leukocytosis, fever, hypotension, increased heart rate, and changes in mental status. Prevention of progression to more serious damage requires immediate, complete elimination of pressure to the involved area.

If the proposition that pressure in excess of normal is the chief cause of pressure ulcers is accepted, then the primary prevention efforts have to be directed toward reducing or eliminating pressure over susceptible areas. The intensity and duration of external pressure and shearing forces necessary for pressure ulcers, bed sores and decubitus ulcers to occur depend on an individual's susceptibility, which could be summarized as their tissue tolerance. Nursing strategies include prevention of prolonged pressure, elimination of shearing forces and friction, and removal of skin secretions and excretions.

Statistically, 21.2% of patients who underwent surgery for more than 4 hours developed 70 pressure ulcers in the first 2 days following surgery. Twenty-one pressure ulcers, bed sores and decubitus ulcers deteriorated in the days following surgery. More than half (52.9%) of the lesions developed on the heels, and 15.7% developed in the sacral area.

Additional interventions that may be indicated for patients most at risk for pressure ulcers, bed sores and decubitus ulcers include avoiding hot water; using a mild cleansing agent that does not irritate or dry the skin; using moisturizers; using topical agents such as moisture barriers; keeping the sheets dry and wrinkle free; providing adequate intake of protein and calories; and maintaining current levels of activity, mobility, and range of motion. Massaging body prominences should also be avoided since this practice has been associated with increased tissue breakdown and risk for the formation of pressure ulcers.] Positioning devices such as pillows or foam wedges should be used to prevent direct contact between bony prominences (eg, knees, ankles). Donut-type devices should not be used because they are known to cause venous congestion and edema.

Continue reading "Comprehensive Care Plans Must Be Instituted to Halt the Incidence of Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Attorney Steven Peck" »

•The United States Census Bureau projected in 2000 that California's elderly population will have doubled by 2025 to 6.4 million - a larger growth rate than any other state.
•The California State Department of Finance claims that the number of California residents age 85 and older - those who are most likely to need nursing homes --- will nearly double by the year 2030, when the bulk of baby boomers will come of age.
•In 2005, the Office of Statewide Health Planning and Development reported that one-fifth of California's nursing facilities did not meet state-mandated requirements for staffing levels.
•In 2006, Centers for Medicare and Medicaid Services reported that twice as many of California's 115,000 plus residents are placed in physical restraints as are nationally.
•From 2001 to 2005, the California Department of Health Care Services, found that two-thirds of all reported deficiencies caused or could have caused significant harm to one of more residents in nursing homes. More than half of all complaints in nursing homes are related to poor quality of care. Eighteen percent of substantiated complaints were related to mistreatment or abuse.
Together, these staggering statistics and projections illustrate the urgent need to address and remedy the poor quality of care in many of California's skilled nursing facilities

Continue reading "Elder Abuse Statistics Are Staggering says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

A Pressure Sore, Bed Sore also known as a Decubitus Ulcer is an area of the skin or underlying tissue that is dead or dying as a result of the loss of blood flow to the area says Nursing Home Abuse and Neglect lawyer Steven Peck. The pressure occurs when a person rests on a bony area for a prolonged period of time. The extended pressure leads to a pressure sore.

Anyone can get a pressure sore, bed sores or decubitus ulcer. They occur in as many as 10% of all hospitalized patients, but it is estimated that up to 80% of individuals with spinal cord injury (SCI) will have at least one pressure sore during their lifetime.

There are four stages of a pressure sore, bed sores and decubitus ulcers..

Stage 1 - Damage is limited to the top two layers of skin, the epidermal and dermal layers. The skin is not broken, but there is redness that does not turn white when touched. A person with dark skin will also see a change in skin color, which may become darker, dry, flaky, or ashy. The area may be warmer than other areas, and there may be a change in the skin's texture.
Stage 2 - Damage extends beyond the top two layers of the skin to the adipose tissue. The skin is slightly broken. The sore appears to be an abrasion, blister or small crater.
Stage 3 - Damage extends through all the superficial layers of the skin, adipose tissue, down to and including the muscle. The ulcer appears as a deep crater and damage to surrounding tissue may be present.
Stage 4 - Damage includes destruction of all soft tissue structures and involves bone or joint structures. Undermining of ajoining tissue and sinus tracts may be associated with these sores.

The Evaluation
Anytime you have a pressure sore, it is essential that you keep weight off of the area and contact you doctor immediately. Your doctor will evaluate your condition to determine your treatment options.

