Infections in Nursing Homes

Federal Government Attempts to Weaken Maryland Nursing Home Regulations Regarding Infectious Diseases

March 27, 2020 | Lebowitz & Mzhen

Nursing homes fill an important role in today’s society; as the population ages and life expectancy increases, more and more Americans are placing their loved ones in nursing homes to care for them when they are no longer able to care for themselves. Unfortunately, not all nursing homes are safe for residents, and sometimes residents may suffer abuse or neglect from the individuals tasked with caring for them. While the federal government has regulations governing nursing homes and standards of care, the current administration has recently attempted to loosen these regulations, causing concern for Maryland nursing home residents.

The proposal to relax regulations governing nursing homes was introduced in July of 2019 but has been drawing particular attention recently due to the coronavirus. According to an article in the New York Times, the federal government’s proposed changes would loosen regulations established during the Obama administration meant to curb deadly infections and diseases in nursing homes. Specifically, the rule would eliminate the requirement that nursing homes employ at least one specialist in preventing infections. Infection-prevention specialists are currently supposed to be at all nursing homes in the country, ensuring that employees are washing their hands and following other safety procedures. Their role is considered especially important when considering that, every year, about 380,000 nursing home residents are killed by infections.

While this proposed change is of concern even without the current pandemic, the coronavirus illustrates the vulnerability of nursing homes to infectious diseases. For example, one nursing home in Washington state has lost 13 residents to coronavirus, and dozens of other residents and employees have gotten ill. National reports indicate that the elderly are particularly susceptible to the coronavirus, with a significantly higher death rate than the general public. Additionally, those living in nursing homes are less able to practice social distancing, increasing their risk. Thus, advocates are urging the federal government to withdraw the proposed changes, which could lead to increased medical neglect, less infection control, and more illnesses and deaths in nursing home populations.

Protecting Maryland Nursing Home Residents During the Coronavirus Outbreak

March 20, 2020 | Lebowitz & Mzhen

Individuals across the world are beginning to experience the devastating impact of Covid-19, commonly known as the novel coronavirus. The new strain of the virus has been identified in every state and is linked to the death of over 150 U.S. residents. Out of these deaths, at least 40 are connected to a single nursing center in Washington, and residents of other long-term care facilities. The widespread exposure throughout these nursing facilities shines a light on the fundamental problems nursing homes have containing the spread of disease. Maryland nursing homes should take the necessary precautions to limit the spread of these types of fast-spreading diseases and infections.

The coronavirus shares some similarities to the flu in that it quickly spreads through person-to-person contact or through respiratory droplets. Further, although the flu can be severe and have high rates of mortality, experts have years of studying the flu and generally know what to expect each season. In contrast, relatively little is known about the new virus and the diseases it causes. However, it is clear that, like the flu, the disease is highly contagious and spreads quickly.

Maryland nursing homes should follow the Center for Disease Control (CDC) recommendations for preventing the spread of disease. These diseases thrive and spread quickly in confined spaces, such as, assisted-living facilities and long-term care facilities. Healthcare workers must follow strict procedures to prevent serious illnesses, injuries, and deaths to their residents. Nursing home workers should practice proper hand hygiene, wear protective equipment, restrict visitors from contacting infected patients, and prevent infected healthcare staff from contacting patients. Nursing homes that do not engage in these practices may be responsible for the spread and consequences of a virus.

Standards for Caring for Nursing Home Patients in Maryland

December 27, 2019 | Lebowitz & Mzhen

Nursing homes must meet certain standards in caring for their residents. The standards that must be met vary, depending on the jurisdiction and the local laws and regulations. Generally, the standards require that a nursing home must provide its residents with a safe environment and that it must exercise reasonable care in caring for its residents. In a Maryland nursing home abuse or neglect case, a plaintiff must show that the nursing home failed to meet its duty in properly caring for the resident under the circumstances. Courts may use different standards, such as national standards set forth for nursing home care and a nursing home’s internal policies.

