The NH’s responsibility to meet the individual needs of each resident is a non-delegable duty. NME Properties v. Rudich, 2003 WL 289415 (D.C. Fla., 2003) explains the analysis.

There are several regulations which make this implicit. Under 20 CFR 483.13(c) the facility must not neglect or abuse a resident. The facility has to develop an individualized plan of care per 483.20(k) that states the services to be provided meet the resident’s needs, which means that the care plan, under the scenario that you’ve described, would specifically state that the facility will rely upon “supplemental one on one private duty nursing to be provided by the resident.” That would be pretty wild and your best dream as plaintiff’s counsel, as it would be tantamount to an admission against interest that they can’t meet the needs of the resident. Facilities cannot admit or fail to discharge residents whose needs the facility cannot meet per 483.12(a)(2). Use of outside resources to meet the facility’s obligations under 483.25 is covered under 483.75(h)(1) & (2). 483.75(h)(2) states that arrangements by the facility “pertaining to services furnished by outside resource must specify in writing that the facility assumes responsibility for” the services.

Nursing homes change with the time
Industry keeps up with residents’ expectations
Originally published April 01, 2007 
By Katie E. Leslie
News-Post Staff

FREDERICK — For many people, the words "nursing home" bring to mind images of cold tile hallways, greenish room lighting, unattended seniors in distress and a sterile environment that speaks more of an outdated hospital than a home.
Some parts of the industry may have earned that reputation, but Cheryl Wright, marketing director for Homewood at Crumland Farms in Frederick, said today’s nursing homes are a far cry from the disturbing visions of yesteryear.

"There’s still a lot of education (in the community) that needs to happen," Wright said. "The reality is, things have changed for the better."

Homewood, one of Frederick County’s 13 nursing homes, is in the new generation of long-term care centers —-multi-staged retirement communities. In such establishments, people 55 and older can live independently in a house or apartment, and as their needs increase, move into an assisted living unit and ultimately into an advanced care unit.

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BY SEAN JAREM
The Dispatch

A Davidson County jury awarded one of the largest civil judgments in the past 20 years Thursday when it found a Lexington nursing home responsible for mistreatment of an Alzheimer’s disease patient.

After three days of testimony and three hours of deliberations, the jury unanimously decided that Living Centers – Southeast Inc., the former owners of Brian Center Nursing Care of Lexington, must pay $480,000 to Emma H. King after she developed numerous pressure sores on her body. The pressure sores eventually led her to be permanently crippled.

The 83-year-old woman went into the nursing home May 9, 2002, for care and rehabilitation following knee replacement surgery, according to court records.

Within two months, King lost nearly 20 pounds, became dehydrated and developed pressure sores in the sacral area. She then developed two more pressure ulcers on her knees, according to medical records provided during the trial.

Jurors heard evidence that King developed a fever after the sores became infected and had to be hospitalized. When she was admitted back into the Brian Center she never recovered from the injuries and eventually lost the use of her legs.

Family members of King took her out of the nursing home Aug. 28, 2003. For a year, she had to undergo surgery on a weekly basis.

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Hidden Cameras Uncover Patient Neglect At Queens Nursing Home
November 22, 2006

Nine employees of a Queens nursing home were arrested after hidden cameras uncovered a case of alleged patient neglect.

Secret cameras were installed at the Hollis Park Manor nursing home as part of an investigation by the state attorney general’s office.

Attorney General Eliot Spitzer says one camera inside a 67-year-old woman’s room revealed weeks of neglect. Spitzer says it also showed employees changing the woman’s records to make it look like she received the proper care.

Now the medical director, two nurses, and six nurses aides are in police custody.

The medical director of the home is denying the charges.

In cases where the medical records contain peripheral,
non medical information, courts have ruled such
information is not privileged. See Ashford vs
Brunswich Psychiatric Center
, 456 NYS 2d 96, (1982),
Moore vs St. John’s Episcopal Hospital, 452 NYS2d 669
(1982).

Notes written by a nurse are generally not protected
by the physician-patient privilege. See Weis v Weis,
72 NE2d 245. Weis is a leading case on this issue. In
Weis the court held that because the statute governing
the physician-patient privilege made no mention of
communications between a nurse and a patient, any
information given to a nurse was not privileged. This
case illustrates the trend seen in many cases where
the courts have interpreted the physician-patient
privilege. The privilege did not exist at common law
and courts construe the statute narrowly.