You also need to be evaluated for proper equipment. You may need bedding with a specialized mattress or a change in your wheelchair cushion.

Stage 1 and 2 pressure sores are usually treated without surgery. Stage 1 treatment is almost always bed rest because it is essential to stay off the pressure sore to allow healing. Other treatments might include wound care, improving nutrition, pressure reliefs and exercises. Treatment for muscle spasms may be necessary to allow the wound to heal.

Surgery might be used for stage 3 and 4 pressure sores located on the sacrum (tailbone), ischium (beneath the buttocks), and trochanter (hips). Surgery may also be needed to treat sores that have not responded to non-surgical treatments, correct a previous surgical failure, remove infection from the hip joint, and prevent exposure of bone, plates or screws.

Patients who are poor candidates for operations in general should not undergo surgery. For example, patients with a history of drug and alcohol abuse are not considered good candidates for surgery. The same is true for patients without adequate social support or appropriate equipment. Because smokers have a greater risk for skin flap failure and other complications, smokers are usually not candidates unless they stop smoking 8 weeks prior to surgery.

Antibiotic use for pressure sore infections can affect treatment and may change the plan for surgery. Infection is suggested by redness at the wound edge, foul odor, or discharge. An additional evaluation is required for medical problems that could complicate the surgery itself or reduce the body's ability to heal. These problems include such things as heart disease, blocked arteries, lung problems and diabetes.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Are A Result of Loss of Blood Flow says Nursing Home Abuse and Neglect Attorney Steven Peck" »

There are four stages of bedsores according to the National Pressure Ulcer Advisory Panel (NPUAP), and they vary in severity and depth says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Stage one bedsores are relatively minor because the skin remains intact. Characteristics include:

•Reddish color (in people with light skin color) that doesn't lighten briefly when touched.
•Skin may be bluish or ashen (in people with dark skin color) or there may be no color change at all.
•The site could be painful.
•The site may be warm or cold, soft or hard.
Stage two bedsores are a bit more serious. Skin is broken and the underlying tissue may be damaged or lost. Characteristics include:

•A shallow basin-shaped wound.
•May also appear initially as a blister that is either fluid filled, or has ruptured.
Stage three bedsores are quite serious. A deep wound is present that is deep enough to expose some of the layer of fat that is found under the skin.

•The wound looks like a crater.
•Yellowish colored dead tissue may be visible at the bottom of the wound. This is called slough.
•The damage may begin to spread outward under the surface of the skin.
Stage four bedsores are very serious and can have some dire consequences. The wound is very deep and could expose underlying muscle, tendon or even bone.

•The bottom of the wound likely contains slough and possibly dark, crusty dead tissue called eschar.
•The damage will extend beyond the wound under the healthy surface skin.

Continue reading "There Are Four Stages of Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Pressure sores also known as Bed Sores and Decubitus Ulcers have probably existed since the dawn of our infirm species. They have been noted in unearthed Egyptian mummies and addressed in scientific writings since the early 1800s. Presently, treatment of pressure sores in the United States is estimated to cost in excess of $1 billion annually says California Nursing Home Abuse and Neglect Attorney Steven Peck.

Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath. These pressures are often in excess of capillary filling pressure, approximately 32 mm Hg. In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, conscious and unconscious, from the areas of compression leads individuals to change body position. These changes shift the pressure prior to any irreversible tissue damage.

Individuals who are unable to avoid long periods of uninterrupted pressure over bony prominences--a group of patients that typically includes elderly individuals, persons who are neurologically impaired, and patients who are acutely hospitalized--are at increased risk for the development of necrosis and ulceration. These individuals cannot protect themselves from the pressure exerted on their body unless they consciously change position or have assistance in doing so. Even the most conscientious patient with an extensive support group and unlimited financial resources may develop ulceration resulting from a brief lapse in avoidance of the ill effects of pressure.

Two thirds of pressure sores occur in patients older than 70 years. The prevalence rate in nursing homes is estimated to be 17-28%.

Among patients who are neurologically impaired, pressure sores occur with an annual incidence of 5-8%, with lifetime risk estimated to be 25-85%. Moreover, pressure sores are listed as the direct cause of death in 7-8% of all paraplegics.

