Nursing Home Negligence Lawyers in Delaware

A bedsore is an ulcer that occurs as a result of pressure and a lack of blood flow to an area of the body for a certain extended time. When these circumstances occur, the skin in the area where the ulcer occurs eventually dies. Bedsores have the potential to spread to muscle and bone. Areas of the body affected by bedsores can include the knees, back of head, shoulder blades, buttocks, hips, and heels.

There are four stages of bed sores. During the first stage, the skin feels warm, and the individual may feel a burning, painful, or itching sensation. On an individual with a dark skin tone, the area appears blue or purple, and on an individual with a light skin tone, the area appears red. During the second stage, the skin begins to take on the appearance of an open wound. Pain and discoloration in the affected area are associated with this stage. During the third stage, the bedsore takes on the appearance of a crater because of internal damage. During the fourth stage, the damage is severe. Risk of infection is high, and the damage may have spread to internal areas including muscle, bone, and tendons.

It’s the same thing. Bedsores are professionally referred to as Pressure Sores or Decubitus Ulcers.

According to information published by Johns Hopkins University, bedsores can be prevented by inspection of skin areas that show redness. This should be done every day with close attention paid to bony areas. Other methods suggested include turning or repositioning residents every two hours; remaining upright and straight while seated in a wheelchair and changing the resident’s position every 15 minutes; giving patients in wheelchairs soft padding to reduce pressure on certain areas; ensuring good skin care to keep areas clean and dry; and serving proper nutrition to promote healing.

Under Code of Federal Regulation, part 483.25 Quality of Care, based on the comprehensive assessment of the resident, the facility must ensure that the resident receives care consistent with professional standards of practice. This is to prevent ulcers unless the individual’s clinical condition proves they were unavoidable. The facility must also ensure that residents receive necessary treatment and services, consistent with professional standards of practice. This is to promote healing, and prevent infection/new ulcers from developing.

Depending on the stage of the bedsore, they pose the risk of serious infections/discomfort to the resident. Infections may be accompanied with fever and chills. If the bedsore’s infection spreads through the resident’s body, they may suffer from mental confusion, quickened heartbeat, and weakness. Bedsores may take days, months, or even years to heal.

The healing process for bedsores can be lengthy. Depending on the case, bedsores can take up to years to completely heal. Infection can also occur, and can prolong the healing process. Infection also carries other symptoms which can negatively impact other bodily processes, and can result in serious disability – even death.

Yes. Often, the case with bedsores is that a loved one discovers the existence of a bed sore before learning that preventative measures may not have been taken. It is likely that a theory of negligence would be used in this kind of case. Under a legal theory of negligence, one would prove the nursing facility staff negligently failed to abide by the professional standards of practice necessary to prevent the occurrence of bedsores. This might include proving that the nursing staff did not assist a resident with turning in bed every two hours.

Falls in nursing home facilities in Delaware are a common cause of injury and death to elderly and disabled residents. There are many precautions that are legally required to be taken to avoid these types of injuries under Delaware law. Some examples include handrails: nursing home facilities in Delaware must equip corridors with firmly secured handrails on each side. See 42 CFR § 483.90; Delaware Reg. 7.4.1.2. Another requirement is that Delaware nursing home facilities must use non-skid flooring materials that are maintained in good condition. 7.4.1.3. And all bathrooms shall have a wall-mounted hand grip at each toilet, bath tub, and shower. 7.4.3.5

Restraints may only be used for medical purposes, and must be of “the least restrictive” kind. 42 CFR § 483.12. Restraints must be ordered by a physician, and the facility must try to make other changes to help your loved one before resorting to the use of restraints. Delaware Reg. 6.3.8.2, 6.3.8.3, and 6.3.8.4.

Yes, upon a resident’s admission to a nursing home, there must be a comprehensive assessment of the resident within 14 days. Delaware Reg. 6.3.3. Included in this assessment must be consideration of physical functioning and structural problems. 6.3.3. Residents must be assessed every year. 42 CFR 483.20. Standards for quarterly review are set by the state. 42 CFR 483.20. The State of Delaware requires a quarterly review of the care plan, or sooner if there is a major change in health. 6.3.7. Nursing facilities have a duty to fill out incident reports which shall be retained in facility files. Under this duty, falls without injury and falls with minor injuries that do not require transfer to acute care facility or neurological assessment must be recorded. 9.7.2.

