Bedsores

There is no reason for a properly cared for nursing home resident who is properly cared for to suffer the neglect and abuse of developing bedsores. Bedsores are painful and a hideous example of negligent care.

Bedsores are sometimes called “pressure sores” or “decubitus ulcers.” These sores are caused by poor nutrition combined with patients being permitted left to lie in beds unattended for long periods of time without being repositioned. In an ulcer’s early stages, the skin will appear red and turn white – like a sunburn – when touched. If left untreated, decubitus ulcers can form cavernous holes in the skin, leaving muscles, tendons, and bones exposed. These bedsores often result in unbearable pain and suffering and often lead to deadly infections.

Bedsores are classified in by stages. A Stage 1 bedsore appears as a painful red inflammation on the skin. By Stage 4, a bedsore has eaten through the skin, tissue and and muscle to expose bone.

Bedsores are very common in nursing homes largely due to nursing homes failing to employ sufficient staff to care for the residents. By no means are bedsores acceptable in today’s nursing home environment. The presence of a bedsore means something’s that something wrong and needs to be addressed. Thankfully, bedsores can be prevented by regular care. Care includes changing a person's position regularly and making sure that nursing home residents have adequate nutrition.

Causes of Bedsores in Nursing Homes

Bedsores result when nursing home residents lie remain motionless in the same position for long periods of time. Prolonged pressure slowly wears away the skin and muscle tissue, causing bedsore wounds to receive inadequate nutrients from the blood. This pressure results in the death of tissue. The bony areas of the body, like the lower back, elbows, knees and hips, are the sharper areas of the body that put the most pressure on skin, tissue and bone.

Because bedsore wounds and tissues are locatedusually develop in places on the body that make have repeated contact with the nursing home bed, there is a strong likelihood that the ulcerous wound will not heal if the patient is not properly treated. Tell your health care provider immediately if you notice a bedsore change color or the bedsore produces a foul odor. Both are strong indicators of infection.

The Four Stages of Bedsores

The effects of bedsoreBedsore injuries fall into four major categories or stages. Since the bedsore tissue damages increases at each stage, the classification of bedsores does not decrease during recovery. This means that a Stage 3 bedsore never heals to a Stage 1 or Stage 2 bedsore. Medically speaking, a Stage 3 that is healing is called a “Stage 3 bedsore in recovery.”

Here are the four stages, each defined by the National Pressure Ulcer Advisory Council (NPUAP):

• Stage 1 Bedsore: Changes in skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin. In darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.

• Stage 2 Bedsore: Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

• Stage 3 Bedsore: Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

• Stage 4 Bedsore: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint, capsule). Undermining and sinus tracts also may be associated with Stage IV pressure ulcers.

Weight Loss

For various reasons,Whether it’s whether due to today’s medications or simply a decrease in how we taste thingstaste as we get much older, age can affect appetite. Nursing homes that are negligent often do not have the staff or dedication needed to make sure their residents get necessary nutrition and hydration. Without proper nutrition, the body begins to eat itself in a serious medical condition called “cachexia,” or “Wasting Syndrome.” This condition includes loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite in someone who is not actively trying to lose weight. As a loved one suffers, other diseases accompany malnutrition.

One of the least obvious warning signs of nursing home abuse - - and often waved off by staff as “just part of getting old” - - is sudden or severe weight loss. Your loved one’s weight loss can be the result of a number of factors, including dehydration, life-threatening illness and poor quality of food.

Undocumented weight loss, especially if other abuse and neglect warning signs are present, should raise strong suspicions about the quality of care your loved one is receiving.

What are the dangers of dehydration, weight loss, and the loss of senses for nursing home patients?

Our bodies are composed primarily of water. Water is vital to proper organ functioning regardless of your age. When the human body starts losing more water than it takes in, dehydration occurs. Dehydration results in exhaustion throughout the body as well as a decrease in blood pressure. This reduces the blood’s ability to deliver important nutrients to the body.

