Broward, Miami and Palm Beach Nursing Home Abuse Law Firm
As the nursing home population of this country has increased, so have the incidents of nursing home abuse. While there are some government oversight and regulation of these facilities, nursing home neglect and abuse has proven to be insidious. Current statistics put the number of abuse victims at over one million annually.
Nursing home abuse takes many forms. Active abuse may mean violence or sexual abuse, while negligence (far more common) is more subtle; withheld meals, dehydration, malnutrition, chemical restraints, improper medication, theft, bedsores and falls. All victims, whether subjected to repeated abuse or a one time incident deserves justice. Nursing home abuse litigation may lead to disciplinary action against specific staff members as well penalties for nursing homes in general. Please click on any of the topics below to learn more about nursing home abuse and how we may assist you:
Bedsores, Pressure Sores, Decubitus Ulcers
Choking/Aspiration of Food
Elopement/Wandering
Medication Errors
Nursing Home Falls
Malnutrition/Dehydration
Infections/Sepsis
Bedsores, Pressure Sores, Decubitus Ulcers
A bedsore or pressure ulcer is an area of skin that breaks down when a person stays in one position for too long without shifting their weight. This often happens to individuals utilizing wheelchairs or who are bedbound even for a short period of time. The constant pressure against the skin reduces the blood supply in that area, and the affected tissue dies. A pressure sore or decubitus ulcer starts as a reddened area of skin that can get progressively worse, forming a blister, then an open sore, and then finally a crater. The most common places for pressure ulcers to develop are either bony prominences (bones close to the skin) like the elbow, heels, hips, ankle, shoulders, back and the back of the head.
Are bedsores preventable?
Absolutely! Caretakers or nursing home staff must assess each patient individually as to the risk of development for pressure ulcers. Any individuals who are bedridden, have fragile skin, chronic medical conditions such as diabetes or vascular disease, malnourishment, mental disabilities such as Alzheimer’s disease or urinary incontinence are more prone to the development of pressure sores. Therefore, competent and regular turning and repositioning of the sick or elderly resident will prevent the development of bedsores. Turning prevents the buildup of pressure on the skin that can result in the development of bedsores. Turning is universally considered to be the most important factor in bedsore prevention. Yet, despite its universal acceptance, many facilities, including hospitals and nursing homes, fail to properly turn and reposition their residents. It can be labor intensive work because the patient needs to be turned at regular intervals. Turning of patients at least every two hours is usually considered to be the minimally accepted standard of care. In bed-bound residents, the staff should turn the patient to their side. If a resident spends most of their time in wheelchairs, the staff needs to lift the residents out of their chairs and reposition them for preventative purposes.
What are the stages of bedsores?
Bedsores or pressure sores are characterized by severity: From Stage I (the earlier sign) to Stage IV (the worst):
- Stage I: A reddened area on the skin that, when pressed, is “non-bleachable” (does not turn white). This indicates that a pressure sore is starting to develop.
- Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
- Stage III: The skin break down now looks like a crater or there was damage to the tissue below the skin.
- Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.
On rare occasions, references will be made to a bedsore that is "unstageable". An unstageable bedsore is usually an indication that a bedsore has advanced so far that a large area of skin, tissue and bone is involved.
Bedsores are a wide spread problem in nursing homes and hospitals. The development of bedsores is an indication of poor nursing care. Often times Nursing Homes tell the family of residents that bedsores cannot be prevented or are just a part of the ageing process. This is simply not true.
With careful assessment and bedsore prevention plans such as pressure relieving mattresses and turning and repositioning programs, bedsores can be avoided. However, the most important part of bedsore prevention treatment ultimately rests with the skill and dedication of the staff.
If you believe that a family member or a loved one has developed a preventable bedsore, contact us at Fenster & Cohen, P.A. and let us assist you.
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Choking/Aspiration of Food
Choking or the aspiration of food is a major concern and risk for elderly nursing home residents with cognitive difficulty such as dementia or Alzheimer’s disease. Stroke victims or individuals with swallowing disorders also face hazards from food. Many elderly residents require special diets and supervision while eating which needs are not met by nursing home facilities. It is the responsibility of the nursing home staff to identify those who may be at risk for choking.