Nursing homes may discharge a resident because the resident proposes a health or safety risk to others in the nursing home. 16 Del.C. § 1127. The facility must develop and implement written policies and procedures that ensure the reporting of crimes. 42 CFR 483.12. A nursing home should take reasonable steps to protect residents from residents who exhibit violent tendencies.

Delaware law provides that facilities must report physical abuse resulting in injury occurring between residents or if without between a staff member or other person and a resident. 9.8.1.1. The occurrence or event must be reported immediately to the Division of Long Term Care Residents Protection. 2.15.

Delaware regulations define supervision as providing oversight to ensure safety, among other things. 2.20. Supervision of nursing is a duty of the director of nursing. 5.4.2.2. This regulation should be read to create a duty for nursing home staff to ensure that residents are safe, including safety from threats of other residents. Other states have found nursing homes liable in cases where residents were harmed by other residents. The question is whether the risk of harm is foreseeable and what action the home took in order to protect residents from the known danger posed by the problem resident.

Absolutely. The facility must not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. 42 CFR § 483.12. Additionally, the facility must not employ individuals who have been found guilty of abuse, neglect, exploitation, or mistreatment by a court of law. Facilities cannot employ individuals who have had a finding entered into a state nurse aid registry concerning abuse/ neglect OR have had a disciplinary action in effect against his or her professional license by a state licensure body. 42 CFR § 483.12.

Facilities must develop and implement written policies and procedures that prohibit abuse/neglect and establish policies and procedures for investigating such allegations. Additionally, the facility must develop and implement written policies and procedures that ensure the reporting of crimes. 42 CFR § 483.12.

Facilities must provide training to their staff that, at a minimum, educates the staff on activities that constitute and procedures for reporting abuse and neglect. 42 CFR § 483.95.

Delaware law provides that the facility shall have written personnel policies and procedures. The personnel records shall be kept current and available for each employee and include results of Adult Abuse Registry checks. 5.5.5. Additionally, physical abuse with or without injury if staff-to-resident must be reported. 9.8.1.3.

Nursing homes must report elopement of a resident in three situations: if the nursing home staff do not know where the resident is and the resident is injured, if the resident has a cognitive impairment and the nursing home staff do not know where the resident is, and if the resident cannot be found in or around the facility and someone calls the police. 9.8.3.1, 9.8.3.2, 9.8.3.3.

The Alzheimer’s Association recommends that staff do the following for a resident who wanders:

1. Come up with an appropriate care plan from the results of the assessment of the resident;
2. Balance mobility and choice of the resident with safety;
3. Work with the resident so that the resident feels safe and secure in the environment;
4. Take note of when and how wandering may occur;
5. Keep track of a wandering resident to ensure safety;
6. Arrange for additional assistance for residents who are new to the nursing home until they have settled in;
7. Train staff members on how to deal with wandering when it becomes unsafe, and how to prevent and address elopement;
8. Know the proper ways to address and speak to residents who are confused and wandering;
9. Allow for safe, indoor paths for residents to walk around;
10. Allow for exercise activities;
11. Make sure needs are met in a wandering resident;
12. Come up with strategies to prevent elopement. https://www.alz.org/media/documents/dementia-care-practice-recommend-assist-living-1-2-b.pdf

Special care and services must be given to residents who suffer from Alzheimer’s and dementia. 5.6.1

It is unbelievable but true: Dementia patients have been allowed as a result of sloppy nursing home care to elope from their wing and from the home entirely on occasion. Some common reasons for lawsuits involving elopement (or exiting the nursing home without the staff’s knowledge) include inadequate training on elopement risk and monitoring; staff neglecting to properly keep track of wandering or elopement risks; under-staffing leading to inadequate and inappropriate supervision of the residents; failure to properly and sufficiently document condition, behavior, and risks; failure to have effective policies for procedure in the case of an elopement; lack of sufficient interventions such as door alarms and locks; and lack of timely response and intervention to prevent or stop an elopement.

