Articles Posted in Nursing Home Lawsuits

Slip and fall incidents among elderly residents in nursing homes can be very serious, sometimes even deadly. One out of every three nursing home residents dies within 12 months of going to the hospital for a slip and fall.  That is just an insane statistic.  Our Maryland nursing home lawyers see too many nursing home fall cases with tragic outcomes. Nursing home negligence is often a major contributing factor when elderly residents fall and injure themselves. In most nursing home fall cases, the negligence involves poor facility maintenance (unkept hallways, wet floors, etc.) or negligent care by staff members (failing to put up bed rails, walking unassisted, etc.). In some cases, however, elderly residents fall because of underlying health conditions. Orthostatic hypotension (low blood pressure) is a health condition that is known to cause sudden falls among elderly nursing home residents. Nursing homes have an obligation to monitor their residents for conditions such as orthostatic hypotension and take appropriate precautions.

What is Orthostatic Hypotension?

Orthostatic hypotension (also known as postural hypotension) is a sudden drop in blood pressure that often occurs when someone gets up from a lying down or sitting position. The term “orthostatic” means an upright posture, and “hypotension” is the medical term for low blood pressure. The clinical definition of this orthostatic hypotension is when standing or sitting up causes blood pressure to drop more than 20 in systolic (top) and 10 in diastolic (bottom) pressure. So if blood pressure is dropping from 120/80 to 100/70 after standing up, this would be considered orthostatic hypotension. When a person sits or lies down, blood collects or pools in the legs or lower body. When a person gets up from this lying down position, the collection of blood in the legs means that there is less blood available to circulate to the heart and brain. This happens in people of all ages. In a normal, healthy person, specialized cells near the heart (baroreceptors) automatically sense this lowered blood pressure when standing up. In response, the baroreceptors are supposed to signal the person’s heart to pump faster and stabilize blood pressure. Orthostatic hypotension happens when this natural process of counteracting lowered blood pressure when standing up does not function properly. In a person with orthostatic hypotension, the baroreceptors do not trigger the appropriate response to counteract the low pressure when standing.

Our lawyers see a lot of pressure sore ulcer cases.  These bedsores come in many shapes, locations and sizes based in part on their etiology.

The hydrocolloid in DuoDERM helps provide absorbency and a “moist gel-like environment” that helps promote moisture to rehydrate, soften, and liquefy the tissue. On contact with the wound drainage, the hydrocolloid matrix forms a cohesive gel that supports moist wound healing.

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Antipsychotic medications (such as Abilify, Seroquel, Risperdal, and Zyprexa) are among the most commonly prescribed medications in the country. But a bombshell report released by Human Rights Watch has found that tens of thousands of elderly patients with dementia are being inappropriately prescribed antipsychotic drugs.

The study states that nearly 180,000 residents in long-term nursing facilities are receiving these unapproved medications. What’s more, it’s believed that roughly 15,000 nursing home residents die each year from anti-psychotic abuse. The use of these drugs against their intended purpose needlessly places vulnerable patients in harm’s way and speaks to a larger epidemic of overmedication in the United States.

Caring for Elderly Dementia Patients

Becoming a Special Focus Facility (SFF) is no honor in the nursing home industry. To be deemed an SFF is to be branded one of the worst nursing homes in the state when it comes to violations. Amid continuous speculation on the level of care being provided in nursing homes in general, homes which are in the SFF program are those most in the spotlight.

Special Focus Facility Program

Centers for Medicare and Medicaid Services (CMS) developed the SFF program back in 1998 to address the issue of poorly performing nursing homes and to strive to improve their performance. It started with each state labeling the two worst offenders to be added to the SFF list and in 2005 it increased that number to 6 slots per state.

The Journal of the American Medical Association (JAMA) released a new study on May 23rd about restraints in nursing homes. The article, Effects of a Guideline-Based Multicomponent Intervention on Use of Physical Restraints in Nursing Homes, detailed the problems with physical restraints in nursing homes—they are unsafe and often illegal or against the standard of care.

