California Nursing Home Abuse Lawyer Blog

Use of Sleep Medication Associated with Increased Risk of Injurious Falls

November 7, 2013 | by Yeroushalmi Law

A study published in the Journal of the American Medical Association found a correlation between an increased risk of hip fractures and injuries from falls and the use of nonbenzodiazepine hypnotic drugs. Such drugs are a class of sleep medication prescribed prevalently by health care providers in nursing home settings to help elderly residents cope with insomnia and other sleeping issues. Nursing homes are environments that generally do not prioritize residents’ quality of sleep. Therefore, nursing home residents often experience poor sleep and insomnia because they frequently take daytime naps, are subject to nighttime awakenings, or may be suffering from sleep disorders such as sleep apnea.

Many elderly nursing home residents suffer from falls in nursing homes, and these falls can lead to fractures, complications, and even death. Many of these injurious falls may take place at night due to risk factors such as toileting, urinary continence or incontinence. Initially, nonbenzodiazepine sleep medications were thought to be safer than benzodiazepines, in relation to fall risks. As such, the study found there was an increase in the use of nonbenzodiazepine hypnotic drugs in nursing homes. However, the results of the study showed that there was actually a two-fold increased risk for hip fractures when nonbenzodiazepine hypnotic drugs were used. The study was conducted using a sample of 15,528 long-stay nursing home residents who were 50 years or older. This population exhibited a 66% increase in their risk for hip fracture after 30 days of using such sleep medication.

Lawsuit Seeks to Increase Nursing Home Resident Protections in California

November 4, 2013 | by Yeroushalmi Law

The non-profit nursing home advocacy group, California Advocates for Nursing Home Reform, has filed a lawsuit against the California Department of Public Health, challenging the constitutionality of a 1992 California law, Health and Safety Code § 1418.8. Under this law, if a physician deems a patient to be mentally incapacitated, the resident is found to lack sufficient mental capacity to deny medical treatments and administration of such treatments. As such, in certain instances, these residents were denied life sustaining treatment, subjected to the use of physical restraints, and administered psychotropic medications if they did not have a surrogate such as a relative, conservator, or guardian to deny such medical treatment decisions on their behalf. This is because the Department of Public Health has construed the law to allow facilities to administer intrusive treatments, along with forcing residents to take anti-psychotic medication.

The complaint cited several appalling instances of such elder abuse made against nursing home residents as a result of actions taken under this law. For example, one nursing home resident deemed mentally incompetent was restrained to his bed and fed through a feeding tube, in spite of his medical chart containing a statement that he was not incompetent. When staff later asked him if he wanted to live or die, the resident did not answer, and staff withdrew his feeding tube, revoked a life-sustaining care order, and sent him to a hospice where he died. This occurred because some facilities have interpreted the statute to allow them to end residents’ lives by denying them life-sustaining treatment via ‘do not resuscitate’ orders. Another shocking occurrence involved a nursing home resident who was administered antipsychotic medication without staff informing or checking with her family members who could advise the resident as to the treatment. The woman was later found to be competent.

Nursing Homes Required to Obtain Informed Consent When Administering Psychotropic Drugs

October 28, 2013 | by Yeroushalmi Law

Many nursing homes often substitute individualized care with the use of psychotropic drugs to make up for the lack of adequate staffing in their facilities. As a result, nursing homes often misuse psychotropic drugs by administering them to residents in order to sedate or control them. This has the tragic result of reducing a resident’s quality of life, because many hazardous side effects accompany the use of these drugs, including death. There are several major classes of psychotropic drugs: antipsychotics such as Risperdal and Haldol, anti-depressants, and anti-anxiety medications. Due to the dangers associated with their use, the FDA issued a black-box warning for anti-psychotics, warning consumers of the increased risk of death for those with dementia, as such drugs have not been approved for this use. Dangerous side effects include, but are not limited to, excessive sedation, weight loss, heart attack, stroke, delirium, agitation, and increased risk of pneumonia.

