Brian has made a commitment to representing families and their loved ones against nursing homes who neglect and cause pressure sores to develop to these loved ones.
Many of our elderly society, like infants, cannot take care of themselves. Families often times are forced with the difficult decision of placing mom or dad, grandma or papa, or even sometimes a sibling in a nursing home. Families do the best they can in finding the suitable nursing home. Families do research and visit several nursing homes to find the “right place.” They finally choose a nursing home which promises around the clock care and a general loving and nurturing environment. The family feels at peace. Unfortunately, those same families are too often times faced with nursing home abuse and neglect against their loved ones.
Brian “stumbled” into nursing home litigation while practicing law with his brother, Andy. Brian had been practicing employment law but assisted his brother in a nursing home case. It was Brian’s first encounter with the cold, hard-fact that nursing homes are businesses to make a profit and many times such desire for profits overrides the patients’ well being. Thus, after a long, hard-fought litigation and trial in that first case and seeing first-hand a jury holding a nursing home accountable for its neglect against a helpless elderly lady, Brian made the decision that he was going to help those families who have loved ones being abused or neglected by nursing homes who are not able to help themselves. It was shortly after that case that Brian co-authored an article entitled “Helping Society’s Most Vulnerable: Nursing Home Litigation” published in The South Carolina Lawyer, to help educate other attorneys in South Carolina with the issues involved in nursing home cases.
Since that time, Brian has handled many types of nursing home cases but has focused his attention and practice on neglect that causes pressure injuries to residents. Generally, a nursing home is under a duty to exercise reasonable care to avoid injury to their patients, and the reasonableness of the care is to be assessed in the light of the patients' physical and mental condition. The nursing home is to protect those who are unable to protect themselves. Because many residents of nursing homes require around the clock skilled care, the duty owed to nursing home residents can be significant.
Pressure sores, or bedsores/pressure ulcers as they are sometimes called, are a serious and unfortunate common occurrence among residents in nursing homes. This is so because the most significant risk factor of developing a bedsore is immobility — someone who cannot move or get out of bed on their own and must depend on the care of another. Because most bedsores are preventable, the mere existence of one may indicate a failure by the nursing home to properly reposition a resident, among other failures.
In short, a bedsore is caused by unrelieved pressure on the skin that results in damage to the underlying skin tissue. There are four stages of bedsores:
• Stage I is an observable redness (alteration of skin) caused by pressure;
• Stage II is an observable thinning of a skin area and appears as a blister or abrasion;
• Stage III is an observable thinning and skin loss with damage to the underlying tissue and appears as a deep crater or blister; and
• Stage IV is a full skin loss with extensive damage to the skin and underlying tissue, involving necrosis (rotting of skin) and may cause damage to the muscle and bone.
When someone is first admitted to a nursing home, the nursing home should perform a full evaluation of the resident to determine the existence of any risk factors for developing a bedsore. The following are a number of risk factors that should be considered by a nursing home when caring for a resident to prevent a bedsore:
• immobility-confined to bed or a chair;
• inability to turn or reposition oneself;
• poor or inadequate nutrition and hydration;
• altered level of consciousness; and
• medical condition that may cause weakening of the skin.
If a resident has one or more risk factors, the nursing home should take proper steps to prevent the development of bedsores. Having these risk factors does not excuse the nursing home if a bedsore develops; it only means the nursing home should provide additional care to prevent them.
The federal regulations state that each nursing home "must ensure that (1) a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and (2) a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing." 42 CFR § 483.25(c).
To prevent the development of bedsores in an at-risk resident, the standard of care requires that many steps should be taken.
• Turn and reposition the resident a minimum of every two hours so that the pressure on the skin is relieved. A more frequent turning schedule may be required, as often as every 30 minutes.
• Inspection of the skin at least once daily for evidence of any redness.
• Reduce the elevation of the head of the bed to reduce friction-the resident sliding down in the bed.
• Keep the skin dry and clean.
• Make sure the resident has proper nutrition-adequate calorie and protein intake. This helps the skin get nourishment and stay healthy.
• Activity. The nursing home should attempt to improve the mobility of the resident.
• Use of an air mattress or other specialized bed. Helps reduce pressure to the areas of the skin which receives the most pressure.
These steps are fundamental and should be taken by the nursing home.
Accordingly, the development of pressure sores, particularly stage III and stage IV, are evidence of neglect. Although in a few residents such pressure sores are unavoidable, most can be avoided. A doctor or registered nurse can review the chart and advise as to whether the development of pressure sores was avoidable.
An underlying issue when litigating these types of cases is whether the nursing home has "sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care."
Not all nursing homes are bad. Not all nursing homes intentionally injure their patients. But too many of the nursing homes simply are more concerned with revenues than they are with providing the proper and necessary care for its patients. This desire for profit lead many nursing homes to cut staffing levels below acceptable standards and cut necessary training for the staff. These are the types of nursing homes we need to remind, strongly, that the health and well-being of the elderly is priority number one. And when the bottom line to these nursing homes is money, litigation is often the only thing that will get their attention.
One of Brian’s cases is illustrative of the common issues in nursing home cases. Brian represented an elderly lady who needed total assistance when she entered the nursing home. She could not bathe herself, eat without help, or even turn herself in her bed. Unfortunately, the nursing home did not give her the total assistance she needed and she developed several pressure sores, including one that reached Stage IV (the worst). This pressure sore developed a foul odor and necrotic (dead) tissue and dead bone. This sore eventually required surgery. (one of Brian’s more recent cases involved a pressure sore causing sepsis and death to the resident)
The nursing home denied any wrongdoing. But through litigation and the discovery process, and the help of experts, Brian discovered that the nursing home failed this lady in many ways.
First, these pressure sores were the result of the nursing homes failure to turn and reposition this lady every two hours. The nursing notes illustrated that she was only turned 3 or 4 times in a five-month period. Further, there was no indication in the nursing home’s records of daily skin inspections. Lastly, the records indicated that when the bed sore was discovered, the doctor was not notified until over a month later. This poor lady never had a chance.
Secondly, these pressure sores were not the only thing this lady had to endure during her nursing home stay. She had an arm fracture (unexplained of course) that was discovered while she was lying on her left arm. Despite the nursing records stating that her left arm was swollen “so big” with bruises on her shoulder and that she was in pain and crying, she was not checked on again until four hours later. The notes indicated the swelling had increased in those four hours so the nursing home left the doctor a message a couple of hours later. No pain medication was given to this lady, despite being in pain and crying, for almost 8 hours after the discovery of the fracture.
Lastly, it was discovered that the nursing home was only able to provide approximately three hours of patient care per day despite the director of nursing for the nursing home admitting that this elderly lady required about 7 hours of care per day according to time estimates on her daily care plan. In fact, nurses and certified nursing assistants of the nursing home had complained about understaffing to the administration on several occasions. With inadequate staffing, it is no wonder this lady was not properly cared for during her stay.
Fortunately, the family intervened and this elderly lady was transferred to another facility by her daughter and was doing much better once she was removed.
Hopefully you never encounter this type of situation. But in the event you do, you want an attorney who has the experience, drive, and knowledge to assist you. If your loved one has been abused, neglected or injured while in the care of a nursing home, please do not hesitate to contact my office for a free and confidential consultation. I will review the circumstances of your case and fully explain your rights and options.