All too often, patients in our nursing homes develop pressure ulcers (sometimes referred to as decubitis ulcers or bedsores) which can develop into a severe infection, horrible pain and possibly death. Unfortunately, these pressure sores develop as a result of poor care and neglect on behalf of the nursing home.
The main cause of a pressure sore is exactly what it sounds like. Pressure sores develop primarily as a result of constant pressure being applied to susceptible tissues and bony prominences. The majority of pressure sores occur on the lower part of the body primarily to the sacrum area, coccyx and heels. The severity of the pressure sores range from a stage I, which is similar to a small abrasion with redness, to a stage IV, which is a full thickness tissue loss which progresses all the way to the bone. The stage IV pressure sores carry a higher risk of a localized wound infection and possibly sepsis which can result in death.
In order to help prevent nursing home abuse and reduce the risk of nursing home patients developing preventable pressure sores, the Federal Government passed specific regulations that nursing homes are required to follow. As you may know, patients at nursing homes are often recipients of Medicaid and Medicare benefits. In order for the nursing homes to receive monetary assistance from the Federal and State Government, they must follow the regulations passed by the Federal Government as well as the laws in the State of New York.
Nursing Home Abuse and Neglect Should Not Occur
Nursing homes are aware that they must follow the regulations of the Federal Government for nursing home care and under the Federal code, they must ensure the following:
- A resident who enters the nursing home facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable.
- A resident having pressure sores receives necessary treatment and service to promote healing, prevent infection and prevent new sores from developing.
- Have sufficient nursing staff to provide nursing and related services to attain and maintain the highest practicable physical, mental and psycho social well-being of each resident.
- Ensure that the medical care of each resident is supervised by a physician and must provide or arrange for the provision of physician services 24 hours a day in case of an emergency.
- Be administered in any manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practical, physical, mental and psycho social well-being of each resident.
Upon admission to a nursing home, the facility must develop a comprehensive care plan for each patient that includes measurable objectives and time tables to meet a resident’s medical, nursing, and mental and psycho social needs that are identified in the comprehensive assessment. The care plan must also identify whether the patient is at risk for developing pressure sores. The care plan must also be periodically reviewed and revised by a team of qualified persons after each assessment. At the time of admission, it is imperative that a care plan is developed to identify risk factors and to specify a particular plan for the prevention of pressure sores. Many patients that are admitted to nursing homes lack the mobility and strength to transfer in and out of bed and thus are at risk for developing pressure sores. The less mobility a patient has, the greater risk they have for developing pressure sores.
The most common preventative measures for reducing the risk of pressure sores are the following interventions:
- Special mattresses
- Turning and repositioning schedule (typically every 2 hours)
- Dressings and other treatment
Turning and Repositioning Schedule
It is imperative that the nursing home staff follow their own plan for the prevention of pressure sores. The single most important measure to reduce the risk of a pressure sore is make sure the patient is turned every two hours. Patients who are at a high risk for developing pressure sores are typically required to be turned every two hours. Even though the prevention plan calls for repositioning of the patients every two hours, it is often ignored.
Proper nutrition is also essential in preventing pressure sores. The Federal Regulations require that each patient is provided with sufficient fluid intake to maintain proper hydration and health. A minimum amount of daily protein is also essential. The failure to do so will also contribute to the development of pressure sores.
Nursing homes are also required to have special mattresses for those patients that are at high risk for developing pressure sores. If a patient is a high risk for developing pressure sores, the nursing home should make sure that they are provided with a special mattress.
It is also important that family members are aware of the nursing home’s preventative plan for their loved ones regarding the prevention and maintenance of pressure sores. Family members should not assume that the nursing home will follow their own safety rules and should attempt to make sure that the staff provides the necessary care as they promised to do.
By accepting Medicare benefits, nursing homes have promised the Federal and State Government and their patients that they will follow the safety rules in the prevention of pressure sores, and if the nursing home chooses to ignore their own safety rules, preventable pressure sores will continue to occur.
Nursing home patients deserve to be treated with dignity, respect and the care necessary to maintain the highest practicable quality of life.
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