Physical and Chemical Restraints – Friend or Foe?

It is a common practice among nursing homes today to use restraints, both physical and chemical, to medically treat a patient.  Not all restraints are illegal, as there are proper as well as improper uses of restraints.  Restraints are used correctly when they are used to keep patients safe or to treat medical symptoms.

Nursing homes often think that the use of physical restraints is necessary to improve the safety of their patients.  However, current research suggests the exact opposite, that they cause more risks than benefits.  Nursing home patients will often not understand why they are restrained.  They become agitated and anxious, and will squirm and wiggle to attempt to get out of the physical restraint, sometimes causing them extreme physical injury.  Many patients who try to escape the physical restraints die from strangulation or become seriously injured when they are trapped in bedrails or fall from their beds.

Chemical restraints are achieved through the use of drugs in order to control the patient’s behavior or restrict his or her freedom.  Some of the most commonly used sedatives are Haldol, Xanax, Risperdal, Benzodiazepine, Lorazepam, Mellaril or Navine.  Nursing homes may attempt to use these drugs to intentionally sedate a resident who is more active, as opposed to using safer alternatives (such as redirecting residents, providing activities that stimulate the residents’ attention, talking with the resident in a calm manner, providing a calm environment and staff that doesn’t stress the resident).  The prescription of psychoactive drugs to control the patient’s behavior without adequate medical justification is illegal.

As the media continues to report instances of improper use of physical and chemical restraints used on nursing home patients, they bring a common nursing home abuse issue to the forefront.  Improper use of restraints can lead to serious emotional injuries, in addition to a number of physical injuries, including bed sores, bruises, fractures, and in the most serious cases, wrongful death.  Many nursing home abuse lawsuits stem from improper restraints used against nursing home patients.

York Law Firm has obtained numerous settlements and verdicts on behalf of our nursing home clients who have sustained injury due to improper use of restraints.  Recently, we achieved a confidential settlement for elder neglect against a nursing home on behalf of a 90 year old female nursing home client who was killed due to the asphyxiation caused by the nursing home’s use of improper physical restraints.  If you are concerned about physical restraints or drugs being used to control/sedate your loved one, please contact York Law Firm at (916) 643-2200.  We are here to help.

York Law Corporation
Sacramento, California
www.yorklawcorp.com
Call today: (800) 939-1832
Local: (916) 643-2200

Water, Water Everywhere, but Not a Drop to Drink

Imagine this – you are left in a room with no access to water or you are incapacitated and have had no fluids for several hours or even days.  Worse yet, you are taking medications that also have a diuretic effect and your body is thirsty for fluids.  The only way to replenish any fluids that your body so badly needs is to call for an attendant, but you can’t communicate and no one checks up on you.  What then?

This is too often the case for many nursing home patients.    Dehydration is one of the most common ailments resulting from elder neglect.  It occurs when a patient is not given enough fluids and, as a result, is unable to perform normal body functions.  When a person is dehydrated, his or her body has lost too much fluids and electrolytes.  While dehydration in general is harmful, it is especially so among the elderly as they are more susceptible to contracting urinary tract infections, pneumonia and bed sores.  If the patient is extremely dehydrated, death can occur.

Dehydration can also lead to a severe medical condition called hypernatremia.  Hypernatremia is an electrolyte problem characterized by a decrease in total body water relative to the body’s total sodium levels.  It is caused when the total water intake is less than the total water loss or when a person receives inadequate water intake.  A major symptom of hypernatremia is thirst, but other clinical manifestations can exist including confusion, seizures and coma.  In critical cases, hypernatremia can lead to organ failure.

With nursing homes that are understaffed, overworked, and improperly trained, it is no wonder that dehydration is so prevalent in nursing homes today.  Nursing home patients cannot monitor their fluid intake themselves, often requiring assistance taking fluids.  The responsibility of carefully monitoring and administering necessary fluids to patients falls on the nursing home facility and its employees.

