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

McKnights Long Term Care had a great article on a study that proves the importance and necessity of one-on-one supervision, exercise, and encouragement when feeding residents in a nursing home.  Because of prevalent understaffing in the nursing home industry, most nursing homes do not or cannnot provide enough staff to make sure that the residents are eating enough nutritious foods.

Supervision and encouragement during meals has been proven to reduce the occurrence of unintentional weight loss among long-stay nursing home residents according to the Journal of the American Geriatrics Society.  Vanderbilt University researchers assessed the unintentional weight loss of 76 nursing home residents.

Half of the group received additional attention during mealtime while the other half served as a control group.  Researchers noticed that 52% of residents maintained their weight when they were part of the extra attention group. That compares with 28% of residents in the control group.  Researchers suggest that groups of three or four residents per staff member during mealtimes are more practical and just as effective as one-on-one care.

The new study found that the combination of light exercise and specific nutritional supplements could help keep seniors fit for a longer period of time.   Researchers at Manchester Metropolitan University in England divided 60 seniors into two groups. One group performed moderate exercise once a week and the other performed high resistance exercise twice a week. Within those two groups, some received carbohydrate and protein supplements before and after exercise; some did not.   While all groups showed improved muscle mass and overall strength at the end of the 12-week trial, the most striking results came from the light exercise group that received supplements, according to the study.

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A jury found Life Care Centers of America guilty of negligence. The jury awarded $1.5 million in compensatory damages to the family of a former resident who died as a result of the nursing home's neglect and negligence.

Life Care Centers of America was sued by Dennis Matthews, son of the late Verdie Matthews. He proved the nursing home allowed Mrs. Matthews to develop severe dehydration and malnutrition which caused her death. 

Thomas Hornbuckle, attorney for Matthews, alleged the nursing home intentionally acted recklessly by falsifying fluid and nutrition records of Mrs. Matthews. Hornbuckle said evidence and witnesses had proved Life Care acted negligently and was at fault in the death of Mrs. Matthews.

Mrs. Matthews, 83, was a resident of the facility from the beginning of April 2006 to May 1, 2006. She was admitted to Bradley Memorial Hospital on May 1, 2006, and died on May 4, 2006. Medical records indicate at the time of admission to the nursing home Mrs. Matthews weighed 105 pounds. At the time of her death four weeks later, she weighed 92 pounds.

Attorney Steve Hornbuckle confirmed the jury found Life Care Centers guilty of negligence in contributing to the death of Mrs. Matthews.   The jury also found the nursing home acted "recklessly," according to Hornbuckle.

The jury will reconvene Monday morning to deliberate on awarding punitive damages. Both attorneys will be given a chance to argue the case.

Jury will decide punitve damages.

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Knoxville News had an article about a nursing home resident who lost a leg due to the nursing home's neglect.    Neglect of a resident at Hillcrest-West nursing home led to the amputation of her leg last month, according to state reports quoting a doctor who consulted on the case.

The state has censured Hillcrest nursing homes for providing substandard care three times in the past two years.   Obviously the corporate managers ignored the problems and did nothing to correct them.

Now, as in the past, Hillcrest is in danger of losing federal funding if problems aren't corrected. Hillcrest-West has until May 25 to submit a detailed plan of correction, said Lee Millman, a spokeswoman for the Centers for Medicare and Medicaid Services.   During a survey conducted April 28 through May 2, the state found violations of "resident protection, administration, records and reporting, and nursing services standards."

Details in the recent state report on Hillcrest-West state that the amputee's pressure wound was at the most severe level when first noted by staff Feb. 7. The leg was amputated above the knee April 22. Doctors said the bone likely was infected and the wound was "exquisitely (intensely) painful" when manipulated.

A podiatrist said the pressure wound was the "result of neglect ... the worst wound I have seen in 12 years," and the surgeon who removed the leg concurred, the report states.   The same patient didn't get the amount of tube-fed nutrition and saline ordered by her doctor, with feedings skipped repeatedly, the report notes. Also, the family was not informed of the pressure wound and was shocked when they learned of the pending amputation, the state report said.

State inspections from 2006 and 2007 report Hillcrest-West patients found on the floor after apparently falling from beds or wheelchairs, failure to properly use restraints or alarms, patients who were unclean, and inadequate staffing.

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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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