Saturday, November 12, 2011

Nursing homes report more felons

What happens when an elder applies to a nursing home who is a convicted felon or a dangerous criminal? What safety meassures are taken by the nursing home to protect the elder residents from predatory actions such as sexual assaults and criminal assaults? Shouldn't they be screened for the protection of all residents? Shouldn't residents families be warned about these types of admissions?
Nursing homes report more felons -

Pressure Ulcers vs Deep Tissue Injury vs Blisters

Our law office has handled several Pressure Sore, Pressure Ulcer cases where the defense tries to categorize a pressure ulcer as a "deep tissue injury" which was hidden and not visible to caregivers thereby excusing the caregivers from observing and treating the wound. They usually contend  that the wound popped up out of nowhere suddenly and in an advanced stage. In other words this wound was unpreventable and untreatable in its earlier stages because it was hidden under the surface of the skin. This defense distorts the definitions and progression of each type of wound.  Usually the actual progression of most skin disorders I have handled were in fact pressure ulcers and not hidden "deep tissue Inujury". Mischaracterizing a pressure ulcer as a deep tissue injury is usually an attempt to skirt the mandate of federal regulations regarding the prevention of bed sores. They are seperate and distinct skin wounds.

483.25(c) Quality of Care - Pressure Sores (also called Tag F314):
"Based on the Comprehensive Assessment of a resident, the facility must ensure that-
(1) A resident who enters the facility without pressure sores does not develop
pressure sores unless the individual’s clinical condition demonstrates that they were
unavoidable; and (2) A resident having pressure sores receives necessary treatment and services
to promote healing, prevent infection and prevent new sores from developing."

The National Pressure Ulcer Advisory Panel in 2007 redefined the definition of a pressure ulcer and
the stages of pressure ulcers, including the original 4 stages and adding 2 stages on deep tissue
injury and 1 on unstageable pressure ulcers.
A Pressure sore is defined in 2007 by the National Pressure Ulcer Advisory Panel (NPUA) as a
"A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony
prominence, as a result of pressure, or pressure in combination with shear and/or friction."
Pressure ulcers develop when capillaries supplying the skin are compressed enough to impede perfusion, leading ultimately to tissue necrosis. Without pressure over a bony prominence you don't have a pressure sore.

NPUA stated in 1998 that a Stage I pressure ulcer is an observable pressure related alteration of intact skin with indicators, as compared to an adjacent or opposite area on the body, which may include changes in one or more of the following: 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, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.  A pressure sore is visible or it is not a pressure ulcer by the 1998  definition.

A "Deep Tissue Injury", by contrast is defined in 2007 by NPUA as "Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear." The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue. Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

Note the distinction created by these definitions when examining a stage 2 pressure ulcer versus a "deep tissue injury":  A stage 2 pressure ulcer: "Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation." Note that NPUA indicates that *Bruising indicates suspected deep tissue injury.
Note also that Stage 2 pressure ulcers can appear as "blisters" but they are indeed stage 2 pressure ulcers not common or benign blisters.
The Hamill Law Group has 34 years experience advocating for injured people including those who have suffered from nursing home neglect, abuse or wrongful death. The Hamill firm represents elders victimized by criminal assaults,  pressure sores , falls , sepsis and malnutrition.  For more information contact the Hamill group at (617) 479-4300 or use the law firm contact form.

See update to Pressure Ulcers vs Deep Tissue Injury vs Blisters

Friday, November 11, 2011

Elder Abuse: Late-in-Life Surgery Excessive?

Surgery is ridiculousy common in older people during the last year, month and even week of life, researchers reported Wednesday. Are these types of surgery just another form of Elder Abuse?
The most comprehensive examination of operations performed on Medicare recipients in the final year of life found that nationally in 2008, nearly one recipient in three had surgery in the last year of life. Nearly one in five had surgery in the last month of life. Nearly one in 10 had surgery in the last week of life!
Do doctors too often operate on an elder who is a dying patient? And if so what pain and anguish does surgery entail? Who profits? The health care industry? At whose expense? The frail elderly patient who is dying? What dignity is lost by end of life unnecessary surgery? Will the the surgery improve or destroy the quality of their life at the end?
Lancet Report Cites Rate of Late-in-Life Surgery -

Thursday, November 10, 2011

Sweet Book of Williamstown Rehab (CareOne LLC) faces possible civil claim

Family of fallen resident recently hired the Hamill Firm to represent them to investigate a possible civil action against Sweet Book of Williamstown Rehab (CareOne LLC) .  John S., a 72 year old  resident died from fall related injuries in 2011 according to an autopsy.
Sweet Brooks latest nursing home performance surveys are discussed here. Sweet Brook scored in the lowest 5% percentile according to state performance survey results for 2011.The Hamill firm has successfully suited nursing homes for wrongful death and fall related cases.

Federal safety regulation 42 CFR §483.25(h) (Ftag 323)  "Accidents" requires that
The facility must ensure that -
(1) The resident environment remains as free from accident hazards as is
possible; and
(2) Each resident receives adequate supervision and assistance devices to
prevent accidents.

Sweet Book of Williamstown Rehab (CareOne LLC)