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Bedsores Are a Strong Indicator of a Nursing Home Patient's Lack of Quality Care

Nov 11, 2013

Among the most disgraceful indignities that people suffer are those involved with nursing home abuse. The horrific stories of abuse rendered upon some of our most vulnerable citizens continue to mount. Yet, despite the attention this abuse has received, it continues to occur.

Although abuse against the elderly can involve physical and sexual abuse, chemical abuse, nutritional abuse, and emotional and psychological abuse, it is the neglect of the elderly that often causes some of the most dangerous reactions. For example bed sores, or pressure ulcers, can range from what the U.S. Centers for Disease Control and Prevention (CDC) describes as one of five stages: No pressure and stages 1 through 4.

In Stage 1, the patient suffers from a persistent area of skin redness that has no break in the skin and does not disappear when pressure is relieved. By Stage 2, a partial thickness in the skin is lost and may look like an abrasion, blister, or shallow crater in the skin. At Stage 3, there is no skin thickness and the subcutaneous tissue is exposed and appears as a deep crater that may damage nearby tissue. When a pressure ulcer reaches Stage 4, the subcutaneous tissue, as well as the full thickness of the skin is lost and muscle or bone is exposed, according to the Mayo Clinic.

The Mayo Clinic also warns that bedsores are often formed when patients who require help to move around are left without assistance over time. This long-term immobility causes pressure on key areas on the body and inhibits blood flow through the skin, causing that skin to become oxygen and nutrient depleted. The skin then breaks down and ulcers begin to form. Bedsores commonly occur on areas considered to be “bony prominences” such as the heels of the feet, lower back, hips, shoulders, elbows, and the back of the head.

According to the CDC, pressure ulcers are serious medical conditions and a critical measure the quality of care at nursing homes. Bedsore complications have been implicated in numerous nursing home resident deaths as well as serious, life threatening complications such as sepsis, cellulitis, bone and joint infections, and a type of squamous cell cancer, the Mayo Clinic warns.

Sepsis occurs when bacteria enters the bloodstream through the ulcer, spreading through the body. Sepsis is a rapidly moving infection that may lead to organ failure. Cellulitis is an acute infection of the skin’s connective tissue and complications may include sepsis, as well as meningitis. Infections of bones and joints—septic or infectious arthritis—can lead to cartilage and tissue damage. Osteomylelitis (bone infections) might lead to a reduction of joint and limb function. Cancer can develop as a complication of untreated bedsores when squamous cell carcinoma develops in Marjolin ulcers—chronic, non-healing wounds. This cancer is aggressive and typically necessitates surgery, according to the Mayo Clinic.

As of 2004, the most recent year for which data was maintained, of the then 1.5 million United States nursing home residents, some 159,000 — about 11 percent — were diagnosed with pressure ulcers, according to the National Nursing Home Survey (NNHS). Of patients diagnosed with a Stage 2, 3, or 4 pressure ulcer, 35 percent required special wound care services.

Bedsores are just one example of how nursing home abuse and neglect can harm this delicate demographic. But, sadly, bedsores are not the only issue plaguing nursing home residents. Recently, a nurse’s aide was arrested over allegations that she physically and mentally abused a resident at a New York nursing home. The abuse in this case involved the aide allegedly twisting the resident’s wrist until it fractured, hitting the woman in the face with, not just her hand, but with a pair of soiled briefs, according to a report issued by Attorney General Eric Schneiderman.

As the elder population expands and people continue to live longer, family members and loved ones must handle the challenge of placing loved ones into a nursing home’s care. Often, nursing homes are the only viable opportunity available when dealing with individuals who are physically unable to care for themselves, those who are diagnosed with Alzheimer’s disease or dementia, or people who are unable to live alone.

We trust nursing home staff with the sacred responsibility of caring for our loved ones as we would ourselves if we had appropriate training and ability. With some 5.2 million Americans diagnosed with Alzheimer’s disease, the issue of abuse in nursing homes has become more than daunting. That number, says a recent Alzheimer’s Association report, could reach 7.1 million in a little more than one decade.

Also, about one in every three nursing homes in the United States have been cited for at least one abuse violation over a two-year period studied, according to a 2001 Congressional report. The report indicated that in over 1,600 of these facilities, the violations were significant enough to cause patient harm or to place residents in jeopardy of either serious injury or death.

In a report by ABC’s “Lateline,” the Australian media outlet spoke with caregivers, facility managers, and former health care officials, who told “Lateline” that there was insufficient time and supplies to properly care for residents, including meeting their most basic needs such as feeding, hydrating, and toileting. In fact, errors with patient medication were common and, often, injuries went unnoticed.

Stories of patients sitting in their own feces and urine or asphyxiating in their own vomit are no longer rarities. In a horrific health care scandal in the United Kingdom, the situation in one nursing home had declined to the point that patients were drinking from vases meant for flowers for lack of appropriate fluids.

If nursing home residents are unable to routinely receive the basic care they require for daily living, it is not surprising that so many of them suffer from pressure ulcers and other serious, life-threatening injuries.

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