South Carolina Nursing Home Lawyer Blog

Sadly, preventable pressure sores (also known as decubitus ulcers and bedsores) frequently occur after an elderly person is admitted to a nursing home. What is a pressure sore? It is an area of skin that has broken down because a person has stayed in one position too long without shifting their weight. Constant pressure on one location will reduce blood supply to the area, and the tissue around that area will die. An estimated 17 to 28 percent of nursing home residents will develop at least one pressure sore.

Nursing home residents are frequently unable to turn themselves or move with normal frequency. As a result, they must rely on their caregivers at the nursing home to move them regularly. But too often, nursing home residents just aren’t moved enough.

Bedsores are categorized according to four different stages, from Stage I (the mildest) to Stage IV (the most severe).

Stage I
A reddened area on the skin that does not turn white when pressed. A pressure ulcer is beginning.

Stage II
An open sore or a blister has developed. The skin around the ulcer is often irritated and red.

Stage III
The sore has formed a crater. Damage below the skin can easily be seen.

Stage IV
The sore has become so deep that there is damage to muscle, tissue, bone, tendons, and/or joints.

Pressure sores frequently become infected, and we often hear reports from new clients of a foul odor. Infections can be critically serious. The tissue around the bedsore can become very warm to the touch.

How can bedsores be prevented?
There are a number of things that nursing homes should be doing to prevent pressure sores from developing in their residents. There are also many things that can be done to heal pressure sores before they worsen. Here are a few. First, nursing home residents who are bedridden, or who suffer from diabetes, circulation problems, incontinence, or mental disabilities must be checked for pressure sores daily. Second, they must have their position changed every two hours. Third, items such as pillows and foam products can be used to reduce pressure. Fourth, residents must be provided with enough healthful food and water. Fifth, skin must be kept clean and dry. Sixth, after urination or a bowel movement, make sure the resident’s skin is promptly cleaned and dried.

When a nursing home resident develops pressure sores, it can be a sign of a serious neglect problem. We recommend that you obtain photos of the wound, but first and foremost, the nursing home resident needs active medical intervention to prevent pressure sores from worsening.

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I am very often asked this question. The first thing I tell people is to choose a non-profit nursing home, if you find a suitable one. Non-profit nursing homes are not perfect. In fact, some non-profit nursing homes have seen some shocking neglect and abuse. However, some of the very best care can be found in good non-profit nursing homes. As a general rule, avoid a for-profit nursing home. The reason for this is that the profit motive very often leads some corporate decision-makers to under-staff and under-supply nursing home facilities. However, in many communities there is no suitable non-profit choice, and in any case, there are things you should look out for in any nursing home. Here is a list of things to consider:

1. – Choose a non-profit nursing home, if possible.

2. – Spend a lot of time making multiple visits to various nursing homes before you make a decision.

3. – Visit your final few choices on holidays, on Sundays, and in the afternoon and evening.

4. – Do not become fixated on fancy lobby furniture, art on the walls, or nice indoor plants. Those things are not good indicators of quality care.

5. – Understand that a guided tour of the facility is usually nothing more than a sales presentation. A guided tour is not a good way to judge a nursing home.

6. – Speak with the residents. Ask them what they think of the care they receive at the facility. Take their comments seriously. How is their grooming? Is everyone in a fog, or can some of the residents carry on a normal conversation? Talk to bedridden residents and residents in wheelchairs. If the facility will not let you speak to the residents, this can be a major warning sign.

7. – Eat a meal yourself to judge the food quality. Don’t take the nursing home‘s word at face value. Visit during mealtimes, and observe whether and how much the residents are eating. Are bedridden residents adequately assisted with eating, or are trays of cold food simply left beside the resident without any assistance?

8. – Are pitchers of fresh water within easy reach of every resident’s bedside?

9. – How does it smell? If rooms, hallways, and the residents themselves smell of urine, feces, or worse, this probably indicates that the residents are not being changed frequently enough. This is a very serious matter, and can easily become life-threatening, and even fatal.

