South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

Standard definitions of infections for use in long-term care facilities would be helpful, both as guidelines for surveillance and as outcome measures for studies of infections and infection control in these facilities.  A new set of definitions was developed at a consensus conference held in January 1989 and subsequently revised by a modified Delphi technique involving consensus conference participants.

Discussion at the conference was based on definitions developed at Yale University (Checko P, et al., unpublished manuscript) and revised by the Co-operative Infection Control Committee1 and on detailed reviews of these definitions written by a sample of 62 infectious disease physicians,
geriatricians, infection control practitioners from long-term care facilities, and authors of published
research in the field. They are intended specifically for use in facilities that provide homes for elderly residents who require 24-hour personal care under professional nursing supervision.

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Caymanmama.com had an article about problems found at Mustang Manor Assisted Living Center including 27 nutrition and sanitation-related issues..  The Oklahoma State Department of Health (OSDH) found problems with on-site cleanliness, nourishment, and the overall welfare of the elderly residents. Reports show the Mustang Manor has been cited for numerous unspecified violations of safety and health in the last two years. These issues amounted to an excess of $35,000 in OSDH-issued penalties. 

Beyond claims of safety and health hazards at the nursing home, officials from the Mustang Police Department have received complaints of criminal activity at the establishment. According to Mustang Police Capt. Willard James, “We received a call that a resident had actually written checks to an employee of the business and had them cashed to have the money returned to her, and she had not received those funds.”

Often the two major areas where a nursing home can cut operating costs to improve profits is staffing and nutrition.  Many nursing homes cut staffing especially of RNs and LPNs to make more money for their corporate owners. 

Nutrition and sanitation are very important to prevent pressure ulcers and infections.

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There have been several articles about the lawsuit filed against Everett Rehabilitation and Care Center that neglected a resident's penis until it rotted off.  See articles here, here, and here.

A lawsuit has been filed against a Washington state nursing home accused of neglecting Charles Bradley's penile infection.   The lawsuit states that Bradley was taken to an emergency room, where doctors discovered his penis had decayed, leaving only a gaping wound. He died 18 days later, in March 2008.   The lawsuit cites an investigation by the state Department of Social and Health Services, which shows the nurse told a manager in November 2007 that the man had a wound on his penis. Staff noticed that Bradley's skin was breaking down while changing his diaper in November 2007.  The records say the manager forgot about the report and neglected to properly care for the wound.  Though staff notified a care manager, that manager failed to notify Bradley's doctor. Instead, the manager went on a three-week vacation and when she returned she forgot about the nurse's report.

Bradley's family claim staff at the nursing home left a wound on the elderly man untreated for months. Nursing home records allege that staff changed the man's diaper daily and provided him weekly baths between November 2007 and March 13, 2008.  During the four months that followed the initial notice of the wound, Bradley's genitals essentially broke apart bit by bit while the elderly man steadily lost weight.   By allowing Bradley's injury to fester and worsen for months, the nursing home and parent company SunBridge Healthcare Corp. violated a promise to care for him. "They trusted that the nursing home would provide the care they said they would provide," family spokesman said Wednesday. "We're not talking about extraordinary care. We're talking about basic daily needs."

An investigation conducted by the center's director of nursing "did not find any impropriety" by staff. State regulators, though, issued the center a citation for failing to meet quality of care requirements set by federal law.  The state determined that the home failed to meet a federal standard for care. The man didn't receive timely medical attention and the facility failed to notify his family or his doctor of changes in his health, the state determined. 

"There was no evidence the facility had contacted the resident's physician … to allow for timely medical intervention," the state investigators said in an investigatory report provided by DSHS. "There was no evidence the facility had contracted their social services department or the resident's family."  A financial penalty was not assessed.

“They definitely should have seen it. There was no documentation that his penis was beginning to fall off,” Gooding said. “We believe they chose not to put it in the records.”  Sounds like a cover up but no monetary fine was issued!

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The NY Daily News had the tragic story of Verda Henry.  She entered a Westchester County nursing home in 2005 after she fell and injured her arm, thinking she would receive therapy and be home in a month.  Two years later, after repeated denied requests to go home, she in the  nursing home because of a horrific, infected bedsore.