Yet, many nursing home employees do not properly administer fluids to their patients.  This can be a result of carelessness (when employees forget to give their patients fluids), leaving water beyond the reach of their patients, or relying on the patient to drink the water him or herself when the elder is simply incapable of doing so.  They can also create situations which increases the risk of dehydrating the patient, such as exposing the older individual to hot temperatures or not identifying drugs that act a diuretic.  Dehydration can also be caused by excessive fluid losses due to illness, or even side effects from medication.  Diarrhea is the most common cause of dehydration, and vomiting also leads to loss of fluids.

The best way to treat dehydration is to prevent it from occurring.  When patients are bedridden, they cannot be left in their room for hours or days at a time without a nursing home employee carefully monitoring them and administering proper fluids.  They must also be sure not to cause dehydration by leaving patients in hot rooms without water, to make sure all water that is given to patients is within reach and that the patient can drink it (and, if not, the staff must assist the elder), or giving the patient drugs that are diuretics without replenishing the fluids lost.

York Law Firm understands the importance of caring for nursing home patients to enable them to thrive.  When dehydration occurs, injuries resulting reduce their ability to thrive, and may even cause their death.  That’s why York Law Firm is so dedicated to helping patients of nursing home abuse.  If your loved one is a nursing home resident who has suffered injury as a result of dehydration, contact one of our many experienced elder abuse attorney to determine whether you are entitled to recovery.

York Law Corporation
Sacramento, California
www.yorklawcorp.com
Call today: (800) 939-1832
Local: (916) 643-2200

What Nursing Home Facility is Right for my Loved One?

Choosing a nursing home facility is a daunting task.  There are reasons why nursing homes are deemed undesirable – many provide inadequate care, and smell like urine and death.  Here are some steps you can take to ensure that your loved one is receiving the best possible care.
First, get a durable power of attorney for medical care so that you can make health care decisions and review medical records for your loved one.

Second, request a complete facility profile from the State Health Department, Licensing and Certification Department for the facility you intend to use. For more information, visit the website for the California Department of Public Health, or call them at (916) 558-1784.

Third, visit the surrounding facilities.  Pay attention to staffing levels – are their sufficient staff meeting the needs of residents?  Notice how many people in the facility seem overmedicated, excessively sleepy or in bed or unable to walk or talk.  If many patients fall into this category, be wary of overmedication at the facility, especially with the psychotropic drugs Haldol, Thorazine, Thiothixene, Droperidol, Fluphenazine, Midazolam, Benzodiazepine, Lorazepam, Mellaril and Prolixin.

Fourth, when reviewing the Admission Agreement, do not agree to and do not initial any arbitration clause.  An arbitration clause is a provision in the admission agreement that tries to force families to waive your right to a jury trial for any potential claims you or your loved one might have against the nursing home.  You are not obligated to agree to or initial an arbitration clause as a condition to having the patient be admitted to the facility.  Arbitration clauses are not favorable to consumers, as it is a waiver of your right to a jury trial and potentially limits your ability to hold a nursing home accountable for neglect or abuse.

Fifth, visit your family member at different times during the day, including meal times. Take notice of the types of food and nutritional balance. Dehydration can lead to major problems (hypernatremia, neurological losses, increased risk of developing bed sores, death).  So always make sure that water is available at all times and that it is easily accessible to the resident.  If your loved one cannot access water due to a disability or limitation (e.g., blind, hand injury, etc.), consult with the nursing facility so that a care plan can be addressed to ensure that your loved one receives adequate fluids throughout the day.

Sixth, be involved in care conferences.  Tell the Administrator or Director of Nurses that you want to be informed of and present at all care conferences to know what the plan of care is for your loved one.

Take seriously any complaints the patient has about mistreatment by the staff, such as “they pull my hair” or “they are mean to me.” Don’t accept the facilities’ statement that the patient is old and doesn’t know what is going on.