Despite knowing and understanding the dangers such drugs pose to residents, they are still administered to sedate residents, particularly in facilities that are understaffed or those that have caregivers who are not qualified or trained. Advocacy group CANHR compiled a database of the nursing homes located in California, and each facility’s rates of psychotropic drug use. Therefore, consumers and their loved ones may find such information particularly useful when conducting a search for nursing homes, as this data may help consumers find a facility without a drugging issue.

Hospital Attempts to Increase Fall Prevention Efforts by Increasing Staffing

October 25, 2013 | by Yeroushalmi Law

Elderly residents of nursing homes and hospitals are often victims of falls and related injuries. As such, one bad fall can significantly lengthen a patient’s hospital stay, which can increase the risk of further complications, as falls can lead to broken bones and even death. However, these occurrences are highly preventable with adequate staffing and fall prevention procedures. Safety experts even state bad falls are events which should never take place inside protective settings such as hospitals.

Currently, 39 states do not require hospitals to report instances of falls that occur within their facilities. However, many states, such as California, require hospitals to report incidences of falls that occur within the hospital to the state health department. Some hospitals have begun moving toward the implementation of more fall prevention methods, and they have proven to be very successful. For example, an increased movement towards patient safety and fall prevention occurred in Washington, when around 90 people fell victim to injuries and death due to falls last year.

Home Care Agencies Now Subject to Increased Regulation in California

October 24, 2013 | by Yeroushalmi Law

On October 15, 2013, California Governor Jerry Brown signed the Home Care Services Consumer Protection Act of 2013. The passage of this Act followed after the veto of a similar bill by the governor last year. It has served as a response to critics who have continually argued that the home health care industry has not been subject to enough regulation and oversight. The loose regulation of this industry has created room for caregivers to engage in acts of neglect and abuse towards their elderly clients, as was demonstrated in a study conducted by the California Senate Office of Oversight and Outcomes.

The study was released in April 2011, and demonstrated how California failed to screen employees who cared for the elderly in their homes. Some of these caregivers had criminal records, but had not been screened prior to employment. This documentation of elder abuse and neglect resulted in an increased push for tight industry regulations in California. The Act will impact approximately 120,000 caregivers and 1,400 home care agencies, and is representative of an effort being made to protect consumers receiving services within this industry.

Physical Exercise Duration and Regimen Linked to Effective Fall Prevention

October 16, 2013 | by Yeroushalmi Law

Many elderly individuals have a higher risk of falling, and usually sustain greater injuries from such falls due to their frail nature. Additionally, because those residing in long term care facilities are generally frailer than their peers living in the community, they are more prone to falling and are likely to suffer greater consequences as a result. While it is commonly known that elderly individuals residing in such facilities are considered to be poor candidates in performing physical exercise due to their functional, cognitive and physical conditions, a study has demonstrated that exercise programs within this population are still effective in reducing the number of falls in this environment.

Physical exercise has been shown to have beneficial effects on cardiovascular and metabolic diseases. However, this study has aimed to demonstrate how physical exercise would also help to reduce an elderly individual’s susceptibility to falls, despite their particularly frail nature. For example, exercise has been shown to promote an increase in strength, muscle flexibility, balance, and endurance. Additionally, exercise has also contributed to reducing physical disability, as well as decreasing functional limitations and restrictions by increasing an elderly individual’s mobility. Combined, these effects from physical exercise were generally shown to promote fall prevention within the elderly population, even in those shown to be frailer and residing in nursing homes.

Exploring the Social and Psychological Effects of Pressure Ulcers

October 15, 2013 | by Yeroushalmi Law

Unfortunately, pressure ulcers are preventable, yet common conditions which arise in elderly individuals who reside in nursing homes and other healthcare settings. Not only do these severe wounds cause physical discomfort and pain, but a study published in Wounds delved into the social and psychological effects of pressure ulcers which contribute to a reduced quality of life. For example, studies have shown that those who have pressure ulcers for six or more months are more likely to suffer from pessimism, which may affect their nutrition, susceptibility to depression, and ability to heal.

