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Nursing Homes Still Profitable during the Recession

Beth Janicek — Wed, 18 Nov 2009 15:13:43 GMT

To many people our recent recession is old news. By now, everyone is used to the downturn in the economy, the rising unemployment rate, foreclosures, and the stock market falling. Despite the weekly news of corporations declaring bankruptcy, some businesses are actually still showing nice profits. For instance, large Nursing home ownership companies are still profitable.

The Ensign Group, Inc. which is in the business of skilled nursing, rehabilitation care services, hospice care and assisted living companies recently reported record results for the third quarter of the fiscal year 2009. The company recorded total revenue of $132.9 million, which is up 14.3% from the $116.3 million recorded last year at this time.

Kindred Healthcare, the Louisville long-term care company recorded revenue growth in each of its three divisions – hospitals, nursing homes, and rehabilitation. The company recorded revenue for the July-to-September period of $1.06 billion, which is a 6% raise. Shares went down to about 4% in after-hours trading.

Five Star Quality Care, Inc. announced its total revenues for the third quarter of 2009 to be $297.2 million, a 5.9% increase from the same period last year.

It is great that these large companies are still profitable. However, I believe that they need to take these profits and put them back into the long-term care facilities. The extra funds could help improve living and safety conditions for residents by better staffing the facilities and by doing a better job of training the employees.

Originally posted at InjuryBoard by Beth Janicek

Officials Find "Total Collapse" of Care at Local Assisted Living Facility

Sandy Grinnell — Tue, 17 Nov 2009 17:21:15 GMT

According to the Orlando Sentinel, after seven complaints, officials from the Florida Agency for Health Care Administration inspected an Emeritus Properties' assisted living facility called Emeritius at Crossing Pointe. As a result of the inspection, they placed an immediate stop to any and all new admissions at this facility.

Inspectors found dozens of violations over a two week period and reported conditions such as:

A patient who died of heart failure after staff members failed for four days to give her the heart medicine she had been prescribed.

Another patient who was given a blood thinner — a medicine she had not been prescribed — that made her so sick, she went to the hospital for an emergency blood transfusion.

An employee who had falsified medication and nurse's orders.

Three Alzheimer's patients with toenails so long they curled around their toes.

Managers who, over several days, could not give an accurate resident count. One day, they were off by more than 30 people.

Emeritus owns four other facilities in Orange County and have fully complied with the Agency's requests, submitting a corrective action plan in writing to address the current problems as well as preventative measures so these conditions will not occur in the future.

It is because of horror stories like these that it is imperative that caregivers fully inspect facilities prior to placing their loved ones in a facility, make unannounced visits, and visit often. Do not let this happen to your loved one!

Originally posted at InjuryBoard by Sandy Grinnell

Faced With More Claims, Long-term Care Insurers Deny Benefits

Nick DiCello — Wed, 02 Sep 2009 09:26:19 GMT

As Baby Boomers aged, there was a boom in the sale of long-term care insurance during the 1990’s. Now, however, an ever increasing portion of our population, which is living longer and longer, is seeking protection under their long-term care policies. One insurance company executive described the situation as follows: “The long-term care party of the 1990s gave us one hell of a hangover in the 2000’s.”

Long-term care insurance is a contract or policy of insurance which promises, in exchange for the timely payment of premiums, coverage for expenses of long-term care, such as the costs of a nursing home or assisted living facility. As more and more Americans with long-term care insurance enter these facilities, the insurance industry is faced with making good on their promises. Some insurers, however, have miscalculated the profitability of certain long-term care insurance products. For example, many insurers fighting to get into the “long-term care party of the 1990s” overestimated policy lapse rates and miscalculated the mortality rates for the target population. Now, during the “hangover,” insurers too commonly attempt to refuse payment of legitimate claims, sometimes on a global scale.

On March 15, 2006, Penn Treaty President and CEO issued a news release indicating that a “review is showing us that our policyholders remaining on claim beyond three years (particularly on policies issued prior to 2002) appear to be living longer than we had previously anticipated, which will likely cause us to pay higher future benefits due to the expanded duration of these claims.”

Denial of a long-term care claim or the loss of one’s long-term care coverage can be devastating. Imagine becoming accustom to life in a long-term care facility only to one day receive a letter from your long-term care insurer stating that it is “no longer medically necessary” that you or a loved one continue to receive nursing home care, and that benefits will end. This is a common exclusion cited by long-term care insurers to deny benefits. Without benefits, the elderly individual must tap into his or her assets to continue to pay for care, or must burden their family for assistance. Ultimately, once one’s assets are exhausted, he or she is forced to seek government assistance.