Report any signs of bad care to the state licensing office in your state that licenses and regulates nursing homes. Be sure to follow up on the complaint to insure accountability.  The California Department of Public Health’s number is (800) 236-9747, or you can fill out a formal complaint online.  You can also contact your County hotline to report instances of abuse.

Do not be intimidated by threats from the facility such as kicking the patient out of the facility because of complaints or the facility’s refusal to cooperate with requests for information.

York Law Firm is dedicated to providing people with the knowledge to avoid nursing home abuse of their loved one.  If you do need an attorney to help protect your legal claim, we encourage you to contact us.  We specialize in nursing home abuse cases.

York Law Corporation
Sacramento, California
www.yorklawcorp.com
Call today: (800) 939-1832
Local: (916) 643-2200

Medicare Attempts to Reduce Health Care Costs and Promote Patient Safety

Certain types of medical errors should never happen.  According to the California Association of Health Plans, preventable medical errors are a leading cause of death in the United States, resulting in over $4.5 billion in additional health spending annually.  Beginning in October 2008, in an attempt to increase and promote safety and wellness and to reduce health care costs, Medicare, Aetna, and other major health care insurers have banned payments for “never events.”  Specifically, Medicare no longer provides additional payment to hospitals unless the events were present at admission. Think about it, it makes sense – why should Medicare insure hospitals and nursing home facilities for events that should never have happened in the first place?

“Never events” are conditions that could have reasonably been prevented.  There are 28 preventable adverse health events that are listed as “never events.”  To be a “never event,” an event must be characterized as the following:

• Unambiguously identifiable and measurable;
• Preventable; and
• Resulting in serious injury or disability, or even death.

Not surprisingly, among the list of “never events” is stage 3 or 4 pressure sores acquired after admission to a healthcare facility.  Pressure sores, also known as pressure ulcers or bed sores, are a result of hospital or nursing home neglect.  When a person is bedridden or in a wheelchair for an extended period of time, circulation is cut off to parts of the body and the sustained pressure creates areas of damaged skin and tissue.  Prolonged pressure on one area of the body can quickly develop into pressure sores.

So why are pressure sores listed as “never events”?  Because all it takes is an attentive caregiver to reposition the patient to eliminate the risk of developing one, along with proper hydration and nutrition.  Pressure sores are an unequivocal sign of neglect.  They wouldn’t happen were it not for the hospital or nursing homes failure to reposition the patient.  Period.

York Law Firm believes this is the first step of many steps to prevent nursing home abuse and neglect.  We understand that pressure sores are extremely dangerous to elders, as they can rapidly progress and can become infected, causing systemic infection and even death.  Unfortunately, too many of our nursing home clients have sustained bad pressure sores, and we have helped them understand their legal rights, held the nursing home accountable and have obtained compensation for their injuries.

York Law Corporation
Sacramento, California
www.yorklawcorp.com
Call today: (800) 939-1832
Local: (916) 643-2200

Adapting to Changing Needs: When a Residential Care Facility is Inadequate

Your mom and dad are getting older, and can no longer live on their own.  They can still walk, talk, and are mentally and emotionally stable, but they need assistance with daily activities that most people take for granted – eating, dressing, bathing, brushing their teeth, or need help with housekeeping.  Where do they go?

Residential care facilities, also known as assisted living facilities, are meant for older individuals who do not yet need 24 hour nursing home care but can no longer live independently.  Residents who live in residential care facilities are not allowed to live on their own but do not require constant nursing care and supervision. Nationwide, roughly 800,000 individuals (mostly elders) reside in licensed facilities, including residential care facilities.  Residential care facilities provide residents with shelter, meals, supervision of medication, and assistance in daily activities.