Patients hospitalized with acute illness have a pressure sore incidence rate of 3-11%. In a study of 658 patients aged 65 years or older who underwent surgery for hip fracture, Baumgarten et al found that 36.1% developed an acquired pressure sore within 32 days after hospital admission.(an acquired pressure sore is one that arose after hospital admission and had reached stage II or higher.) Although the 32-day period included time spent by patients in rehabilitation facilities and nursing homes, the highest incidence rate for pressure sores occurred during the patients' acute hospital stays.

Disturbingly, even with current medical and surgical therapies, patients who achieve a healed wound have recurrence rates of as high as 90%.

Continue reading "The Treatment of Presures Sores, Bed Sores and Decubitus Ulcers Costs Over One Billion Dollars In The United States Annually" »

Mandatory reporting of Elder Abuse is very important. There are several comparisons being made to elder abuse, child abuse & domestic violence when it comes to this issue.

It is not uncommon for a victim of either Domestic violence or elder abuse to contact our office and demand or plead that we should not file a civil complaint or restraining order against the abuser.

As Nursing Home Abuse and Neglect and Elder Abuse Lawyers the Peck Law Group will file and litigate these claims.

If we conclude that we have sufficient evidence to prove our case, we will move forward and hold the elder abuser accountable.

We need our ER nurses, paramedics, APS case workers, police officers, bank tellers, caregivers, clergy and the like to step forward and report their observations - without fear of repercussion.

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As elders become more physically frail, they're less able to stand up to bullying and or fight back if attacked. They may not see or hear as well or think as clearly as they used to, leaving openings for unscrupulous people to take advantage of them. Mental or physical ailments may make them more trying companions for the people who live with them..

Tens of thousands of seniors across the United States are being abused:
Harmed in some substantial way often people who are directly responsible for their care
More than half a million reports of abuse against elderly Americans reach authorities every year, and millions more cases go unreported.

Where does elder abuse take place?
Elder abuse tends to take place where the senior lives: most often in the home where abusers are apt to be adult children; other family members such as grandchildren; or spouses/partners of elders. Institutional settings especially long-term care facilities can also be sources of elder abuse.

The different types of elder abuse:
Abuse of elders takes many different forms, some involving intimidation or threats against the elderly, some involving neglect, and others involving financial chicanery. The most common are defined below.

Physical abuse:
Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.

Emotional abuse:
In emotional or psychological senior abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress.

Sexual abuse:
Sexual elder abuse is contact with an elderly person without the elder's consent. Such contact can involve physical sex acts, but activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse.

Neglect or abandonment by caregivers:
Elder neglect, failure to fulfill a caretaking obligation, constitutes more than half of all reported cases of elder abuse. It can be active (intentional) or passive (unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does).

Not providing healthcare, but charging for it :
Overcharging or double-billing for medical care or services
Getting kickbacks for referrals to other providers or for prescribing certain drugs
Overmedicating or undermedicating
Recommending fraudulent remedies for illnesses or other medical conditions
Medicaid fraud

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Sepsis is a serious medical condition caused by an overwhelming immune response to infection. Chemicals released into the blood to fight infection trigger widespread inflammation.

Inflammation may result in organ damage. Blood clotting during sepsis reduces blood flow to limbs and internal organs, depriving them of nutrients and oxygen. In severe cases, one or more organs fail. In the worst cases, infection leads to a life-threatening drop in blood pressure, called septic shock. This can quickly lead to the failure of several organs -- lungs, kidneys, and liver -- causing death.

Sepsis occurs in 1% to 2% of all hospitalizations in the U.S. It affects at least 750,000 people each year.

The term sepsis is often used interchangeably with septicemia, a serious, life-threatening infection that gets worse very quickly and is often fatal.

Sepsis Causes and Risk Factors

Bacterial infections are the most common cause of sepsis. However, sepsis can also be caused by other infections. The infection can begin anywhere bacteria or other infectious agents can enter the body. It can result from something as seemingly harmless as a scraped knee or nicked cuticle or from a more serious medical problem such as appendicitis, pneumonia, meningitis, or a urinary tract infection.

Sepsis may accompany infection of the bone, called osteomyelitis. In hospitalized patients, common sites of initial infection include IV lines, surgical incisions, urinary catheters, and bed sores.

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Bedsores (pressure sores or decubitus ulcers) are painful skin ulcers which develop when constant pressure on a body part shuts down blood supply to that skin area says Nursing Home Abuse Attorney Steven Peck.

This happens when we sit or lie in the same position for too long. Affected skin becomes starved of oxygen and nutrients.

