California Nursing Home Abuse Lawyer Blog

Using Lysostaphin to Combat Staphylococcal Infections

October 7, 2013 | by Yeroushalmi Law

Lysostaphin is a natural enzyme that functions as an antibacterial against staphylococcal infections including Staphylococcal aureus and Staphylococcal epidermidis. It is effective against combating these infections because it attacks the bacterial cellular wall of staphylococci, and is capable of destroying the bacterium within minutes. Staphylococcal aureus infections, particularly MRSA (methicillin-resistant Staphylococcal aureus), are a continuing concern within healthcare settings. This is because they are responsible for a large portion of infections which arise from implantable devices such as catheters, which act to provide a pathway for MRSA to travel into the body. While anyone may contract a staphylococcal infection, they are of particular concern within certain groups such as those residing in nursing homes. The elderly population is generally at higher risk due to their vulnerable state and weakened immune systems. Contraction of such infections not only lead to skin infections, but when the bacteria enters the bloodstream, it may spread into other organs, infecting them, and may also lead to sepsis, pneumonia, and other severe complications including death.

MRSA bacterial cells are capable of forming a community of bacterial cells, known as biofilms, on medical devices and damaged tissue, thereby surviving and spreading infection. Unfortunately, the biofilms that form on such devices are generally antibiotic resistant, and it becomes increasingly difficult to treat the infection. As a result, the device will either have to be removed or replaced via surgery, and the patient will require an intensive antibiotic treatment plan. However, subjecting the patient to this type of invasive procedure heightens their risk for further complications. Additionally, despite this course of action, infection reoccurrence is still relatively high due to the increasing antibiotic-resistant nature of the bacterium. Therefore, lysostaphin has been studied and considered as an alternative anti-staphylococcal treatment. This is because lysostaphin has been known to effectively destroy staphylococcal bacterial cells, and has been demonstrated to be particularly effective against MRSA.

Government Shutdown and its Impact on National Healthcare

October 4, 2013 | by Yeroushalmi Law

A government shutdown took place Tuesday morning on October 1, 2013, due to Congress’ failure to pass a 2014 spending measure before the midnight deadline on Monday. The shutdown has resulted in about 800,000 federal employees being furloughed, allowing only for ‘essential’ government workers to continue performance of their duties. While the shutdown coincided with the launch of the Affordable Care Act, the opening of the new health insurance marketplace was able to move forward as planned.

The government shutdown will have various effects on federal agencies, including the healthcare industry. Federal agencies have provided information stating that Medicare will operate without disruption for the immediate future. Additionally, Medicaid funding was made available for states on October 1. The Administration on Community Living has reported that it will continue to support its Aging and Disability Resource Centers, along with the Health Care Fraud and Abuse Control program through the provision of mandatory appropriations. However, the ACL will cease providing funding for senior nutrition programs, elder abuse and neglect prevention services, and the long-term care ombudsman program due to the shutdown. The Department of Veterans Affairs will continue in operation, meaning that all VA medical facilities will remain open and in operation. Therefore, nursing home care will continue to operate within these facilities.

Healthcare-Associated Infections Threaten Elderly Residents in Nursing Homes

October 2, 2013 | by Yeroushalmi Law

All elderly individuals residing in nursing homes are highly susceptible to healthcare-associated infections (HAIs), a significant cause of fatalities and needless suffering. Common healthcare-associated infections include urinary tract infections, skin infections such as pressure ulcers, pneumonia, influenza, scabies, and methicillin-resistant Staphylococcus aureus (MRSA). These infections are known as healthcare-associated infections (HAIs) because they are typically acquired by patients who are receiving treatment for an initial ailment while at a healthcare setting, such as a nursing home, urgent care center, or hospital.

According to the Centers for Disease Control and Prevention (CDC), about 1 in every 20 hospitalized patients will acquire a healthcare-associated infection during their stay. These patients, particularly those who are elderly, are already in a much weakened clinical condition. Therefore, they are at a higher risk of contracting an HAI resulting in complications and even death. Thus, it is extremely important that these patients receive high-quality and safe care within these facilities. Caretakers must be aware of an elderly patient’s susceptibility to HAIs and therefore should take preventative measures to protect against them.

Generally, when an HAI is detected, the cause of the infection must be identified by healthcare providers. After, they will need to assess which antibiotic treatment, duration, and dosage will be proper in an individual patient’s case. However, caretakers should not rely on antibiotics to fix the problem. Rather, they should first implement preventative practices to avoid the infection from arising in the first place, as many of these infections are preventable.

Preventable Falls Pose Serious Risks to Elderly Population

October 1, 2013 | by Yeroushalmi Law

The Centers for Disease Control and Prevention (CDC) reported that about one out of three people who are 65 years and older fall each year. Moreover, one-half to three-fourths of nursing home residents suffer from falls every year. These falls, while preventable, are dangerous and may have lasting, serious repercussions for this vulnerable population. For example, these falls may not only result in permanent disability and a diminished quality of life, but the CDC reported that within nursing homes, there are about 1,800 elderly residents who die from falls each year. However, while serious, such falls are very preventable.