Many nursing home cases involve neglect rather than intentional abuse. Examples of potential neglect include unsanitary living conditions and poor personal hygiene, which can cause sicknesses, especially to residents who are often already sick and elderly.

Almost 35,000 people die each year from drug-resistant infections, according to recent data from public health officials. The latest projection of deaths in the country is double the previous estimates, revealing the prevalence of drug-resistant infections, as one recent news source reported.

Jury Finds in Family’s Favor After Nursing Home Resident Dies from Toe Infection

April 21, 2017 | Lebowitz & Mzhen

Claims against nursing homes can arise in a variety of circumstances, including abuse, neglect, and failures to properly treat patients in their care. As a result, many of the claims against nursing homes and other long-term care facilities allege the facility was negligent in some way. As in any negligence claim, in a nursing home claim alleging negligence, a plaintiff must establish that the defendant owed a duty to the plaintiff, the defendant breached that duty, the breach caused the plaintiff’s injury, and the plaintiff sustained damages.

In nursing home claims, after a plaintiff proves that a nursing home owed a duty to the resident, the next issue is whether the defendant’s conduct fell below the standard of care. This is the standard that a defendant is expected to meet under the circumstances present in the particular situation. In some cases, a nursing home resident may die at a nursing home, but the home may not be at fault. Thus, in order to establish liability, a plaintiff has to show that the facility did not properly care for the resident, and this conduct led to the resident’s injuries. A recent case shows the type of evidence necessary to succeed in a nursing home negligence lawsuit.

Jury Awards Family $450,000 After Resident Dies from Infection

A jury recently found a rehabilitation center was negligent in its care of a blind, diabetic resident,
and it awarded the man’s family $450,000 in damages. According to one news source, the man, a 79-year-old retired tractor mechanic, died in November 2014, just a month after he was admitted to the center. The evidence presented at trial showed that the man was on dialysis and developed an infection in his big toe that turned gangrenous and that led to his right leg being amputated and ultimately to his death.

Nursing Homes Across the Country Shown to Be Hotbed for MRSA Virus

June 2, 2015 | Lebowitz & Mzhen

Late last month, an article by Newsmax Health conducted an investigation into a frightening statistic that the superbug MRSA can be found in roughly 25% of all U.S. nursing homes. According to the report, the largest contributing cause to the transmission of this antibiotic-resistant bug is contaminated gloves.

The article, working off a study conducted by Infection Control & Hospital Epidemiology, notes that there is a gap in education among nursing home employees regarding the transmission and seriousness of MRSA.

The study, which took place in Maryland and Michigan nursing homes, showed that in 28% of nursing homes the MRSA bacteria was present at some level. The largest contributors were glove- and gown-contamination, with glove-contamination being more prevalent. The study explains that washing hands and changing gloves between residents is crucial to stop the spread of the deadly disease.

Study Suggests Norovirus Poses Risk to Nursing Home Residents of Hospitalization or Death

October 26, 2012 | Lebowitz & Mzhen

A recent review of norovirus outbreaks in nursing homes found a correlation between outbreaks and higher rates of both hospitalizations and mortality among residents. While the correlation does not necessarily mean that the norovirus directly causes a greater number of hospitalizations or deaths, the data obtained by the study could prove useful in identifying risks faced by nursing home residents during outbreaks of communicable disease. This can in turn help nursing home administrators enact policies to protect and preserve their residents’ health and safety.

The norovirus is a highly contagious virus commonly associated with the stomach flu. It can affect anyone, regardless of age or general health condition, with symptoms ranging from stomach pain and nausea to acute gastroenteritis. People can contract an infection from other infected people, contact with contaminated surfaces, or ingestion of contaminated food or water. According to the Centers for Disease Control and Prevention (CDC), the norovirus sickens around 21 million people in the U.S. annually, and it is responsible for as many as seventy thousand hospitalizations and eight hundred fatalities per year.