If you or a loved one has had their claims for long-term care benefits denied or their policy rescinded, contact the trial attorneys at Spangenberg, Shibley & Liber, LLP for a consultation, and protect your legal rights.

Originally posted at InjuryBoard by Nick DiCello

Mentally Ill Patients Pose Danger to Elderly Nursing Home Residents

Kristina Labanauskas — Tue, 24 Mar 2009 17:40:05 GMT

There has been a significant increase in the number of mentally ill patients residing in nursing homes. And, mixing frail elderly with younger and stronger mentally ill patients in nursing homes has resulted in violence throughout the country.

Nearly 125,000 young and middle-aged adults with serious mental illness lived in U.S. nursing homes last year. That was a 41 percent increase from 2002, when nursing homes housed nearly 89,000 mentally ill people ages 22 to 64. Younger mentally ill people now make up more than 9 percent of the nation's nearly 1.4 million nursing home residents, up from 6 percent in 2002.

This increase is in large part a result of the closing of state mental institutions, the shortage of hospital psychiatric beds, and the surplus in nursing home beds, as today’s elderly are more likely to stay in their homes as they are healthier than previous generations.

States are responsible for screening mentally ill patients, as federal law prohibits nursing homes from admitting a mentally ill individual unless the state has found that person needs the nursing home’s high level of care.

Although federal law guarantees residents the right to be free from physical abuse, a number of tragic cases have occurred in nursing homes.

If you or someone you know has been the victim of abuse, contact a professional to discuss whether legal action should be pursued.

Originally posted at InjuryBoard by Kristina Labanauskas

New Website to Help Families Learn About Nursing Homes

Billy Cunningham — Sat, 14 Nov 2009 08:40:00 GMT

The National Citizens for Nursing Home Reform (http://www.nccnhr.org/ ), a consumer advocacy group for nursing home residents and caregivers in nursing, homes, announced that the Brown University Center for Gerontology and Healthcare Research has introduced a website designed for nursing home researchers that provides data on nursing home care in the US. The website states that its goal is to allow researchers to trace relationships between state policies, local market forces and the quality of long-term care and enable policymakers to craft state and local guidelines that promote high-quality, cost-effective, equitable care for older Americans. NCCNHR believes the site will also be enthusiastically received by many consumer advocates looking for detailed data and more sophisticated comparison tools than provided on other website such as Nursing Home Compare.

The interactive database, www.LTCfocUS.org, incorporates information from a number of government sources-Medicare reimbursement claims, OSCAR (CMS's Online Survey, Certification and Reporting system), the MDS (Minimum Data Set), and Brown's own survey of state Medicaid policies Users can interact with the website by creating interactive maps and tables with comparative information about states, counties, or individual nursing homes. All data provided on the website are also available to download.

The website provides the type information that users can employ to choose up to five variables. It allows the user to create a chart comparing all nursing homes in a state. The broad range of variables from which to choose includes number of beds; for-profit and chain status; percent of Medicare and Medicaid beds; Alzheimer's units; occupancy rates; age ranges, gender and race of residents; direct care staffing (RN, LPN, CNA); acuity of care; certain MDS quality measures; source of admissions (hospital or home); and 30-day rehospitalization rates (a potential indicator of quality not found on Nursing Home Compare).

The website is sponsored by the National Institute on Aging-funded Shaping Long-Term Care in America project housed at the Brown center. While its stated purposes are to "allow researchers to trace clear relationships between state policies and local market forces and the quality of long-term care" and to allow policymakers "to craft state and local guidelines that promote high-quality, cost-effective, equitable care to older Americans," NCCNHR recommends that consumer go to this site to perform their researches about nursing homes in their areas before placing a loved one there. The more you can know about your options for placing loved one in a nursing home , the better equipped you'sll be to help prevent any nursing home negligence or abuse.

