California Nursing Home Abuse Lawyer Blog

Preventable Falls Pose Serious Risks to Elderly Population

October 1, 2013 | by Law Offices of Ben Yeroushalmi

The Centers for Disease Control and Prevention (CDC) reported that about one out of three people who are 65 years and older fall each year. Moreover, one-half to three-fourths of nursing home residents suffer from falls every year. These falls, while preventable, are dangerous and may have lasting, serious repercussions for this vulnerable population. For example, these falls may not only result in permanent disability and a diminished quality of life, but the CDC reported that within nursing homes, there are about 1,800 elderly residents who die from falls each year. However, while serious, such falls are very preventable.

The injuries resulting from these falls may range from head trauma, to a variety of fractures including hip and leg fractures. In addition, many traumatic brain injuries are caused by falls. Not only do these falls lead to physical injury, but many elderly residents who do fall also begin to develop a fear of falling which may further limit their willingness to engage in physical activity. If elderly residents begin to reduce their mobility, it will heighten their actual risk of falling. Additionally, their fear of falling may also lead to feelings of helplessness and depression.

Unfortunately, statistics demonstrate that falls occur more frequently among nursing home residents. It is true that nursing home residents are generally in poorer health and frailer than their peers, as they are generally older and suffer from other chronic problems. In addition, they may need more aid in going about their daily activities. However, despite these factors, falls and resulting injuries are very preventable if caretakers remain proactive in fall prevention. Thus, it is important and necessary for caretakers to assess patients to identify their fall risk and implement prevention strategies.

Arbitration Agreements Are Not in the Best Interests of Elderly Residents

September 25, 2013 | by Law Offices of Ben Yeroushalmi

An increasing number of nursing homes have implemented forced arbitration agreements within their admissions process. This has resulted in elderly residents and their family members signing away their constitutional rights and protections in order to obtain care within these facilities. However, consumers should be aware that nursing home arbitration agreements are inherently unfair and disadvantageous to vulnerable elderly residents and their family members. Therefore, it is important that residents and their family members understand what an arbitration agreement is and realize that they are not required to sign or agree to them.

What is an arbitration agreement?

An arbitration agreement states that the resident agrees that if a dispute arises between the facility and the resident, the resident will agree to bring the dispute before a professional arbitrator, rather than file a lawsuit with the court for resolution in front of a jury. When a case is taken to an arbitrator, the arbitrator will make the final decision and appeals are not allowed as arbitration is conducted in private and is not subject to judicial review. Therefore, arbitration agreements may essentially have the effect of allowing nursing homes to escape accountability for their wrongdoings since these agreements prevent residents and their families from suing the facility if their loved one was to suffer injury, harm, or even death while under their care.

What does California Law require?

It is important to note that in California, under the California Health and Safety Code § 1599.81(a), nursing homes are forbidden from requiring residents or their families from signing arbitration provisions in order to obtain admission into a facility or to continue their stay in such facilities. Additionally, under California Health and Safety Code § 1599.81, California also requires that nursing homes place arbitration agreements on forms separate from the admission agreement documents, and states that a resident may not waive their ability to sue the facility for violations of their Patient’s Bill of Rights. However, even with such laws in place, residents and their family members must remain cautious. They should ensure preservation of their constitutional right to take their case to court if necessary by refusing to sign arbitration agreements.

Remedying Aggressive Behavior in Elderly Dementia Patients

September 24, 2013 | by Law Offices of Ben Yeroushalmi

Those suffering from dementia are generally members of the elderly population, and as life expectancy continues to increase, the need to address dementia and its complications also increases. Dementia is comprised of a variety of symptoms, some of which include memory loss, impaired judgment, and difficulties with language and motor function. However, other issues also plague dementia patients and their families. For example, those suffering from dementia have been found to exhibit aggressive behavior, such as biting, hitting, or shoving when angry, scared, or confused.