The injuries resulting from these falls may range from head trauma, to a variety of fractures including hip and leg fractures. In addition, many traumatic brain injuries are caused by falls. Not only do these falls lead to physical injury, but many elderly residents who do fall also begin to develop a fear of falling which may further limit their willingness to engage in physical activity. If elderly residents begin to reduce their mobility, it will heighten their actual risk of falling. Additionally, their fear of falling may also lead to feelings of helplessness and depression.

Unfortunately, statistics demonstrate that falls occur more frequently among nursing home residents. It is true that nursing home residents are generally in poorer health and frailer than their peers, as they are generally older and suffer from other chronic problems. In addition, they may need more aid in going about their daily activities. However, despite these factors, falls and resulting injuries are very preventable if caretakers remain proactive in fall prevention. Thus, it is important and necessary for caretakers to assess patients to identify their fall risk and implement prevention strategies.

Arbitration Agreements Are Not in the Best Interests of Elderly Residents

September 25, 2013 | by Yeroushalmi Law

An increasing number of nursing homes have implemented forced arbitration agreements within their admissions process. This has resulted in elderly residents and their family members signing away their constitutional rights and protections in order to obtain care within these facilities. However, consumers should be aware that nursing home arbitration agreements are inherently unfair and disadvantageous to vulnerable elderly residents and their family members. Therefore, it is important that residents and their family members understand what an arbitration agreement is and realize that they are not required to sign or agree to them.

What is an arbitration agreement?

An arbitration agreement states that the resident agrees that if a dispute arises between the facility and the resident, the resident will agree to bring the dispute before a professional arbitrator, rather than file a lawsuit with the court for resolution in front of a jury. When a case is taken to an arbitrator, the arbitrator will make the final decision and appeals are not allowed as arbitration is conducted in private and is not subject to judicial review. Therefore, arbitration agreements may essentially have the effect of allowing nursing homes to escape accountability for their wrongdoings since these agreements prevent residents and their families from suing the facility if their loved one was to suffer injury, harm, or even death while under their care.

What does California Law require?

It is important to note that in California, under the California Health and Safety Code § 1599.81(a), nursing homes are forbidden from requiring residents or their families from signing arbitration provisions in order to obtain admission into a facility or to continue their stay in such facilities. Additionally, under California Health and Safety Code § 1599.81, California also requires that nursing homes place arbitration agreements on forms separate from the admission agreement documents, and states that a resident may not waive their ability to sue the facility for violations of their Patient’s Bill of Rights. However, even with such laws in place, residents and their family members must remain cautious. They should ensure preservation of their constitutional right to take their case to court if necessary by refusing to sign arbitration agreements.

Remedying Aggressive Behavior in Elderly Dementia Patients

September 24, 2013 | by Yeroushalmi Law

Those suffering from dementia are generally members of the elderly population, and as life expectancy continues to increase, the need to address dementia and its complications also increases. Dementia is comprised of a variety of symptoms, some of which include memory loss, impaired judgment, and difficulties with language and motor function. However, other issues also plague dementia patients and their families. For example, those suffering from dementia have been found to exhibit aggressive behavior, such as biting, hitting, or shoving when angry, scared, or confused.

A recent New York Times article explored the aggressive behaviors associated with dementia, stating that physically aggressive behavior generally occurs in a considerable minority of those suffering from dementia. Therefore, caretakers of dementia patients in hospitals and nursing homes may feel the need to use physical and chemical restraints or anti-psychotic drugs in order to control aggressive behaviors. However, this may be highly inappropriate. While the justifications for their actions may arise from fears that dementia patients may hurt themselves or those around them, it has been found that behavioral approaches are more effective in soothing aggressive behavior compared to inappropriate use of drugs and restraints in order to remedy the issue.

New Study Explores Link Between Hypotension and Pressure Ulcer Development

September 20, 2013 | by Yeroushalmi Law

Many elderly residents who are hospitalized or living in nursing homes frequently develop pressure ulcers, the development of which risk further complications and even death. Consequently, caretakers for the elderly, particularly those in hospitals and nursing homes, must take precautions to prevent pressure ulcer development within this population. Studies have been conducted demonstrating a correlation between hypotension, or low blood pressure. Specifically, hypotension has been demonstrated to be an important risk factor in the development of pressure ulcers because research has found that hypotension in elderly patients, particularly those in poorer health, contributed to decreased blood flow at pressure points. This, in turn, would contribute to the death of cells and tissue in that area, leading to pressure ulcers.

However, a legal doctrine known as the ‘egg-shell skull’ rule can apply in this context. This rule holds an individual responsible for all consequences arising from their injury-causing actions towards another, even if the resulting injury to the victim is one that is unusually severe due to an underlying or pre-existing condition. Therefore, those caring for the elderly must be especially vigilant in protecting patients against pressure sores, particularly if an elderly patient is at risk for hypotension. This can be done by promptly identifying which elderly patients have hypotension, or those who are susceptible to developing hypotension, and allocating proper attention and resources to such patients. By doing so, caretakers can identify which elderly patients are particularly vulnerable to pressure ulcer development due to their clinical condition and can take early preventative measures before pressure ulcers arise and complications occur.