Her daughter, Patricia Henry, said she and her children visited her normally active mother every day at Sutton Park, often for eight hours. The family complains that the facility was short-staffed.  "There would be a nurse and she would run between floors and they had no time," Henry said. "Nobody checks on her. Nobody feeds her. Every time we asked to take her home there was a reason we couldn't."

One day, Patricia Henry went to change her mother's gown and noticed the bedsore, already in an advanced stage, over her mother's tail bone.   Within days the sore was infected and she heard her mother's last words - screams - as doctors scraped at blackened skin.

"You could put your whole hand down in her back," she said. "You could see the bones and spinal cord. It was like raw meat. Mommy screamed until she couldn't scream no more."   Henry wants justice for her mother, who died a painful death because of a negligent system.

Bedsores, or pressure ulcers, are lesions caused by unrelieved pressure on the skin. They are largely preventable with adequate nutrition and by making sure a patient is regularly moved or turned every two hours, but are also often fatal once infected.

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Often when maggotts are found in a resident's pressure ulcer (normally caused by the lack of proper wound care and cleaning), the nursing home tries to argue to the family that the maggotts are a method of cleaning the wound and that the nursing home intended the maggotts to clean the wound (despite no physician order typically).  Well, that frivolous argument has now been proved wrong.

Reuters had an article about a recent study in the British Medical Journal of the world's first controlled clinical trial of maggot medicine.  Maggotts may clean wounds quicker than normal treatment but this does not lead to faster healing. Some patients also found so-called "larval therapy" more painful. 

To find out more, researchers at Britain's University of York recruited 267 patients with venous leg ulcers and treated them either with maggots or hydrogel, a standard wound-cleaning product. They found no significant difference in outcomes or cost.  Larval therapy works because maggots eat only dead and rotting tissue, leaving a clean wound. They do not burrow into healthy flesh, preferring to eat each other when they run out of food. 

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A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.

A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.

McKnight's had a recent note about the most recent study analyzing the data of pressure ulcers in nursing homes.  More than one in 10 nursing home residents had a pressure ulcer in 2004, according to newly released statistics from the Centers for Disease Control and Prevention.

The report proves widespread neglect related to wound care.  Roughly 159,000 nursing home residents—11% of the total—had some form of pressure ulcer. Stage two pressure ulcers were the most prevalent, the report found.   However, many nursing home employees have no training in wound care and do not know how to properly stage a pressure ulcer.  

Younger residents who experienced shorter lengths of stay also were more likely to have pressure ulcers.   This disproves the defense argument that "old" people get pressures ulcers and that they are "unavoidable".  

A total of 35% of those with pressure ulcers stage two or higher (more severe) received "special" wound care treatment, according to the CDC.   There were no significant differences in pressure ulcer rates between white and non-white residents, according to the report.

The report, "Pressure Ulcers Among Nursing Home Residents: United States, 2004," was released Wednesday.   Authors gathered data for the report from the 2004 National Nursing Home Survey, which sampled responses from more than 14,000 nursing home residents around the country. The CDC report can be found online at http://www.cdc.gov/nchs/pressroom/upcoming.htm.

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McKnight's had an article about New Jersey passing a bill that would require nursing home operators to switch from regular mattresses to pressure-relief mattresses within three years.  No reason was given why the industry was given three years to replace the useless mattresses.  Operators would have to buy the more costly and effective mattresses when replacing older ones starting a year from the bill's enactment.

“While pressure redistribution mattresses may cost more up front than the standard spring mattresses, we cannot put a price on the continued health and wellness of our state's most vulnerable senior citizens,” said bill co-sponsor Sen. Bob Gordon (D-Bergen). “While these new mattresses alone won't make bed sores an ailment of the past, they will greatly reduce the incidence of bed sores, and make their treatment much easier on the dedicated nursing home staff.”

Hopefully, the rest of the country will follow. Pressure relieving mattresses are one of the keys to preventing painful and potentially fatal pressure ulcers.

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McKnight's has an article about diabetes in the nursing home population. One out of every four residents over the age of 65 is diagnosed with diabetes, according to a new report from the Institute for the Future of Aging Services. Researchers analyzed data representing 1.32 million nursing home residents over age 65.