A recent New York Times article explored the aggressive behaviors associated with dementia, stating that physically aggressive behavior generally occurs in a considerable minority of those suffering from dementia. Therefore, caretakers of dementia patients in hospitals and nursing homes may feel the need to use physical and chemical restraints or anti-psychotic drugs in order to control aggressive behaviors. However, this may be highly inappropriate. While the justifications for their actions may arise from fears that dementia patients may hurt themselves or those around them, it has been found that behavioral approaches are more effective in soothing aggressive behavior compared to inappropriate use of drugs and restraints in order to remedy the issue.

New Study Explores Link Between Hypotension and Pressure Ulcer Development

September 20, 2013 | by Law Offices of Ben Yeroushalmi

Many elderly residents who are hospitalized or living in nursing homes frequently develop pressure ulcers, the development of which risk further complications and even death. Consequently, caretakers for the elderly, particularly those in hospitals and nursing homes, must take precautions to prevent pressure ulcer development within this population. Studies have been conducted demonstrating a correlation between hypotension, or low blood pressure. Specifically, hypotension has been demonstrated to be an important risk factor in the development of pressure ulcers because research has found that hypotension in elderly patients, particularly those in poorer health, contributed to decreased blood flow at pressure points. This, in turn, would contribute to the death of cells and tissue in that area, leading to pressure ulcers.

However, a legal doctrine known as the ‘egg-shell skull’ rule can apply in this context. This rule holds an individual responsible for all consequences arising from their injury-causing actions towards another, even if the resulting injury to the victim is one that is unusually severe due to an underlying or pre-existing condition. Therefore, those caring for the elderly must be especially vigilant in protecting patients against pressure sores, particularly if an elderly patient is at risk for hypotension. This can be done by promptly identifying which elderly patients have hypotension, or those who are susceptible to developing hypotension, and allocating proper attention and resources to such patients. By doing so, caretakers can identify which elderly patients are particularly vulnerable to pressure ulcer development due to their clinical condition and can take early preventative measures before pressure ulcers arise and complications occur.

Investigation Reveals Mass Dismissal of Elderly Abuse Cases

September 18, 2013 | by Law Offices of Ben Yeroushalmi

A recent investigation by the Center for Investigative Reporting revealed that the California Department of Public Health dismissed about 1,000 pending cases in 2009 which alleged caretaker abuse and theft, without taking any action. This hurried dismissal of cases occurred to alleviate the Department’s extreme backlog of cases. These closed cases involved caregivers accused of assaulting or abusing their patients, some of which involved elderly patients. The closing of these pending cases has allowed for these caregivers to retain their licenses, thereby allowing them to continue to work in nursing homes, hospitals, and other health care facilities throughout Southern California. These abuse cases have been reported from facilities in Los Angeles, Riverside, San Diego and Santa Barbara, ranging from abuse and neglect to suspicious deaths. Therefore, we must remain vigilant in ensuring that instances of abuse against the elderly in such facilities go reported and ensure such caregivers are removed from their positions to prevent further harm.

The investigation found that the Department of Public Health rarely took action against these caregivers, despite clear evidence of allegations of abuse, and that the number of caregivers removed from their jobs for their wrongful actions has declined. Specifically, investigators found that about 81% of cases were closed in 2012 without taking any action against an accused caregiver. What is even more worrisome is that there was also an extreme drop in the number of cases involving suspicious deaths from abuse that were sent to law enforcement to be investigated and prosecuted. It should be noted that this decline in action is not due to a decrease in complaints, but rather, is correlated with the hurried removal of the Department’s backlog of pending cases. As a result, even though accused caregivers and their employers may have engaged in wrongful conduct, they are still licensed to work and care for vulnerable patients and are not being held accountable.

Reducing Unnecessary Antipsychotic Drug Use in Nursing Homes

September 16, 2013 | by Law Offices of Ben Yeroushalmi

The Department of Health and Human Services Office of Inspector General (OIG) released a report in 2011 finding that antipsychotic drugs given to elderly residents of nursing homes were not administered in compliance with standards set forth by the Center for Medicare and Medicaid Services (CMS). Such medications, when used properly, can be effective in aiding a patient’s mental and physical well-being. However, unnecessary antipsychotic drug administration is dangerous and not appropriate in the care of the elderly. Unnecessary drug administration practices may include excessive dose administrations, drugs provided in excessive durations, lack of adequate monitoring, or the administration of drugs in the presence of adverse effects which show the dosage should be lowered or discontinued. It has been found that improper or excessive administration of antipsychotic drugs may not only result in death but may lead to unnecessary hospitalization, falls, heart attacks, strokes, and other complications.

