Studies show that almost 50% of California nursing homes do not meet federal standards in preventing pressure ulcers. The problems are so widespread that the treatment of these ulcers – also called bed sores – will no longer be covered by Medicare if the sore was acquired after admission into a nursing home.

Family members should be aware that a bed sore can develop in only a few hours if an area of the skin is subjected to enough pressure that cuts off blood flow to that area. The skin will initially appear red and will be painful, slowing appearing to have a purple color. This is the best time prevent the sore from advancing to something more serious.

Nursing home and assisted living residents are at high risk for developing pressure ulcers, and those residents that are bedridden, wheelchair bound, or those will limited mobility must be examined frequently for the development of bedsores. A small bedsore can quickly become a large sore if treatment is not promptly provided.

People frequently ask for a recommendation to a “good” nursing or residential care facility. It’s a question that is difficult to answer, other than to state that the style of the building or the cost of the care is rarely a good indicator of quality of care. I have sued nursing and residential facilities that look like the Ritz Carleton, and I know that smaller, “mom and pop” facilities are capable of providing excellent care.

The first step is to find a facility that suits your needs. In may be its location in relation to family or friends, or one that offers a specific service such as dementia care. Once you have narrowed it down to a few, visit the facilities and speak with the administrator or the admissions director, and ask for a tour. While on the tour introduce yourself to other residents and ask them about the facility, the things they like and don’t like, and ask if you can speak with the privately. Frequently your first impression is the most accurate, so trust your instincts.

After the tour, return unannounced to the facilities you like best a few days after your tour, and visit at various times of the day so you can see the program it runs throughout the day. It’s important that these visits are unannounced so you can see the “real” facility and not the one portrayed on the official tour (hopefully they are the same).

Nursing homes around the country are now requiring prospective residents to agree to binding arbitration before admittance into a home. By signing an agreement to arbitrate, nursing home residents are forever giving up any rights to seek compensation in a court of law for harm caused by caregivers who abuse or neglect a resident, or for any other nursing home malpractice. Those claims would be handled by an arbitrator, usually a retired judge or an experienced (but often jaded) lawyer.

These arbitration clauses have profound implications, and should be avoided when possible. As this Wall Street Journal article points out, they are a part of a nursing-home-industry strategy to use arbitration agreements to reduce litigation costs, take cases away from juries, and lower compensation awards.

Apparently it has worked. According to a nursing home industry study, average costs to settle cases have begun decreasing as claims of poor treatment are increasing. Nursing homes have learned over the years that neglect or abuse of a vulnerable senior citizen is an emotionally charged thing. And when juries get emotionally charged, they tend to take action to right the wrong that has been committed – usually in the form of verdict commensurate with the wrongdoing – exactly as the U.S. Constitution intended.

This list contains the issuance of citations to Southern California nursing facilities by the California Department of Public Health over the last six months. All the citations listed are issued for reasons related to patient care. For verification of the citation, please contact the local department office or Walton Law Firm LLP.

<font size='2'Facility Date Citation
Los Angeles Nursing Homes
Ayer-Lar Health Care Center 09/21/07 Class B
Bellflower Convalescent 01/29/08 Class B
Brierwood Terrace Convalescent 12/28/07 Class B
Calif. Healthcare and Rehabilitation 11/14/07 Class B
Casitas Care Center 12/19/07 Class B
Chandler Convalescent 10/3/07 Class B
Country Villa Los Feliz 11/29/07 Class B
Country Villa Wilshire 01/4/08 Class A
North Walk Villa Convalescent 12/10/07 Class A
Orange County Nursing Homes
Coastal Community Hospital 10/11/07 Class A
San Bernardino Nursing Homes
Citrus Nursing Center 10/11/07 Class AA
Ontario Health Center 03/19/07 Class A
Sky Harbor Care Center 10/24/07 Class AA
San Diego Nursing Homes
La Mesa Healthcare Center 02/06/08 Class B
Lemon Grove Care and Rehabilitation 01/10/08 Class B
Life Care Center Escondido 01/24/08 Class B
Palomar Continuing Care 11/15/07 Class A
Palomar Heights Care Center 01/31/08 Class AA
Pleasant Care Convalescent 10/19/07 Class B
Villa Las Palmas Healthcare 12/14/07 Class B
Vista Knoll Specialized Care 12/4/07 Class B
Ventura Nursing Homes
Maywood Acres Healthcare 11/5/2007 Class A
Victoria Care Center 11/20/07 Class A

Class AA: The most serious violation, AA citations are issued when a resident death has occurred in such a way that it has been directly and officially attributed to the responsibility of the facility, and carry fines of $25,000 to $100,000.

