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June 17, 2014

The Effects of Sepsis on the Elderly


The American Thoracic Society met for their annual conference where findings from a recent sepsis study was presented. Sepsis infections also known as blood infections can cause whole body inflammation, organ decay, and in some severe cases death. Sepsis is particularly fatal among the elderly and those with weakened immune system such as infants and those with HIV/AIDS. At the annual conference the researchers of a recently published study in the Journal of American Medical Association discussed the deadly effects of sepsis and the increased rate at which emergency departments are seeing patients present with sepsis along other infections. The occurrence of sepsis has been steadily rising with about one of out every 10 patients being treated for sepsis in U.S. hospitals. Even more telling the study found that 52 percent of those who died in a hospital were diagnosed even if sepsis was not the direct cause of the patient's death. Dr. Vincent Liu, the lead study author indicated that the researchers were surprised at the number of deaths in which sepsis was present. Approximately as many as "1 in 2 patients dying in the US hospitals had sepsis." Further stating the need for improved care for sepsis patients in order to save many more lives.

Sepsis and the Elderly:

Sepsis deaths have been on the rise according to the U.S. Centers for Disease Control and Prevention. During a ten-year span from 2000 to 2010, the rate of deaths associated with sepsis infections increased 17 percent equating to a death toll of 135,000, an increase from 45,000 deaths. The Mayo Clinic defines sepsis as a "potentially life-threatening complication of an infection." Sepsis, which is the body's response to fighting a severe infection often caused by pneumonia, abdominal infection, kidney infection or a bloodstream infection such as bacteremia, can trigger inflammation throughout the body. The inflammation can prove deadly as damage to multiple organ systems can occur, if left to progress sepsis can also cause blood pressure to severely drop which may also lead to death. The longer a patient goes untreated with sepsis the lower the chances of survival. Early treatment is particularly important for those with advanced aging.

It has even been suggested that for those over the age of 65 who contract sepsis the long-term effects may include being susceptible to cognitive impairment. A 2010 study in the Journal of the American Medical Association authored by the lead researcher Theodore J. Iwashyna, MD, PhD, of the University of Michigan Medical School, found that sepsis may have a direct link to 20,000 new cases of dementia among those 65 years or older who contract sepsis each year in the U.S. While there have been advances in the treatment of sepsis prevention among the elderly is vital to their survival and overall quality of life. Vaccinating those with compromised immune systems against the flu and pneumonia is still one of the best practices available.

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March 12, 2014

Distilling the 2014 Nursing Home Ratings by U.S. News & World Report



When a family makes the decision to transition a loved one into a nursing home it can be an overwhelming and understandably emotional experience. The daily care, safety, and overall wellbeing of your loved one are being placed in the hands of another. It is a duty that many nursing home staffs and facilities pride themselves in excelling in. U.S. News & World Report has released their sixth annual data and ratings results of nearly every nursing home in the United States. The search tools and valuable information within the detailed U.S. News database can help make choosing a nursing home a better, quicker, safer, more informed experience. The user-friendly search tools gives a multi-layer approach in finding a suitable nursing home that meets the needs for you or a loved one. It is estimated that over 3 million Americans live in approximately 16,000 nursing homes throughout the United States. That number is expected to only increase as the nation's older adult population continues to steadily climb. Much of the raw data relied on by U.S. News in rating nursing homes comes from Nursing Home Compare, the federal database detailing every Medicare and Medicaid certified nursing home in the country. You can search by state, region, city, or zip code, or by a numerical star rating of 1 to 5. The 2014, ratings of 1,893 nursing homes in Pennsylvania indicate that 702 nursing homes, about 25 percent, earned a five-star rating, while less than 5 percent of Pennsylvania nursing homes earned a one-star rating.

Distilling the ratings:

There are three key areas that the overall ratings correlate to, the nursing home's individual ratings of their (1) state-conducted health inspections, (2) sufficient nursing staff and, (3) the quality medical care measures. As a nursing home injury specialist with practices in both Pennsylvania and New Jersey, when looking at a nursing home's overall rating, I place particular importance on a nursing home's nursing staff rating. The nurse staff rating relates to the average number of hours per day of care received per resident from nurses and physical therapists. A nursing home with a low rating for nursing staff raises concerns as understaffing is the leading cause of neglect and abuse in nursing homes and long care facilities. When a nursing home is inadequately staffed the required daily care to stave off fatal infections, pressure sores, devastating falls, and to meet the minimal quality of care required by both federal and state regulation, is often found lacking. Sufficient staffing is a critical component in running a safe, clean, well managed nursing home, so much so that all nursing homes participating in Medicare are required to meet specified requirements of the Federal Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987. Specifically facilities are legally required to have "sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident." Therefore, when narrowing down the choices of a nursing home facility remember to pay close attention to the nursing home's staff rating, as this singular component can have life-altering effects.

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July 19, 2012

As If We Didn't Have Enough Trouble with Pennsylvania Nursing Home Negligence and Abuse: Woman Stole Over $300,000 from 67-Year-Old Resident


Nursing home negligence and abuse in Philadelphia and elsewhere is a national epidemic - and a national disgrace.