Hip Fractures Among Older Adults

More than 95% of hip fractures among adults ages 65 and older are caused by falls (Grisso et al. 1991). These injuries can cause severe health problems and lead to reduced quality of life and premature death (Wolinsky et al. 1997; Hall et al. 2000).

How big is the problem?

In 2003, there were more than 309,500 hospital admissions for hip fractures (NCHS 2006).
From 1993 to 2003, the number of hip fracture hospitalizations increased 19%, from 261,000 to 309,500 (NCHS 2006).
However, after adjusting for the increasing age of the U.S. population (U.S. Census Bureau 2006), the hip fracture rate decreased 14%, from 901 per 100,000 population in 1993 to 776 per 100,000 population in 2003 (NCHS 2006).
In 1990, researchers estimated that the number of hip fractures would exceed 500,000 by the year 2040 (Cummings et al. 1990).

What outcomes are linked to hip fractures?

As many as 20% of hip fracture patients die within a year of their injury (Leibson et al. 2002).
Most patients with hip fractures are hospitalized for about one week (Popovic 2001).
Up to 25% of adults who lived independently before their hip fracture have to stay in a nursing home for at least a year after their injury (Magaziner et al. 2000).
In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion (CDC 1996).

 

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Falls in Nursing Homes

How big is the problem?

In 2003, 1.5 million people 65 and older lived in nursing homes (National Center for Health Statistics 2005). If current rates continue, by 2030 this number will rise to about 3 million (Sahyoun et al. 2002).
Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported (Rubenstein 1997).
As many as 3 out of 4 people in nursing homes fall each year (Rubenstein et al. 1994). That’s twice the rate of falls for older adults living in the community.
Patients often fall more than once. The average is 2.6 falls per person per year (Rubenstein et al. 1990).
About 35% of fall injuries occur among residents who cannot walk (Thapa et al. 1996).
About 5% of adults 65 and older live in nursing homes. But people in nursing homes account for about 20% of deaths from falls in this age group (Rubenstein 1997).

How serious are these falls?

About 1,800 people living in U.S. nursing homes die each year from falls (Rubenstein et al. 1988).
About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures (Rubenstein et al. 1988).
Falls can make it hard for a person to get around, cause disability, and reduce quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation (Rubenstein et al. 1994).

Why do falls occur more often in nursing homes?

Falling can be a sign of other health problems. People in nursing homes are generally more frail than older adults living in the community. They tend to be older, have more chronic illnesses, and have difficulty walking. They also tend to have problems with thinking or memory, to have difficulty with activities of daily living, and to need help getting around or taking care of themselves (Bedsine et al. 1996). All of these factors are linked to falling (Ejaz et al. 1994).

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SHARON OSTROFF, Individually and as Power of Attorney for Lillian Restine,

Plaintiff, v. ALTERRA HEALTHCARE CORPORATION, Defendant.

CIVIL ACTION NO. 05-6187

UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF

PENNSYLVANIA

2006 U.S. Dist. LEXIS 50730

July 25, 2006, Decided

Sharon Ostroff, individually and as power of attorney for Lillian Restine, her mother, filed suit against Alterra Healthcare Corporation ("Alterra") for personal injuries suffered by Restine while she was a resident at an assisted living facility operated by Alterra. Defendant moved to compel arbitration pursuant to a Residency Agreement signed by plaintiff Ostroff. In an Order & Memorandum dated June 7, 2006, the Court denied defendant’s motion to compel arbitration. Ostroff v. Alterra Healthcare Corp., F. Supp. 2d , 2006 WL 1544390 (E.D. Pa. June 7, 2006). In that Order & Memorandum, the Court held that the Residency Agreement was a contract of adhesion and thus procedurally unconscionable. Id. at *5. The Court also ruled that the Agreement was substantively unconscionable, because it severely restricted discovery available to plaintiff n1 and reserved access to the courts for defendant while requiring plaintiff to arbitrate all disputes. Id. at *8. Because the arbitration clause was procedurally and substantively unconscionable, the Court refused to enforce it. Id. Defendant has now filed a Motion for Reconsideration and to Vacate that Order of June 7, 2006. For the reasons below, defendant’s motion is denied.