Class A: Class A citations are issued when violations present imminent danger to patients or the substantial probability of death or serious harm, and carry fines from $2,000 to $20,000.

Class B: Class B citations carry fines from $100 to $1000 and are issued for violations which have a direct or immediate relationship to health, safety, or security, but do not qualify as A or AA citations.

The quality of care provided by California nursing homes has declined by almost every measure since the implementation of a new Medi-Cal rate system that increased funding the nursing facilities according to a new study by the University of California, San Francisco (UCSF). Meanwhile, nursing home complaints and the issuance of deficiencies have grown dramatically since the rate hike.

Critics contend that the nursing home industry crafted the rate hike on the basis that it was necessary to improve care. And while staffing levels improved under the new law, nursing home staff turnovers increased. The study reveals that 144 nursing homes in California failed to meet state minimum staffing requirements (.pdf).

According to the California Advocates for Nursing Home Reform:

Budget cuts proposed by Governor Schwarzenegger could cripple California’s oversight of Residential Care Facilities for the Elderly. Further damage to the already struggling oversight program could put thousands of RCFE residents at risk.

According the California Advocates for Nursing Home Reform (CANHR), the proposed cuts come at a time when assisted living care is growing at a rapid rate. There are more than 7,000 assisted living facilities in the state, an increase of more than 25% over the last decade. Current law requires an inspection of RCFEs only once every five years, a dramatic decline from the 1980s when such facilities were subject to inspections twice a year.

Inspecting RCFEs once every five years or less is a recipe for neglect and abuse,” said Patricia McGinnis, CANHR’s executive director. “Care standards and residents’ rights become virtually meaningless when inspections are so rare. Issuing a license under these conditions deceives consumers who assume the state is conducting regular inspections or offering oversight and protection to residents.

The signs and symptoms of a brain injury are not always as clear as you might think. Most patients who suffer a traumatic brain injury can walk, talk, and give the appearance of a normally functioning person. There are, however, symptoms that point to brain trauma.

The month of March is set aside to increase the awareness of traumatic brain injuries, which can be caused by a bump, blow, or jolt to the head. The Centers for Disease Control and Prevention reports that falls – particularly in people over age 75 – are the leading cause of brain injuries in the United States.

Those who care for the elderly should be aware of the symptoms of a brain injury. In a mild injury, a person might have a persistent headache, confused, or have blurred vision. Another symptoms is a lost of smell or taste. A more severe injury may cause vomiting, slurred speech or weakness in arms or legs.

Those of us who sue nursing homes and assisted living facilities for elder abuse and neglect of residents know how hard it is to uncover the evidence needed to meet our burdens of proof (which are higher than the typical case). Whether it’s proving a systemic problem of understaffing, ignoring resident fall risks, or establishing false charting, the victims of abuse or neglect always face tremendous hurdles in proving they were neglected. In reality, it’s usually the family trying to prove the wrongdoing since the victim is frequently dead because of the abuse or neglect.

What we certainly don’t need is nursing home caregivers, through their union representatives, colluding with industry trade groups to lobby against the rights of nursing home residents all in the name of job security and wages. This disturbing article in the San Francisco Weekly suggests that for the Service Employees International Union this might be a goal.

According to the article, the two-million-member SEIU, the country’s largest union, would offer political support for nursing home industry goals of limiting patients’ or families’ right to sue for abuse and neglect in exchange for the right to organize nursing home employees in a number of California nursing facilities. This collaboration has led to a division within union ranks, and a growing dispute between SEIU’s California healthcare affiliate and the national union office.

When there is sustained pressure in an area of skin that cuts off circulation to that area, the skin will start to breakdown creating what is common called a bedsore or pressure ulcer. If you’ve never seen one, consider yourself lucky. Not properly cared for, these sores and develop into wounds so deep that muscle and bone can sometimes be exposed.

It has been reported that two million Americans experienced pressure ulcers every year, usually the result of a combination of poor nutrition, dehydration, and immobility. Recent studies, however, suggest that fighting bedsores requires a team approach, enlisting not just the bedside caregivers, but many other nursing home employees.

A study by the Journal of the American Geriatrics Society involving 52 nursing homes around the United States reported a reduction of almost 70% of serious bedsores acquired in the facilities after utilizing a team approach to the prevention and treatment of sores.

In an effort to save some taxpayer money and improve patient care at the same time, the Centers for Medicare and Medicaid Services (CMS) has made a list of health conditions that are preventable and should never occur in the nursing home or hospital setting.

According to the National Quality Forum, “never events” are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.

The list of “never event” endorsed by CMS contains 28 negligent events ranging from a surgery performed on the wrong part of the body, to the discharge of an infant to the wrong person. Those listed events that frequently occur in nursing homes are:

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