Originally posted at InjuryBoard by Billy Cunningham

Stage 4 Bed Sore (Decubitus Ulcer)

M. Brandon Smith — Fri, 30 Mar 2007 00:09:55 GMT

The final stage in the bed sore classification system is stage 4. In a stage 4 bed sore, the most serious and advanced stage, almost all skin has been lost in the affected area and a very deep wound has occurred. The would itself has extended through the muscles, tendons, organs, and/or bones. Stage 4 bed sores, also termed decubitus ulcers, almost always require surgical intervention to remove the decayed and necrotic tissue. The infection status in a stage 4 bed sore is very serious and can lead to extremity amputation and/or death if not treated properly. A stage 4 bed sore is only seen in the most egregious circumstances of neglect and improper care. In the hospital or nursing home setting, a stage 4 bed sore should NEVER occur. Sadly for thousands of residents and patients each year, however it does time and time again.

Originally posted at InjuryBoard by M. Brandon Smith

Fairness in Nursing Home Arbitration Act Does Not Become Law

Billy Cunningham — Sat, 30 May 2009 09:05:53 GMT

In January I wrote a blog on S. Bill 2838, Fairness in Nursing Home Arbitration Act. This bill never became law. The last action taken by the Senate on the bill was in September when it was reported favorably out of committee and then on October 1, 2008, it was placed on the Senate Legislative Calendar under General Orders. Calendar No. 1109. This bill has now been proposed in previous Sessions of Congress last two years. At the end of each session all proposed bills and resolutions that haven't passed are cleared from the books. The bill was never debated by the Senate. This means the bill will have to be reintroduced under a new number in the next session.

The bill was sponsored by Sen. Mel Martinez [R-FL] and co-sponsored by Sen. Patrick Leahy [D-VT], Sen. Russell Feingold [D-WI], Sen. Richard Durbin [D-IL] and Sen. Herbert Kohl [D-WI]. I would urge all you to contact your Senators and Congressmen before the next session and urge them to get this bill reintroduced and passed.

Nursing home abuse continues and arbitration is not the way to handle these cases. When loved ones are put in nursing home today the facility often presents a series of documents to be signed in order for the family member to be admitted. Often stuck in the middle of all those is an arbitration agreement. I have never seen one drafted that is designed to favor or even equally treat the resident. Those agreements are signed by residents with dementia who do not have the capacity to enter into any other kind of contract. Or they may be signed by a family member who does not have a power of attorney or court appointment authorizing them to enter into contracts on their behalf. The nursing home does not care who signs them- it is just part of a process. That process is not in the best interest of the resident. I have seen forged signatures on nursing home arbitration agreements and had one facility admit it forged the signature.

One way to protect against this happening is for everyone to have a power of attorney that prohibits the attorney in fact from entering into any contract that has an arbitration clause or agreement in it. Here is an example of the clause that should be in every power of attorney:

“NO POWER TO AGREE TO BINDING ARBITRATION. Although I have given my attorney-in-fact this general and durable power of attorney, I specifically withhold from my attorney-in-fact the power to agree or consent to binding arbitration, or to agree to any other process that would preclude the right to have a jury decide any issue in controversy concerning my person or my property; this does not, however, preclude non-binding alternative dispute resolution processes such as mediation. “

There are things we can all do to protect our loved ones in nursing home. Let’s start a letter writing campaign now to get the Fairness in Nursing Home Arbitration Act reintroduced and passed.

Originally posted at InjuryBoard by Billy Cunningham

15 Nursing Home Residents Abused In Albert Lea Nursing Home

Mike Bryant — Sun, 31 Aug 2008 11:27:01 GMT

In a shocking story from a Albert Lea Nursing home workers passed the time by "having fun" with 15 residents. Sexually touching, beating and gagging them being a daily activity. Hubert Humphrey talked about the way a society is doing could be judged by the way they cared for their elderly. This story is a horrid story of that treatment at it's lowest.

Nursing Homes are often medical necessary for many families. They can be very expensive. They are the residents homes surrounded by professionals in charge of caring for them. The place they should always feel safe.

If you have a family member in a nursing home , it is important to look around on each visit. Be vigilante in certain areas. Look for signs of Physical Abuse, Neglect, and Verbal/Emotional abuse. If you see signs of abuse:

Contact the Nursing Home Administrator and tell them your concerns.
Contact the Minnesota Board of Aging.
Contact the police department in the municipality where the abuse occurred.

It's important that we protect all of those that have contributed to society and who are the most vulnerable.

