Articles Posted in Pressure Sores

The government recently adopted a more accurate measurement for determining when a nursing home has sufficient staffing levels and the results show a glaring problem across the nursing home industry. According to Kaiser Health News, the new method of recording hospital staffing shows a 12 percent decrease in hospital staffs. Further, there seems to be a severe fluctuation at many nursing homes which have sufficient nurses during the week but insufficient staff on the weekends. The new evidence shows that despite the minimal Medicaid requirements on the nursing staff levels at nursing homes, many nursing homes are still failing.

Under the previous method for calculating nursing staff, nursing homes would be required to provide all payroll information for the previous two weeks and government regulators would tally and report on the number of nurses employed during that time period. Because nursing homes sometimes knew when an inspection would occur ahead of time, this method was not generally considered accurate. Under the new method for calculating nursing staff, which Medicare began in April of this year, nursing homes must provide a report to Medicaid on staffing throughout the entire year.

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A Canadian man is telling the story of a short-term hospital stay that turned into a year-long nightmare after he developed a pressure ulcer, also known as a decubitus ulcer or bedsore. The senior citizen, Vinal Michaud, was admitted to the hospital for kidney stones – a fairly routine medical procedure. After spending ten days at the hospital in June 2007, Michaud was released back to his home. It was only when he returned home that he discovered the pressure ulcer.

Michaud, who is a paraplegic and does not feel sensation below his waist, only discovered bedsore when his at-home nurse saw the wound and alerted him. According to Michaud, the nurse told him “We’re going to have to look at that right away.” A doctor visit diagnosed the pressure ulcer as a Stage IV bedsore – the most serious categorization. Michaud, who said he could not feel the pressure ulcer developing because he has been unable to walk since his spinal cord was crushed in a tractor accident when he was ten-years-old, began medication and ointments immediately.

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A Canadian woman developed a stage-four pressure ulcer after spending several weeks at a hospital recovering from hip surgery. The woman, Lola Chiasson Hawkins, had a bed sore so deep it reached to her bone by the time the hospital staff recognized the severity of the problem and took corrective measures. Perhaps even worse, her stage-four bed sore, the most severe kind, was only discovered because of her family’s diligence.

According to her children, Hawkins developed the bed sore after spending fifteen days in the hospital recovering from hip surgery and a bout of pneumonia that followed her surgery. When told by the hospital doctors that their mother had a pressure ulcer from being unable to move during her recovery, the children assumed the doctors would begin treating and caring for the ulcer. Unfortunately, this was not the case. A full 21 days after being originally diagnosed with the pressure ulcer, the children said the room had a smell so foul that it was difficult to even stay inside of the hospital room with their mother. Because the nurses and hospital staff seemed unconcerned, the children began to investigate on their own and learned the pressure ulcer had become much worse – apparently ignored and untreated by the hospital nurses and doctors. One of the children, speaking to CBC.ca, said the sight of the bedsore made him “shocked and sickened.”

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Over the past four years, the Franklin Center for Rehabilitation and Nursing received 26 citations from the New York State Department of Health. All of these citations related to violations concerning the treatment and health of the senior citizens at the Queens nursing home. Compared to the state average, this facility received approximately the average number of citations. However, residents of this facility were more likely to be physically restrained (4.6 percent of all residents) and more likely to have a catheter inserted (1.4 percent of all residents), according to the New York Department of Health. In addition to these issues, the government agency cited the elder care facility for the following violations:

1. The nursing home failed to adequately prevent pressure sores.

Franklin Center for Rehabilitation and Nursing did not adequately protect its residents from pressure sores, or bed sores in violation of Section 415.12(c)(2) of the New York Code. Under this New York regulation, each nursing home in New York must ensure that their residents do not develop pressure sores while at their facility, unless unavoidable.

For residents who enter the nursing home or elder care facility with pressure ulcers, or bed sores, the nursing home must provide “necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.”

Franklin Center violated this regulation when one of the residents, with a stage-four pressure ulcer, the most severe type, did not receive necessary treatment. Specifically, the health examiner noted that the nurse applied a “dressing appliance that was too small, and she dried the wound using improper technique.” When asked by the health examiner to explain her actions, the nurse admitted she should have “patted the wound dry instead of wiping in order to prevent tissue damage.”

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According to the Kaiser Health News, an average of 21 percent of nursing home residents are readmitted to the hospital within 100 days of returning to their nursing home. Now, Medicare plans to crack down on these nursing homes who either allow nursing home residents to return too quickly or fail to properly administer the resident’s post-hospitalization care. According to Medicare, most nursing home patients are readmitted for mostly preventable problems, such as dehydration, bedsores, infections, and medication errors. While patient advocates believe there can be significant room for improvement in these re-hospitalization rates, they also caution against punishing nursing homes who send their elderly residents to the hospital.