But nursing facilities themselves are not the only parties who commit egregious, illegal actions. Witness the case of a Bensalem woman, who was arrested in June for allegedly stealing more than $300,000 from a 67-year-old woman living in an area nursing facility. Investigators say that 65-year-old Virginia Marquardt had obtained Power of Attorney for her neighbor, after the woman's husband passed away back in July 2007.

This power allowed Marquardt to control the woman's assets, money, and bank accounts. Marquardt then allegedly embarked on a series of abuses of her power and trust. First, she made herself a 50% beneficiary of the estate. Then, in the spring of 2008, she drew up a new will for the victim, naming herself as beneficiary of her assets to the tune of 50%.
If that wasn't insult enough, Marquardt then allegedly slowly stopped paying for woman's nursing home care. The outstanding balance for the care climbed over $20,000 in 2009.

By the end of that year, Marquardt had stopped paying the home entirely. She told the facility that the resident had run out of money. Meanwhile, the victim still possessed investments that had not been liquidated.

In 2010 and 2011, Marquardt did pay for some of the nursing home care, but the outstanding balance continued to grow. Investigators later found that Marquardt had siphoned off more than $300,000 of assets and used that money to pay for trips to Las Vegas, to buy luxury watches, and to pay off credit cards. Finally, in June, police arrested Marquardt and set her bail at $300,000. After posting 10% of that money, she was released, and the court system will now determine what will happen to her.

This case sounds very sad for a number of reasons. Assuming the allegations are true, who knows what motivated Ms. Marquardt to engage in this behavior? Furthermore, who knows how the 67-year-old's care might be affected by the financial double cross?
This situation illustrates how Philadelphia nursing home financial abuse cases can take years to surface.

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August 15, 2011

New Jersey Nursing Home Immune From Lawsuits as Charitable Organization - Griffin v. Bayshore Medical Center


As a Philadelphia injury lawyer, I was interested to read about a personal injury case against a nursing home that could not go forward -- not because the case was weak, but because nonprofit nursing homes are immune from many lawsuits in New Jersey. Edward Griffin et al. v. Bayshore Medical Center et al. brought two similar and related claims by two people injured in the same way at the Bayshore Nursing Home. Edward Griffin died of complications from a fall he took outside the home after he tripped on a protruding piece of sidewalk. Philomena Papa fell over the same protrusion about five month later and suffered permanent injuries. Papa, her husband, and the estate and son of Griffin sued the home and its associated corporate entities, but the Superior Court of New Jersey's Appellate Division found the home was immune under New Jersey's Charitable Immunities Act.

Griffin, 91, was on his way to visit his wife in the home when he tripped and fell on Oct. 16, 2007. The fall broke his C2 vertebra and landed him in the intensive care unit, where he stayed until his death the following Nov. 6. Papa, 86, was on her way to visit her husband in the home when she fell and broke several bones, including her kneecap and the orbit bone of one eye. She now relies on a cane. Both families brought their complaints in one suit naming Bayshore Medical Center, Bayshore Community Hospital and Bayshore Health Care and Rehabilitation Center. Bayshore Health Care Center is a nonprofit organization and part of a group of entities that also includes Bayshore Community Hospital. Bayshore Rehabilitation Systems Inc., however, is for profit. Despite the similar names and being located on the same road, the nursing home's parent entity said it was not related to Bayshore Rehabilitation Systems, and extensive discovery could not connect them. The trial court therefore granted summary judgment to the defendants and denied a cross-motion to file a new amended complaint.

Plaintiffs appealed, arguing that there was a genuine issue as to whether Bayshore Rehabilitation Systems made the nursing home a for-profit entity not entitled to protection under the Charitable Immunities Act. The Appellate Division disagreed. It noted that summary judgment was granted 13 months after the claim was originally filed, and after "a no doubt diligent search" by the plaintiffs that failed to come up with anything. The mere existence of a for-profit corporation with a similar name did not cast doubt on that status. Thus, there was no genuine issue of material fact to try. The court also denied their argument that they should have been granted leave to amend their complaint to allege gross negligence and recklessness, which would have given them an opportunity to avoid the Charitable Immunities Act. Gross negligence, the court said, is "wanton or reckless disregard for the safety of others" -- and it disagreed that failure to fix the protruding sidewalk qualifies as grossly negligent or reckless. The sidewalk protrusion of an inch and a half simply does not qualify, the court noted. Thus, it upheld both of the trial court's rulings.

As a Pennsylvania nursing home lawyer, I'm disappointed that these plaintiffs were unable to get their day in court. It should surprise no one that many of the visitors to a nursing home are older people themselves, because they are the loved ones of older people -- their spouses, brothers and sisters and friends as well as children and grandchildren. For older people, a trip and fall that a child might shake off can be life-changing, because it can cause injuries that rob them of their independence. As Griffin's family discovered, it can even be fatal if the victim is unlucky enough to fall on the head or neck. Leaving dangerous conditions like a tripping hazard unfixed is not Pennsylvania nursing home abuse as families normally think of it, but it is certainly dangerous and highly avoidable. As a Philadelphia medical malpractice lawyer, I'm glad Pennsylvania does not recognize a charitable immunities defense.

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