Originally posted at InjuryBoard by Mike Bryant

National Pressure Ulcer Advisory Panel's Pressure Ulcer Staging System

Jacob Diesselhorst — Thu, 15 Nov 2007 16:58:34 GMT

National Pressure Ulcer Advisory Panel's Updated Pressure Ulcer Staging System

Abstract
The National Pressure Ulcer Advisory Panel has updated the definition of a pressure ulcer and the stages of pressure ulcers based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country. The amount of anatomical tissue loss described with each stage has not changed. New definitions were drafted to achieve accuracy, clarity, succinctness, clinical utility, and discrimination between and among the definitions of other pressure ulcer stages and other types of wounds. Deep tissue injury was also added as a distinct pressure ulcer in this updated system.
Problems with Staging Systems
Inherent to the accuracy of pressure ulcer staging is: (1) knowledge of the integumentary anatomy and deeper tissue layers including the ability to identify and differentiate between these layers; (2) assessment and differential diagnostic skill (Nix, 2006); (3) and validity (accuracy) and reliability (consistency of results) of the staging system. Illustratively, a 2007 inter-rater reliability study comparing pressure ulcer staging between staff nurses and certified wound, ostomy, continence nurses (CWOCN) in two National Database of Nursing Quality Indicators (NDNQI) prevalence surveys using the NPUAP staging system reported a 65% agreement between raters Kappa = 0.514 across all stages of pressure ulcers (Nickoley, Helvig, Ritter, & Heinsler, 2007). Of the 235 "potential pressure ulcers identified," 16.6% were eliminated from the study as they represented etiologies other than pressure (such as candidiasis, maceration, denudement) (Nickoley et al., 2007).
Comparatively, 44 pressure ulcer experts were asked to classify lesions, using 56 photographs, as normal skin, blanchable erythema, pressure ulcers using the EPUAP grades 1 to 4 or incontinence lesions (Defloor & Schoonhoven, 2004). The percentage of agreement was 94.5% and the multi-rater Kappa was 0.80 (Defloor & Schoonhoven, 2004). Lesions secondary to incontinence were most often misclassified as grade 2 (blisters) or grade 3 pressure ulcers (Defloor & Schoonhoven, 2004).
Staff nurses frequently ex hibit uncertainty in accurately differentiating between Stage II, Stage III, and lesions secondary to moisture and/or friction (Doughty et al., 2006; Defloor et al., 2005; Pieper & Mattern, 1997; Zulkowski & Ratliff, 2006). Given the ulcer's anatomical location, herpetic, fungal, and moisture lesions are of ten misclassified as pressure ulcerations (Defloor et al., 2005). Neuropathic foot ulcers, epidermal stripping from adhesive removal, reactive hy peremia, bruises, radionecrosis, surgical wounds, and ulcers secondary to venous and arterial insufficiency have also been staged incorrectly using the NPUAP system. Diagnostic inaccuracies result in inappropriate prevention and treatment interventions, misappropriated health care expenditures with the potential for punitive regulatory, litigious, and quality implications.
Deep Tissue Injury as an Etiology
In 2001, the concept of another etiology for pressure ulcers was discussed by the NPUAP. These pressure ulcers were known to begin as "purple" or "bruised" looking tissue and many had a propensity to become large Stage IV ulcers quickly (Black & Black, 2003). The term "deep tissue injury" was selected because it was likely that the etiology of these pressure ulcers was high levels of pressure at the bone-muscle interface. Deep tissue injury (DTI) was initially defined as "A pressure related injury to subcutaneous tissues under intact skin. Initially, these lesions have the appearance of a deep bruise and they may herald the development of subsequent development of a Stage III-IV pressure ulcer even with optimal treatment" (NPUAP, 2001).
A task force was formed and a thorough review of the literature was conducted to determine previous documentation on the phenomenon of DTI. Surprisingly, some existed. In 1873, Paget wrote that ulcers could erupt from intact skin and that tissue may be purple or yellow from extravasation of blood. He went on to say, the deeper tissues die, including muscles and bones, where sloughing follows in the skin and fat and the place under the skin ulcer is empty. Groth (1942), a German scientist, created ulcers in an animal model by applying external pressure and described these ulcers that started in muscle as "malignant." Even Shea in 1975, in addition to defining the stages of pressure ulcers, included a "closed pressure ulcer." Through these sentinel pieces of literature it was apparent that the idea of a DTI pressure ulcer was not new, but had been overlooked with the current staging system. A literature review identified many variations in terminology used to describe DTI (Ankrom et al., 2005).
Reexamining and Updating the Definition and Stages
