California Nursing Home Abuse Lawyer Blog

Understaffing and Lack of Resources in Los Angeles Nursing Homes Leads to Improper Prevention and Treatment of Pressure Sores and Puts Patients at Risk for Wound Infections

January 3, 2012 | by Yeroushalmi Law

In the January issue of the Journal of American Medical Directors Association, an article titled “When is a Chronic Wound Infected?” studies various methods of determining when a chronic wound is infected and judges which of these methods is most accurate. The article begins by explaining that the skin is a major barrier against infection, and therefore, the risk of a wound becoming infected is extremely high when skin starts to break down. The criteria for a wound to be considered infected requires that bacteria be present in the wound, and that this bacteria is producing tissue damage. There are many different types of wounds, but this particular article studies chronic wounds, such as pressures sores.

Physicians and wound care specialists use colony forming units (CFU) per gram of tissue to measure the presence of bacteria in a wound. They have established the “10^5 Rule,” which asserts that in the surgical closure of ulcers, spontaneous healing will occur at bacteria levels lower than 10^5 CFU. This rule implies that once spontaneous healing occurs, the possibility of infection is diminished and caretakers can conclude that the chronic wound is not infected. However, according to the American Medical Directors Association, the “10^5 Rule” may be inaccurate because there are factors other than the quantitative measure of bacteria that contribute to the development of infections. One such factor is the virulence of the bacteria. For example, certain infections, such as staphylococcus aureus, pseudomonas aeruginosa, and Bacteroides fragilis are so virulent that even at levels below105 CFU, infection is highly likely and requires treatment.

The article determined that a tissue biopsy is the most accurate method of determining whether or not a patient is suffering from an infected wound. However, most skilled nursing facilities do not perform biopsies. Instead, they obtain a surface swab of the wound and test the sample for the presence of infectious bacteria because this process is less costly and much simpler than a tissue biopsy. Despite its practical benefits, the use of surface swabs to determine if a wound is infected can be misleading. Often, the infection is incorrectly diagnosed and consequently, patients do not receive proper treatment and are unable to make a full recovery.

However, laboratory tests are not completely at fault when an infected wound is incorrectly assessed. In nursing homes that are understaffed, as well as in those that employ unqualified nurses, infected wounds are often overlooked, ignored, or inaccurately diagnosed. In fact, pressure sores are usually preventable and it is therefore the responsibility of the nursing staff to take these preventative measures, so that your loved one may avoid the pain and suffering that is caused by an infected wound. In the case that a pressure sore becomes infected, it is the duty of the nursing staff to ensure proper treatment. In addition to the usage of medications, some treatments include pressure relieving techniques, such the use of special mattresses and the repositioning of the patient, as well as the cleaning and dressing of the wound.

Recent Study Proves Exercise Is Effective in Reducing Loss in Muscle Strength and Encourages Los Angeles Nursing Homes to Use It

December 30, 2011 | by Yeroushalmi Law

Loss of muscle strength in elderly adults is an extremely serious problem because it occurs within the entire elderly population. Between the ages of fifty and seventy, adults lose thirty percent of their muscle strength. As they approach the age of seventy, elderly adults experience a loss in muscle strength of 1.5 percent per year. Because loss of muscle strength is associated with physical frailty, increased dependency, and a decline in strength, balance, coordination, reaction time, flexibility, and muscular and cardiovascular endurance, it is important to prevent or delay its onset for as long as possible. Lower muscular endurance and balance, specifically, are directly responsible for the occurrence of falls.

Fortunately, treatments and exercises exist to increase and improve muscle strength in elderly adults. One treatment, called progressive resistance training, was recently studied by the American Medical Directors Association and published in the November issue of its journal. Progressive resistance training involves exercises that are performed against an external, opposing force that increases as muscle strength increases. The study proved that this type of exercise is effective in improving muscle strength in elderly adults.

It is important to ensure that your loved one’s skilled nursing facility is not only providing treatments and exercises to prevent loss in muscle strength, but also preventing avoidable injuries, such as falls. Although exercises can improve muscle strength, a gradual decline in strength is, unfortunately, sometimes inevitable in elderly adults. It is therefore the responsibility of the skilled nursing facility to prevent falls from occurring. The key to preventing falls is to draft an individualized care plan for each resident. More importantly, nurses must abide by this care plan in their daily caretaking. However, nursing homes are often understaffed, which makes it difficult for nurses to carry out care plans. Unfortunately, therefore, preventable falls occur much too often in nursing homes.