According to a government report, cited by NPR, a full 10.8 percent of re-hospitalizations are preventable. The causes for the high rate of unnecessary hospitalizations are numerous. First, the nursing home may not follow the hospital’s post-hospitalization care routine for their resident. In one example cited by the news organization, nurses at a nursing home in North Carolina injected a patient with a blood thinner twice a day – despite written instructions from a hospital doctor to cease all blood thinning medication. The second cause concerns overloaded hospitals, which would prefer to offload patients onto nursing homes in an effort to free-up space for more patients.

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Between 2014 and 2018 Beach Gardens Rehab and Nursing Center in Queens, New York received 92 complaints by its residents and 19 citations by the New York Department of Health. The Department of Health inspects all nursing homes throughout the state every 9 to 15 months to ensure their compliance with all laws regulating nursing homes and the treatment of their residents. These are several of the citations the Queens nursing home received over the last few years:

1. The nursing home failed to prevent pressure ulcers or bed sores.
Beach Gardens Rehab and Nursing Center received a citation in June 2017 for failing to prevent its residents from receiving pressure ulcers. Under Section 483.25(c) of the Federal Code, all nursing homes must “ensure that a resident who enters the facility without pressure sores does not develop pressure sores…” Further, if a resident does have pressure sores then the nursing home is obligated to provide “necessary treatment to promote healing, prevent infection and prevent new sores from developing.” In this instance, the New York Health inspector randomly sampled three residents at the facility that had not entered with pressure ulcers. According to the inspector, one of these residents later developed a pressure ulcer on their left heel after the nursing home failed to use preventative measures, despite documentation that the resident posed a moderate risk for pressure ulcers.

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Monitoring and reporting of elder abuse is one of the most important responsibilities delegated to New York regulators. However, recent news reports have cast a light on the accuracy and effectiveness of these reports. Advocates for elder care say the data collected by regulators does not effectively represent the harm caused to nursing home patients when the facilities violate state or federal regulations. Based on the evidence provided, it appears these advocates may be correct.

According to the Centers for Medicare and Medicaid Services (CMS), only 4 percent of all regulatory violations result in “actual harm” to a resident at its facility. While the data is collected at a federal level, state regulators are required to perform the inspections and relay the information to CMS. In New York, the legal entity responsible for inspecting nursing homes is the New York Department of Health.

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A Pennsylvania judge allowed a lawsuit against a nursing home seeking punitive damages over a patient’s pressure ulcer to proceed to trial, according to Law360.com. The lawsuit, filed in 2016, alleges that a nursing home’s reckless behavior allowed for a resident to develop multiple pressure sores. Sadly, these pressure ulcers, now referred to as pressure injuries, caused the nursing home resident’s death only months afterward.

The nursing home resident, Mary Ann Miller, entered the nursing home in November 2015 after a broken hip. According to nursing home regulations, Miller’s broken hip and resulting immobility qualified her as “high-risk” for developing pressure ulcers, or bedsores. Unfortunately, the nursing home did not sufficiently monitor Miller, who was originally only intended for a short-term stay while her hip healed. Unable to move and not properly cared for by the retirement home, Miller developed multiple pressure ulcers on her back and heels. After causing the pressure ulcers through its negligence, the lawsuit further alleges the nursing home failed to adequately treat the bedsores.

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resident-left-in-empty-hallOver the previous four years, the United Hebrew Geriatric Center in Westchester County received 22 citations for violating New York law on nursing home safety. The violations were all categorized as “moderately severe”, according to the New York Department of Health.

While the quality of care received by patients at the facility was higher in some areas of treatment compared to the rest of New York state, the facility scored below the state average in the number of residents who experienced a major fall (2.3 percent) and the percent of residents whose ability to move independently worsened during their long-term stay (14.4 percent). Further, according to the New York State Department of Health, 2.1 percent of nursing home residents received a diagnosis of pressure ulcers, or bed sores – a largely preventable type of harm.

According to the state’s inspectors, the following laws and regulations were violated by the United Hebrew Geriatric Center in the last several years: Continue reading

A new report by Time Magazine shines a harsh light on the hospice care industry in America – reporting that 21 percent of hospices, accounting for more than 84,000 patients, failed to provide critical care to patients in 2015.  The report, which includes vivid and heartbreaking stories, points towards a largely unregulated industry that received almost $16 billion in federal Medicare dollars last year.

sick-man-nursing-home-300x200Hospice is provided to Medicaid patients if they are expected to pass away within six months. Starting in the 1970s, hospice care focuses on relieving the symptoms of a patient and providing “comfort care.” The use of hospice care has become increasingly popular in the last couple decades.  According to the National Hospice and Palliative Care Organization, enrollment in hospice care has more than doubled since 2000.

While most Americans think of hospice as a location, the reality is that most Americans utilize hospice care so they can pass away in their own home. With 86 percent of Americans saying they want to die at home, the trend is unlikely to reverse anytime soon, either.

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