The following assessment practices are recommended by the Alzheimer’s Association:

1. Get information from the resident’s previous caregivers about the resident’s past wandering habits and successful prevention strategies
2. Take note of the patterns and habits of the wandering resident, as well as medical, psychological, and physical conditions which cause the wandering
3. Assess the risks of the wandering behavior
4. Assess what measures are in place to ensure the safety of the wandering resident
5. Determine if the resources and staff of the facility are able to effectively meet the needs and safety requirements of the wandering resident
6. Consider the resident’s past, and what memories could trigger wandering
7. Consider physical mobility of the resident.

https://www.alz.org/media/documents/dementia-care-practice-recommend-assist-living-1-2-b.pdf

Nursing home facilities should flag residents who are at risk for eloping from the facility. The nursing home should then figure out what it can do to help that resident remain safe. This could potentially involve having the resident placed in a locked unit.

Nursing homes should adapt their facilities to provide for the safety of residents. Steps to accomplish this may include the use of security cameras or door alarms.

Staff should also undergo trainings throughout their employment to teach the proper protocol to deal with residents who are at risk from eloping from the nursing home.

It also helps when the nursing home will work with the doctor and the resident’s family to come up with the best plan for the resident’s care and safety.

When a resident is admitted to a nursing home, it is required that the nursing home assess the resident’s mental patterns, typical routine, mood, patterns of behavior, activities, and diagnoses/conditions. 42 CFR 483.20. Delaware Reg. 6.3.3.

Restraints can be used only for a medical purpose, and cannot be used for the purpose of punishing the resident or for the convenience of the caregivers. 42 CFR 483.12, Delaware Reg. 6.3.8. The facility is also required to consistently assess whether the restraints are still necessary, and must use the “least restrictive” type of restraint possible. 42 CFR 483.12. This consistent evaluation must also include strategies to eliminate the need for use of restraints through other means. Delaware Reg. 6.3.8.2. The evaluation should also consider the use of restraints which are less restrictive. Delaware Reg. 6.3.8.6.The caregivers must also document which medical symptoms and reasons the restraints need to be used. Delaware Reg. 6.3.8.1. The nursing home must also use and document other strategies and alternatives to minimize or eliminate the use of restraints. Delaware Reg. 6.3.8.3. The nursing home can only implement the use of restraints with a written order from a physician after the use of other interventions proved unsuccessful in promoting the safety of the resident. Delaware Reg. 6.3.8.4. The order must make note of what type of restraint is permissible. Delaware Reg. 6.3.8.4. And the nursing home must make sure the use of the prescribed restraint is “safe and effective[.]” Delaware Reg. 6.3.8.5.

Bedrails are a big danger and they are often misused as a restraint. They should remain down unless being used by the resident. As a result of improper use of bedrails, residents may be injured and even worse may die. Bedrails become dangerous when there is too much space between the mattress and the bedrail. This allows resident to fall down between the mattress and bedrail, and they may not be strong enough to pull themself out. Compression on the resident’s chest cavity may result in their loss of their ability to breathe. For more information, go to: http://www.nursinghomeabuseguide.org/injuries/bedrail-injuries/ Bed rails should never be relied on as a restraint for patients.

Residents who suffer from incontinence must be given “appropriate treatment and services” which will help prevent UTIs and help the resident regain control over urination. 42 CFR 483.25. Symptoms of urinary tract infections in the elderly may differ from those that are traditionally known. Some symptoms that an elderly individual with a UTI may experience are falls, decreased mobility and appetite, urinary retention, lethargy, incontinence, and agitation. Sometimes, fever, back pain, nausea, vomiting, and flushed skin may occur. The elderly are at a higher risk for UTIs. UTIs can occur as a result of not having soiled diapers changed soon enough. Preventative measures for UTIs include staying hydrated, changing diapers within reasonable time, staying away from caffeine and alcohol, maintaining cleanliness in the genital area, avoiding douches, not waiting when feeling the urge to urinate, and making use of vaginal estrogen. Nursing home staff need to ensure that residents, specifically those who are incontinent or struggle with mobility, are dry and clean. Monitoring for potential symptoms is critical, as well as taking preventative measures. If a UTI is not treated, it can spread to the kidneys and blood stream, and the infection can become life-threatening. Early medical intervention is key.

