The Buffalo News reported the tragic and preventable death of Frank Williams.  Frank Williams died Dec. 21, 2016, from sepsis from pressure ulcers or bedsores he suffered at Safire Rehabilitation at Northtowns.  Williams didn’t have any skin breakdown or bedsores when he left Kenmore Mercy Hospital and entered the nursing home for rehabilitation after a stroke. Williams’ case illustrates how vulnerable individuals who go to poorly rated and understaffed nursing homes for rehabilitation can quickly succumb to preventable but lethal ailments like bedsores.

Four months later, when he returned to Kenmore Mercy, the retired ironworker had seven bedsores on the lower half of his body. He died 14 days later from sepsis – an extreme response to infection – according to his death certificate. Hospital records cite infections from bedsores as the most likely cause of the sepsis.

After he arrived, hospital records note, Kenmore Mercy staff discovered bedsores on the lower half of his body, including one with “foul smelling drainage” and greenish gray and black spots, along with dead tissue.

According to hospital medical records, there were bedsores on his lower back, right ankle, right and left heels and right big toe. There were two lesser wounds on his right pelvis and scrotum. 

“The sore on his right ankle looked like it was down to the bone,” Mark Williams said.

“They told me this is the worst case of bedsores they have ever seen from that nursing home,” his son, Mark F. Williams Sr., recalled doctors and nurses telling him in the emergency room. “The sores were black. I’d never seen that before. I was shocked. I thought it was the black plague.”

Bedsores, also known as pressure ulcers, occur when a section of the body is pressing against a surface for too long and not repositioned to alleviate the pressure. Several other factors, such as nutrition, the surface on which the body is pressing and moisture also contribute to bedsores, according to experts in the prevention of  these injuries. Yet there is consensus among nursing homes and other health care providers that the vast majority of pressure injuries can be prevented.  In fact, the nationwide average for pressure ulcers is less than 5% in most facilities.

 

Numerous media accounts of the tragic story of Army vet York Spratling appeared last month.  It is a horrendous story and one we hear too often nowadays.  York Spratling first checked into Consulate Health Care in December 2016 while suffering from diabetes.  Walking and feeding himself was a struggle, making living on his own impossibly unrealistic.

The 84-year-old U.S. Army veteran’s pressing medical needs were blatantly ignored by the nursing home staff last year — and he died shortly after.  Less than three months after being admitted to Consulate Health, Spratling’s condition took a terrible turn for the worse, and on Feb. 24, 2017, he was carried out of the nursing home on a stretcher and rushed to the emergency room.  The ER trip, however, wasn’t the product of diabetic concerns.

Shortly after Spratling’s admission to the hospital, the doctor informed the family that York needed painful surgery to remove dead tissue from his genitals, which had been infected with gangrene. After the procedure to remove the rotten flesh, Spratling’s condition worsened exponentially. Soon after, York Spratling was dead.

The doctor said “he had never seen anything like that before, especially in this day and age,” York’s son Derwin Spratling said. “It really freaked us out.”  Spratling’s condition was “way past obvious,” Derwin Spratling said. “This is so past obvious that it’s mind-blowing.”

“Everything was about to fall off, it was so rotten,” York Spratling’s brother, Obie, affirmed.

“Who was taking care of this man?” Spratling’s sister, Lula Price-Brown, asked. “His private area, nobody washed that.”

State investigators from Florida’s Agency for Health Care Administration, or AHCA, which oversees nursing home regulations, began looking into Spratling’s case in the aftermath of gross mismanagement and custodial neglect of a nursing home patient.

The AHCA had already cited the Consulate Health Care nursing home three times in the year leading up to the 84-year-old’s death, with each report pointing to inadequate staffing and an inability to provide even the most basic care for patients, such as bathing or hygiene.

Months before Spratling’s death, an unnamed patient at the same nursing home submitted an alarming complaint to AHCA inspectors, noting, “I have not had a shower in I don’t know how long,” according to the report.

When questioned about Spratling’s case, meanwhile, nursing home staff reportedly told state investigators that the stench emanating from his infection was so bad that it could be smelled from the doorway of his room. But despite the easily discernible health risk, staff members didn’t document or notify a doctor about the infection until a full five days after first noticing the odor, the report said.

Following his wrongful death, a subsequent report conducted by the Florida Department of Children and Families ruled that Spratling had indeed died due to “inadequate supervision and medical neglect.”

The AHCA, however, reportedly took no action against the facility despite the report’s pointed contents, thus allowing the nursing home’s conditions of patient squalor to persist.