10. – Are there enough certified nursing assistants (CNAs) on staff during all three shifts? Ask residents if the facility has enough staff in private.

11. – Every facility receiving Medicare funds must have the latest State Survey of the facility ready for you to review. Read the State Survey in detail, and look for potential problems. Also, review Medicare’s own online comparison and rating of each nursing home here.

12. – Speak with family members of the residents. Ask them about any problems. Take their answers seriously.

13. – Meet the Director of Nursing, the Medical Director, and the Administrator. Is delivering the highest level of care possible their primary focus? Does the Medical Director visit with each resident frequently (daily or weekly)?

14. – Ask if the facility allows you to install a computer camera (a so-called “granny cam”), so that you can monitor your loved one’s room when you are away. If the answer is “no,” ask yourself why such cameras wouldn’t be encouraged.

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Here are some more warning signs that could mean that your loved one is being neglected or abused:

1. Your loved one frequently becomes ill, and you and/or the physician are not immediately notified.

2. Incidents involving fractures or broken bones, particularly broken hips.

3. Over-medication.

4. The unexplained death of your loved one.

5. Another resident injuring your loved one.

6. Injuries occurring during a so-called “wandering” episode, where the staff is not aware that your loved one has gone missing for a period of time.

7. Neglecting your loved one’s daily necessities, including food, water, and clothing.

8. Failing to care for your loved one’s existing medical conditions.

9. Your loved one becomes malnourished or dehydrated.

10. Your loved one’s clothing goes missing.

11. Your loved one’s personal hygiene suffers.

12. Failing to provide necessary medical attention.

13. Forcing your loved one to stay in their room.

14. Slapping, pushing, shaking, or beating your loved one.

15. Your loved one suddenly has open wounds or cuts.

16. The nursing home cannot or will not explain your loved one’s condition.

17. Under-medicating your loved one.

18. Unreasonable physical restraints.

19. Over-use of chemical restraints or psychotropic medications.

20. Sexual Assault or Rape.

21. Physical Assault or Battery.

22. Your loved one suddenly wants to be isolated all of the time.

23. Unusual behavior suddenly develops in your loved one.

24. Sudden personality change.

25. Your loved one suddenly becomes withdrawn.

26. Your loved one is very upset emotionally or becomes extremely agitated.

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As the percentage of seniors in our society gets larger and larger, more and more people are being cared for in assisted living communities, rest homes, and nursing homes. The quality of care in these homes must be at a high level, because the medical issues facing their residents are as complex as they are numerous. Sadly, however, many nursing homes are staffed by an inadequate number of nursing assistants. Nursing staffs are frequently not given proper training, adequate supplies, or sufficient compensation. They work longer hours than they should. They aren’t given the tools they need to do their job. It is a disaster waiting to happen – and disasters are happening in many nursing homes and assisted living facilities all over our country. It is a silent epidemic.

Nursing home residents are a highly vulnerable population. Very often, the residents are relatively isolated, too, and this makes them an easy target for substandard care.

Warning signs include:

injuries requiring hospitalization or emergency treatment,
extreme weight loss,
repeated falls,
medication errors,
elder reports of abuse,
unexplained bruising,
pressure sores (decubitus ulcers), and

These are just some of the warning signs. There are many more.

So, what can you do? First and foremost, visit frequently. Visit on Sundays, on weekends and holidays, and at varying times of day. Second, talk to the Administrator, the Director of Nursing, the Doctor (Director of Medicine) and the nursing home’s Social Worker. Third, talk to the nursing staff. Fourth, talk to the ombudsman in your state. If your loved one was or is in a South Carolina nursing home, feel free to call me at (803) 808-9600, and I can provide you with the name and telephone number of the ombudsman assigned to the appropriate county.