15. Treatment of Pressure Ulcers
Treatment of Pressure Ulcers
Clinical Guideline Number 15
AHCPR Publication No. 95-0652: December 1994
Foreword

The incidence of pressure ulcers is sufficiently high, especially among certain high-risk groups, to warrant concern among health care providers. These groups include elderly patients admitted to the hospital for femoral fracture (66-percent incidence) and critical care patients (33-percent incidence). In addition, the prevalence of pressure ulcers in skilled care facilities and nursing homes is reported to be as high as 23 percent. An extensive study of acute care facilities reported a prevalence of 9.2 percent, and in one study of quadriplegic patients the prevalence was 60 percent.

Because prevention of this debilitating condition is believed to be less costly than its treatment, the panel initially produced a guideline entitled, Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline, No. 3. Although it is certainly desirable to prevent pressure ulcers, individuals still enter the health care system with ulcers or develop ulcers during periods of increased vulnerability as their physical condition deteriorates. This guideline addresses the treatment of pressure ulcers. It is intended for clinicians who examine and treat persons with pressure ulcers, and the treatment recommendations focus on (1) assessment of the patient and pressure ulcer, (2) tissue load management, (3) ulcer care, (4) management of bacterial colonization and infection, (5) operative repair, and (6) education and quality improvement.

AHCPR appointed an external panel of multidisciplinary experts in this field to develop the guideline. To provide a scientific basis for this guideline, the panel conducted comprehensive literature searches, reviewed more than 45,000 abstracts, evaluated approximately 1,700 papers, and cited 333 references to support this guideline.

The panel solicited input from a broad array of organizations and individuals. Testimony was provided by interested parties at a public forum on April 9, 1992, in Washington, DC. A draft of the guideline was distributed to and analyzed by participants at a conference sponsored by the National Pressure Ulcer Advisory Panel and the Wound Ostomy and Continence Nurses Society in March 1993. The Treatment of Pressure Ulcers Guideline Panel also invited peer review by individual experts, professional organizations, consumers, and Government regulatory agencies. Health care agencies conducted pilot reviews to evaluate the clinical applicability of the guideline. In all, more than 400 reviewers have critiqued various drafts of this guideline.

This first edition of Treatment of Pressure Ulcers will be periodically revised and updated as needed so that future editions reflect new research findings and experience with emerging technologies and innovative approaches. To this end, the panel welcomes comments and suggestions regarding the current guideline. Please send written comments to Director, Office of the Forum for Quality and Effectiveness in Health Care, AHCPR, 6000 Executive Boulevard, Suite 310, Rockville, MD 20852.
Treatment of Pressure Ulcers Guideline Panel

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Pressure Ulcers

Also referred to as decubitus ulcers or bed sores, these are lesions caused by unrelieved pressure resulting in damage to underlying tissue. Pressure ulcers usually occur over a bony prominence such as the sacrum or heel, and are staged to classify the degree of tissue damage1. The risk for pressure ulcer development is increased for the person who is immobile and confined to a bed or chair. Pressure ulcers are classified into four categories, depending upon their severity, and are generally caused by unrelieved pressure on the bodies soft tissue.

In addition to pressure, the forces of friction and shear may contribute to wound development in the patient who is malnourished, incontinent, insensate and/or cognitively impaired. Assessment tools, such as the Norton2 or Braden3 tools, assist the clinician to identify patient factors that increase the risk for pressure ulcer development. Appropriate interventions and resources can then be targeted to intervene and reduce patient risks of pressure ulcer development or recurrence.

1. European Pressure Ulcer Advisory Panel. Pressure Ulcer Treatment Guidelines
2. Norton, D., McLaren, R., Exton-Smith, A.N. (1962) An investigation of geriatric nursing problems in hospital. Edinburgh: Churchill Livingstone
3. Bergstrom N., Braden, B. Lazuzza, A. (1987) The Braden scale for predicting pressure sore risk. Nurs Res; 36:4, 205-210

Information provided with support from the Wound Healing Research Unit, Cardiff