The study, “Hospitalizations and Mortality Associated With Norovirus Outbreaks in Nursing Homes, 2009-2010,” was published in the October 24/31, 2012 online edition of the Journal of the American Medical Association. The researchers reviewed records from Medicare and the CDC for a period from January 2009 through December 2010 from three states: Oregon, Pennsylvania, and Wisconsin. Their review covered 308 nursing homes, with a combined total of 407 reported outbreaks of norovirus. The norovirus outbreaks lasted a median of thirteen days. Twenty-nine percent of the total number of reported hospitalizations and seven percent of the reported deaths occurred during reported outbreaks.

New Methods Available to Help Nursing Home Staff Track Life-Threatening Infections

October 17, 2012 | Lebowitz & Mzhen

Healthcare-associated infections (HAIs), generally defined as bacterial, viral, or fungal infections contracted by patients while receiving medical treatment, are a potentially major hazard for residents of nursing homes and other long-term care facilities (LTCFs). As many as 2.8 million LTCF patients may contract HAIs, some of them fatal, every year. A group of epidemiologists recently revised the definitions used in the surveillance of HAIs, providing new tools to document and track infections. The Centers for Disease Control and Prevention (CDC) has also issued new guidelines to help LTCF’s monitor HAIs. These new tools will hopefully help reduce the development and spread of infections among nursing home residents.

HAI Surveillance Definitions

In the October 2012 issue of the Society for Healthcare Epidemiology of America’s (SHEA) journal, Infection Control and Hospital Epidemiology, a panel of experts present a new set of definitions for use in monitoring LTCF infections. The existing set of definitions, known as the McGeer criteria, date back to 1991.

A group of experts led by Allison McGeer published a set of definitions in the February 1991 issue of the American Journal of Infection Control. The purpose of the McGeer criteria was to establish a uniform set of guidelines to monitor infections in nursing homes, such as standards for identifying newly-contracted or worsened acute infections that require monitoring.

According to the paper containing the revised definitions, the McGeer criteria work well in nursing homes providing non-acute care to older residents, but they do not necessarily address concerns faced in LCTFs providing acute care and care to younger patients. New types of nonhospital treatment facilities have appeared since 1991, so newer criteria for identifying and tracking HAIs is necessary.

Flu Vaccination of Nursing Home Staff Linked to Decline in Patient Flu Outbreaks

September 14, 2011 | Lebowitz & Mzhen

A study has identified a link between increasing rates of influenza vaccination among nursing home staff and decreasing rate of flu infection among patients. The study, which looked at 75 New Mexico nursing homes, found an 87% decrease in the likelihood of a flu outbreak in facilities where 51% to 75% of direct care workers received vaccinations. This supports earlier findings from the Centers for Disease Control and Prevention, which has encouraged healthcare workers to get vaccinated against the flu.

Interestingly, the study also found that high rates of vaccinations among nursing home patients led to higher odds of a flu outbreak in that home. Researchers suggest that this is due to lower rates of vaccination among staff in nursing homes with high rates of patient vaccinations. This finding would further support the conclusion that high rates of staff vaccination keeps outbreak rates low.

The Centers for Disease Control and Prevention (the “CDC”) currently recommends that healthcare workers obtain annual vaccinations against the flu. Their research found that only 13% of healthcare workers reported a requirement of vaccination from their employers. At the same time, a substantial majority of healthcare workers reported vaccinations being available at work, often at no charge.

Outbreaks of disease in the nursing home environment are a persistent concern. Officials at a nursing home in Turtle Creek, Pennsylvania are currently fighting an outbreak of Legionnaire’s disease that has sickened eight people so far. A 2009 study in Ontario, Canada found that, of the 83 disease outbreaks reviewed, 91% of them occurred in long-term care facilities. A 2003 study published in the journal Clinical Infectious Diseases found that one-third of the reports of infectious diseases from nursing homes involved sudden disease outbreaks. The study examined reports of respiratory infections, including influenza, tuberculosis, and pneumonia; gastrointestinal illnesses such as E. coli, salmonella and viral agents; skin infections; and antibiotic-resistant bacteria. The study concluded that the environment of nursing homes allows easy transmission of disease outbreaks, largely due to close living conditions, lack of proper diagnostic equipment, and the already-diminished health condition of many nursing home residents. Recommendations included greater management plans and surveillance of symptoms in patients to try to recognize diseases before they reach outbreak status.