Types of Physical Restraints

Physical restraints are used for many reasons in nursing homes. Staff may be concerned that residents will fall out of bed or a wheelchair, will leave their rooms, or even leave the building (elopement). Staff might simply want an easier job—a restrained resident can, unfortunately, sometimes accomplish that goal. Approximately 20.4% of residents in United States nursing homes are forcibly restrained. Types of restraints include bed rails, belts, and wrist restraints.

There appears to be a correlation between antidepressant drugs (selective serotonin reuptake inhibitors or SSSIs) and falling injuries in nursing home patients who have dementia. The British Journal of Clinical Pharmacology released the results of a study that should make people take pause when approving certain medication for their loved ones who have dementia.

SSRIs are mostly used to treat clinical depression. There is a lot of debate over whether they are even effective—some studies show them to be no more reliable than placebos. (I think they probably work for some, but probably a minority, of patients.) SSRI antidepressants include:

• Paxil

A wrongful death lawsuit has been filed in Texas after a nursing home resident fell from her bed and suffered severe and eventually fatal neurological injuries.

The facts are awful. A woman was found on the floor, next to her bed, yelling for help. She was neurologically alert and coherent, but bleeding from head trauma, and in severe pain. According to the lawsuit, the woman was placed back in bed, where she was later discovered nonresponsive, taken to the hospital, and died from her injuries.

Plaintiff’s lawsuit alleges that contrary to the doctor’s orders, the woman’s bed was not in a low position, and floor mats and a bed alarm were not being used. Though she was a high fall risk resident, a care plan and nursing interventions (to prevent a fall) weren’t followed. The lawsuit further claims that the nursing home’s nurses were not adequately trained or apprised of the resident’s care plan.

Based on more than 70,000 nursing home residents, and 1 million non-institutionalized Medicare enrollees 65 years and older, it is being reported that the elderly “are frail and often have advanced medical problems, which puts them at higher risk of dying after surgery.” An example cited states that 12 out of 100 nursing home residents who had their appendix removed died within a month of the procedure, as compared to 2 out of 100 elderly people living on their own.

The study revealed that the death rates were consistently higher among people in nursing homes. Why is this? Researchers have said that we may be too aggressive with surgery in nursing home residents, that they are frail and often have advanced medical problems. This puts them at a higher risk of dying after surgery.

Over 36 million Americans are currently over the age of 65. By 2050, that number is expected to raise to 86.7 million. We have an estimated 1.4 million residents living in 16,000 nursing homes in the United States. Incredible statistics.

This problem did not sneak up on us. We all knew that our population was aging. It is a great thing. People are living longer and more productive lives. Today, 80 is the new 60. But there are byproducts of civilization’s leap forward. We keep saying we realize there is a problem with nursing home abuse and neglect. But the problem is getting better, not worse.

In nursing homes and assisted living facilities, the most common problem is not abuse, but negligence: care and treatment by nursing homes that just will not spend the time to provide a reasonable and humane level of care. Nursing home residents are also getting run over with overmedication (“Here, have some Seroquel”), and financial exploitation. The elderly are also at risk of improper monitoring and post-operative care, following their return to the nursing home after surgical procedures. Less common – but still all too common – is mental, physical, emotional and/or sexual abuse. Any of these things can have a devastating effect on nursing home patients. Old equals vulnerable in far too many cases.

A new study in the American Journal of Infection Control found that 15% of our nursing homes received poor marks for controlling infection.

Things are a little dirty. Okay. So what? The “so what?” answer makes you do a double take: infections kill 400,000 nursing home residents each year.

It is important to make clear that due diligence from the nursing home would not have changed the outcome for the vast majority of these people. Still. That is an incredible stat. The Internet provides so much great information but one of the great downsides is statistics are more meaningless than ever, even good statistics. If an unassailable study came out that said kids who have first names starting with the letter “S” scored 200 points higher on the SATs, people would start naming their kids Sarah and Steve for a few weeks and then everyone would forget about it.