Injuries from falls account for roughly 36 percent of potentially preventable visits to the hospital emergency room by nursing home patients. According to the U.S. Centers for Disease Control and Prevention (CDC), nursing home falls frequently go unreported. Despite the lack of accurate nursing home fall data, the CDC still receives between 100 and 200 reports of nursing home falls each year from average-sized nursing homes. A nursing home of average size, as defined by the CDC, has approximately 100 beds for elder residents. 

Nursing home falls frequently cause a disability, functional decline, reduced independence, and reduced quality of life for an elderly person. Patients with a fear of nursing home falls may also experience feelings of helplessness, loss of function, depression, anxiety, and social isolation. It is important to take precautions, both in and out of a nursing home facility, to prevent elderly falls, fractures, and injury.

Unfortunately, preventable falls in nursing homes are a common occurrence.  In 2003, the CDC estimated 1.5 million adults over the age of 65 were living in nursing homes. At this rate, there will be roughly 3 million nursing home patients by 2030.According to the CDC:

• Between 50 percent and 75 percent of elder patients suffer from a nursing home fall each year. This rate is twice as large as the rate of falls which occur for elders living in the community.
• The CDC estimates that roughly 5 percent of elders, age 65 and older, are nursing home residents. However, nursing home patients make up about 20 percent of deaths as a result of an elderly fall.
• Nursing home patients typically fall multiple times each year. The CDC averages this statistic at 2.6 falls per nursing home patient, per year.
• Roughly 35 percent of elderly fall injuries happen to nursing home patients who cannot walk.
• Between 10 percent and 20 percent of nursing home falls result in serious injury for the elder patient.
• Approximately 1,800 elderly patients die each year as a result of nursing home falls.

Nursing home falls may be caused by one, or a combination of, the following reasons:

• Environmental hazards within the nursing home, such as poor lighting, wet floors, incorrect bed height, or inadequate wheelchair size and maintenance
• Certain types of common nursing home medications, such as anti-anxiety or sedative medications
• Changes in medication types or doses
• Staff attempts to move the patient from one place to another without the assistance of other staff members or properly using assistive devices
• Improper elder foot care
• Using shoes that do not fit correctly
• Improper use, or inadequate maintenance, of walking aids

Falls are preventable

 Research suggests that many nursing home falls are preventable with the proper fall prevention programs in place. Nursing homes must take the time to assess new patients for falling risks and potential modifications to enable safer mobility of that patient. The nursing home staff must maintain a high degree of education on nursing home fall prevention. The staff should also be aware of any nursing home patients that have a particularly high risk for falling. Any necessary mobility devices should be easily used and well-maintained.

Environmental hazards that cause nursing home falls present a pronounced risk for patients. Nursing home negligence may result in dim lighting, making it hard for patients to see well enough to walk. Wet or slippery floors in nursing homes are extremely unsafe, as elderly patients frequently have preexisting mobility and balance problems. Items such as beds, chairs, or mobility devices must be easily accessible for the patient. Bathrooms should provide seats, handles along the walls, and no-slip flooring when possible. Failure to supply a safe environment for patients is grounds for a nursing home negligence lawsuit.

Bedsores are more common on areas that have bones that stick out from the affected area, including the tailbone, ankles, and heels.

Those at the greatest risk of getting bedsores are elderly individuals who have medical problems that prevent their ability to turn themselves in bed or on a wheelchair. This emphasizes the importance of preventing bedsores rather than treating them with surgery or other methods. Bedsores can become a problem when they are left untreated. If you or a loved thinks that bedsores have formed due to abuse or neglect, then you should consider a free legal case review with an experienced nursing home abuse lawyer at Carlson Injury Law to see what help you can get.

Symptoms of Bedsores

There are various stages of bedsores that differ in their severity (3). According to the National Pressure Ulcer Advisory Panel, the stages of bedsores is as follows:

Stage I

In stage one disease, the skin is still intact. It usually appears reddened and doesn’t blanch when touched. Bedsores in stage I may be painful, soft, warm, tender, firm or cold when compared to normal skin.

Stage II

In stage II of bedsores, the epidermis (outer layer) and the dermis are broken open and lost. There may be a shallow wound that is red or pinkish in color, which may resemble a ruptured blister.

Stage III

Stage III involves having a deep wound that exposes fatty tissue. The ulcer typically resembles a crater with a yellow-colored base of nonviable tissue. The damage may spread to surrounding areas of normal skin.

Stage IV

In this stage of bedsores, there is a great deal of lost tissue that can expose the tendons, muscles or bones. The base of the wound contains dead tissue that is crusty and dark in color, and there is damage extending into healthy tissue.

Typical Sites of Bedsores

If the individual is confined to a wheelchair, the sore usually occurs on the tailbone, buttocks, shoulder blades, the backs of the arms and legs or on the spine.

For patients who are bedridden, the most common sights of bedsores include the sides or back of the head, ears, shoulder blades, heels, ankles, behind the knees, the tailbone, the lower back, or the hip.

Causes of Bedsores

Pressure sores are usually caused by excess pressure of an object against the skin that decreases the flow of blood to the skin. As a result of the pressure, the skin becomes prone to damage. Contributors to getting a bedsore include the following:

• Ongoing pressure on the skin.The pressure of the skin against an object is greater than the pressure inside the blood vessels in the body so that tissue, particularly skin cells, become damaged and die off. They tend to happen in places on the body that aren’t padded with muscle or fat.
• Friction. This is defined as resistant to motion. The skin may be dragged across the bed during position changes. The sores tend to develop mostly in places that are moist or that have fragile skin.

