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The novel coronavirus, COVID-19, has left unprecedented marks on society, triggering stay-at-home orders, shelter-in-place orders, ceasing all in-office activities for non-essential businesses, implementing social distancing measures, to mention a few. The airborne respiratory disease is highly contagious and unfortunately, fatal to a percentage of its victims. And as novel as it is, from the limited research we have thus far, one thing is clear: The most vulnerable, with the highest risk of fatalities, are those 65 years and older, those with underlying health conditions, and those residing in long term care facilities. The unfortunate truth for those who live in skilled nursing facilities is that often times, they check off on all of these traits. Skilled nursing facilities are for seniors or dependent adults who have more complex medical conditions and need all-around, 24/7 skilled nursing care.

Despite clear knowledge that the elderly, residents in skilled nursing facilities, those with compromised immune systems and underlying medical conditions are disproportionately endangered by COVID-19, on March 30, 2020, the California Department of Public Health (CDPH) released an absurd All Facilities Letter (AFL)  mandating the admission of COVID-19 positive patients into skilled nursing facilities.

This AFL follows a series of AFLs warning facilities of what is to come, of the potential of an influx of COVID-19 cases, and of the necessary procedures and precautions facilities should implement to protect its residents. One of these AFLs, dated March 20, 2020 states all skilled nursing facilities in California must take precautionary measures to protect their elderly residents from COVID-19 by preventing the initial introduction of the virus in their facility. What is counterintuitive, contradictory, and outrageous of the mandated admission of confirmed COVID-19 patients, then, is this: they claim to want to protect those most at risk of COVID-19 then proceed by implementing the opposite. This CDPH directive directly and carelessly puts the most vulnerable populations in the frontlines of infection and potential death. The existing examples of nursing home COVID-19 outbreaks demonstrate the grim truth: most nursing homes are egregiously unprepared for infection control, let alone readily equipped to handle a wave of COVID-19 positive admissions.

In January 2019, Amtrak sneakily added a forced arbitration clause into their ticket purchasing process. When a customer now wants to ride the Amtrak train, he or she is forced to agree to forced arbitration. Forced arbitration in this context means if the customer has any legal claims against the company, whether in the past, present, or future, the customer can now only bring his grievances to an individual arbitrator rather than to a trial by jury in a court of law or through class action.

The dangers of such a clause are profound and many. First, the clause was so subtly added that it only came to the attention of consumer advocates and political leaders in November 2019. Appalled, these advocates are calling on Congress to take action on behalf of train riders who would no longer have the same protections as those who brought their cases to the court in the past did. Such an immoral clause means the typical protections provided by a court of law and a jury would no longer be available to potential victims of violations from Amtrak. Consumers can only complete the purchase of their ticket if they sign and agree to enter forced arbitration in any case of injury, loss, or violation.

In 2015, when an Amtrak train derailed in Philadelphia, killing 8 and injuring over 200, the victims and their relatives were able to pursue redress through a class action lawsuit. The settlement reached by the parties was $245 million dollars. Although no amount of money could ever compensate for the loss or injury of human life, the protections the plaintiffs had under a court of law were a jury, a trial, and a judge—none of which are available under forced arbitration. They were able to have their case seen by their own peers, not an individual arbitrator hired by the company they were claiming damages against. In forced arbitration, it is the individual arbitrator who ultimately decides the compensation of the parties. This course of action is significantly cheaper and favorable for Amtrak and will not result in the same vindication provided by a trial and court of law. In fact, often times, the arbitrators subtly write in language that are favorable to the companies hiring them.

Admitting yourself or a loved one to a nursing home or residential care facility can be a daunting process. You are often required to sign dozens of forms, and it may be difficult to understand exactly what you are signing when you are in one of the most hectic and stressful situations in your life.