Pressure ulcers are known to impact general physical health, as complications and even death may occur. Additionally, pain almost always accompanies the presence of a pressure ulcer, and studies have shown that 84% of those with pressure ulcers have reported pain even while they are at rest, with some expressing their pain to be at an excruciating level. In addition, many have expressed experiencing fatigue due to sleep disruptions because of the presence of the ulcers. Thus, because of these ongoing factors, patients already experience a diminished quality of life.

Experts Seek to Shift Perceptions of Behaviors Associated With Dementia Patients

October 11, 2013 | by Yeroushalmi Law

Elderly individuals suffering from dementia often exhibit certain behaviors, such as aggression, agitation, or anxiety, which many people consider to be symptoms of dementia. However, experts have noted that categorizing these behaviors as ‘symptoms’ and applying such terminology to these behaviors may be misleading or mistaken. This is because research has demonstrated that many behavioral expressions by dementia patients are actually a result of certain situational triggers or due to physical, social, or psychological needs that are unmet. Therefore, experts are now recommending that the term ‘behavioral expression‘ be used in place of ‘behavior symptoms or problems.’
This is in hopes that a terminology shift will lead to a change in the methods caretakers implement when trying to address these behaviors, moving away from medication as the only treatment method. Experts believe that resorting to pharmacological methods and attributing dementia patients’ behavioral issues primarily to dementia alone will remove focus from the underlying social situations which may be triggering the behavior, thus placing the focus on the dementia patient’s brain pathology alone. However, focus should be placed upon improving dementia care through patient-centered, individualized methods.

Studies Show Correlation between Pressure Ulcers and Skin Changes that Occur with Age

October 10, 2013 | by Yeroushalmi Law

Recent research has been conducted to explain why the elderly population may be at higher risk for pressure ulcer development. Our skin functions as a defensive barrier against physical and chemical trauma and disease. However, research has uncovered correlations between skin changes that occur with age which may serve as risk factors for pressure sores. This is because various changes in the skin’s structure occur with time, impacting the skin’s ability to heal wounds quickly and leaving it more vulnerable. The skin of elderly individuals has increasingly fewer epidermal cell layers thus deteriorating its ability to serve as an effective barrier. Additionally, as people age, subcutaneous fat will deteriorate. This will have the effect of decreasing support of one’s skin from underlying bone. In addition, skin will generally respond with less vasodilation when there is external pressure, furthering the likelihood for pressure sore development.

Because of these changes, elderly individuals in nursing homes are highly susceptible to the development of pressure ulcers. Despite the fact that it is highly preventable, statistics reveal that about 2.5 million people develop pressure sores every year in the United States alone. Of these individuals, up to 24% develop pressure sores in long term care facilities, while 38% develop pressure sores during their stay at acute care hospitals. Pressure sores not only diminish an individual’s quality of life but may also lead to death. Thus, early identification and treatment are critical in preventing the development and worsening of sores, and the complications that may result due to their development.

NIH Increases Funding to Promote Nationwide Effort in the Fight Against Alzheimer’s Disease

October 8, 2013 | by Yeroushalmi Law

The U.S. National Institute of Health (NIH) recently announced that it would be providing $45 million in funding for researchers to test novel drugs and therapies towards Alzheimer’s disease prevention, promoting a nationwide effort to find a solution to this prevalent degenerative disease. The NIH hopes this funding will help support research to find ways in which to stop the onset of Alzheimer’s, or at least delay its destructive progression. The United States has currently invested around $400 million to date in the fight against Alzheimer’s.

Alzheimer’s disease is currently the most prevalent form of dementia plaguing the elderly population and affects an individual’s ability to engage in daily activities. This aspect of the disease is devastating as it greatly impairs an individual’s independence. According to the Centers for Disease Control and Prevention (CDC), there are currently about 5 million Americans living with Alzheimer’s disease. Our elderly loved ones are at higher risk of being affected by Alzheimer’s disease, as age is currently the most significant known risk factor correlated with the disease.