Unfortunately, because many elderly nursing home residents currently suffer from dementia, there has been a growing concern that antipsychotic medication has been administered inappropriately to control behavioral problems related to dementia. To combat this issue, CMS launched a National Partnership to Improve Dementia Care in 2012 with the goal of protecting the elderly receiving dementia care in nursing homes and other healthcare settings. Specifically, the partnership sought to protect against unnecessary antipsychotic drug use unless there was a valid, clinical purpose. The partnership also sought to encourage nursing homes and others providing dementia care to consider non-pharmacological alternatives for the elderly.

Elder Physical Abuse Prevalent in Nursing Homes

September 13, 2013 | by Law Offices of Ben Yeroushalmi

Research on the prevalence of physical abuse in nursing homes has been difficult to conduct because there are significant flaws in the method of collecting the data. Both nursing home staff and resident families often harbor a sense of guilt which causes under-reporting in surveys conducted to address this issue. Nursing home staff may be less inclined to report instances of elder abuse because they or a colleague may be the perpetrators of the abuse. Similarly, family members may be hesitant to report elder abuse because they may feel a sense of culpability for having admitted their loved one to the facility in which they were victimized. Unfortunately, allowing abusers to continue performing their jobs puts more elderly at risk of being physically abused.

A study published in the Journal of Elder Abuse and Neglect found that the overall prevalence of physical abuse in nursing homes is 24.3 percent. This study challenges the previously held belief that physical abuse correlated with increasing age in nursing home residents. In fact, it found that with each increasing year the chance of being physically abused decreased by 49 percent. This may be due to the fact that the prevalence of cognitive deficiencies increases with age, meaning that such residents need more group supervision than one-on-one staff to resident supervision. The increase in group supervision takes some responsibility off an individual staff member, allowing for a decrease in frustration or annoyance. This means that in order for there to be more successful monitoring of older residents, nursing homes must hire enough staff to ensure that their current staff members are not over-burdened with responsibility and performing poorly.

Another important finding in this study indicated that “needing help moving” was the only category which predicted abuse in the elderly. This study is significant because it reveals that those that are most in need of long term care, such as those with mental health issues and mobility problems are most at risk for physical abuse at these facilities. More importantly, this discovery highlights the need for better staff training at nursing homes, so that staff may be better equipped to deal with a highly dependent or troublesome resident with patience and respect. Because the majority of physical abuse of elderly in nursing homes involves caretaker mistreatment, an improvement in the quality of training would likely decrease the overall prevalence of nursing home abuse.

Mold Contamination In Antipsychotic Drug Prompts Product Recall

September 12, 2013 | by Law Offices of Ben Yeroushalmi

Johnson & Johnson initiated a product recall of their antipsychotic drug, Risperdal Consta, on Wednesday due to mold contamination of their product. Risperdal Consta is an antipsychotic medication that has been approved for use in patients with bipolar 1 disorder and schizophrenia. It should be noted that this recall only impacts the injected drug Risperdal Consta, and not the oral pill medication Risperdal.

While the company has stated that the risks to patients are low, patients should be aware that the effects of using the contaminated product include reactions or infections at the injection site. Additionally, those who have compromised immune systems may also be at risk of developing a systematic infection. The elderly are a particularly vulnerable population, and caregivers must be cautious and vigilant in ensuring that the elderly patients taking Risperdal Consta are not administered a contaminated batch.