• Shear forces.This happens when two different surfaces are caused to move in different directions. If the patient moves around in bed, there can be friction on a body area, resulting in the formation of a bedsore.

Risk Factors Of Bedsores

Those at greatest risk of bedsores are those that cannot easily move about in bed or have to remain in bed or a wheelchair for long periods of time. Causes of a lack of mobility include the following:

• Paralysis
• Sedation
• Poor health
• Any injury that requires prolonged bed rest or the use of a wheelchair
• Coma
• Surgical recovery

Age can play an important role in one’s risk of getting a bedsore. Older individuals are more vulnerable to having skin that is thin, fragile, dry and less elastic when compared to the young. Individuals with spinal cord injuries or other neurological disorders that lack independent mobility can get bedsores if they are not moved frequently.

Those who lose weight during a long-lasting illness will lose the protective fat, making them more prone to bedsores.Those who are dehydrated or have poor nutrition do not have the resources to repair damaged skin. If the skin is excessively moist or too dry, this can increase the friction between bed clothing, the bed and the skin. People with bowel incontinence can get local infections of the buttocks that combine to form infected bedsores.

People with diseases that decrease blood flow to the skin are also more likely to get bedsores. This includes those who are diabetic or who have vascular disease. Smokers are at a higher risk of bedsores, as are people with decreased mental awareness. People with muscle spasms have increased shearing of the skin against the bed and can develop bedsores as a result.

BED SORES ARE PREVENTABLE

To prevent bedsores, Nursing Homes should implement the following measures to protect our loved ones:

• Frequent repositioning.Regular repositioning is required to prevent and treat bedsores. For wheelchair-bound individuals, weight must be shifted about every fifteen minutes. Nurses or caretakers should reposition the person every hour. Facilities should encourage the use a trapeze bar in bed in order for your loved one to move his or her body around without having too much friction or shear force.
• Physical Therapy. Patients who have severely limited mobility should be in a physical therapy program. This can help them to keep moving and to keep the blood flowing. It also helps to prevent the muscles from atrophying. If a patient is able to walk, they should be allowed to do so.
• Regular Skin Checks. A nursing home should regularly check the paitent’s skin to see if there are any signs of bedsores. The sooner a problem is discovered the sooner the issue can be corrected. It is easier than waiting until the sores progress. Patients should be kept clean and linens should be clean and dry at all times. Foam pads on the bedding can provide more comfort and cushioning, particularly for the areas that are prone to developing the sores. Beds that can raise and lower and those that can change the amount of pressure can be helpful as well.
• Proper Nutrition and Hydration.

Proper nutrition and hydration are critically. This can help your loved one to have stronger and healthier skin, thus reducing the risk of bedsores. In the event a bedsore does develop, proper nutrition and hydration can accelerate the healing process and help stave off infection.

If you notice bedsores on a loved one, they are the result of negligence. The staff at the facility is responsible for not noticing and doing anything about these sores. It is important to remove the patient from the situation and seek medical attention for the sores. In addition, it is important to contact the authorities to let them know the situation so they can investigate. An experienced nursing home abuse injury at Carlson Injury Law can guide you through this process.

Weak muscles and other physical issues make choking a serious danger for our loved ones. A nursing home’s failure to mitigate the risks of choking threatens the safety of our loved ones.

 Risk Factors of Choking

Swallowing is a reflexive motion that requires a perfectly coordinated muscle performance. That balance is disrupted when disease and age weaken the throat and esophagus. Difficulty swallowing, called dysphagia, can affect all ages, but it’s more common in aging adults.

Some of the signs and symptoms of dysphagia include:

• A hoarse voice
• Coughing or gagging when swallowing
• Cutting food into small pieces to help with swallowing
• Drooling
• Frequent heartburn
• Inability to swallow
• Pain while swallowing
• Regurgitation
• The sensation of food stuck in the throat or chest

All of these symptoms could be the side effects of disease and illness. A stroke that twists the mouth or loss of control from amyotrophic lateral sclerosis (ALS) directly impact the ability to chew and swallow. Indirectly, radiation therapy from cancer can scar the esophagus, or medications that cause dry mouth can affect swallowing.

Diseases of the mind like dementia and Alzheimer’s can also lead to choking. Residents left unsupervised can fail to properly chew their food or cut it into small enough bits. Even with someone by their side, an untrained or inexperienced staff member can hurt instead of help their resident. Slow chewing, other residents’ needs, or overworked staff are also factors that can lead to a fatal distraction.

CHOKING IS PREVENTABLE

To prevent a patient from choking, the nursing home should properly assess whether the patient is a choking risk. Once an appropriate assessment has been completed the nursing home should establish strict food guidelines and dietary restrictions for your loved one. Such measure should likely include:

• Adding prescribed thickening agents to drinks, either gum-based or starch-based, to increase density and make swallowing easier
• Carefully tracking the foods a resident is served
• Making food easier to swallow through puree or julienne cutting
• Monitoring how fast a resident is eating
• Supervising residents during meal times