Sometimes, skilled nursing facilities utilize physical restraints, in order to reduce the risk of falls. However, recent studies have shown that the use of restraints, over time, does not effectively decrease the rate of falls in nursing homes.

Furthermore, the use of physical restraints can lead to an array of health problems, such as pressure sores, incontinence, and depression. It is also a direct violation of Patients’ Rights, which state that restraints may only be used for medical purposes, and even under such circumstances, patients may refuse treatment.

Because falls are avoidable through proper prevention techniques, it is completely inexcusable that falls occur so often in nursing homes. If your loved one has suffered injuries from a fall that eventually led to death, you may be able to make a Wrongful Death claim. Such claims are warranted when a nursing home’s neglect is directly responsible for a resident’s death.

Nursing homes must encourage residents to partake in activities and exercises to increase their muscle strength. Although progressive resistance training has proven effective, elderly adults still remain at a high risk for falls. Therefore, skilled nursing facilities must also take precautions to lower the risk of falls.

Study Shows That Understaffing Is Directly Linked to Poor Treatment of Pressure Sores in Los Angeles Nursing Homes and Leads to an Overall Decline in Quality of Life

December 29, 2011 | by Yeroushalmi Law

Pressure sores, also known as decubitus ulcers or bed-sores, are common in elderly adults who are not properly cared for or neglected. They are especially prevalent among those who reside in nursing homes, often as a direct result of neglect by caregivers.

Pressure sores can occur when a patient remains in one position without moving, putting pressure on one area of the body for an extended period of time. There are varying degrees of seriousness, but all levels require an attentive and qualified staff. It is the responsibility of the nursing home to take preventive measures, such as repositioning their patients, in order to decrease the risk of pressure sores developing or getting wore.
Treatments for pressure sores also require a high amount of involvement from qualified and well-trained nurses.

One type of treatment involves multi-layer bandaging of pressure sores, as well as special footwear for patients. This treatment has proven to be highly beneficial to patients with pressure sores, as it improves healing and increases overall quality of life. However, despite its benefits, this practice is not commonly used in skilled nursing facilities.

In a recent study, the Australian Wound Management Association and the New Zealand Wound Care Society sought to discover the reason for such low usage of bandaging practices in nursing homes. They hypothesized that, perhaps, lack of funding was the reason for the low usage of bandage treatments in nursing homes. Two different groups were formed to conduct the study. One group received funding for bandage treatments and the special footwear that it requires, while the other group did not receive any funding. However, in the end, both groups were found to have the same rate of usage of bandage treatments. Because there was no significant difference between the group that received funding and the group that did not, the researchers concluded that usage of bandaging in skilled nursing facilities is not effected by the cost of treatment or lack of funding. Instead, the study discovered that the reason for such low usage of bandaging in nursing homes is directly related to staffing issues.

Although the cost of special footwear is substantial, the most expensive requirement for the treatment of pressure sores is nursing care. Because it is such a high cost, care facilities often opt out and hire less staff in attempts to save money and increase profits. However, adequate staffing is absolutely necessary for the proper treatment and prevention of pressure sores. Nurses must also be qualified and knowledgeable. The study found that often times, bandaging was not used because nurses failed to notice the onset of a pressure sore or poorly assessed its level of severity and therefore were unable to provide immediate treatment to patients. In homes that do use bandaging, the study discovered that nurses were often applying the bandages incorrectly, thus lowering the effectiveness of the treatment.

Study Shows That Nearly Half of All Medical Homes Fail to Meet National Standards of Quality

December 28, 2011 | by Yeroushalmi Law

On December 22, 2011, The Seattle Times published an article, titled “Medical; Patients, Doctors Differ on High-Quality Care,” about patient-centered medical homes. Although a survey on the satisfaction of patients showed that they were generally satisfied with their physicians, a recent study conducted by the Health Service Research Journal reported that 46 percent of medical homes fail to meet national standards in quality of care to even qualify them as medical homes.