Elderly patients eat less. When the elderly don’t eat a regular, balanced diet, their bodies begin to draw nutrients stored in body tissues. At first, the body will burn fat deposits for its energy. However, when fat reserves fall low, the body begins to “cannibalize” or “eat” its own muscles, even including those that beat the heart. As the malnourished body degenerates, the chance of infection and illness increase. Bed sores are almost impossible to heal when combined with malnourishment. When you are thirsty or hungry, you simply get up and grab something to eat or drink. But Unfortunately, a bedridden loved one in a nursing home doesn’t does not have that option. Your loved one relies on a nurse or caregiver – often handling many patients – to help them.

As bodies age, so do the senses. The deadening of the senses of taste and smell requires special attention by nursing home staff to make sure that incapacitated residents are receiving and finishing their meals. If food is unappetizing the result can be similar, as can a reaction to medication. Doctor-prescribed prescription drugs can diminish appetite. It should be no surprise that simply not eating can also weaken appetite in a vicious circle of starvation.

No matter what the cause, a loved one under nursing home care should not be denied the attention and concern necessary to make sure meals are edible, healthy, and eaten. If someone you care about is not eating, it’s it is time for you to tell the nursing home that you are concerned and to have the home tell you what they intend to do about it.

Bruises

If you see bruises on a loved one’s body, your family should demand answers. There is no excuse for remaining silent. Bruises are not part of good nursing home care.

Bruises are pools of blood from broken capillaries right under the skin. They heal slowly in people with poor circulation. Bruises will occur when an unsupervised resident is allowed to fall or is struck by a member of the nursing home staff. Any bruise or cut requires immediate medical attention as well as an evaluation to determine its cause. To make matters worse, sometimes a bruise may be a telltale sign of sexual abuse. Bruises should never be ignored. Older people bruise more easily, but every bruise should be evaluated.

Bruises: where and why nursing home residents bruise

Bruises can occur for a number of reasons. Because bruising is much more common in the elderly – and can increase with an improper diet, malnutrition and dehydration – bruises are a good barometer of other forms of nursing home neglect and abuse.

Inattentive or abusive staff can cause a number of problems. These including include bruises on hips and arms from falls, as well as bruises from the use of bed rail restraints or physical abuse. Bruising along the wrists can indicate the use of cuffs or other questionable uses of force and/or physical restraints. Bruising can also occur when a nursing home resident is struck by a member of the nursing home staff or attacked by another patient in an unsupervised situation.

Residents are often quiet about abuse

Nursing home residents often won’t can not and will not report abuse. They might beare often targets of physical abuse because they are physically or emotionally weaker than their abuser. The memory of older residents can’t always be trusted. Think of it this way: Tthere is often abuse because the resident’s dementia disables their ability to remember being hurt; as a victim, they can’t remember the incident.

There are many reasons for this type of behavior, even by patients who can recall what happened. Some nursing home residents fear retribution from abusive staff if they “tattle.” Some victims of abuse pretend the attack didn’t happen simply because they feel they deserved to be mistreated. Others are resigned to the mislaid notion that nothing can be done. Still others willfully remain quiet, believing that silence might encourage less abuse.

Nursing Home Resident Abuse

Nursing home management won’t refuse to acknowledge that physical violence and sexual abuse occurs far more frequently than residents and their families believe. Major reasons for these acts of perverse violence include insufficient background checks for employees as well as penny-pinching corporate environments that promote money-making and cost-cutting over patient care. Admitting the problem means that the nursing home is responsible for the injury. It’s no wonder then that unscrupulous nursing homes simply often deny that anything occurred.

What to do? Simply talk to the patient.

Never miss and opportunity to speak with your parent or loved one in the nursing home about their care. Do it frequently and don’t be afraid to ask about bruises and injuries that you notice. Let them know that you want to hear about what’s happening to them, that you believe them and that you care. Clear communication with the outside world gives a nursing home resident hope for better treatment and less painful care. It reminds them that their life still has meaning. The numbers show that frequent contact drastically reduces the incidents of abuse and neglect.

Falls

Sure-fire symptoms of nursing home neglect are serious tumbles and frequent falls. The nursing home management has the legal responsibility to develop a plan for each nursing home resident to help prevent falls. Don’t let a minor fall go undocumented. Falls often lead to major medical expenses. Tumbles by residents can result in lasting injuries which are .sometimes fatal.