Recently, more and more nursing homes and care facilities are slipping arbitration agreements into the stack of paperwork for you to sign upon admission. Although they may tell you that these agreements are “voluntary,” people often feel pressured to sign to make sure that they or their loved ones make it into the facility for necessary care without hassle, even though you may not completely understand the effects of signing a document filled with legal jargon. It is important that you refrain from signing these agreements and to get in touch with a Los Angeles elder abuse attorney if you need help.

What Are Arbitration Agreements?

Arbitration agreements are drafted by the nursing home’s lawyers with language that favors themselves. When you sign an arbitration agreement, you are signing away your constitutional right to bring a dispute, including an elder abuse and neglect claim, to be heard in court in front of a judge and a jury of your peers. Instead, you are agreeing to bring the dispute to an arbitrator, who is a private, independent person appointed to settle the matter.

Nursing homes and care facilities will tell you that arbitration is cheaper, faster, and more efficient than bringing a potential claim to a court of law. This is simply false, and an elder abuse attorney in Los Angeles may help if you are faced with signing, or have already signed, an arbitration agreement. Continue Reading

Falls are the most common injuries among the elderly. Nursing home residents are twice as likely to experience falls than non-residents, and falls have been linked to nearly 2,000 resident deaths per year. The elderly are also more prone to injury because of a high chance of having osteoporosis, which makes their bones very fragile, takes longer for them to heal, and makes them more vulnerable to infections.

Many falls are not reported by nursing homes or care facilities. Even though residents are, on average, older and more vulnerable than non-residents, most of these falls should be able to be prevented. It is important to know the causes of falls and how to prevent a fall injuring you or a loved one. Get in touch with a Los Angeles elder abuse lawyer if you or a loved one has fallen at a facility.

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Pressure ulcers are severe and sometimes life-threatening medical conditions that affect a high number of patients and residents living in nursing homes and assisted living facilities. Several studies show that as high as one-in-five patients and residents of these facilities have experienced signs of a pressure ulcer at some point in their admission.

Pressure ulcers are a form of elder abuse and neglect and are often caused by nursing home staff failing to care for the basic needs of a patient or resident. These injuries do not happen instantaneously. It is important to understand how to prevent pressure ulcers to ensure that you or your loved one is receiving the best medical care possible. Contact a Los Angeles nursing home lawyer if you believe that your loved one has been a victim of this type of neglect.

What Are Pressure Ulcers?

Pressure ulcers, which are also referred to as pressure sores or bed sores, are skin and tissue injuries caused by persistent pressure or friction to certain areas of the body. The most common areas for pressure ulcers are the back, buttocks, elbows, hips, heels, and ankles. Patients and residents with limited mobility, especially people in wheelchairs or who are bed-bound, have a greater risk for pressure ulcers than others because they typically spend long periods of time in one position.

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The consequences of lack of communication between hospitals and skilled nursing facilities (SNFs) are not new knowledge. According to a 2013 study, in the U.S. alone, more than 5 million patients transition from hospital to SNFs yearly. These transitions heavily rely on the thorough communication of healthcare professionals and paraprofessionals to ensure adequate care for patients. However, hospitals and local SNFs typically operate as separate entities causing a myriad of miscommunication. Communication issues that may happen between the facilities include incomplete, contradicting and/or mismatching verbal and written care plans. These problems may cause SNF staff to delay—or never deliver—proper care for patients, resulting in potentially fatal consequences. For example, noting the wrong medication can cause a stroke patient to relapse into another stroke and an avoidable hospital readmission. While many factors can be used as scapegoats to explain these mistakes, these problems are not new, and as professionals in the field, SNFs should establish better communication and points of accountability before accepting a patient to ensure the dignity and quality of care of patients. A recent study published by the Journal of the American Geriatrics Society by multiple medical doctors have indicated that a significant number of hospital readmissions from SNFs were likely preventable.

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As our population ages, there has been an increase in the number of elderly patients that undergo neurosurgical interventions. This increase is accompanied by aging risk factors, such as frailty, that increase the risk of complications post-surgery. A recent study undertook the task of surveying how recent falls affected patients who underwent a neurosurgical operation, focusing on a patient’s outcome relative to their fall history in the six months prior to their surgery.