Staff must be properly trained on how to prevent the spread of infection through proper hygiene and cleanliness procedures. 6.9.4.1. The nursing home must put unto place an infection control committee. 6.10.1.1. The committee must consist of members from different roles in the facility. 6.10.1.2. The purpose of this committee is to write the policies which will be implemented in the facility to curb infection. 6.10.1.3. The facility must ensure that all materials used for grooming and hair of residents are kept clean in accordance with infection policies. 7.4.4.4. Federal law requires that nursing home facilities establish programs for controlling and preventing infection. The program must involve means of reporting occurrence of infection and have policies designed to control, prevent, and identify infection. Facilities must also put written policies into place. 42 CFR 483.80. Facilities must have a plan for when and how isolation will be implemented to contain the spread of infection. 42 CFR 483.80.

If a resident has a suspected or confirmed case of a contagious disease, precautions should be taken. 6.9.1.4. When it comes to contagious diseases, all regulations from the Division of Public Health and guidelines from the CDC should be followed. 6.9.1.1. If a resident is admitted with or contracts a disease which is included on the List of Notifiable Diseases/Conditions from the Division of Public Health, it must be reported to the resident’s doctor and the medical director of the nursing home. A report should also go out to the Division of Public Health.

Proper hygiene is critical to prevent scabies. Nursing home facilities must keep their buildings clean and free from harmful germs and other infections. If an outbreak occurs, the facility must notify local health departments to deal with the problem. Individuals who are diagnosed with scabies should be isolated from other patients and employees until 24 hours after treatment. Once diagnosed, the facility should designate a small number of employees to directly handle that patient. Thus, avoiding contact with other members of the facility.

The elderly are at a greater risk for contracting scabies due to thinner skin, loss of elasticity, and a slow healing rate. Scabies occurs when tiny mites burrow into the top layer of the skin. This causes a rash and severe itching. The reason why scabies can be spread in nursing home facilities is because it is transferred through skin contact with an infected person for a lengthy time. It can also occur through contact with items that are contaminated, but this is not as common. People who have been infected with scabies may not even know it, because symptoms can take weeks to reveal themselves. It is important for those infected to receive treatment, and for infected items, such as sheets and clothes, should be washed and dried with high heat. A special cream can usually help to get rid of scabies, and other treatments may help to relieve the itchiness. Itching can be problematic in the elderly because it can result in wounds that are at risk for infection. For more information on scabies infections in skilled nursing facilities, go to https://www.agingcare.com/articles/scabies-a-common-skin-condition-in-long-term-care-facilities-188246.htm

Federal law provides the facility must employ a qualified dietitian or other clinically qualified nutrition profession either full-time, part time, or on a consultant basis. This professional is one who holds a bachelor or higher degree granted by a regionally accredited university in the United States with completion of the academic requirements of a program in nutrition or dietetics; completed at least 900 hours of supervised dietetics practice under the supervision of registered nutritional professional; and is licensed or certified as a dietitian or nutrition professional by the State where the service is performed. 42 CFR § 483.60

Federal law provides that menus must be reviewed by the facility’s dietitian or other clinically qualified nutrition profession for nutritional adequacy.

Delaware State law states the immediate nutritional needs of each resident shall be addressed upon admission. 6.5.3.1 The comprehensive nutritional assessment which includes an evaluation of each resident’s caloric, protein and fluid requirements within 14 days of admission. 6.5.3.2 The facility shall have ongoing evaluations and assessments. 6.5.3.3.

It is the duty of the nursing home to train its staff in the proper treatment of blood sugar levels for diabetic residents. Each resident requires different amounts of insulin and the facility has a duty to administer the correct amount. Facilities must administer blood sugar medicine on a proper schedule, dosage, and make sure the patient ingests the medicine.