If a nursing home resident has difficulty swallowing, the nursing home staff should provide soft foods, cut up food into small pieces and make sure the resident is in an upright position while eating. Most importantly, the nursing home staff should carefully monitor the residents during meal times to prevent choking. Choking incidents may result in injury, medical complications and death.
Meal times are when the nursing home residents are most reliant upon their caregivers. It is important that residents are attended by the staff that are familiar with their needs and ability. Too often, high staff turnover and understaffing lead to lapses in care. Most often, choking occurs when the resident is left unattended while eating their meals. The staff should monitor what the resident is eating, the amount of food consumed and whether the resident is swallowing properly to prevent choking or aspiration.
When choking incidents do occur, they are typically covered up and attributed to other causes. For example, the State of California in September 2008 fined an Anaheim Nursing Home $75,000 in the case of an elderly man whose death was reported for months as a heart attack- although he really choked on a tuna sandwich. The State Health and Human Service documents showed that the Anaheim Crest Nursing Center initially claimed that the victim died of a heart attack and did not disclose the sandwich incident until three months later and only after the coroner concluded that the resident choked to death. The victim was supposed to receive only pureed foods. According to state documents, the resident suffered from dementia and had two choking incidents that evening prior to his death. In the first incident, the patient was given the wrong diet even though there was a history of swallowing problems. Later that evening, the victim was left near the food cart where he grabbed a tuna sandwich and began to eat. He died within an hour. The staff at the nursing center did not try to clear his throat and provide appropriate emergency care.
The State of New York in 2008 fined the Crossings, a New York nursing home $13,000 for failing to provide emergency medical treatment to a resident who was choking. In that case, an 81 year old woman was left unattended by a nurse as she was eating her dinner. When the nurse returned to the woman’s room she found the resident with her mouth open, not breathing and her lips were blue. The nurse failed to call an appropriate “code blue” and the woman died.
Unfortunately, the State of Florida has not been vigorous in its regulation of nursing homes and assisted living facilities. Most adverse incidents are not aggressively investigated by the State. Even when negligence is found on the part of a facility, fines are either rare or low. In one of our recent cases, the State of Florida fined a Broward County Nursing Home $750 for violations which resulted in a death of a resident.Further, adverse incident reports and State investigative reports are privileged so that the family of residents are unable to obtain information which accurately describes the injury or death of their loved ones. As a result of such secrecy, these reports will not be admitted in evidence in any court proceedings arising out of the negligence of a nursing home.
At Fenster & Cohen, P.A. we have handled many choking cases where residents have died or became brain damaged as a result of food. In every case, the nursing home has not only failed to admit fault, but has claimed that the resident has either died from a heart attack or a stroke. It is only through aggressive representation and diligent inquiries from appropriate sources that these claims can be overcome. If you have a loved one in a nursing home or assisted living facility who has been injured as a result of choking or aspirating food, please call as and let us assist you.
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Elopement/Wandering
We have all heard news reports of elderly residents escaping from nursing homes or assisted living facilities unattended who have been seriously injured or killed as a result. Wandering or elopement" from a facility is a preventable occurrence which would never happen if appropriate safety measures are instituted. There are no excuses for a nursing home’s failure to keep residents who are prone to wandering from leaving the premises of the facility. Nursing homes that care for patients who are prone to wander or elope should have the following safeguards in place:
- Door alarms
- Window locks
- Door locks
- Bracelets that track each resident’s location
- Adequate staff to monitor residents
- Emergency plans to locate residents who may wander from the facility
"Wandering" refers to a cognitively impaired person moving about a nursing home or long term care facility without an understanding or appreciation for what they are doing. A nursing home resident’s propensity to wander should be identified in the initial care plan when the resident is first admitted to the facility. Residents who are most likely to wander are those who suffer from Dementia, Alzheimer’s, or who may be heavily medicated.
