IDPH has cited and fined Eastside Health & Rehab in Pittsfield after a resident there developed pressure ulcers on his buttocks.
The citation that IDPH issued is interesting because it has two parts and taken together, it tells a story about what is happening at this facility.
Bed sores are also called pressure ulcers because one of the main causative factors is pressure from the weight of the body against a resting surface such as a bed or a chair. Typically, they occur over bony prominences such as the hips, ankles, or heels. Major risk factors for developing pressure sores include immobility, incontinence, and poor nutritional status.
Federal regulations relating to the issue of bed sores in nursing homes requires (a) that when a resident enters a nursing home without bed sores, they must receive care, consistent with clinical standards of practice, to prevent bed sores and not develop them unless they are unavoidable and (b) once they develop bed sores, they receive care, treatment, and services to promote healing, prevent infection, and prevent the onset of new bed sores.
The issue of bed sores is something which is addressed in the care planning process. When a resident is admitted to a nursing home, they are assessed for risk of developing bed sores, usually through the use of a tool like the Braden scale. If they are determined to be at risk for developing bed sores, then a care plan must be put into place. The care plan will usually include elements like providing prompt incontinence care, use of barrier creams, turning and repositioning every two hours, and regular skin checks. The development of a bed sore or the decline of one is something which requires physician notification so that orders for treatment can be obtained.
The usual regimen of providing incontinence care, turning and repositioning, and doing frequent skin checks is a labor-intensive exercise. As a general proposition bed sores do not develop as a result of a single violation of the care plan during a single shift. However, as the shortcomings in the delivery of care pile up over time, then the onset of new bed sores becomes more predictable.
The first resident at issue was at risk for developing bed sores. He developed Stage 2 pressure ulcers to both sides of the buttocks. These healed, but then about a month and half later later, was noted to have unstageable pressure ulcers to both buttocks. By definition, an unstageable pressure ulcer is at least a Stage 3 pressure ulcer because there is dead tissue in the wound bed which keeps the bottom of the wound bed from being seen. When the state surveyor asked the Director of Nursing why these were not discovered until they were unstageable, she was unable to explain it.
Which brings us to the other issue raised in the citation. While the state surveyor was in the facility doing her inspection, she saw that one resident was left sitting in his wheelchair, asleep and unmoved for a four hour period. The standard for preventing pressure sores is to turn and reposition every two hours. When residents go longer than that, the prolonged amount of time that the skin is exposed to pressure increases the chance of a bed sores developing.
What these two instances together tell us is that the routine care that is necessary to prevent and treat bed sores is not being provided. With regard to the first resident, regular skin checks should have detected the bed sore before it became unstageable. Bed sores are more easily treated when they are less severe, and the decline from a Stage 2 to unstageable is significant. Failure to detect that and notify the doctor before it became unstageable is a significant lapse in care. In the same way, the failure to resposition the resident in his wheelchair is also a lapse in care which increased the risk of injury to that resident. And all this is just a snapshot of what is happening at that nursing home.
The real question is why, of course. And the answer to the likely lies in understaffing of the nursing home. Understaffing of the nursing home is a key feature of the nursing home business model. 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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