Investigation Reveals Mass Dismissal of Elderly Abuse Cases

September 18, 2013 | by Yeroushalmi Law

A recent investigation by the Center for Investigative Reporting revealed that the California Department of Public Health dismissed about 1,000 pending cases in 2009 which alleged caretaker abuse and theft, without taking any action. This hurried dismissal of cases occurred to alleviate the Department’s extreme backlog of cases. These closed cases involved caregivers accused of assaulting or abusing their patients, some of which involved elderly patients. The closing of these pending cases has allowed for these caregivers to retain their licenses, thereby allowing them to continue to work in nursing homes, hospitals, and other health care facilities throughout Southern California. These abuse cases have been reported from facilities in Los Angeles, Riverside, San Diego and Santa Barbara, ranging from abuse and neglect to suspicious deaths. Therefore, we must remain vigilant in ensuring that instances of abuse against the elderly in such facilities go reported and ensure such caregivers are removed from their positions to prevent further harm.

The investigation found that the Department of Public Health rarely took action against these caregivers, despite clear evidence of allegations of abuse, and that the number of caregivers removed from their jobs for their wrongful actions has declined. Specifically, investigators found that about 81% of cases were closed in 2012 without taking any action against an accused caregiver. What is even more worrisome is that there was also an extreme drop in the number of cases involving suspicious deaths from abuse that were sent to law enforcement to be investigated and prosecuted. It should be noted that this decline in action is not due to a decrease in complaints, but rather, is correlated with the hurried removal of the Department’s backlog of pending cases. As a result, even though accused caregivers and their employers may have engaged in wrongful conduct, they are still licensed to work and care for vulnerable patients and are not being held accountable.

Reducing Unnecessary Antipsychotic Drug Use in Nursing Homes

September 16, 2013 | by Yeroushalmi Law

The Department of Health and Human Services Office of Inspector General (OIG) released a report in 2011 finding that antipsychotic drugs given to elderly residents of nursing homes were not administered in compliance with standards set forth by the Center for Medicare and Medicaid Services (CMS). Such medications, when used properly, can be effective in aiding a patient’s mental and physical well-being. However, unnecessary antipsychotic drug administration is dangerous and not appropriate in the care of the elderly. Unnecessary drug administration practices may include excessive dose administrations, drugs provided in excessive durations, lack of adequate monitoring, or the administration of drugs in the presence of adverse effects which show the dosage should be lowered or discontinued. It has been found that improper or excessive administration of antipsychotic drugs may not only result in death but may lead to unnecessary hospitalization, falls, heart attacks, strokes, and other complications.

Unfortunately, because many elderly nursing home residents currently suffer from dementia, there has been a growing concern that antipsychotic medication has been administered inappropriately to control behavioral problems related to dementia. To combat this issue, CMS launched a National Partnership to Improve Dementia Care in 2012 with the goal of protecting the elderly receiving dementia care in nursing homes and other healthcare settings. Specifically, the partnership sought to protect against unnecessary antipsychotic drug use unless there was a valid, clinical purpose. The partnership also sought to encourage nursing homes and others providing dementia care to consider non-pharmacological alternatives for the elderly.

Elder Physical Abuse Prevalent in Nursing Homes

September 13, 2013 | by Yeroushalmi Law

Research on the prevalence of physical abuse in nursing homes has been difficult to conduct because there are significant flaws in the method of collecting the data. Both nursing home staff and resident families often harbor a sense of guilt which causes under-reporting in surveys conducted to address this issue. Nursing home staff may be less inclined to report instances of elder abuse because they or a colleague may be the perpetrators of the abuse. Similarly, family members may be hesitant to report elder abuse because they may feel a sense of culpability for having admitted their loved one to the facility in which they were victimized. Unfortunately, allowing abusers to continue performing their jobs puts more elderly at risk of being physically abused.

A study published in the Journal of Elder Abuse and Neglect found that the overall prevalence of physical abuse in nursing homes is 24.3 percent. This study challenges the previously held belief that physical abuse correlated with increasing age in nursing home residents. In fact, it found that with each increasing year the chance of being physically abused decreased by 49 percent. This may be due to the fact that the prevalence of cognitive deficiencies increases with age, meaning that such residents need more group supervision than one-on-one staff to resident supervision. The increase in group supervision takes some responsibility off an individual staff member, allowing for a decrease in frustration or annoyance. This means that in order for there to be more successful monitoring of older residents, nursing homes must hire enough staff to ensure that their current staff members are not over-burdened with responsibility and performing poorly.

Another important finding in this study indicated that “needing help moving” was the only category which predicted abuse in the elderly. This study is significant because it reveals that those that are most in need of long term care, such as those with mental health issues and mobility problems are most at risk for physical abuse at these facilities. More importantly, this discovery highlights the need for better staff training at nursing homes, so that staff may be better equipped to deal with a highly dependent or troublesome resident with patience and respect. Because the majority of physical abuse of elderly in nursing homes involves caretaker mistreatment, an improvement in the quality of training would likely decrease the overall prevalence of nursing home abuse.