Patient complaints have continued since Spratling’s death, with “neglect and inadequate staffing” principal among them. Eight months after York Spratling was rushed to the emergency room with rotting flesh, another patient told AHCA inspectors, “I wallow around in this bed in my own piss.”

According to the Mayo Clinic, “Gangrene refers to the death of body tissue due to either a lack of blood flow or a serious bacterial infection. Gangrene commonly affects the extremities, including your toes, fingers, and limbs, but it can also occur in your muscles and internal organs.”

 

Cochrane Oral Health investigated how proper personal hygiene especially mouth and dental care can prevent pneumonia.

Does oral (mouth) care cut down pneumonia (a lung infection) in nursing homes? We aimed to summarize the findings from studies known as “randomised controlled trials” in order to identify whether mouth care helped prevent pneumonia in elderly people living in nursing homes or other care facilities, and which approach to mouth care was best.

Pneumonia is common among elderly people living in nursing homes. Nursing home-acquired pneumonia (NHAP) is a bacterial infection of the lung that occurs in residents of long-term care facilities and nursing homes. Poor oral hygiene is considered to contribute to the likelihood of contracting an infection. Professional mouth care is a combination of brushing teeth and mucosa, cleaning dentures, using mouthrinse, and check-up visits to a dentist, while usual mouth care is generally less intensive, and is self-administered, or provided by nursing home staff without special training in oral hygiene.

This review was carried out through Cochrane Oral Health. We searched scientific databases for relevant studies, up to 15 November 2017. We included four studies, with a total of 3905 participants randomly assigned to treatment or usual care. Participants were long-term-care elderly residents in nursing homes who did not have pneumonia at the beginning of the studies. Some of the participants had dementia or systemic diseases. All studies focused on the comparison between ‘professional’ mouth care and ‘usual’ mouth care. None of the studies evaluated oral care versus no oral care.

We identified four studies, all of which compared professional mouth care to usual mouth care in nursing home residents.

From the limited evidence, we could not tell whether professional oral mouth care was better or worse than usual mouth care for preventing pneumonia. The evidence for death from any cause was inconclusive, but the studies did suggest that professional mouth care may reduce the number of deaths caused by pneumonia, compared to usual mouth care, when measured after 24 months.

Only one study measured negative effects of the interventions, and reported that there were no serious events. The most common non-serious events reported were damage to the mouth and tooth staining.

The quality of the evidence is low or very low, because of the small number of studies and problems with their design. Therefore, we cannot rely on the findings, and further research is required.

NBC News recently discussed the dangers of sepsis, a severe infection that can quickly turn deadly if not cared for properly.  Year after year, nursing homes around the country have failed to prevent bedsores and other infections that can lead to sepsis, an investigation by Kaiser Health News and the Chicago Tribune has found.  Sepsis is a bloodstream infection that can develop in bedridden patients with pneumonia, urinary tract infections and other conditions, such as pressure sores. Mindful of the dangers, patient safety groups consider late-stage pressure sores to be a “never” event because they largely can be prevented by turning immobile people every two hours and by taking other precautions. Federal regulations also require nursing homes to adopt strict infection-control standards to minimize harm.

However, no one tracks sepsis cases to know how many times these infections turn fatal.  A federal report found that care related to sepsis was the most common reason given for transfers of nursing home residents to hospitals and noted that such cases ended in death “much more often” than hospitalizations for other conditions.

A special analysis conducted for KHN by Definitive Healthcare, a private health care data firm, also proves that the toll — human and financial — from such cases is huge.  Examining data related to nursing home residents who were transferred to hospitals and later died, the firm found that 25,000 a year suffered from sepsis, among other conditions. Their treatment costs Medicare more than $2 billion annually, according to Medicare billings from 2012 through 2016 analyzed by Definitive Healthcare.

 “This is an enormous public health problem for the United States,” said Dr. Steven Simpson, a professor of medicine at the University of Kansas and a sepsis expert. “People don’t go to a nursing home so they can get sepsis and die. That is what is happening a lot.”

The costs of all that treatment are enormous costing taxpayers tens of millions of dollars per year.  Most of which is preventable if the nursing homes were given adequate care.  Yet the systemic failures that produce sepsis persist and are widespread in America’s nursing homes, according to data on state inspections kept by the federal Centers for Medicare & Medicaid Services. Most of the blame, regulators, experts, and patient advocates say, lies in poor staffing levels.  In 2001, a federal government study recommended a daily minimum of 4.1 hours of total nursing time per resident, which includes registered nurses, licensed practical nurses and certified nursing assistants, often referred to as aides.

