| Resource Library |  Download PDF Version |
Fall 2005 - Nursing Home Litigation Newsletter:
Neglect: Pressure Sores
The incidence of pressure sores is sufficiently high to warrant concern among health care providers.* Studies reveal that pressure sores are prevalent in up to 23 percent of our nation's nursing homes.*
Staging- Pressure sores or decubitus ulcers usually occur over bony prominences and are graded or staged to classify the severity of the wound.
Stage 1 - A defined area of persistent redness in lightly pigmented skin, or may appear as persistent red, blue, or purple hues in darker skinned individuals.
Stage 2 - The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
Stage 3 - The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
Stage 4 - Extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures.
Mechanism of Injury -Decubitus ulcer formation results from pressure, although it can also occur from friction. Blood vessels in the skin and underlying tissues are compressed and tissue decays from lack of blood circulation. Areas at greatest risk include: the coccyx, hips, heels, and elbows.
Standard of Care -Federal regulations provide that nursing home residents should not develop pressure sores unless their clinical condition demonstrates that it is "unavoidable." See 42 C.F.R. 483.25.
Assessments-Since pressure sores can develop within 2 to 6 hours of the onset of pressure, at-risk residents need to be identified and have interventions implemented promptly. Research has shown that a significant number of pressure ulcers develop within the first four weeks after admission to a long-term care facility.*
* See Bergstrom N, Bennett MA, Carlson CE, et al. Pressure Ulcer Treatment.Clinical Practice Guideline. Quick Reference Guide for Clinicians, No. 15. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Pub. No. 95-0653. Dec. 1994.
Risk factors that increase a residents susceptibility to develop pressure sores include:
- Impaired/decreased mobility;
- Exposure of skin to urinary and fecal incontinence;
- Malnutrition, and dehydration;
- End stage renal disease, thyroid disease, diabetes mellitus, or peripheral vascular disease.
Prevention -
Decubitus ulcers are generally considered preventable and their development is oftentimes evidence of neglect in the areas of nutrition, hydration, hygiene, positioning and/or infection control. Prevention consists of changing the person's position every two hours or more often, if needed.
Treatment and Care -
Treatment of decubitus ulcers involves removing pressure from the affected tissue, keeping the area clean, promoting tissue regeneration and removing necrotic (dead) tissue, which can form a breeding ground for infection. The use of antibiotics when appropriate is also part of the treatment plan.
Infection/Death -
Individuals with pressure sores may develop bacteremia, sepsis, cellulitis, and/or osteomyelitis, which may result in death. Bacteremia and sepsis associated with pressure ulcers are commonly caused by staphylococcus aureus, gram-negative rods, or bacteroides fragilis. When patients with pressure ulcers develop clinical signs of sepsis (e.g., unexplained fever, tachycardia, hypotension, deterioration in mental status), urgent medical attention is required. Appropriate treatment requires obtaining blood cultures, treating with antibiotics that will cover these organisms and rule out other causes of the symptoms.
It is estimated that staff salaries comprise 70% (or more) of the cost of running a nursing home facility. Since nursing home staffing ratios are not closely regulated, personnel are cut to increase profitability.*
Report of U.S. Congress, Committee on Government Reform**
Over 30% of nursing homes in the United States were cited for abuse violations during the two-year period between 1999 and 2001.
More than 2,500 of the abuse violations during this two-year period were serious enough to cause actual harm to residents or to place residents in immediate jeopardy of death or serious injury.
The percentage of nursing homes cited for abuse violations in annual inspections doubled during the period from 1996 through 2000.
*D. Keene, ATLAs Litigating Nursing Home Cases (Oct. 2001).
** Minority Staff Report of the House Committee on Government Reform, Abuse of Residents is a Major Problem in U.S. Nursing Homes (July 30, 2001).
COMMON NEGLIGENCE, ABUSE and NEGLECT IN NURSING HOMES
- Understaffing of Nursing Homes.
- Failure to adequately supervise residents according to proper Care Plans.
- Failure to take adequate precautions to prevent falls.
- Failure to provide proper nutrition and hydration.
- Over-medication or under-medication.
- Failure to prevent pressure sores.
- Use of unwarranted restraints.
- Assault, physical and verbal abuse, and rape.
- Retaliation for making a complaint or filing a grievance.
RECENT CASES FROM AROUND THE COUNTRY
SETTLEMENT: $350,000 North Carolina
Injuries: Decubitus ulcer, infection, death
Nursing home was negligent in caring for a 78-year-old woman with pressure sores, which became infected. The patients family called an ambulance after nursing home staff failed to respond to their requests for help. The patient died at another nursing home following her discharge from the hospital.
SETTLEMENT: $240,000 New York
Injuries: Re-fractured hip, reconstructive surgery
A 69-year-old woman went into nursing home following surgery to repair fractured hip. Plaintiff was a high risk for falling and suffered from dementia. Nursing home failed to take adequate fall precautions and plaintiff re-fracturing her hip attempting to get out of wheelchair.
FREQUENTLY ASKED QUESTIONS
Q: What steps should be taken to investigate a nursing home claim?
A: The first step is to listen to your clients story. If there is any reason to suspect that there may have been abuse, neglect or negligent care, you should consult with an attorney experienced in nursing home litigation as soon as possible.
A thorough pre-suit investigation includes at least the following steps: obtaining and reviewing nursing home and medical records; photographing and videotaping evidence, interviewing witnesses, researching the facility, its ownership, corporate structure, and licenses; examining investigations and surveys conducted by state and federal agencies; researching prior disciplinary actions and previous lawsuits as well as consulting with experts in the fields of medicine, nursing and administration. Careful evaluations may take months and can be very expensive, depending on the nature of the allegations.
NEWS
Jeffrey Padwa testified before the Rhode Island Board of Health on October 28th regarding the proposed Rules and Regulations for Licensing of Assisted Living Residences.
Jeffrey Padwa attended recently the 28th Annual Meeting of the National Citizens Coalition for Nursing Home Reform, where he consulted with federal and state regulators, ombudsman, and attorneys from across the country.