Among the findings: Non-white residents were twice as likely to have diabetes as white residents; diabetic residents were younger than their non-diabetic counterparts; and the prevalence of diabetes in U.S. nursing homes was higher in 2004 compared to previous years. IFAS is the applied research arm of the American Association of Homes and Services for the Aging. Those afflicted with the disease are at a greater risk for developing other conditions that can affect their quality of life and care needs, according to researchers. Diabetics are more likely to take more medication and arrive at a nursing home with pre-existing circulatory problems. Diabetics are also 56% more likely to have a pressure ulcer upon admittance. The research was published in the February 2008 issue of Diabetes Care. To view the report, please go to http://www.futureofaging.org.

This underscores the need for better nutritional assessments and interventions requiring getting blood work and lab results on a regular basis.  This also shows why preventative measures are needed to prevent skin breakdown.

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The NY Times has an informative article on the multi-disciplinary approach needed to prevent pressure ulvers in nursing home residents. 

The article defines a pressure ulcer as an area of skin breakdown that occurs when sustained pressure cuts off blood circulation — usually in patients confined to their beds nursing homes — a bedsore can result in a wound so deep (sometimes to the bone) and painful that some patients require narcotics. If a bedsore becomes infected, the complications can be fatal.

Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence.  New research requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. 

Dr. Joanne Lynn, who helped begin the project when she was a senior natural scientist with the RAND Corporation (she has since joined the Medicare centers), said the goal was to educate nursing home workers in bedsore prevention and to encourage them to come up with creative, low-tech solutions of their own. “It was a combination of education, cheerleading and something like systems engineering,” Dr. Lynn recalled.

Nutrition including additional protein, special mattresses made of high-density foam to reduce pressure in key areas, keeping feet elevated, repositioning frequently, keeping incontinent residents dry with routine changes, and proper fitting clothes are easy low tech solutions to preventing the developement or worsening of pressure ulcers. 

Clinicians document four stages of pressure ulcers, in which Stages 1 and 2 are superficial sores and Stages 3 and 4 are deep wounds that result from death of the skin and underlying tissues.

Dr. Horn, of the Institute for Clinical Outcomes Research, praised the collaborative as “the first major national effort driven by Medicare to reduce pressure ulcers.” But she said that better outcomes could be achieved if more nursing homes improved their documentation, so that all of the information on a given resident, including details on eating, urinary and bowel function, appeared on a single sheet, with key reminders to nursing assistants and other staff members about best practices.

Bedsores are “a major quality-of-life issue, and a self-esteem issue,” said Joanie Jones, a nurse at David Place in Nebraska. “No one wants to have sores on their bottom. I don’t care how old you are. You still want your skin intact.”

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We have numerous cases where a resident suffered horrible painful pressure ulcers because of the lack of preventative treatment.  The nursing homes always claim that the pressure ulcers were "unavoidable" due to the age of the resident.  A new comprehensive study disproves that claim.

This article discusses the purpose and success of preventing pressure ulcers from forming when nursing homes provide preventative care.

The Pressure Ulcer Collaborative project had been aiming for a 25 percent reduction in new occurrences of bedsores by encouraging health workers to use proven strategies to prevent skin deterioration.  Instead, the 150 hospitals, nursing homes and home health care agencies participating reduced new bedsores on average by just over 70 percent between September 2005 and May 2007.

Bedsores, technically known as pressure ulcers, are painful, occasionally deadly skin lesions caused by unrelieved pressure  that can cause infection and destroy tissue, muscle and bone if not properly treated.  They also can trigger depression, affect a patient's self-image and complicate treatment.

At the beginning of the New Jersey project, 18 percent of newly admitted patients developed a bedsore while receiving care. By the end, the rate had been cut to 5 percent of new patients, Holmes said.

Holmes said the preventive steps started with a prompt evaluation of each new patient, with every square inch of their skin examined and their risk of developing bedsores determined based on a standardized scale.

Hospitals then had to follow strategies to prevent development of bedsores. Options included shifting the patient to a new position every two hours, use of heel cushions and other padding for vulnerable pressure points, even use of special air mattresses that alternately inflate and deflate different areas, spreading pressure around.

Patients not eating or drinking enough water _ a common problem with older patients _ got a nutritional consultation because inadequate caloric intake or protein stores, as well as dehydration, can lead to skin tearing and breaking down.  Frequent follow-up examinations of the skin also were required, along with new ones for patients suddenly bedridden, as after surgery.

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