Articles Posted in Bedsores, Pressure Sores, Decubitus Ulcers

The U.S. Nursing Home rating system was introduced twelve years ago, providing for ratings from one to five stars. It was meant to provide a way for people to evaluate and compare nursing homes for their loved ones. However, an investigation by the New York Times recently revealed that the rating system is not an accurate reflection of the quality of care given at a nursing home. The investigation found that many nursing homes have manipulated the system to improve their ratings and hide problems, raising serious concerns for Maryland nursing home residents.

The rating system is based on a combination of self-reported information and on-site inspections. The investigation found that the information submitted to the Centers for Medicare & Medicaid Services (C.M.S.) is often wrong, making facilities appear cleaner and safer, and that the government rarely audits the data provided through self-reporting. Accidents and health issues are often unreported, it also found. Abuse and neglect were discovered through inspections at five-star facilities, but the inspectors rarely found the infractions serious enough to lower the ratings. A previously conducted study from the University of Chicago found that nursing homes did not report about 40 percent of residents who were hospitalized after serious falls.

It also found that the nursing homes were not prepared for the pandemic in part because the rating system allowed them to ignore staffing requirements and infection-control deficiencies. Over 13,000 nursing home residents have died due to COVID-19. The Times found that residents at five-star facilities were about as likely to die due to COVID as residents at one-star facilities. At some nursing homes with five-star ratings, “residents developed bed sores so severe that their bones were exposed.” The son of a resident at a five-star facility on Long Island who died from COVID-19 in the spring believed that the facility was short-staffed or overcrowded because before contracting COVID-19, his mother was moved from a private room into one with other residents.

Last month, an appellate court in Georgia issued a written opinion in a case brought against a hospital involving allegations that the hospital was negligent in allowing the plaintiff to develop a stage IV bed sore. Ultimately, however, the court rejected the plaintiff’s case because the required expert affidavit that was filed along with the case failed to comply with state-law requirements.

The Facts of the Case

The plaintiff was admitted to the defendant hospital while he was unconscious. While he was being treated by the hospital, he developed a stage IV pressure ulcer near the base of his back. The plaintiff filed a personal injury lawsuit against the hospital, claiming that the hospital staff was negligent in failing to assess and treat the pressure ulcer and to properly care for him while he was unconscious.

As is the case in Maryland, under Georgia state law, medical malpractice plaintiffs must submit an affidavit in support of their claim. Essentially, the affidavit must come from a medical profession in a relevant field, and it must “set forth specifically at least one negligent act or omission claimed to exist and the factual basis for each such claim.”

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A recently published news report discusses the tragic story of an 88-year-old man who passed away in August 2015 after developing gangrene in two improperly untreated pressure wounds, or bedsores, that significantly worsened while he was living at a nursing home. According to the report, the deceased man’s daughter-in-law discovered the wounds while visiting her father at the nursing facility and requested that he be taken by ambulance to a hospital for immediate treatment. Despite the request, the nursing home staff refused, insisting the wounds were minor and manageable. Against the advice of the nurses and employees at the nursing home, the resident’s daughter took him to the hospital herself.

The Man Was Not Hospitalized Soon Enough and Succumbed to a Gangrene Infection

Although his daughter took matters into her own hands and hospitalized the man after she discovered what appeared to be severely infected pressure wounds, the action was not taken soon enough to save his life. By the time the man arrived to the hospital, the infection had taken over, and his organs were shutting down. He passed away shortly after he was admitted. Seeking answers and compensation for the apparent negligence of the nursing home, the man’s daughter pursued elder abuse and nursing home neglect claims against the nursing facility. According to the report, the daughter alleged that the medical professionals and support staff at the nursing home failed to properly prevent, diagnose, or treat his condition, ultimately resulting in his death.

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The executor of a deceased former resident’s estate has filed a wrongful death claim against a Chicago area nursing home on behalf of the woman’s surviving family members. According to a local news source, the family is seeking damages for the woman’s wrongful death, which was allegedly caused by the negligence of the employees and management of the nursing facility where she died. The lawsuit was filed on August 10 in Illinois state court and is seeking over $50,000 in damages, according to the news source.