"Elopement" is when a nursing home resident leaves the nursing home itself without staff knowledge and gets into harm’s way. Elopement from nursing homes occurs among residents who suffer from dementia or who are on medications that cause confusion. Every resident should be assessed for these conditions and appropriate precautions should be undertaken to prevent residents who may be confused from leaving the facility.
If you have a loved one who may be prone to wandering, you must ask the administrator if safety measures are in place and functioning. When a nursing home agrees to provide care for a resident who is disoriented or has dementia, the nursing home implicitly agrees that they are able to proper care for that individual and they are responsible for providing that care. If for any reason a facility believes that it is not equipped to handle a particular resident, they should not accept that resident into the facility. If you have a loved one who has been injured or killed as a result of wandering or eloping from a nursing facility, please contact us at Fenster & Cohen, P.A. and let us help you.
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Medication Errors
Medication errors are unfortunately common in nursing home facilities and assisted living facilities. By some accounts, 1.5 million people are injured on an annual basis due to medication errors. Of these 800,000 are in nursing home facilities. In addition to giving the wrong medication or the wrong dosage of medications, there is a history of druggin residents to calm their behavior. Psychotropic medications such as Depacote, Zyprexa, Resperidol, Seroquel and Ativan have been known to be administered to residents who are "acting up". The practice of using medication to control behavior of residents is known as “chemical restraints”. A whopping 1/3 of nursing home residents have been prescribed antipsychotic drugs such as Resperidol, Seroquel and Zyprexa. In fact, prescription sales of these three drugs have more than tripled from 2000 to 2007. Dispensation of these drugs is often profitable for the facilities. Every time medication is given, it is an opportunity for a nursing home to charge. Most often the charges are attached on to the Medicare and Medicaid tab.
Further, the use of antipsychotic drugs has continued even though studies have demonstrated their ineffectiveness in Alzheimer’s patients with aggressiveness and delusions. The widespread use of antipsychotic drugs covers up the fact that most facilities are understaffed. It is far easier to have a patient down a couple of pills then to provide skilled nurses, psychiatrists and therapists to treat their underlying needs.
In addition to overmedication, the administration of the incorrect medication is also common place. We have had clients who have died at nursing facilities because the facility gave improper medication to the resident. We have had clients who have died as a result of an improper dosage of medication which caused respiratory depression and death. In order to insure that your loved one is receiving proper medication administration:
- Review each medication with the physician to determine its necessity.
- Make sure your list of medications is complete.
- Identify the condition for which each medication is prescribed.
- Determine the potential for any drug interactions.
- Determine the potential for any drug versus disease interactions.
- Can the drug regimen be simplified?
- Are there any newer, safer drugs available to substitute current medication.
- Is it possible to discontinue a medication?
- Try to have one physician prescribe all medications.
- Make sure each physician involved in the patient’s treatment is aware of each other.
The failure to provide medications is another hazard facing nursing home residents. Many situations that involve the failure to provide medications result from problems with a transfer of a resident’s medical chart from a hospital or facility where they were prior to their admission to a nursing home. Nevertheless, nursing homes have a responsibility to provide quality care to their residents. This includes conducting an assessment upon admission to insure all medical needs are met. Our office is currently working on a case where a Miami Nursing Home failed to provide insulin to a diabetic resident upon his admission to the nursing facility. As a result of the nursing home neglect, our client went into diabetic ketoacidosis which means that the individual does not get enough sugar into their cells. The failure to give insulin resulted in my client’s death even though this condition should have been diagnosed by the nursing home. The injuries and death from the failure to administer medication are completely preventable and result from nursing home staff neglect. If your loved ones have been a victim of over medication or improper medication administration, please contact the law firm of Fenster & Cohen for assistance.
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Nursing Home Falls
By some accounts, every elderly person in America will fall at least one time over the course of the next two years. Many of these falls cause injury and some will even cause death.
In the nursing home setting, many clients and their families focus their attention on tying a specific number of falls to a facility’s responsibility. There really is no magic number of falls necessary to establish neglect or negligence. Each case is unique and the facts and circumstances surrounding the injury must be considered.
