IDPH has cited and fined Integrity of Smithton nursing home after a resident there developed a pressure ulcer on his heel which became infected and required hospitalization.
Federal regulations regarding pressure ulcers or bed sores provide that when a resident is admitted to a nursing home without pressure ulcers a resident should receive care, treatment, and services consistent with professional standard so that they should not develop them unless they are clinically unavoidable. When a resident enters a nursing home with pressure ulcers or develops them after admission, then the regulations require that the resident receive care, treatment, and services necessary to promote healing, prevent infection, and prevent the development of new pressure ulcers.
When a resident is admitted to a nursing home, one of the steps in the care planning process is to assess the resident’s risk for developing bed sores, usually using a tool like the Braden scale. If a resident is at risk for developing bed sores, then that should be addressed in the care plan. If a resident develops new bed sores or has a decline in an existing wound, then this is something that requires physician notification to obtain new treatment orders and a revision of the resident care plan.
When this resident was first admitted to the nursing home, he was ambulatory, but then developed a pressure ulcer to his heel. When the wound was first documented, it was listed as being an unstageable deep tissue pressure injury/pressure on his left heel measuring 6×11 cm with a 2.5×2.5 cm necrotic area in the center of the heel. An unstageable pressure injury is one in which the base of the wound bed cannot be seen due to the presence of dead tissue in the wound. By definition, it is considered a Stage 3 or Stage 4 wound.
The nursing home staff notified the doctor who issued orders for treatment including floating the heels from the surface of the bed and using a pressure relieving boots to help reduce pressure on the wound. The onset of the wound coincided with the loss of the ability of the resident to bear weight on the leg, resulting in his discharge from physical therapy and occupational therapy.
A little less than 2 months after the wound developed, the wound care nurse noted an odor coming from the wound along with an increase in drainage. These are signs of infection, and the nurse obtained an order from the doctor to send the resident to the emergency room.
There, the resident was diagnosed as suffering from osteomyelitis (a bone infection). He was placed on IV antibiotics and underwent a surgical debridement of the wound. If the debridement and antibiotics are not successful in resolving the infection, amputation is the likely outcome. Either way, this resident had been significantly debilitated by the development of the bed sore. This has led to a loss of his ability to walk and to transfer, all of which will have long-term negative effects on the quality of his life, assuming that he survives.
When interviewed by the state surveyor, the Director of Nursing claimed that the wound was a vascular ulcer and that therefore the nursing home was not responsible. However, it was assessed as being a pressure ulcer at the outset by the nursing staff and the treating vascular surgeon also characterized the wound as a pressure ulcer, noting that vascular ulcers do not normally develop in the area where this wound occurred.
In nursing home abuse and neglect lawsuits involving pressure ulcers, the medical issues are often front and center. Many nursing home residents have risk factors for the development of these wounds, and nursing homes often defend these cases aggressively by claiming that the wound was not a pressure ulcer or that the development of the wound was the natural progression of the underlying risk factors, i.e., that the resident was old and sick, rather than the poor care which the resident received.
Understanding the difference between the various kinds of wounds and how they develop is a critical part of being an effective nursing home abuse lawyer, and in particular how they result from the systemic poor care that nursing home resident receive. One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
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