Author Archives: Adam Peck

California SB 345 aligns state and federal law regarding the ombudsman’s office. It emphasizes the ombudsman’s ability to advocate on behalf of long-term care recipients, something advocates say has been politically challenging, since the agency is housed within the Department of Aging.

The Older Americans Act responsibilities of the State Ombudsman and now placing those issues into California law is really what the State of California needed and leaves any doubt that the State Ombudsman can now do his job effectively says California Elder Abuse Attorney Steven Peck.

The bill also calls for an annual report and re-establishment of an advisory council. The deadlines for those tasks were amended.

Long Term Care Ombudsman Services are a mystery to many people. People have difficulty “pronouncing it, spelling it or understanding what it is, Peck says. The service is a vital one for all elders and dependant adults.

“When you think of the state ombudsman, they should be the best advocate,” Peck says “It’s about the office. The state ombudsman needs to be the loudest and best advocate of all and help eradicate Elder Abuse throughout the State of California and the United States.

Pressure Ulcers, Bed Sores and Decubitus Ulcers:

A pressure ulcer, also known as a bedsore or decubitus ulcer, is a wound of the skin caused by prolonged, unrelieved pressure to that area. Pressure ulcers occur most frequently around bony prominences such as the tailbone, hips, heels, ankles and elbows.

Causes:

Many factors can contribute to the formation of pressure ulcers, bed sores also known as Decubitus Ulcers. The main cause is unrelieved pressure to a location of skin on the body. This constant pressure inflicts damage by decreasing the area’s blood supply and traumatizing the skin. When this pressurized spot rubs against other surfaces (such as bed sheets or wheel chairs), the tissue is further damaged. Other contributing factors are:

Excess moisture (fecal or urinary incontinence)
Poor nutrition and/or hydration
Generally poor health

Types

Pressure ulcers are categorized according to their characteristics by their severity:

Stage I: The beginning stage

The skin is intact.
The skin appears red or ashen and doesn’t blanch (lighten in color) when touched.
The area may be painful, firm, soft, warm or cool.

Stage II: An open wound

The pressure ulcer may look like a shallow, pinkish red bowl-like wound, or it may appear as an intact or ruptured blister.

Stage III: A deep wound

The pressure ulcer has a crater-like appearance.
Deep damage may expose a fat layer.
The bottom of the wound may have some yellow dead tissue (called slough).

Stage IV: Large scale tissue loss

The wound exposes bone, muscle or tendons.
The bottom of the ulcer contains slough and/or dark, crusty dead tissue (called eschar).
The deep damage is extensive and well beyond the original wound.

Signs and Symptoms

Pain can be a common symptom of pressure ulcers. Having any of the characteristics defined in the stages of pressure ulcers is cause for concern. A red mark that does not change over time or a blister that appears to worsen may be a pressure ulcer and should be evaluated by a healthcare professional.

Who Is at Risk

Anyone with limited mobility is at risk for developing pressure ulcers. Immobility, temporary or permanent, may be due to:

Surgery
Coma
Sedation
Paralysis
Bed rest or use of a wheel chair
General weakness

Other risk factors include:

Decreased sensory perception
Medical conditions that affect circulation
Decreased mental awareness

Treatment Options:

If not treated, pressure ulcers can lead to sepsis (infection of the blood), bone and joint infections and death. Stages I and II pressure ulcers heal within several weeks with general wound care and treatment of the risk factors contributing to the wound’s formation. Stages III and IV ulcers are difficult to treat and, if found in an individual with multiple chronic conditions or a terminal illness, treatment may simply be focused on managing the wound rather than on healing it completely. General wound care involves a combination of the following:

Relieve the pressure: Frequent repositioning is imperative. Individuals confined to a wheelchair should change positions at least every 15 minutes. Those confined to a bed should be repositioned at least every 2 hours. In all cases, bony areas should be cushioned as much as possible.

Remove damaged tissue: The damaged tissue can be removed by cutting, irrigating or using chemical ointments to break down the tissue.

Clean and dress the wound: Pressure ulcers are cleansed with saline solution and can be dressed with a variety of dressings. All dressings aim to keep the wound at the appropriate moisture level while also creating a barrier to prevent infection.

Other treatments include antibiotics, pain management and improving nutrition.
Prevention

Pressure ulcers are much easier to prevent than to treat, but that doesn’t mean they all can be prevented. Wounds may still develop with persistent and appropriate care due to the overwhelming nature of risk factors in some individuals. Take the following steps to help prevent pressure ulcers:

Change position frequently and avoid trauma to the skin when shifting positions (lifting and turning rather than scooting or dragging the skin)
Keep the skin clean and dry
Inspect the skin regularly, particularly in bony areas – get assistance if you are unable to view skin in some areas of your body
Eat a well balanced diet and drink plenty of fluids

State public health officials confirmed Wednesday they are in the process of revoking the license for a troubled Joliet nursing home.

Hillcrest Nursing and Rehabilitation Center, 777 Draper Ave., also was scheduled to be decertified for Medicare on April 1, said Melaney Arnold, communications manager for the Illinois Department of Public Health.

Arnold could not confirm Wednesday that the center was scheduled to close May 15. A woman who answered the phone at Hillcrest on Wednesday said Amy Sparks, who is listed as the administrator of the facility on both the IDPH website and the facility’s website, no longer was working there. No administrators were available to comment, the woman said.

Joliet Mayor Tom Giarrante said he called the Illinois Department of Public Health on Wednesday to ask if the state could do another inspection on Hillcrest before it closed. He did not hear back as of Wednesday afternoon.

“I’m not trying to get them to keep it open,” Giarrante said. “I just want them to do another inspection before May 15 to see if it will pass.”

Giarrante said he did not know if the facility could be kept open with another inspection. But he said he was concerned about people losing jobs once Hillcrest closes.

In April, the IDPH investigated complaints from 10 out of 16 residents who were transferred out of the facility between March 17 and 23. The state found residents were transferred without regard to their preference of facility.

One resident is quoted in a state report as saying: “All the residents were told (Hillcrest) was closing. We were told it was because of (a resident alleged to have sexually and physically assaulted 23 residents) … and funding problems. They said the facility … did something very wrong and everyone had to go.”

A separate IDPH investigation found that between May and October, a 26-year-old male Hillcrest resident sexually, physically or mentally abused at least 23 other residents.

Residents told investigators the man exposed himself and assaulted male and female residents, threatening to “come back with a gun” if they reported the incidents.

That incident is not the first complaint filed against Hillcrest, which has a history of state investigations going back at least 10 years.

In February the state investigated an incident where a resident was discovered dead in her room, a coaxial cord wrapped around her neck and mouth.

In March, state investigators found the facility staff gave a resident too high a dose of a prescription seizure medicine, which resulted in hospitalization.