In determining a nursing home’s fall related liability, it is important to determine not just the actual number of falls that occurred prior to the injury, but to look at the situation as a whole. Taking a look at a resident’s “fall risk assessment” completed by the facility on admission should help determine what safeguards should have been in place to prevent falls. In the case of multiple falls, it is important to look to see if a new assessment was completed after each fall. In other words, the facility’s action after a fall are just as important as the circumstances surrounding the fall itself.
Falls in nursing homes occur for variety of reasons. Some of the more common causes for fall are:
- Muscle weakness and walking or gait problems.
- Hazards in the nursing home-wet floors, poor lighting, improper heights, improperly maintained wheelchairs, equipment left out of place.
- Medications-drugs that effect the central nervous system, such as sensitive anti-anxiety drugs (psychoactive drugs).
- Improperly fitting shoes or incorrect walking aids.
- Frequent use of restraints.
- Inadequate staffing levels that fail to provide sufficient assistance to residents.
Each year, 1.8 million Americans over the age of 65 are injured in falls. According to the centers for disease, control and prevention, some rebound as if the injury never happened. But to some, the fall sets off a downward spiral of physical and emotional problems – including pneumonia, depression, social isolation, infection, blood clots and muscle loss – that becomes too much for their bodies to withstand.
Upon admission to a facility, a nursing home has an obligation to conduct an assessment of every resident to determine their risk levels for fall. A resident is at a high risk of falling when they have cognitive difficulties, physical difficulties, suffer from dizziness or are bedbound. In order to lessen the risk of falls, precautionary measures to prevent a resident’s fall may include:
- The use of the guardrails on the beds.
- The use of an alarm system to alert staff if the resident leaves their beds.
- The lowering of the bed itself to minimize the risk of injury from falling from an elevated height.
- An adequate number of staff to provide assistance.
- Moving a resident closer to the nurses’ station to increase supervision.
- More assistance in ambulation.
While Federal and State laws may specify a minimal staffing ratio, the fact remains that many nursing home residents who are at a high risk for falling need significantly more attention than the bared-bone staffing requirements. Nursing homes residents’ with dementia, Alzheimer’s, and low blood pressure are particularly susceptible to falls.
According to Charlene Harrington, a University of San Francisco, California Professor, who has studied nursing home staffing “only 5% of nursing homes around the US has adequate staffing”. What happens to the 95% of nursing home residents, who are exposed to chronic under-staffing, poor employee training and high staff turnover? More than 1,800 people die each year in nursing home falls.
In 2005, the last year for which statistics are available, 433,000 people over 65 were admitted to hospitals after falling, and 15,800 died as a result of the fall. Broken legs and broken hips are common. One in five hip – fracture patients over the age of 65 die within a year after surgery, according to the CDC; one and four have to spend a year or more in a nursing home. When younger people fall, they tend to break their wrists catching themselves, but in older people, who have slower reactions and less upper/body strength, the weight more often falls on their hips or heads. Any underlying conditions like heart disease or respiratory problems, increase the chances of a downward health spiral.
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Malnutrition/Dehydration
The failure to provide the most basic level of care can result in malnutrition and dehydration for elderly residents of nursing home facilities. It would appear to be rather obvious that facilities must provide basic food, water and a decent environment for the residents. However, the reality is that an overwhelming majority of nursing home injuries and deaths could be avoided if the facility provided this basic level of care.
If your loved one has sustained a fall during a nursing home admission, Fenster & Cohen, P.A. will provide a free case analysis to determine if a law suit against the facility is warranted. Why not put our experience advocating on behalf of the elderly to work for you today?
There are numerous cases where an elderly individual is admitted to a nursing home for care-giving responsibility and the resident is not properly fed or hydrated. If this occurs the resident can quickly develop dehydration, kidney failure and potentially infection. The failure to provide sufficient liquids to an elderly resident can have deadly consequences. Unfortunately, this happens far too often in nursing facilities where there is a failure to provide basic care to disabled or elderly individuals.