As we get older our joints grow weaker and our body balance shifts. People in their later years suffer from muscular degeneration and poorer vision. These conditions ,combined with the side effects of medications and poorly managed living areas found in too many of our nation’s negligent nursing homes. These, are the ingredients to ain a sad recipe that produces falls, the cause for the largest number (29%) of injury deaths in adults aged 65 and over?

How often have your heard, “he’s not as steady as he used to be” or “she’s not as nimble as I remember.” While the effects of aging definitely increase the chances of a person falling, taking a fall falling under what was promised to be careful, responsible and professional care in a suitable facility , is not just not acceptable in today’s world. Even minor falls can cause major and lasting injury. Maybe even death in some cases. It is essential that your loved one receive the treatment and attention they deserve in their nursing home so that preventable falls do not occur.

Staff Falling Down on the Job

By law, when a resident enters a nursing home. , the nursing home or assisted living facility must design a “Care Plan.” The resident’s care plan must include an assessment of the resident's risk of falling. It’s from this evaluation that the nursing home determines what assistance your loved one may need from day to day.

Unfortunately, many nursing home falls are due to nursing home staff negligence. Wet floors, poor lighting, improper bed height, and poorly fitted wheelchairs in nursing homes are compounded by staff inattention.

The permanent effect of nursing home falls

Unfortunately, mistakes by negligent staff and management can have permanent effects. Nursing home experts estimate that two-thirds of all elderly who fall will suffer another fall again within six months. A Center for Disease Control and Prevention report states: “Of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard to get around or live alone and increase the chance of early death.”

Prevention

Falls can – and should – be prevented without using restraints. Although nursing home residents with a history or high risk of falls are often confined by restraints such as bed rails, reports have shown that limiting a resident’s personal freedom of movement can actually contribute to fall-related injuries.

Nursing homes can reduce the risk of falls through regular physical conditioning and walking programs, lowering bed heights, keeping clutter free from around the bed, installing raised toilet seats and handrails, fixing or replacing substandard wheelchairs and furniture, making sure that residents are wearing properly fitted shoes, and having enough staff to assist with transfers between the resident’s bed, chair and toilet. These are all simple actions and adjustments – often inexpensive – that can prevent falls and injury.

Restraints

Nursing homes may restrain patients using physical and chemical restraints.

• Physical restraints involve any method that the patient cannot remove easily and which restricts their freedom of movement. These include leg restraints, arm restraints, hand mitts, cuffs, wheelchair safety bars, bed rails, and lap pillows. Nursing homes also restrain patients by tucking their bed sheets so tightly under the mattress that they aren’t able to move.

• Chemical restraints include requiring patients to take heavy sedatives, which are designed to make nursing home patients more ‘manageable’. Chemical restraints include mood-altering drugs and psychoactive drugs.

The easiest means of patient management is to limit their mobility, often for the convenience of the nursing home’s staff. This limited mobility puts the patient in danger of strangulation, bedsores, adverse drug reactions, and reduced bone mass. This lack of mobility results in physical discomfort, feelings of frustration, and loss of dignity. Patients are often forced to stay seated in a chair or lie in bed for hours, unable to get up to use the bathroom or move about.

Examples of Physical Restraints Used in Nursing Homes

Physical restraints include any restraint method that cannot be removed easily, that restricts freedom to move, and limits access to normal body movements and activities. Some examples of physical restraints include leg restraints, arm restraints, vest or jacket restraints, waist belts, hand mitts, cuffs, wheelchair safety bars, bedrails, and lap pillows.

Nursing homes also restrain patients by using less obvious physical restraints. An example is placing a wheelchair-bound patient so close to a wall that the wall prevents the patient from rising. Negligent, devious, and poorly trained nursing home workers are continually finding new ways of cutting corners in their care for your loves ones.

The Danger of Nursing Home’s Chemical Restraints

Any non-therapeutic drug that prevents a nursing home patient from normal mobility should be viewed as a chemical restraint. While mood-altering drugs can be useful in restoring good health and spirits, psychoactive drugs are often misused as chemical restraints to manage a resident’s behavior. How many pills are dispensed to residents solely for the convenience of the caregiver?

