Pressure Ulcers

There are strict Federal and State regulations prescribing what steps a nursing home and its staff must take to prevent and heal pressure ulcers.  The regulations specify that no resident who enters a facility without pressure ulcers should develop pressure ulcers while at the facility unless it is “unavoidable.”  It is never unavoidable unless the ulcer develops despite adequate assessment, planning, implementation and monitoring of the resident’s condition.  Some residents may be more susceptible to pressure ulcers due to decreased mobility, diabetes or vascular disease, but even in those cases, pressure ulcers are usually avoidable with proper care and treatment.  Pressure ulcers range from Stage I ulcers, which are characterized by reddish skin following prolonged pressure, to Stage IV ulcers characterized by open sores which run through the skin and down into the tissue or bone beneath.  Pressure ulcers can become infected, leading to sepsis and death.  The bottom line is that in most cases, nursing homes should be able to prevent the development or worsening of pressure ulcers, and the regulations require that.  Ulcers occur because staff leave residents lying in one position or in urine or fecal matter too long.  This happens because some nursing homes are chronically understaffed, and CNAs simply do not have sufficient time to reposition residents frequently enough to prevent bed sores.  In addition, residents may be malnourished or dehydrated, thereby lacking the protein, caloric and water intake necessary to heal their skin.  Residents and their loved ones must be vigilant to make sure that nursing home staff are taking the necessary steps – the steps mandated by law – to protect against pressure ulcers.

New York Times: Doctors Say Medication Overprescribed For Dementia

The New York Times recently reported that doctors have found the anti-psychotic medications are overprescribed for dementia and alzheimers patients, particularly those who are residents of nursing homes. http://www.nytimes.com/2008/06/24/health/24deme.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1214618341-mX42KSg/N0jjqNLeiWyVYw

 

The Times reported that about one-third of all nursing home residents have been prescribed anti-psychotic drugs.  The drugs are often prescribed “off label,” because they have not been FDA approved for use by elders.

 

 

Soft Diets

There have been a number of nursing home residents who have choked and been injured or died as a result of the failure of the nursing home and its staff to follow orders to provide the resident with a soft diet or mechanical soft diet.  These diets are intended for residents who are unable for various reasons to consume certain difficult to chew and swallow foods.  For a more detailed description of soft diets, please see http://www.gicare.com/pated/edtgs35.htm.  Often, the reason that the diet is not followed is that there are insufficient staff or staff who are not adequately trained to meet resident needs.

Antipsychotic Medications

A recent study found that “elderly dementia patients prescribed antipsychotic drugs are at three times the risk of a serious health problem or dying within a month of treatment, compared to those not given the drug.” 

Strangulation Death & Cover Up

Here is a story about a woman nursing home resident in Mt. Vernon, New York who was asphyxiated and died when her head was caught in the bars of her bed after nursing home staff failed to lower the bed as required. http://www.wnbc.com/news/16320692/detail.html Other nursing home staff re-arranged the resident’s body in an effort to cover up their negligence. However, one staff member made an anonymous call to the government regulators to report the incident, and the regulators later investigated and confirmed the report.

$6 Million Verdict in Morphine Overdose Death Case

A jury in Tuscan, Arizona has awarded $6 million to the family of a nursing home resident who died from an overdose of Morphine. 

 

http://www.tucsoncitizen.com/daily/local/85219.php

 

This is just another example of the danger faced by nursing home residents from mismanagement and errors in administering prescription medications.   

GAO Report

The Government Accountability Office (GAO) issued a report this week showing that a substantial portion of surveys of nursing homes by state regulators failed to identify significant deficiencies.  The report indicates that “during fiscal years 2002 through 2007, about 15 percent of federal comparative surveys nationwide identified state surveys that failed to cite at least one deficiency at the most serious levels of non-compliance—actual harm and immediate jeopardy.”

 

The New York Times described the findings of the GAO report: http://www.nytimes.com/2008/05/15/washington/15health.html?_r=1&sq=nursing%20home&st=nyt&oref=slogin&scp=2&pagewanted=print

 

For the full text of the GAO report see:

http://www.gao.gov/new.items/d08517.pdf

 

Despite the findings in the report, Maine’s State surveyors performed better than most.  In fact, from 2002 through 2007, in twelve surveys comparing the State and federal survey results, Maine surveyors did not miss a single deficiency on the most serious levels of “actual harm” or “immediate jeopardy.”  However, on those same 12 comparative surveys, Maine surveyors missed 6 deficiencies with the potential for more than “minimal harm” to the nursing home resident.  Thus, on 50 percent of the comparative surveys analyzed by the GAO, Maine surveyors had missed at least one potentially significant nursing home deficiency.  In short, while Maine surveyors are doing better than most of their counterparts in other states, there is room for improvement.  The demands upon surveyors will only increase as Maine’s nursing home population continues to grow with the rapidly increasing elder population of the State.