When nursing homes neglect to monitor medications properly due to a lack of time or a disruption in their communication, elderly residents suffer the consequences by having to be admitted to the hospital for an adverse drug reaction. Such has been the case in many nursing homes, and many residents have continuously been victimized. The attorneys at the Law Offices of Ben Yeroushalmi believe that your loved ones deserve attentive, high quality care. If you believe your loved one is a victim of elder abuse or neglect, call us immediately at (888) 606-3453 so that we may work together to put an end to elder abuse and neglect. With offices in both Northern and Southern California, we can help you regardless of what part of the state in which you reside.

Nursing Home Neglect Encompasses Elderly Patient Dental Hygiene

September 10, 2013 | by Law Offices of Ben Yeroushalmi

A recent New York Times article brought to attention the growing oversight and neglect of dental hygiene in elderly residents in nursing homes. While the Elder Abuse Act states the failure to assist in personal hygiene constitutes an example of neglect, family members are finding their loved ones in nursing homes suffering from such neglect as oral health is not prioritized. Elderly residents in nursing homes all over the United States currently suffer from a range of dental hygiene issues, such as gum disease and cavities, partly due to the failure to maintain proper dental health. Several states conducted surveys to assess the oral health of nursing home residents, finding many suffered from substantial oral debris, along with broken teeth.

While the number of elderly residents in nursing homes continues to increase, understaffed nursing home workers struggle to provide even basic oral hygiene such as brushing residents’ teeth twice a day. Regrettably, it appears that such care falls secondary to providing other basic care such as providing food and repositioning residents to prevent bedsores. However, nursing home employers must provide medically necessary care and this includes oral care and hygiene, a requirement that is mandated in the Omnibus Budget Reconciliation Act of 1987.

Unfortunately, many elderly residents in nursing homes also suffer from dementia along with other medical issues. Thus, many of these residents must take prescription drugs which can have the effect of drying out the mouth and reducing saliva. As a result, without proper oral hygiene, these elderly residents are particularly susceptible to rapid deterioration of oral health.

Apathy Contributes to Weight Loss in Elderly

June 18, 2013 | by Law Offices of Ben Yeroushalmi

A June 2013 study published in the Journal of American Medical Directors Association found that apathy is the behavioral symptom most strongly correlated with weight loss in nursing home residents. This comes as a surprise because it was commonly believed that depression was most closely related to weight loss in this demographic. However, the study found that depression, along with agitation and rejection of care did not increase the elderly’s risk of losing weight.

Weight loss is a serious threat to the elderly’s health because it increases their risk for hip fractures, pressure sores, infections, anemia, fatigue, and even mortality. In Alzheimer’s victims in particular, weight loss can lead to a rapid cognitive decline. Therefore, in order to prevent these possible complications, it is important for nursing home caregivers to monitor residents’ weight closely.

This study is significant because it equips nursing home staff with new ways to detect and prevent deterioration in the health of their residents. Subjects in this study who displayed apathetic behavior lost more weight in the following three months than those who did not. This means that if such behavior is counteracted early enough, weight loss can be prevented. It is important to emphasize that there are many non-pharmacological methods to eradicate apathy. First, it is important that nursing homes have enough staff to keep a close watch on residents in order to detect any dulled emotional responses, indifference, poor social engagement or other symptoms of apathy. Also, caregivers should seek ways to eliminate or limit the administration of psychoactive medications because some have been known to cause anorexia.

Sadly, many nursing homes are not properly staffed , leaving many apathetic residents undiagnosed and at risk of weight loss. Apathy is not a behavioral issue like agitation or depression, as it does not cause any disturbance to other residents or staff, making it easier to ignore or leave untreated. However, the long term implications of ignoring apathy due to improper staffing are a serious decline in resident health. Furthermore, improper staffing and poor quality of care at a facility can exacerbate a resident’s apathy. This is why it is necessary for nursing home staff to be properly trained so as to provide the residents with emotional and psychological comfort. It is also important to emphasize that there are many strategies that nursing home staff may use to decrease the prevalence of apathy. Engaging the elderly in simple activities, such as listening to live interactive music or adding cognitive stimulation, have been known to counteract the effects of apathy. In those whose apathy was properly treated through activity engagement, weight loss was curbed and turned into a healthy weight gain.