Nursing home caregivers often miss early signs of infection, which can start with fever and elevated heart rate, altered mental status or not eating.  Too few nurses or aides raises the risks of a range of safety problems, from falls to bedsores and infections that may progress to sepsis or an even more serious condition, septic shock, which causes blood pressure to plummet and organs to shut down. Poor infection control ranks among the most common citations in nursing homes. Since 2015, inspectors have cited 72 percent of homes nationally for not having or following an infection-control program.

Forget everything you know about “normal” body temperature and fever, starting with 98.6.  There’s no single number for normal. It’s slightly higher for women than men. It’s higher for children than adults. And it is lowest in the morning.  98.6 is an antiquated number based on a flawed study from 1868.  That number was the work of Carl Reinhold August Wunderlich, a 19th-century German physician who wrote a seminal text using data from 25,000 patients. He concluded that 98.6 degrees is the body’s normal “physiologic point,” and that fever begins at 100.4 degrees.  Wunderlich took patients’ temperatures under the arm, a method that produces readings that are lower (and less reliable) than temperatures taken orally, offsetting some of the disparity.

The facts about fever are a lot more complicated. A new study, published online last month in the Journal of General Internal Medicine, refutes the age-old benchmark of 98.6 degrees Fahrenheit. Instead, the study found an average normal temperature in adults of 97.7 degrees, as measured with an oral thermometer.  As for fever, the study shows that it begins at 99.5 degrees, on average.

“A temperature of 99 at six o’clock in the morning is very abnormal, whereas that same temperature at four o’clock in the afternoon can be totally normal,” says Jonathan Hausmann, a rheumatologist at Boston Children’s Hospital and Beth Israel Deaconess Medical Center in Boston, who gathered 11,458 temperatures in crowdsourced research using an iPhone app called Feverprints.

Hausmann believes body temperature to be a flexible concept, viewed in context with age, gender, time of day, and other factors—much in the way weight is evaluated based on height, and how the thresholds for normal blood pressure differ based on age.

In the body’s first response to pathogens, proteins called pyrogens flow through the bloodstream to the hypothalamus, which responds by ramping up the heat. Fever helps your body fight infection by stimulating the immune system, sending a kind of alert to the body’s defenses. It also creates a more hostile environment for bacteria and viruses, making it more difficult for them to replicate.

WYMT reported that Mark Dyer is in the hospital fighting for his life because of the neglect he suffered at Knott County Health and Rehabilitation Center.  The family said a nursing home did not take proper care of Mark Dyer, and that it all could have been prevented.

In the last days of February, the family noticed Dyer seemed sick. The family posted pictures of Dyer’s condition on Facebook. They said Dyer smelled like he had not been bathed in days, his tongue was swollen, and his skin was swollen, and his skin was dry and peeling when he brought to the hospital. When he arrived at the hospital, doctors said Dyer had pneumonia and was septic which is life threatening.

“We have always been a very close family,” said Dyer’s niece, Robyn Dyer Shrum.  “When you can’t care for someone at home, you expect excellent care at a nursing home,” said Shrum.  Dyer was taken to the Knott County Health and Rehabilitation Center. The facility is near most of his family. “It’s heartbreaking that we might have to move him from that nursing home because a lot of our family members won’t be able to go visit him like they can now,” said Shrum.

You are trusting these people to take care of your family and this happens and there is just no trust,” said Shrum’s cousin and Dyer’s niece, Kristy Dyer Johnson.  “This is disgusting. This is neglect at its worst,” said Johnson.  “Pray for Mark, pray for our family. He needs all the prayers he can get. He is a good, Christian man,” said Johnson.

 

Westchester News 12 reported that new allegations of abuse and neglect arose from a grieving son who claims his mother died due to the lack of care at troubled Sapphire Nursing Home in Goshen.  Joseph Guyt’s mother, Lillian, died month at a hospital after being in the care of staff at Sapphire Nursing Home in Goshen.  Guyt claims he complained about the conditions to both the facility and state over the past year, providing News 12 with documents as proof.

Liilian was immobile and wheelchair-bound due to severe arthritis. He says she developed an avoidable urinary tract infection at Sapphire that spread to her kidneys, proving fatal within days. Guyt believes it was caused by being left daily – sometimes allegedly for hours – in urine and feces by Sapphire staff.

“It’s really a systemic issue. They’re not isolated incidents at all. It’s a horror show at Sapphire,” he says.

The allegations come on the heels of a state probe in which Sapphire was issued multiple violations, accusing the home of understaffing and patient neglect.

 

 

 

McKnight’s had an article about the importance of hand washing to prevent infections from spreading in nursing homes.  A new study finds that — by harnessing hand hygiene methods already popular in hospitals — infections in nursing homes can be prevented.  Researchers concluded that implementing simple hand-hygiene protocols in nursing homes helped drop both mortality rates and the number of antibiotic prescriptions doled out, according new study results published in the February American Journal of Infection Control.