Patients in medical homes are expected to have a team of nurses, doctors, and technicians to constantly be caring for them. Unfortunately, many skilled nursing facilities are understaffed and instead, this “team” of nurses, in reality, is actually just a few nurses who also has to attend to many other patients. In such environments, it is nearly impossible for residents to receive the one-on-one attention that they need. Quality of care is directly dependent on adequate staffing. If a facility is understaffed, it will not be able to provide high-quality care to your loved one. When searching for a nursing home, it is very important that you place quality of care as a priority and ensure that the facility is adequately staffed.

Understaffing leads to an array of injuries in California nursing homes, especially when the facility in appropriately utilizes restraints. When nurses are unable to meet the needs of all their patients, they often use physical or chemical restraints to subdue their patients, making them easier to handle. In addition to being a direct violation of Patients’ Rights, the use of restraints also leads to pressure sores, incontinence, and chronic depression.

The study also found that a lack of resources and infrastructure also contributed to a decline in quality of care in medical homes. In a ranking of the top hospitals of 2011, Leapfrog Group listed technological resources as one of the most important determining factors of quality of care in medical facilities. Make sure that your loved one’s nursing home has a strong infrastructure and offers the latest in technology and resources to provide your loved one with the care that he or she deserves and to prevent any avoidable suffering.

New Medicare Program to Improve Quality of Care in Los Angeles Nursing Homes

December 21, 2011 | by Yeroushalmi Law

A new Medicare program is aimed at reducing medical costs, while improving quality of care for the elderly, The Arizona Republic reported on December 20, 2011. Instead of paying doctors after each patient visit, the new health initiative gives health providers a budget within which they must work. The only way to increase this budget is by proving that they provide a high quality of care for their patients. Unfortunately, no such program exists for skilled nursing facilities, so they are often guilty of operating at quality levels much below standard. The quality of care that a nursing home provides is reliant upon its staff’s ability to meet the needs of its patients. Inadequate staffing refers not only to the amount of staff available, but also to the quality of care that they provide.

Understaffing occurs when nursing homes fail to meet the legal standard that requires them to provide patients with an adequate amount of staff to meet all their needs, which California law has quantified as a minimum of 3.2 nursing hours per patient, per day. Inadequate staffing is directly linked to quality of care because when a facility is understaffed, its quality of care declines significantly.

Nurses are often forced to work extended shifts when their skilled nursing facilities are understaffed. These longs shifts increase nurses’ chances of memory lapses, confusion, and slowed judgment, according to a recent study. Consequently, staffing errors occur, putting the lives of the residents in danger, as these mistakes are often fatal. When a care facility is directly responsible for the death of a patient, a Wrongful Death claim can be made by the patient’s successors as compensation for personal loss and suffering.

In other cases, nurses, pressed for time, may shortcut their caretaking procedures and resort to practices that constitute elder abuse. Such practices include, but are not limited to, the use of restraint, which can be either physical or chemical. They are used for the purpose of subduing patients and making them easier to care for. However, regardless of the justification that nurses give in support of restraints, the use of restraints, whether chemical or physical, is a direct violation of Patients’ Rights, which state that patients may only be restrained for medical purposes, but, in any case, are always entitled to refuse treatment.

Inadequate Staffing in Los Angeles Nursing Homes Forces Nurses to Work Long Hours and Increases the Chance of Fatal Errors

December 18, 2011 | by Yeroushalmi Law

On December 14, 2011, Modern Healthcare reported the dangers of extended hours and long shifts in healthcare facilities. While the correlation between exhaustion and increased error may seem obvious, many nurses have difficulty accepting this truth and determining the point at which their fatigue may lead to fatal consequences. The effects of fatigue include, but are not limited to, confusion, memory lapses, and impaired judgment. Many healthcare facilities fail to comprehend the seriousness of the consequences that can be caused by staffing errors. Often, these careless errors are fatal and lead to the death of a patient.

Nurses are often forced to work long hours because health facilities are understaffed. Even when they are well-rested, nurses who work in inadequately staffed facilities are more likely to make careless errors because they are constantly pressed for time, as they need to attend to more patients than they are able to handle alone. Factoring in exhaustion, in addition to the problem of understaffing significantly increases the chance of error, while decreasing quality of care of patients.

Inadequate staffing has many consequences including an increased risk of falls and incontinence, as well as dehydration and malnutrition. In both cases, patients require one-on-one assistance and individualized care plans. However, when nursing homes are understaffed, nurses simply do not have the time to meet the specific needs of each resident. Not only is understaffing a serious problem because of the health and safety risks it poses, but it is also illegal.