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People frequently ask me, “What exactly is elder abuse?” The phrase “elder abuse” simply means the physical, emotional or sexual abuse or neglect of an older person. Every year, many thousands of older Americans are mistreated in their own homes, in elder care facilities, and in nursing homes. We see an increasing number of older people being abused and neglected in nursing homes, and many believe that the root of the problem is greed.

Let me explain.

A lot of nursing homes and elder care facilities are for-profit. That means that behind all of the niceties, their chief motive is to make as much money as they possibly can. There is nothing wrong with earning a profit, but some nursing homes take things too far. A lot of facilities are intentionally understaffed – to save costs and boost profits. The care of your loved family member is often left to poorly-trained, overworked, and under-paid nursing assistants (sometimes called CNAs). A lot of facilities make it a habit of operating with far less staff than is required by state law. Many facilities do not perform background checks on their new hires, so you don’t really know who is given the responsibility to take care of your loved one. The work is highly stressful, too, so burnout, lack of sympathy for the nursing home residents, negative job attitudes, and ultimately sometimes abuse can occur.

It’s scary, but it is preventable, too. Nursing homes do not have to let their facilities get beyond their control. A lot of these homes rake in unbelievable amounts of profits. It is when patient care suffers at the hands of profits that we are called upon to step in.

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It’s true. Well, it’s sort of true.

The Bethesda Retirement Center, a not-for-profit home near Chicago, recently organized a night out at a biker bar called the Evil Olive after nursing home resident Elizabeth Barrett asked about it. A group of residents wanted to go, so the facility’s life enrichment director put it together. Ms. Barrett had the idea of the residents dressing up as bikers for their night on the town. So, one man and seven women, ranging in age from sixty-five to ninety-seven and dressed up in full biker regalia, and invaded the Evil Olive. The Chicago chapter of A.B.A.T.E. showed up numerous members for the event, as did the Latino American Motorcycle Association. About 100 people attended, to help raise funds for a touch-screen computer for the residents to use for internet access back at the home.

Some of the experienced bikers in the crowd had planned to go for a spin on their motorcycles with the residents, but the night was too cold. Maybe next time. Thanks go to Chicago’s NBC affiliate for reporting.

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After two careful days of deliberation, citizens in Ventura County, California determined that stroke victim Maria Arellano had been harmed profoundly – so profoundly that they measured the harms at $7.75 million dollars. Mrs. Arellano was nearly seventy years old, when she entered the Fillmore Convalescent Center for care, after she had suffered a debilitating stroke.

During a visit with her in 2006, Mrs. Arellano’s family members noticed that she had unexplained bruises. Alarmed, they notified the administrators of the nursing home. The nursing home, however, decided not to investigate at all, according to reports. Still concerned, the family set up a hidden camera on a side table, to capture what was happening when they could not be there. You see, Mrs. Arellano could not speak because of the stroke.

What the family saw shocked them.

Nursing home employee Monica Garcia was seen slapping Mrs. Arellano. Garcia bent back her wrists and fingers. She pulled Mrs. Arellano by her hair. Garcia was violent and cruel in her treatment of her helpless patient.

What’s worse is that the nursing home knew there was a problem with Garcia, but they allowed her to work with the residents anyway. At the trial, the jury saw evidence that a number of families had complained about potential abuse inside the nursing home, and at least one other family had named Garcia in writing.

The Arellano family offered to settle their legal claims for $500,000 – but the Fillmore Convalescent Center offered them nothing – not a penny – to settle the case.

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In yesterday’s New York Times, Alex Berenson reported on an under-appreciated threat to thousands of vulnerable patients in our country. More than 400 long-term acute care hospitals have opened across the country in the past quarter century. Just like the majority of nursing homes, many of these long-term care hospitals are owned by for-profit corporations, whose profits can increase dramatically when the facility is understaffed. The article focuses on the biggest player in the long-term care industry: Select Medical Corporation, a Pennsylvania based, for-profit corporation which owns 89 long-term care hospitals.

