Articles Posted in Pressure Sores

Medicare recently lowered the overall ratings of almost one-fourth of the country’s nursing homes due to insufficient staff levels. The move comes after Medicare adopted a new, objective measurement for staffing nursing homes. Previously, Medicare relied on unverifiable data submitted by the nursing homes. Medicare ratings, which can range between one and five stars, are provided for several categories of nursing home care, such as its rating of pressure ulcers or slip-and-falls, along with an overall rating for the nursing home. Medicare now gives the lowest rating, a single star, to 1,387 nursing homes across the country, according to The New York Times.

Medicare requires all nursing homes to have a licensed nurse working at all times and a registered nurse working at least eight hours every day. The payroll data submitted to Medicare by the nursing homes show that the registered nurse requirement produced the majority of compliance problems. Registered nurses, who have the highest level of training and education requirements, are typically able to provide medical services, such as diagnosing illnesses or prescribing medicine.

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A deadly bloodstream infection, sepsis continues to plague nursing homes in New York and throughout the country. Despite strict federal standards meant to prevent infections and harm to patients, the number of sepsis infections originating in nursing homes continues to increase each year. In a study conducted by Definitive Healthcare, at least 25,000 senior citizens die from sepsis infections received at nursing homes across the country each year. Give the enormous and unnecessary loss of life, nursing home advocates and government regulators are pushing for stricter standards and greater accountability for nursing homes.

An article by Legal Reader recounts the sad and unfortunately common story of one nursing home resident who passed away from sepsis. According to the article, the elderly man’s daughter, Shana Dorsey, found a “purple wound” on her father only a few weeks before he passed away in 2014. Medical staff at the nursing home told Dorsey the wound was a pressure ulcer or bed sore and not serious. Unfortunately, the pressure ulcer was severe and eventually led to the sepsis infection that killed her father. Dorsey then joined the thousands of other families across the country by filing suit against the nursing home because their loved one died of a preventable sepsis infection.

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The reporting at one nursing home in New York is intensifying as more allegations of neglect and abuse continue to surface. A steady drumbeat of news reports has thrust Sodus Rehabilitation and Nursing Center in the Buffalo area and its mistreated residents into the spotlight over the last year. As the dangerous and unhygienic conditions have come to light, outrage in the community has grown and families of the residents say they are scared for their loved ones.

The nursing home, previously named Blossom View, first received attention from the local news last year when one man came to visit his father and found him dead. Admitted only two weeks earlier, the nursing home resident had fallen several times, suffered multiple bruises, head injuries, and even several broken bones during his short stay. The staff told the son they already knew and simply forgot to notify the family or remove the body.

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Sepsis, a deadly bloodstream infection, is a common and largely unreported consequence of pressure inuries/ulcers. According to a recent article by The Chicago Tribune, sepsis was the most common reason that elderly residents are transferred from their nursing home to hospitals. Despite the massive financial and human implications, the newspaper states the problem is largely unreported because lawsuits against nursing homes are frequently settled out-of-court and include confidentiality clauses.

While the number of pressure ulcers leading to sepsis infections is not measured by federal regulators, the number of patients sent from nursing homes to hospitals and then die of the infection is at least 25,000, according to The Chicago-Tribune. This preventable cause of death leads to thousands of lawsuits filed all over the country against nursing homes and hospitals that allow their loved ones to become infected. In addition to the massive human toll, sepsis infections are an expensive burden on the healthcare system. Medicare pays more than $2 billion annually for sepsis treatment.

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An Australian man passed away from a preventable pressure injury/ulcer he received while at an Australian hospital. According to ABC North and West, the pressure ulcer, or bed sore, developed and became so severe that the Australian’s organs shut down. Now, the family of Peter James McBride is demanding answers from the hospital and its staff.

After falling twice on February 7, 2015, McBride’s wife admitted him to the hospital where he spent the next eight weeks on bed rest before transferring to an elder care facility. McBride died only days after arriving at the elder care facility. According to the coroner, the Australian man’s death was entirely preventable and pointed towards several lapses that paint a picture of an incompetent hospital staff and a severe lack of appropriate procedures necessary to prevent pressure injuries/ulcers.

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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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