Vaccinating nursing home staff against known contagions is an important step in this process. Nursing homes must also commit to maintaining a clean environment for its residents. Many infectious diseases can reach outbreak status in a nursing home simply due to a lapse in cleaning. Respiratory illnesses such as influenza are commonly transmitted directly from one person to another, but germs can also persist on various surfaces. An elderly individual, practically one with an already-suppressed immune system, who comes into contact with a contaminated surface risks infection.

Another Nursing Home Negligence Lawsuit for Madison County Home

August 25, 2011 | Lebowitz & Mzhen

A fourth nursing home abuse and negligence lawsuit has been filed this week against the owners of a Kentucky nursing home complex, after a resident allegedly suffered from inadequate care when her healthcare rights and safety were reportedly threatened.

According to a news development from the Richmond Register that our Maryland nursing home attorneys have been watching, Viola Fields was a resident of Kenwood Health and Rehabilitation Center from the end of October until the beginning of December in 2010. James Rutherford, Fields’ guardian, claimed that Fields, who is incapacitated and not of a sound mind, did not receive the minimum standard of healthcare that should have been available to her as a vulnerable nursing home resident. Rutherford claims that the home violated her nursing home rights as a long-term care resident.

The lawsuit accuses Kenwood of nursing home negligence for failing to provide Fields with timely and accurate nursing home healthcare and medication assessments, proper resident supervision, necessary medical intervention, and from failing to prevent accidental injury. Kenwood is also being accused of medical and corporate negligence.

Rutherford claims that the nursing home’s wrongful conduct caused the rapid deterioration of Fields’ health and physical condition, and led to the direct development untreated pressure ulcers, wound infections, sepsis, pneumonia, urinary tract infections and weight loss. The lawsuit accuses the home of acting with fraud, malice, gross negligence and reckless disregard for the health and safety of Fields and her rights as a nursing home resident. Rutherford claims that because of these injuries, Fields experienced physical impairment, and suffered embarrassment, along with incurring significant medical expenses.

Detecting and Preventing the Four Stages of Bedsores

July 26, 2011 | Lebowitz & Mzhen

In a recent Anne Arundel County nursing home blog, our attorneys reported on the problem of pressure ulcers in nursing homes, and the importance of detecting and treating bedsores before they develop into serious infections that could be life threatening.

Bedsores, or decubitus ulcers, affect nearly one million people in the U.S. causing around 60,000 deaths due to complications from the advanced development of the ulcers, like osteomyelitis or sepsis.

As reported in a related Baltimore nursing home injury lawyer blog, pressure sores often form due to nursing home negligence, when immobile residents, or residents who have difficulty moving, are confined to their wheelchairs or beds, restricting the blood flow on certain areas of the body where there is prolonged pressure, causing a lack of circulation and skin breakdown.

Pressure sores often develop in four stages:

• Stage I: When the skin on an area of the body starts to break down, it becomes discolored and red. This is an important stage for healthcare practitioners to identify bedsores, especially with at-risk residents, as pressure sores can be prevented and reversed if caught in the early stages.
• Stage II: The discolored area of a developing bedsore turns into a blister or scrape that forms a sore, resulting from the skin’s breakdown. If the sore does not receive immediate treatment, the skin will continue to deteriorate.
• Stage III: If the pressure sore is not cared for properly, the skin will continue to break down, causing significant loss of the soft tissue beneath the skin’s surface, forming a crater.
• Stage IV: The crater beneath the skin’s surface deepens, in many cases as large as a grapefruit or fist, where the muscle and bone along with tendons and joints, become severely damaged. Residents who suffer from Stage IV pressure sores often experience severe pain and frequent depression, and the massive ulcers can lead to illnesses like sepsis or osteomyelitis that can lead to wrongful death.