Author Archives: Adam Peck

Mrs. W is an 80-year-old woman who was recently discharged from the hospital after treatment of a severe infection in her leg that took a very long time to heal. Her hospitalization was also complicated by facility-acquired Clostridium difficile infection. Because she was still frail, Mrs. W stayed with her daughter following discharge. One morning, her daughter found Mrs. W lying on the bathroom floor awake but nonresponsive and unable to move. Paramedics took Mrs. W to the emergency department of the nearest hospital, where it was determined that she had had a stroke. Mrs. W was admitted to the intensive care unit. On admission, nurses documented a bruise on her right trochanter that was assumed to have been caused by the fall . Eventually this bruise opened up into a full-thickness pressure ulcer.

Noting that Mrs. W was at high risk for a pressure ulcer, bed sores, and decubitus ulcers prevention interventions and skin protection were instituted immediately. Mrs. W was moderately obese and had diabetes, hypertension, and hypothyroidism. She also had evidence of poor peripheral perfusion, and her “tissue tolerance” was judged to be unusually low. These factors probably played a role in the rapid deterioration of Mrs. W’s bed sore, pressure sore and skin ulcer and the inability of the nursing staff to halt the progression of the injury despite prompt and diligent nursing care. However, Mrs. W’s family was angry about the pressure ulcer, blamed the nursing staff, and initiated a lawsuit against the nurses and the hospital.

The Peck Law Group, California’s number one and soon to Be Arizona’s premier Nursing Home Abuse and Neglect Lawyers are advocating for more oversight of nursing homes in California, Arizona, and all over the United States..

Recently we were advised of one patient at an nursing home facility that had maggots in her trachea and another patient that had maggots on an open bed sore also known as a pressure sore and decubitus ulcer. These type of cases are specific examples and unfortunately are not isolated incidents or unique to any particular nursing home. Rather, they are indicative of a statewide failures to provide quality nursing care at all times and to protect nursing facility residents from harm says Nursing Home Abuse and Neglect Lawyer Steven Peck. Other incidents which we have litigated include, a skull fracture from a fall from wheelchair wherein the resident died three days later because of bleeding in the brain, another patient dying from injuries sustained in a fall from a wheelchair without foot pedals, and what seems like a typcial nursing home negelct problem of Elopement transpired when a resident was able to leave a nursing home facility and sat in a wheelchair on the side of the road and no staff members were disciplined.

Low nurse staffing levels are considered the strongest predictor of poor nursing home quality leading to abuse and neglect says California Elder Abuse Attorney Steven Peck.

The 10 largest for-profit chains operate about 2,000 nursing homes in the United States, controlling approximately 13 percent of the country’s nursing home beds.

In recent decades, nursing home chains have undergone a considerable expansion. A number of chains were publicly-traded companies until the early 2000s, when five of the country’s largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses.

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share.

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing which lower staffing could lead to bed sores, malnutrition, dehydration, and infections.

Recent Medicare cuts in payment rates for nursing home residents – by 11 percent in October, 2011 – may further jeopardize the health and safety of residents if the chains respond by reducing staffing and wages, Harrington said.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse “staffing hours” than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, bed sores and decubitus ulcers, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents such as malnutrition and dehydration.

The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

The authors said that more study is needed on the subject. They also said that greater accountability and quality oversight mechanisms would help improve nursing home care, along with effective funding incentives and sanctions for low staffing and poor quality.

Source: UCSF