“Hand hygiene protocols have traditionally focused on acute-care settings. Our study is changing this narrative, underscoring that we can take a proven intervention practice and make it work outside of the hospital space, by specifically adapting it to long-term settings,” said Laura Temime, lead author of the study and a professor at the Conservatoire National des Arts et Métiers, in Paris, in a press release.

Newsweek reported that a new study published online in Acta Neuropathologica suggests that eight young adults who developed serious brain plaque buildup may have been “infected” with amyloid proteins via dirty medical instruments during brain surgeries in their youth.

Brain plaque buildup is one of the most recognized characteristics of Alzheimer’s disease, as well as other neurodegenerative diseases, such as Creutzfeldt-Jakob Disease (CJD), also known as “human” mad-cow disease, New Scientist reported. Eight patients in England experienced brain plaque buildup caused by excessive amyloid proteins so severe it caused blood vessels in their brain to burst.

Researchers from University College London reviewed the cases of eight young patients who had experienced cerebral amyloid angiopathy (CAA), a condition where amyloid proteins build up in blood vessels in the brain. Not only are both CAA and Alzheimer’s disease both characterized by brain plaque buildup, but both illnesses are also found in much older patients. All eight patients were under 60-years-old, therefore not yet at risk for brain plaque buildup. In addition, none of the patients were at predisposed genetic risk for this disease, New Scientist reported. Instead, the researchers found these patients shared one salient common factor: brain surgery during adolescence.

Lead researcher Sebastian Brandner, a professor of neuropathology at University City London and his UCL team, hypothesized that the amyloid proteins may have been transferred into the patients’ brains during surgery by hitching a ride on surgical instruments that had not been cleaned well enough, New Scientist reported.

The theory is that medical instruments previously used on Alzheimer’s patients were then used on these young adults. If the tools were not properly cleaned, amyloid proteins from the Alzheimer’s patients could then be transferred to other patients operated on with the same tools.

Brandner told Newsweek that there are no other risk factors that can explain such early onset CAA, and this suggests that transfer of proteins via medical tools is likely why these patients developed the disease so young.

“Brain surgery is so far the most likely cause,” said Brandner. “In theory other routes are thinkable, but we have no evidence.”

This is not the first time researchers have proposed that brain proteins can be transferred from patient to patient via surgery. A 2015 study also led by Brandner also suggested that fragments of sticky amyloid proteins spread among patients through contaminated surgical tools, The Guardian reported.

Brain protein buildup in young people is rare but not completely unheard of. Another study from 2015 suggested that plaque buildup in young people could simply be a sign that the “resource” and “machinery” needed to make these protein clumps already exist in young people.

“The implication appears to be that if we want to prevent these clumps from forming when a person becomes old, we may need to intervene much earlier than we have thought, to try and get rid of amyloid very early in life,” the 2015 study co-author Changiz Geula, a professor at the Northwestern University Feinberg School of Medicine in Chicago who focuses on Alzheimer’s disease, told CBS News.

WABE reported on the problem of infections in Georgia nursing homes.  The article was written by Andy Miller, editor and CEO of Georgia Health News. Kaiser Health News study and analysis of federal inspection records found that 43 percent of Georgia nursing homes have been cited for infection-related problems in recent years.  The KHN analysis of four years of federal inspection records shows 74 percent of nursing homes nationally have been cited for lapses in infection control — more than for any other type of health violation.

Nationwide, only one of 75 nursing homes found deficient in those four years has received a high-level citation that can result in a financial penalty, the analysis found.

The federal Centers for Medicare and Medicaid Services has required long-term care facilities to establish better systems to prevent infections, detect outbreaks early on and limit unnecessary use of antibiotics through a stewardship program.  Infections cause a quarter of the medical harm cases that Medicare beneficiaries experience in nursing homes, according to a federal report. They are among the most frequent reasons why residents are sent back to the hospital.

As average hospital stays have shortened from 7.3 days in 1980 to 4.5 days in 2012, patients who a generation ago would have recuperated in hospitals now go to nursing homes for short term rehabilitation.  This increases the acuity and needs of the residents without a corresponding increase in the necessary staffing.

You’ve got this influx of vulnerable patients, but the staffing models are still geared more to the traditional long-stay resident,” said Dr. Nimalie Stone, the Centers for Disease Control and Prevention’s medical epidemiologist for long-term care. “The kind of care is so much more complicated that facilities need to consider higher staffing.”