When staffing errors or inadequate staff lead to the death of a patient, a Wrongful Death claim may ensue. If nursing home neglect is directly responsible for a resident’s death, the successors of the patient may demand compensation for the personal losses that they have suffered.

Department of Health and Human Services Now Providing Incentives to Los Angeles Health Agencies in an Attempt to Stop Preventable Injuries

December 17, 2011 | by Yeroushalmi Law

On December 14, 2011, Modern Healthcare reported that the Department of Health and Human Services is implementing an incentive program to award up to $216 million to health agencies in an attempt to reduce preventable injuries. Despite the honorable intentions of the program, the truth of the matter is that health agencies will now be receiving awards for following procedures that they should have been following all along. A similar problem can be found in nursing homes. Often, skilled nursing facilities are careless in their caretaking processes due to a lack of incentive. Unfortunately, most of the injuries that occur in nursing homes are usually avoidable, but nurses are just too understaffed or unmotivated to take measures to prevent them.

Most injuries in nursing homes occur when patients fall. Common injuries include, but are not limited to, hip fractures and head trauma. Even when elderly adults survive these injuries, they often are unable to make a full recovery. Because one injury has the ability to trigger a gradual decline in the overall health of elderly adults, it is extremely important to take every measure possible to prevent an injury from occurring in the first place. Nursing homes need to create individualized care plans for all their patients, especially those that have conditions that increase their risk of falling. Even more important is that these care plans are carried out by nurses every day.

Unfortunately, it is not rare that these care plans are drafted and then completely disregarded by nurses in their daily caretaking procedures. When nurses are unable to follow care plans, it is usually because they are understaffed and simply do not have the time to provide each patient with the specialized, one-on-one care that they need.

Sometimes, in an attempt to prevent falls, nurses will justify the use of physical restraints. This is, however, a direct violation of Patients’ Rights, which assert that a patient is not to be restrained in any way, except for when medical reasons require it. However, even under these circumstances, patients have the right to refuse treatment. Physical restraints actually incur more harm than they do benefit. In fact, a recent study has confirmed that the use of physical restraints does not decrease the likelihood of falls in nursing homes. However, the use of physical restraints is linked to incontinence, depression, isolation, pressure ulcers, and an overall decline in mobility.

Man Sent to Recover in Care Facility Dies by Suffocation Because of a Staffing Error: Nursing Home Neglect at Its Worst

December 16, 2011 | by Yeroushalmi Law

On December 11, 2011, the Detroit Free Press published a series of articles investigating nursing home neglect. The first article, titled “Nursing Homes with Good Staff, Stopgaps Can Still Fail”, reports the accidental death of a man as a direct result of nursing home neglect. After having an accident, James Culbert was sent to a care facility to recover. Instead, he died a painful, devastating death by suffocation because the night staff had forgotten to connect his ventilator and check his vital signs. By the time the staff realized their error, it was much too late. Unfortunately, deaths as a result of careless errors are a common occurrence in nursing homes. In the second part of its series, titled “Troubled Nursing Homes Aren’t Closed,” the Detroit Free Press discusses how care facilities are able to remain open, despite major violations of state and federal codes, and incidents, such as James Culbert’s, that often result in death. Finally, the last portion, “Nursing Homes: A Caring Staff Makes All the Difference,” emphasizes the importance of an adequate, highly-qualified staff.

Staffing is the fundamental problem directly linked to all other issues that may occur in nursing homes. While care facilities are legally obligated to meet the minimum of 3.2 nursing hours per patient per day, they are also held accountable for providing high-quality care for their patients. In your search for the best nursing home for your loved one, the Detroit Free Press cautions against automatically correlating quality of care to the physical appearance of the facility because looks can be deceiving. Surprisingly, the Detroit Free Press found that the newest facilities that market luxurious living and provide generous accommodations are sometimes ranked lowest in quality of care. Instead, the article emphasizes the importance of an adequate, qualified staff.

Unfortunately, many nursing homes lack such a staff. The Detroit Free Press investigated various deaths that occurred in nursing homes and found that many of them could have been prevented with a more attentive staff. Falls were among the most common causes of death, simply because a patient would fall down and hours would pass before a staff member even noticed, often much too late. Another common staffing error involves medications. The Detroit Free Press reported one death in which a man was given another patient’s diabetes medication. When patients’ lives are on the line, it is crucial that caregivers avoid making such careless mistakes. In some serious cases, caregivers even forgot to feed patients, who eventually starved to death. This raises the issue of malnutrition and dehydration, which provides clear evidence of nursing home neglect, even when it does not directly lead to death.