The skin breaks down and an ulcer (sore) is formed. Friction between skin and clothing or bedding may cause bedsore formation. Areas along the backbone, shoulder blades, heels, hips, and elbows are common ground for bedsores.

Healthy people don't usually develop bedsores since we're constantly adjusting posture and position, shifting the 'pressure' of body weight around. We tend to acquire pressure sores when we are unable to recognise or say that we are uncomfortable (e.g. in dementia, Alzheimer's or mental illness), or we are physically unable to reposition ourselves (paralysed, bedridden or wheelchair bound). Seniors are at risk.

If skin is kept excessively dry or moist (in sweat, urine, or feces, and breeding bacteria) it is likely to break down when faced with friction or pressure. Complications leading to death can happen when bacteria enter the wound then the blood, infecting body parts including the brain

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Are Caused By Lack Of Blood Supply says Nursing Home Abuse and Neglect Lawyer Steven Peck" »

Patients admitted to US hospitals for severe sepsis are increasingly more likely to survive their hospitalization, have more severe infections, and require long-term care or assistance at home, according to new research published in the November issue of Chest. These trends occur against the backdrop of an aging population with increased comorbidities.

Across the United States, hospitalizations resulting from severe sepsis were nearly 2.5 times greater in 2007 than in 2000. There were 781,725 hospitalizations resulting from severe sepsis (2.38% of all hospitalizations) in 2007 compared with 300,270 hospitalizations (0.99% of the all hospitalizations) in 2000. The frequency of severe sepsis rose steadily year to year, peaking at 343 hospitalizations per 100,000 US adults in 2007, which is more than a 2-fold increase from the 143 hospitalizations per 100,000 US adults seen in 2000.

Severity of sepsis also worsened during the same period, with an average of 1.62 and 1.90 organ system failures at admission in 2000 and 2007, respectively (P < .001). The percentage of severe sepsis hospitalizations with 3 or more organ failures increased from approximately 15% to 25% (P < .001). In-hospital death rates also declined from 39.6% to 27.3% during the same period. Respiratory failure was the most frequent type of organ failure in 2000 compared with renal failure in 2007.

The investigators used data from the US Census Bureau and the Healthcare Costs and Utilization Project's Nationwide Inpatient Sample to estimate the burden of severe sepsis hospitalizations per 100,000 patients says Los Angeles Nursing Home Abuse and Neglect Lawyer Steven Peck of the Peck Law Group. They adjusted data on hospital discharge status for demographics, the number of organ-system failures, and comorbidities.

Continue reading "Long Term Care Is Increasing for Elders and Dependant Adults That Acquire Severe Infections In Long Term Care Facilities" »

Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away.

Signs of an infected pressure sore include the following:
•Thick yellow or green pus
•A bad smell from the sore
•Redness or warmth around the sore
•Swelling around the sore
•Tenderness around the sore

Signs that the infection may have spread include the following:
•Fever
•Chills
•Mental confusion or difficulty concentrating
•Rapid heartbeat
•Weakness
How are infected pressure sores treated?
The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenously (through a needle put in a vein) or orally (by mouth).

How can I tell if the sore is getting better?
As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing.

Continue reading "California Nursing Home Abuse and Neglect Lawyer Steven Peck Explains What Transpires When a Pressure Sore, Bed Sore, or Decubitus Ulcer Becomes Infected" »

Pressure sores (bedsores, decubitus ulcers, pressure ulcers) are areas of skin damage resulting from a lack of blood flow due to pressure.

Sores often result from pressure but may also result from pulling on the skin or friction, particularly over bony areas.
The diagnosis is usually based on a physical examination.
Treatment includes cleansing, removal of pressure from the affected area, special dressings, and, sometimes, surgery.

Pressure sores can occur in people of any age who are bedridden, chairbound, or unable to reposition themselves. They are more common among older people. They tend to occur over bony projections where pressure on skin can be concentrated, such as over the hip bones, tailbone, heels, ankles, and elbows. They occur where there is pressure on the skin from a bed, wheelchair, cast, splint, or other hard object .Pressure sores lengthen the time spent in hospitals or nursing homes and increase the cost of care. Pressure sores can be life threatening if they are untreated or if underlying health conditions prevent them from healing.

Continue reading "Nursing Home Abuse and Neglect Is Rampant In Bedridden, Chairbound and People Who Are Unable To Reposition Themselves" »