The Plaintiffs Allege that the Defendants Failed to Adequately Supervise the Condition of the Deceased Resident

The plaintiffs in the case of Rodriguez v. Aperion Care International are the surviving family members of a woman who died earlier this year while living at a nursing home facility operated by the defendants. According to the allegations discussed in the news article, the woman died after suffering from skin breakdown and pressure ulcers that she developed while bedridden at the defendant’s facility. These conditions, which allegedly led to her death, are commonly known as bedsores and are generally preventable if residents are cared for properly.

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Earlier this month, two studies came out of the University of Maryland that examined why many nursing homes are providing inadequate care to their residents. The answer will probably not surprise many who have stayed in a nursing home themselves or had a loved one stay in a nursing home: The studies show that high turnover rates among staff members have a detrimental effect on overall nursing home quality, as well as the quality of care offered by the nursing home.

A recent article by Infection Control Today details a few of the studies’ findings, including one that suggests high Certified Nurse Assistant (CNA) turnover results in an increase chance that a patient will suffer from a pressure ulcers, pain, or a urinary tract infection. The basis conclusion of both studies is that preventing nursing home staff turnover should be a higher priority for nursing home management.

Nursing Home Management in Maryland

While these studies indicate that an increase in CNA turnover increases the odds of health problems in nursing home patients, the fault does not all lie with the individual CNAs. Nursing home management is charged with making many of the staffing decisions that lead to the high turnover in the first place. If nursing home management does not create a healthy, pleasant working environment, high turnover is inevitable.

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The Maryland Attorney General announced last month Maryland has reached an agreement with

with Healthpoint and DFB Pharmaceuticals, its partner. The settlement, to which fifteen additional states and the federal government are also plaintiffs, is a result of allegations that Healthpoint was responsible for causing false claims to be submitted to the Maryland Medicaid programs for one of its products called Xenaderm. Xenaderm is a skin ointment that was prescribed to many nursing home, and potentially other, patients for the treatment of bed sores. However, the drug has not received the required approval from the Food and Drug Administration (FDA).

The various complaints related to the settlement alleged that Healthpoint unlawfully marketed Xenaderm without FDA approval. The allegations further claimed that this marketing was modeled upon a drug created some time before 1962, which itself had received review from the FDA. The FDA ruled in the1970s that the principal ingredient in Xenaderm was “less than effective” for treating bed sores, its intended use. The defendant(s) allegedly misrepresented the drug’s regulatory status repeatedly in reports that it submitted to both federal and state agencies.

Subject to terms of the $48 million settlement, which is to be awarded to 47 states and the federal government, defendants Healthpoint and DFB Pharmaceuticals will have to pay roughly $33 million to settle Medicaid-based claims nationally. Maryland itself will receive nearly $350,000 in refunds to the state’s Medicaid program, which accounts for the improper payments on behalf of both the state and federal governments.

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Pressure sores or ulcers, which are commonly referred to as bed sores, are probably among themost common sort of potential new injury incurred by nursing home patients who are incapable of moving about freely. While they can be annoying or painful, they can also become infected and lead to a vast array of additional complications for nursing home residents. Perhaps most importantly, they can be prevented.

It’s for this reason that federal law makers have passed regulations for nursing home facilities which address this problematic complication.

42 CFR § 483.20 entitled “Resident Assessment” requires a comprehensive assessment of the resident. While this blog post focuses on the skin care assessment and bed sore prevention, the facility is required to assess 17 other factors, all related to the patient’s condition upon entering the facility. The facility has 14 days from the person’s arrival to complete this assessment, and it then has 7 days from the completion of the assessment to develop a care plan addressing the patient’s various needs.

42 CFR § 483.25 Quality of Care, explicitly addresses what must be done in regards to bed sores specifically. It states that based upon the comprehensive assessment, the facility must ensure that:

  • A resident who enters the facility without bed sores does not develop them (unless the person’s individual medical condition makes them unavoidable); and
  • A resident who does have bed sores must receive proper treatment and/or services to promote the healing process, prevent infections from developing, and prevent new sores from happening.

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A nursing home in Hyattsville, Maryland has been under investigation by state health officials for more than a year following multiple allegations of neglect, including at least one death. The number of complaints and cited deficiencies led the state to put the nursing home on a national register of nursing homes with poor track records. Although the nursing home has faced fines totaling thousands of dollars, state officials claim that it has not resulted in improvements to care at the facility.