There are five causes for eviction in residential care facilities.  One of them is if after a formal assessment, the facility determines that it can no longer meet the resident’s changing care needs.  Often times, a resident will first be appropriately admitted to a residential care facility.  As time goes on, his or her condition may progress and worsen.  Although once minimally self-sufficient, the person may now require 24 hour care provided by a nursing home facility.  Because residential care facilities are considered non-medical facilities and are not required to have nurses, certified nursing assistants or doctors on staff, an elder who becomes increasingly frail or now suffers from an illness or disability would be better served in a nursing home facility.  In fact, if a residential care facility for the elderly (RCFE) retains a resident for whom they cannot meet his or her needs, it is dangerous and can have deadly consequences.  For example, a RCFE is not adequately staffed with nursing personnel to care for residents with Stage 3 or Stage 4 pressure sores because pressure sores that are not adequately treated by the appropriate nursing personnel can become infected, leading to systemic infection or death.  Likewise, dehydration is a serious concern in the elderly (especially those suffering from dementia or Alzheimer’s disease) and can lead to death.  RCFE personnel are not sufficiently trained to identify signs and symptoms of dehydration, which can be fatal.

If someone you love is not receiving adequate care in his or her residential care facility, contact York Law Firm immediately.  We have helped clients obtain the compensation they deserve for this horrendous error.  For example, we achieved a confidential settlement against a nursing home for an 84 year old female client who suffered severe dehydration, leading to critical hypernatremia, a stage 4 pressure sore and sepsis, all of which led to her premature death.

York Law Corporation
Sacramento, California
www.yorklawcorp.com
Call today: (800) 939-1832
Local: (916) 643-2200

When the Numbers Just Don’t Add Up

Elders residing in nursing care and residential care facilities often do not receive the care you would expect.  Many residents are abused or neglected.  They contract illnesses, suffer from untreated wounds that become infections, and in severe cases, they may die.

One of the main causes of nursing home abuse and neglect is a direct result of a nursing home’s deliberate choice to understaff its facilities.  Most nursing homes are profit driven.  This means that they will cut corners in order to insure that they are profitable.  One of their methods is to only employ the minimum amount of people necessary for the nursing home to function, even if the level of functioning is subpar at best.

What is the result?  Patients pay for services they aren’t receiving, employees are paid (usually not very much) but have too many patients to handle, and who’s left to benefit?  The nursing home facility at both the monetary and physical expense of its elderly patients.

California has strict nursing home staffing requirements.  The law requires that nursing homes administer a minimum of 3 hours and 12 minutes of direct care for each patient.  Failure to provide the minimum care required results in nursing home patients who are neglected – they may be left in soiled linens for hours or even days at a time, or they are not repositioned.  The body cannot withstand sustained pressure for long periods of time, since circulation to parts of the body will be cut off.  This increases the risk of developing painful bed sores, a fate that no one should have to endure and can easily be avoided.

If you suspect that your loved one is receiving inadequate care due to elder care understaffing, here’s a few things you can do.

• Report the understaffing to your local ombudsman.  Ombudsmen serve as advocates for nursing home residents.  Contact the California Department of Aging for the name and number of the long term care ombudsman program nearest you.
• Also, you can contact your county Adult Protective Services (APS).  APS is responsible for investigating complaints of abuse, exploitation and neglect of adults who are elderly or disabled.  A list of Adult Protective Services’ contact information organized by California county is provided here.
• Contact the Department of Public Health and file a complaint with the Licensing Division at 1-800-236-9747.

Of course, York Law Firm can help you obtain the compensation you deserve.  We know both the Federal and California laws pertaining to nursing home abuse and neglect and will apply them strategically to bolster your claim.

York Law Corporation
Sacramento, California
www.yorklawcorp.com
Call today: (800) 939-1832
Local: (916) 643-2200

Nursing Home Chain Pays Big for Understaffing their Facilities

What would motivate a jury to award $640 million in damages against one nursing home chain?  If the violation of law is so egregious, then the verdict serves as a reminder to all other nursing homes to abide by the law or suffer severe financial consequences.

This was the case in Humboldt County.  An Orange County-based nursing home firm was ordered to pay $640 million in a class action lawsuit for understaffing their 22 California nursing homes.  California requires nursing homes administer a minimum of 3 hours and 12 minutes of direct care for each patient, something that the nursing home chain simply could not achieve with the amount of employees then employed.