Drug abuse is less apparent than bruises or other markings on the skin. It may also be difficult for the abused or family members to detect. While abused nursing home residents may suspect they are being drugged, these residents often wait too long to confirm their suspicions. The result of drug abuse can include major internal injury or death.

What can you do about over zealous physical and chemical restraint?

Physical and chemical restraints must be prescribed by a doctor. Nursing home patients restrained under medical orders must be very closely monitored. For bodies weakened by age and illness, physical and chemical restraint abuse is common. Not sure what is the proper level of restraint? Ask to speak to your patient’s doctor. Still not satisfied? Get a second opinion. Under no circumstances should your loved one be under restraint, either physical or chemical, without your knowledge.

Staff Inattention

Let’s be clear: Nursing homes are businesses. Many business owners increase profits is by cutting labor costs and increasing the work of employees. Nursing homes are no different. Many nursing homes today are understaffed, with nurses and care providers who are often overworked.

When the staff can’t respond in a timely manner, mistakes happen. Pills are dispensed too often, not at all, or for the caregiver’s convenience. Patient personal hygiene suffers. Signs of serious illness are overlooked or ignored. Staff inattention and failure to respond to patients’ requested needs is the number one complaint filed against nursing homes.

Nursing home residents need special care. They cannot care for themselves or they wouldn’t be in the nursing home to begin with. They are our grandparents, great grandparents, parents, children, and friends. Do not remain silent if you believe your loved one is not receiving the care, attention, and dignity they are entitled to at a nursing home. Speak up.

The most common complaint against nursing homes is the staff’s failure to respond in a timely manner. Your loved one needs special care and supervision that can’t be found elsewhere. Staff inattention decreases the comfort and quality of nursing home care for residents while increasing their risk of serious injury and death.

Nursing home management and staff that are responsible intend the best for your loved one. However, when the nursing home staff are too overworked to respond to the “Call” button, problems multiply. Medication is given too often or not at all. Patients are left for long periods of time unattended in chairs or beds. Hygiene suffers. Weight loss and other signs of serious illness are overlooked. We are impatient and angered when we wait an hour in a doctor’s waiting room. Imagine waiting hours for a simple glass of water or needing assistance getting out of bed to go to the bathroom, pressing the “Call” button . . . .but no one comes.

Nursing Homes Are Businesses

At their core, nursing homes are businesses. Decisions about staff salaries are weighed against the demand for profits and shareholder value. When poorly paid nursing home staff works 12 hours a day to pay their own bills, it is tough for them attentively tend to the needs of patients under their care. And when turnover is high, the long hours wearing on an inexperienced staff can have disastrous consequences. These consequences include bedsores, weight loss, falls, abuse and bruises.

Nursing home reports are available

At the nursing home, read staff reports. This is a great way of checking up on how attentive your nursing home staff is. As an example from a CBS News story, one very shocked daughter knew her mother had been in a coma for 12 months, but found that the home’s staff had written that she was up and walking around instead!

The reality of care today

The reality of dealing with aging and serious injury at nursing homes today is complicated and stressful for staff with direct responsibility for every day patient care. This stress leads a small number of nursing home nurses, aides, and other staff to give patients substandard care or to withdraw needed care.

Alzheimer's patients need constant attention. They often wander off and find themselves innocently in harm’s way. When your loved one has been found unattended, staff inattention and laziness is to blame, not the patient.

Being Present at the Nursing Home, Even When You’re Not There

Nursing home residents who are visited often by their families and friends tend to receive better care. If you can’t visit in-person, call and talk to the people who take care of your loved one. When you do visit a nursing home, make occasional trips outside of your regular schedule. Make friends with other residents at the nursing home and ask them about your loved one. As one ABC News story reports, most negligent abuse occurs because of the low traffic through nursing homes.

If you or a loved one has been injured at a nursing home, please contact LEITNER VARUGHESE PLLC at 855 LV LAW NY (855 585 2969).