According to WTTG News in Washington DC, the St. Thomas More nursing home received sixty citations from state health inspectors in 2010 for deficiencies. It received thirty-six citations in 2011, and it has received twenty-seven in 2012 as of mid-November. The state’s Office of Health Care Quality (OHCQ) has reportedly cited it for deficiencies such as medication errors, residents’ rights violations, and failure to follow patient care plans. About three months ago, according to one complaint, a patient died after nursing home staff failed to provide adequate emergency medical treatment. A medical malpractice lawsuit accused the nursing home of negligence in the 2005 death of a resident from bedsore-related complications. The nursing home settled the suit in 2011 for an undisclosed amount.

WTTG reported the story of James Franklin, a former patient at the facility who allegedly nearly died from injuries similar to those of the decedent in the lawsuit mentioned above. Franklin went to St. Thomas More after a hospital discharge, and at the time of his admission, medical records reportedly showed that he had a bedsore described as “small and healing.” Franklin returned to the hospital a month later, where the bedsore was found to have grown to cover a large section of his back and buttocks. The wound had turned gangrenous, and infection had spread deep into his tissues. He was in septic shock and at risk of imminent death. He is reportedly recovering at a different nursing home, but still has health difficulties resulting from the bedsore. Franklin’s wife filed a formal complaint against St. Thomas More with OHCQ. An investigation of Franklin’s case by state health officials reportedly found no evidence of abuse or neglect, but the Franklins are persisting in their claims.

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A new study suggests that previous beliefs regarding certain dementia patients’ use of feeding tubes are incorrect. Feeding tubes, the belief went, could rectify nutritional imbalances and therefore aid in the healing of pressure ulcers, also known as bedsores. Research has generally been inconclusive, but this new study appears to disprove the premise entirely.

Patients reviewed in the study who had bedsores when receiving the feeding tube showed no improvement, and patients who previously lacked bedsores before were more likely to develop them with the feeding tube. The study’s conclusions are important to nursing home residents, their families and loved ones, and those who advocate for their safety.

The study looked at hospital records for patients with advanced cognitive impairment, commonly known as dementia, who had a percutaneous endoscopic gastrostomy (PEG) tube inserted, and were then returned to the nursing homes where they live. The purpose of the feeding tube is often to correct nutritional imbalances in the patients, who may suffer from eating disorders brought on by dementia. The study’s lead author has also said that nursing homes and hospitals, looking to cut expenses where possible, may view feeding tubes as a good investment, even if they are not strictly medically necessary. Using feeding tubes in residents suffering from dementia frees up staff members who might otherwise have had to feed those residents by hand.

The study’s findings indicate that not only does the use of feeding tubes not improve a patient’s recovery from bedsores, but that these devices may actually put patients more at risk for having bedsores. Nursing home residents who had no bedsores upon arriving at the hospital were 2.27 times more likely to get a bedsore after getting the feeding tube. Among residents who already had bedsores when they received their feeding tube, researchers found that the bedsores were less likely to heal.

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A Colorado jury ruled for the family of a man who died due to complications from bedsores. The family of Henry Frazier sued the nursing home where the man lived, alleging that staff members’ neglect caused Frazier to develop the bed sores, and that the nursing home failed to notify the family of his condition. The jury awarded the family $3.2 million for Frazier’s wrongful death.

Frazier first entered Pioneer Healthcare Center in Rocky Ford, Colorado in May 2009. For a time, he reportedly worked as a janitor at the center, although he suffered from Parkinson’s Disease and had difficulties with mobility. His family, including his wife and adult children, visited him often, with his wife spending two to four hours a day with him. Despite this, the family was not made aware of the injury that would take Frazier’s life until it was too late.

The bedsores began to develop in September 2010, when he was no longer able to move about the facility. Frazier stopped eating or drinking. Confined to his bed, he became “unresponsive.” By early October, Frazier had reportedly developed severe bedsores on his buttocks and scrotum, according to a nurse’s aide who gave this information to Frazier’s son. The nurse’s aide said that he was concerned that he might lose his job for speaking out, but he was also afraid for Frazier’s life. The bedsores had become infected and gave off a foul odor.

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