Two out of five nursing home residents suffer from some form of dehydration. Dehydration in a nursing home can occur for a variety of reasons, including diarrhea, the effects of medication, inability to perceive thirst, physical inability to drink or swallow and embarrassment relating to incontinence. In the vast majority of occasions, a resident’s dehydration is due to inadequate care. Common situations involving dehydration include:
- The failure of the nursing home to employ adequate staff, which results in the staff’s inability to properly feed the residents.
- The failure of the staff members to pay adequate attention to those residents needing assistance with eating.
- Failure to properly educate the staff on nutrition and feeding methods.
- Failure to provide proper supervision over those who provide nutritional services.
In addition to monitoring a resident’s intake of food, the staff should be on the lookout for the following signs of dehydration:
- Dark yellow urine
- Sunken eyes
- Ashen skin
- Dry skin
- Bleeding gums
- Urinary tract infection
- Weight loss
It is not too much to ask that a nursing home provide necessities such as water to the residents. Some states have even classified dehydration deaths as homicides.
Malnutrition is also a far too common occurrence in these facilities. They can occur for a variety of reasons including the resident’s inability to process food in ill-fitting dentures. These are risks which must be considered by the nursing facility in developing appropriate nutrition and diet plans for the resident. It may be necessary to utilize liquid supplements as opposed to making sure that each resident needs enough food to get necessary vitamins, minerals, protein and calories.
If you notice that your loved one has signs of malnutrition or dehydration or if you think they are not getting enough food or fluids at the nursing home, you should immediately notify the nursing staff and the physicians to prevent potentially serious, life/death threatening consequences. If your loved one has been injured as a result of malnutrition or dehydration, please contact Fenster & Cohen, P.A. to assist you in this matter.
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Infections/Sepsis
MRSA (methicillin-resistant staph aureous) infections in nursing homes have increased dramatically over the past 15 years. In fact, a sampling of 1,111 residents and 553 staff in 45 nursing homes revealed 24% of residents and 7% of the staff were MRSA carriers. MRSA is a form of staph bacteria that is resistant to most antibiotics. In the older population, the ineffectiveness of certain drugs is dangerous because it weakens their immune system and there is more difficulty fighting off serious infections.
Most strains of MRSA can still be treated with the antibiotic “Vancomycin”. However, new strains of drug-resistant MRSA has now become more prevalent and the use of Vancomycin to treat MRSA is becoming less effective. Most MRSA outbreaks or infections can be averted if health care professionals wash their hands, use hand sanitizers and keep wounds covered with dry bandages.
Another risk of infection in nursing homes is the development of infection in central venous catheters. A central venous catheter is a tube usually inserted in an arm or chest and threaded through a vein until it reaches a large vein close to the heart. Central venous catheters are used to administer medication, supply nutrition or blood products to a resident. More than 40% of blood stream infections are related to people with central venous catheters. An estimated one to five percent of people with central venous catheters who get an infection die from them. Infections can typically be avoided if catheters are flushed regularly and sterile technique and conditions are maintained. If you have acquired a blood infection during your hospital or nursing home stay, do not assume the condition was inevitable. Infections from catheters can be avoided.
"Sepsis" is a bacterial infection in the blood stream or body tissues. Sepsis is a common medical condition which accounts for:
- 1-2% of all hospitalizations
- 25% of all intensive care visits
- 10% of deaths in facilities
In most cases, the treatment consists of antibiotic and surgical drainage. Sepsis most commonly results from pressure sores or urinary tract infections in the nursing home setting. Interventions with antibiotic therapy is the key to successful treatment.
If your loved one has developed a serious infection in a nursing facility, please call Fenster & Cohen, P.A. to discuss your specific circumstances and whether we can be of assistance to you and your family.
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If you or a loved one is in need of legal assistance, call Fenster & Cohen, P.A. (954) 845-8989, (561) 737-7789 or (877) 845-8989 or submit an online questionnaire. The initial consultation is free of charge, and if we agree to handle your case, we will work on a contingency fee basis, which means we get paid for our services only if there is a monetary recovery of funds. In many cases, a lawsuit must be filed before an applicable expiration date, known as a statute of limitations. Please call right away to ensure that you do not waive your right to possible compensation.