Articles Posted in Pressure Sores

On June 17, 2013, a patient at Barnabas Nursing Home passed away from complications arising from her pressure ulcers. Her family has sued the nursing home and hospital and believes that their family member received negligent treatment and that the hospital and nursing home should be held responsible for her death. Continue reading

Pressure ulcers, commonly referred to as “bed sores”, are a growing problem among elderly and immobile patients, according to a study by the University of Michigan. According to the study, the amount of pressure ulcers may be up to ten times as common as the Medicare program reports.

The different rates proffered by Medicare and the University of Michigan study derive from the different methods used to detect pressure ulcers. Medicare uses billing data – which is sourced from an administrative team interpreting notes on medical records left by doctors and nurses. Because hospitals receive financial penalties for a higher number of pressure ulcers, there is an incentive for hospital administrations to downplay the number of sores within their hospitals.

The University of Michigan study, however, compared the data given by the hospital administration to “surveillance data” – basically, monitoring the skin assessments given by nurses at hospitals. This data showed that pressure ulcers were up to 10 times more common than the “administrative data” offered by Medicare suggests. According to Jennifer Meddings, M.D., M.Sc. and assistant professor in the Department of Internal Medicine, this information shows the need for a standardized approach to diagnosing bedsores – so the data provided is both accurate and uniform across hospitals.

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A new wireless scanner may be able to detect pressure ulcers (commonly known as “bedsores”) earlier than current methods. The new technology was developed by Bruin Biometrics, a California company, and uses NASA technology. According to Bruin Biometrics, the new scanner can detect pressure ulcers up to four days earlier. Currently, pressure ulcers are mainly identified by visual inspection where nurses roll over patients and inspect their skin – a archaic and intrusive method.

Pressure ulcers are chronic wounds to a local area of skin and tissue, generally seen in patients that are bedridden or otherwise immobile. Pressure ulcers are a common, expensive, and frequently deadly medical condition. An estimated 11 percent of patients in “regulated care settings” (or, nursing homes) will develop pressure ulcers. In Ireland, pressure ulcers account for a full 4 percent of the country’s healthcare budget. Sadly, advanced pressure ulcers (stage three and stage four) can frequently be fatal and the number of fatalities caused by these ulcers is on the rise. Across the world, deaths attributable to pressure ulcers have increased almost 33 percent between 2000 and 2010.

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Four nursing home staff members were arrested for neglecting to provide care to a 94-year old resident at Focus Rehabilitation and Nursing Center, Cooperstown, NY. The elderly female resident was diagnosed with a 4cm x 2cm pressure sore after allegedly being left in the same recliner for 41 hours over Memorial Day weekend this year. The female resident, identified as “M.P.” received only one meal, one medication administration, and only one time was incontinence care provided by staff over the nearly 2 day window, as captured by facility surveillance footage. Not until the resident was removed from the recliner was she diagnosed with a pressure sore.

The NY Attorney General Eric T. Schneiderman announced the arrest and arraignment of four Focus Rehabilitation and Nursing Center employees on charges alleging they each failed to provide care to a resident. The four staff members, including 2 Licensed Practical Nurses (L.P.N.) and 2 Certified Nurse Assistants, (C.N.A.) were arraigned on 8/2/16 in Otsego Town Court in Fly Creek, NY. According to Schneiderman’s press release, Lorraine Caldwell, L.P.N., Amanda Gus, L.P.N., and Sarah Schuyler C.N.A. were arraigned on various felony charges including Falsifying Business Records, Endangering the Welfare of an Incompetent or Physically Disabled Person in the first degree, and the misdemeanor charge of Wilful Violation of Health Laws. Donna Gray, C.N.A., was arraigned only on the misdemeanor charge of Wilful Violation of Health Laws. New York Penal Law 260.25, Endangering the welfare of an incompetent or physically disabled person in the first degree, states that “A person is guilty of endangering the welfare of an incompetent or physically disabled person in the first degree when he knowingly acts in a manner likely to be injurious to the physical, mental or moral welfare of a person who is unable to care for himself or herself because of physical disability, mental disease or defect.”

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The Centers for Medicare & Medicaid Services (CMS) created the Five-Star Quality Rating System in order to help consumers, families, and caregivers compare nursing homes easily and help identify areas they may have questions about. The site rates each nursing home on a scale of 1 to 5; nursing homes with 5 star ratings are considered to be above average quality and homes with a 1 star rating is considered to have lower than average quality.  In order to obtain a high rating from CMS it is important to have adequate measures in place in order to that focus on prevention and early detection for wound/skin care, falls, and urinary incontinence. It is also important to have measures in place that focus on weight loss, dehydration, infection, and dementia care.