This jury award signifies one of the most substantial (if not the most substantial) jury awards in a nursing home case.  The amount was calculated to reimburse each patient on each day that the chain of nursing homes did not provide the minimum staffing requirements.

Patient care suffered as a direct result of the nursing home chain’s decision to understaff their facilities.  They were forced to wait longer for care, such as changing of soiled linens and clothes or being repositioned.  If older people cannot change themselves, then they are forced to sit or lay in their own urine until a caregiver arrives.  While the elderly wait in the urine, their skin is being weakened by the moisture, making them more susceptible to bed sores.  Unfortunately, bed sores are the underlying cause of death for several thousands Americans each year.

York Law Firm takes their role seriously as an officer of the court.  We feel it is our duty to help enforce nursing home standards and regulations.  The only way to prevent nursing homes from continuing to abuse and neglect its patients is to make examples of the ones that do commit violations.  We are proud to have achieved the first nursing home neglect case that went to trial in Sacramento County for a $3 million jury verdict.

York Law Corporation
Sacramento, California
www.yorklawcorp.com
Call today: (800) 939-1832
Local: (916) 643-2200

$29 Million Verdict Serves as a Public Reminder – Nursing Home Abuse and Neglect is Against the Law!

Unfortunately, elders in nursing homes often experience some form of neglect or abuse.  While national statistics on elder abuse are currently not recorded, in 2004, the National Center on Elder Abuse (NCEA) estimated a 19.7 percent increase in the total reports of elder abuse and neglect and a 15.6 percent increase in substantiated cases since the last survey was conducted four years prior. They also found that 1 to 2 million elders have been “injured, exploited, or otherwise mistreated.”

Nursing home abuse is morally reprehensible and against the law.  However, it is still a prevalent problem.  What would motivate nursing home facilities to break the law?  Profit.  Nursing homes run like a business – they will act in a way which maximizes profits at the expense of their patients’ health and safety.

To achieve higher profits, they will often hire people who are unfit for their positions, inadequately train them, or fail to run background checks on them (thereby exposing patients to potentially dangerous individuals).  In addition, nursing homes will hire only the bare minimum necessary for the nursing home to function, resulting in nursing home employees caring for more patients and having more responsibility than they can handle.

The result can be devastating.  Elders in nursing home facilities require 24 hour care and often suffer from an illness or disability.  Many require numerous daily medications just to function at a minimal level.  Forgetting to administer proper medication or over-medicating a patient can result in severe illness or even death.  Abuse – physical, sexual, verbal, etc. – can also permanently affect a patient’s health and compromises his or her safety.

What makes matters worse is that many patients are unable to report instances of abuse or neglect.  Nursing home patients are often unable to effectively communicate.  Those who do report abuse may not be believed, or don’t report it for fear of retaliation.

So what can you do if your elderly loved one has been abused or neglected in a nursing home facility?  Find an experienced elder abuse attorney to handle your case.  Lawsuits against nursing home facilities are numerous and often involve multi-million dollar settlements and verdicts.

Sacramento County recently upheld a $29 million verdict ($1.1 million for pain and suffering and a whopping $28 million for punitive damages) for the death of a 79 year old female nursing home patient, Frances Tanner.  She was originally admitted into the Rocklin nursing home with mild dementia and died just 7 months after admittance from an infected bed sore. The patient’s death was deemed a direct result of the nursing home’s illegal understaffing of its facility, resulting in patient neglect and Tanner’s untimely and tragic death.  The $29 million verdict is believed to be the largest ever for an elder abuse case in Sacramento County.

York Law Firm specializes in nursing home abuse cases and we have obtained our clients millions for their wrongful treatment.  What makes us so successful is our desire to fight injustice and protect the rights of the “little guy.”  We will fight against the system responsible for injuring your loved one.

York Law Corporation
Sacramento, California
www.yorklawcorp.com
Call today: (800) 939-1832
Local: (916) 643-2200