Families of Los Angeles Nursing Home Patients Must Be Cautious of Nurse Tampering with Patients’ Drugs

December 15, 2011 | by Yeroushalmi Law

On December 11, 2011, the Associated Press reported that three nurses were convicted of tampering with their patient’s drugs. All three nurses had been previously convicted of various drug-related crimes and yet were still able to secure jobs at skilled nursing facilities. One nurse, previously convicted for forging prescriptions, was convicted once again, this time for diluting five of her patients’ morphine solutions. Another nurse who stole her patients’ drugs at her previous job was found guilty of adding tap water to one of her patient’s painkillers. The last nurse, fired from her previous job for drug discrepancies, was caught stealing syringes of morphine and replacing them with a dangerous sodium chloride solution. The most disturbing truth about these crimes is that they occur in nursing homes nationwide and are often a cause of pain, suffering, and death in nursing home patients. In this specific situation, blame can be placed on the nursing home for failing to implement background checks on its employees. By simply being a bit more thorough in their hiring processes, nursing home management has the ability to significantly improve quality of care in skilled nursing facilities.

Staffing is the root cause of most problems in nursing homes. While the term ‘inadequate staffing’ is most often associated with quantity, people often overlook that it must also be applied to quality of care as well. A nursing home staff can be inadequate if it fails to provide a high standard of care or if its members are not qualified for the job. Similar to the situation reported above, management of nursing homes often fail to hire nurses who are best qualified to provide the care that your loved one requires. It is important that you emphasize both quantity and quality of care when choosing a skilled nursing facility for your loved one.

Diabetes: An Increasingly Prevalent Issue in Nursing Homes that Requires Immediate Attention

December 12, 2011 | by Yeroushalmi Law

The prevalence of diabetes is increasing exponentially in the American population. In nursing homes alone, it has been found that 20 percent of adults between the ages of sixty-five and seventy-five suffer from diabetes, and that 40 percent of adults over the age of eighty suffer from this common illness. Because of its widespread nature, the Journal of American Medical Directors Association featured an “Update on Diabetes in the Elderly and in Nursing Homes” in its November 2011 issue.

The article reported that in the elderly, diabetes often manifests itself as weight loss, fatigue, and nocturia. Because these issues are often attributed to old age, 25 to 41 percent of elderly adults remain undiagnosed. Therefore, it is important that your loved one’s nursing home is adequately staffed with trained professionals who recognize that these may in fact be signs of diabetes, rather than automatically blaming old age as the underlying cause.

Understaffing also becomes a major issue in the treatment of diabetes. Elderly adults who are diabetic suffer a great burden of disease. They are constantly being transferred in and out of hospitals, and are at higher risk of hypertension, heart failure, kidney disease, visual impairment, and foot problems. Due to the various ailments that often accompany diabetes, adults who suffer from this illness require additional staff assistance for activities of everyday living. Therefore, if your loved one suffers from diabetes, it is crucial for you to ensure that his or her nursing home facility is providing your loved one with the care and assistance that he or she requires as a diabetic.

Caregivers must also be very alert and observant because diabetic residents are also more susceptible to falls. Studies have shown that diabetic residents suffer more fractures than residents who do not have diabetes. This is a significant issue because falls can have serious implications, including death, that can often be avoided with an active and attentive staff.

Regarding the treatment of diabetes, the article emphasizes the importance of individualized care plans, especially in patients with dementia. There is evidence to show that patients with cognitive impairments are less likely to be put on a special diet. Because diabetes is an illness that is directly linked to nutrition, it is essential that every patient’s nutritional needs are met, whether or not they have dementia.

According to the Journal of American Medical Directors Association, the goals of diabetes treatment should be to decrease pain and nocturia, while limiting cognitive impairment. Because diabetic patients are more vulnerable to infections, such as pressure ulcers, the influenza, methicillin-resistant staphylococcus aureus (MRSA), scabies, clostridium difficile (C. difficile), and sepsis, another goal of treatment is to decrease the likeliness of contracting any of the above infections. Additionally, caregivers should strive to improve incontinence and prevent falls in diabetic patients.