The study’s overall findings were that patients with at least one fall six months prior to a neurosurgical procedure, had an increased risk of complications following their discharge. It specifically focused on the number of those discharged to a facility post-surgery, re-admittance rate, and the rate of complications. 18 % of those studied were discharged to a long term care facility after the operation, 17% were readmitted within thirty days, and 28% also had a complication arise within thirty days of their discharge date.

The results of this study give reasons to include fall history in preoperative risk assessments prior to any neurosurgery. While the frailty of an elderly patient is already considered in these assessments, it is important to include patients fall history since there reason to believe that these falls affect patients’ recovery. Neurosurgical procedures  As shown in the study there is a higher risk of complications that arise when a patient has suffered a fall.

Many people today use medication unnecessarily. The smallest flu or cold warrants the use of antibacterial medication that often does greater harm to our bodies. We ask our doctors for medications that cure common illnesses without thinking of the effects that these medicines may have on our bodies in the future. A rising concern in the medical field is the emergence of antimicrobial-resistant microorganisms (ARMs). Although resistance to antimicrobial organisms is a natural occurrence, over the years the cases of ARMs have been rapidly growing. The over-consumption and misuse of medication has created antimicrobial resistance on every continent.

An increasing worry is that soon common diseases, such as pneumonia and tuberculosis, will become fatal to those that acquire them. With an increased exposure to antimicrobial medicines, these diseases may continue to develop a stronger resistance to medications used now, creating a possibility that they may not work in the future. Resistant strains of bacteria are caused by inappropriate prescription of antibiotics when the patient truly doesn’t need them, or a misuse by the patient, for example stopping the use of the medication before the infection is fully treated. ARMs can cause post operation infections, result in limb loss, or complications in the central nervous system. A report  recently published by the OECD estimates that globally, at least 70,000 people die a year due to these resistant bugs.

Not only are ARMs a health risk, they have now become a financial burden. It takes hospitals more time, resources, and money to treat infected patients. The OECD report estimates that an additional 10,000 to 40,000 USD are spent treating patients infected by an ARM. In addition, global markets are also affected by these resistant microorganisms. In 2015 chicken sales in Norway dropped by 20% after news got out that a resistant strain of E. coli was found in the meat.

The regular use of physical restraints on patients in nursing home facilities without an appropriate medical reason or regard for their dignity and wellbeing is not only a strong indicator of poor quality of care, but also a sign of elder abuse and neglect.  Older adults with dementia in particular are affected by this organizational conduct and are vulnerable to debilitating physical and psychological side effects.  Moreover, it is a violation of their human rights. In the United States, a staggering 38% of senior patients in these types of facilities experience being physically restrained at least once every day.  Although a variety of organizations that strive to reduce or eliminate the use of physical restraints exists, most of their initiatives have not been successful.  However, a longitudinal, multidirectional psychosocial and educational program that was developed to promote patient-centered care for older adults with dementia and reduce the use of physical restraints was implemented in 41 nursing homes with positive results.

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Malnutrition is one of the primary dangers for older adult residents living in long-term care settings.  Defined as the state of not having adequate food and micronutrient intake, malnutrition is common among elderly patients and can damage physical and cognitive functioning.  Nursing home and assisted living facility staff must protect their patients from inadequate micronutrient intake in order to help maintain their quality of life and avoid increasing their risk of morbidity and mortality. Multiple factors at the patient (e.g., dementia), staff (e.g., training, staffing levels during meals), and home (e.g. quality of meals) levels interact and contribute to the increase in risk of poor food intake.  Substantial research has shown that inadequate nutrient density of food is one of the top 10 deficiencies in nursing homes.  These facilities must improve their quality of meals in order to promote food intake and enhance nutritional status and quality of life of their patients. Studies that have focused on micronutrient needs for improving the health and quality of life of residents in long-term care have found that even at the meal planning level, much improvement is needed in regards to nutrient density.

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