A bill proposed in October 2015 called The Nursing Home Accountability Act set forth guidelines that would make a nursing home facility with two or less stars ineligible for a future mortgage/loan.  This method is far more stringent than the  current Housing and Urban Development (HUD) standards.  HUD is a major lender for nursing home facilities.  Although this legislation is not likely to pass, it provides a glance into possible future legislation surrounding this topic.
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Monroe County nursing homes have been cited for numerous deficiencies that often place residents at risk, yet they are still open for business; a Rochester nursing home remained open for two years after receiving chronic violations from the government. Democrat and Chronicle, a newspaper in Rochester, NY found that more than 1/3 of violations received have been cited by Department of Health (DOH) inspectors during previous or checkup inspections (repeat offenses). In some instances, the conditions that led to repeat citations were the basis of wrongful death lawsuits.

reportThere are 34 nursing homes in Monroe County, all of which were cited for a total of 768 state and federal violations during the period of 2012 to 2015; 38% of those citations were repeat deficiencies. The DOH is supposed to ensure that nursing homes comply with regulations of minimum standards of care by making random visits every nine to 15 months and posting the results of inspections online.  However, many believe this method is not enough and the state should do more as a means of enforcement. Rose Marie Fagan, a citizen of the town of Victor said that there is no reason for less than excellent nursing home care and that the community should demand better for the elderly. Continue reading

The Department of Justice (DOJ) announced the creation of regional task forces whose objective will be to toughen enforcement against nursing homes providing substandard care. This initiative was launched in accordance with the DOJ’s Elder Justice Initiative and is expected to include members from the U.S. Attorney’s Office, Medicaid Fraud Control Units, state and local prosecutor’s offices, Department of Health and Human Services, state Adult Protective Services, Long-Term Care Ombudsman, and law enforcement. These groups will come together to exchange information and share their concerns on substandard nursing homes with hopes of resolving these issues in a timely and effective manner.

Benjamin Mizer, Principle Deputy Assistant Attorney General, used the 2014 Extendicare Health Care Services case as an example of a similar collaboration that was successful. Extendicare and its subsidiary were billing Medicare and Medicaid for substandard nursing care, unnecessary rehabilitation therapies, not following protocol to prevent pressure ulcers and falls, and not having enough nurses to care for patients; the company was able to work with the federal government and eight states and settle the case for $38 million. The DOJ worked closely with other agencies and state governments in this case to come to an agreement and Mizer hopes to expand this model of federal-state collaboration through the task forces. Continue reading

Nursing homes are restricted in the amount of Medicare dollars they receive from federal and state governments. In addition, a large portion of their income is generated by payments from residents for services and stays. Rather than increasing the level of care and access to medical personnel, some nursing homes have focused their attention on increasing unnecessary luxuries to attract more residents.

In 2011 alone, Medicare paid $2.8 billion towards hospital bills for infected bedsore that required her to be hospitalized.

Experts have labeled this bait-and-switch the “chandelier effect” because the nursing home will promise bells and whistles and instead continue to deliver sub-par care for high prices. By focusing on unnecessary luxuries, nursing homes are unable to provide the residents with what they really need – competent medical care. A resident enticed by the attractive amenities will soon find that they will be unable to enjoy any of the amenities if they don’t receive proper care. In fact, many residents have died as a result of the substandard care in today’s nursing home facilities.

Dumont Center for Rehabilitation and Nursing Care, a Westchester Nursing Home located in New Rochelle, was cited by the Department of Health in a September, 2014 deficiency report. Among the numerous failures uncovered by the DOH were failure to prevent the development of pressure ulcers.

The resident was admitted to the nursing home as a known risk for the development of pressure ulcers. Her assessment revealed that she did not have any pressure sores of Stage I or higher. Approximately nine months into her stay at the facility, the resident fell while walking without the use of her walker. After being transferred to the hospital post-fall, it was discovered that she had fractured her hip and needed surgery. Following the surgery and recovery time in the hospital, she was sent back to Dumont.

As she continued recuperation from the surgery, the resident developed a Deep Tissue Injury to her right heel. At the time of its discovery, the sore was unstageable. Although the nursing home had initiated a careplan to prevent pressure ulcers from developing, a review of the CNA Accountability records showed that interventions had been ordered, but not implemented. Only after the sore had developed did the Accountability records show a pillow to elevate the heel and a low air loss mattress. Additionally, an “EZ boot” had been ordered to further off-load pressure, however it did not appear to have been implemented. The DOH made efforts to interview the CNA who had provided care for the resident following her return to the facility after surgery, but the charge nurse LPN could not identify the CNA. In an interview that the DOH was able to conduct, the LPN Rehab and Wound Care nurse told investigators that the nursing home did not even stock the EZ boots that had been recommended by the Wound Care Specialist.

A Decision and Order issued by the Hon. Stanley Green in Bronx County Supreme Court in March, 2014 denied defendants’ summary judgment motion as to negligence and violations of NY Public Health Law in a Bronx nursing home negligence action. Judge Green did grant summary judgment for the defendants as to an assault and battery cause of action.

The facts surrounding the complaint involved a nursing home fall and the subsequent development of pressure ulcers. Plaintiff had been admitted to the defendant nursing home as a resident with a high risk for both pressure ulcers and falls. One particular morning several months into the resident’s stay, a CNA entered her room on her care rounds. After raising the bed and removing a nearby floor mat, the CNA left to prepare a wash cloth in the bathroom. Upon re-entering the resident’s room, the CNA found her on the floor with several cuts to the face. In addition to the fall, the resident developed several pressure sores during her stay at the defendant facility.

The nursing home moved for summary judgment on grounds that the fall was unavoidable, and that it had exercised all reasonable care with respect to the resident’s treatment. In addition, the defendant moved for dismissal of the Public Health Law cause of action as duplicative of the negligence cause of action.

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