Berenson examined government inspection reports, evidence from lawsuits, and federally-mandated reports, before he concluded that there is reason for concern about the care being given to the patients in Select Medical Corporation hospitals, and in other long-term care hospitals around the country. For example, according to the article, Select hospitals were cited nearly four times more often for Medicare violations than the rate for regular hospitals in 2007 and 2008. Also, long-term care hospitals have a significantly higher rate of bedsores and infections than the rate in regular hospitals. These problems, according to the Times, can be traced directly to the understaffing of these hospitals.

Not enough staff creates poor care. It’s that simple.

In our area, Select Medical Corporation owns facilities in Atlanta, Augusta and Savannah, Georgia; Durham and Winston-Salem, North Carolina; and Bristol, Knoxville and North Knoxville, Tennessee.

Select Medical’s biggest competitor is another for-profit, publicly-traded company, Kindred Healthcare. Kindred Healthcare has facilities nearby in Charleston, South Carolina; Atlanta, Fayetteville, Marietta, and Savannah, Georgia; and in Chapel Hill, Durham, Gastonia, Graham, Greensboro, Kinston, Lincolnton, Monroe, Raleigh, Rocky Mount, Scotland Neck, Wilmington, and Zebulon, North Carolina.

Whether it is a nursing home or a long-term care hospital, when there is a high turnover rate, and a long-term understaffing problem, patient care will inevitably suffer, and preventable injuries and deaths can occur.

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The mistreatment of John Danzy was so bad that it made history in the State of New York. His case was the first in New York State where a jury decided that punitive damages had to be awarded against the nursing home that neglected him.

John Danzy was 76 years old, and an Alzheimer’s patient who was placed in the care of the Brooklyn Queens Nursing Home in Brooklyn in 2002. According to the Danzy family, when he was admitted into the nursing home, he was walking without assistance, and he weighed almost 250 pounds. His condition rapidly changed as the nursing home began to “care” for him. After only nine months Mr. Danzy could no longer walk, he lost 100 pounds, and twenty bedsores riddled his body.

When his family discovered his condition, Mr. Danzy was transferred to another facility, but it was too late. He unfortunately succumbed to infections in the bedsores. To make matters worse, when Mr. Danzy’s family expressed concern over the treatment that Mr. Danzy had endured, the nursing home reportedly altered their records to make them appear that they were giving Mr. Danzy the attention and care that is required by law, according to reports. An FBI specialist who examined the records testified that over one hundred alterations were made to the nursing home records before they were provided to Mr. Danzy’s family. The good citizens of New York who served on the jury did not appreciate the nursing home‘s apparent attempt at creative writing. Mr. Danzy’s estate was awarded $3.75 million for the pain and suffering Mr. Danzy endured at the end of his life, and to punish the nursing home for its egregious conduct, the jury added an additional $15 million.

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Through no fault of her own, Maria Arellano had suffered stroke. That stroke left her unable to speak. Communication with anyone became profoundly difficult. She was 71 years old when she began residing at the Florence Convalescent Center in Ventura, California. Maria’s family placed her there for professional around-the-clock care to be provided to their loved one. What happened next was horrible, but Maria couldn’t tell anyone what was happening. Little did her family know the horrors this woman would endure in her silence.

Family members came to visit her often. Soon, they started noticing strange bruising on Maria’s body. Naturally, this worried them. It worried them enough to talk to the folks in charge of the home. They wanted to know what was causing all the bruising. But according to the family, their inquiries and complaints went unanswered. So they did what any reasonable family would do to protect their loved one. They set up a video camera in her room and hid it on her nightstand. And what they caught on tape was unthinkable.

It showed an employee of the nursing home, Monica Garcia, slapping the helpless Maria, pulling her around by her hair, painfully bending her fingers, neck, and wrists, and shoving and pushing her around in a shower chair. Monica Garcia ended up being charged for criminal battery. Ms. Garcia pled no contest and served only 10 days on work release. Maria’s family filed suit against the facility for hiring and keeping on staff such a person, and a jury of citizens awarded $7.5 million against the facility for the harm done to Maria.

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