At the 2005 Consensus Confer ence the NPUAP achieved its goal of clarifying the understanding of deep tissue injury, yet soon realized that deep tissue injuries did not neatly fit into the current staging system. Thus began an intensive 2-year examination and revision of the entire staging system. Current research was analyzed. Opinions were actively solicited from researchers, clinicians, educators, and public policymakers at a variety of public meetings and forums. NPUAP alumni were invited to participate. NPUAP board members engaged their colleagues at the EPUAP to discuss their common concern of accurately staging (or grading) pressure ulcers. Based on this ongoing feedback, NPUAP members drafted multiple iterations of a pressure ulcer staging system and sought expert critique and feedback.
Definitions were drafted with the goal of achieving accuracy, clarity, succinctness, clinical utility, and discrimination between and among other definitions for both stages of pressure ulcers and other types of wounds. A key determinant of accuracy was available scientific evidence. Brevity was emphasized in drafting definitions. Each definition includes a "further description" to support educational efforts and refine clinical utility and clarity.
In 2005, the NPUAP posted a draft of the staging definitions on its Web site and solicited public comment. Participants were asked to rate the qualities of clarity, succinctness, accuracy, and discrimination for each definition. Unlimited space was provided for recommendation for revision. Two hundred volunteers participated in the survey, representing 45 of 50 states. The majority of respondents were CWOCNs or nurses with wound care experience. Some physicians, physical therapists, and administrators also responded. Percent agreement for the qualities of clarity, succinctness, accuracy, clinical utility, and discrimination ranged from 56% to 75% for deep tissue injury, 76% to 91% for Stage I, 83% to 95% for Stage II, 83% to 96% for Stage III, 72% to 98% for Stage IV, and 73% to 90% for the definition of unstageable pressure ulcers. While these results were encouraging, the NPUAP examined all comments contained in a 60-page report and made further im provements to the staging definitions. This lengthy validation and refinement process set the stage for the 2007 NPUAP Con sensus Confer ence.
During the 2007 Consensus Conference, attendees were asked to use the updated definitions of pressure ulcers to classify 30 photographs of pressure ulcers and other dermal lesions. Percent of agreement was computed with an average of 60% for all photos. The majority of inaccuracies were due to classification of pressure ulcers on the foot or heel in patients with diabetes or arterial inflow diseases as diabetic foot ulcers or arterial ulcers, rather than pressure ulcers.
Deep Tissue Injury
Deep tissue injury is the newest pressure ulcer in the updated staging system. The definition of DTI was derived from multiple clinical cases as "purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear." The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue. Today, many of the cases of DTI are recognized after the fact and the word "suspected" can be added to the clinical diagnosis. Note that blood blisters have been included in this definition. NPUAP believes that blood blisters represent a deeper level of injury than a serum-filled blister yet the true depth of tissue damage is not known. NPUAP realizes that deep tissue injury may be difficult to detect in individuals with dark skin tones and placed this information in the description of deep tissue injury. Also, from retrospective data review, it is fairly well known that evolution of DTI may in clude a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. It may heal or evolution may be rapid, exposing additional layers of tissue even with optimal treatment.
Stage I
NPUAP continues to view Stage I pressure ulcers as a sign of risk. The updated definition is "intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area." Further description of a Stage I is "The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate 'at risk' persons (a heralding sign of risk)."
An important component of the revision of the Stage I definition was to remove any reference to deep tissue injury (see later discussion). Stage I pressure ulcers are also considered reversible in that no irreparable tissue damage has occurred. Even though pain is used as a descriptor of Stage I pressure ulcers, pain often does exist in pressure ulcers at all stages. It should not be assumed that just because tissue is missing, pain sensation is not present.
Stage II. Even though the staging system was designed for pressure ulcers only, the Stage II definition lacked clarity to differentiate true Stage II pressure ulcers from other wound etiologies, which pressure redistribution alone would not improve. NPUAP changed the definition of Stage II pressure ulcers to clarify the use of the term Stage II for pressure ulcers only. The updated definition is "Partial thickness loss of dermis presenting as a shallow open ulcer with a red or pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister." Blood blisters are thought to be due to damage to tissues deeper than the dermis and are not to be classified as a Stage II. Similarly, the presence of slough on a pressure ulcer bed also indicates damage to deeper tissue and these ulcers should not be classified as a Stage II.
Further descriptions of a Stage II pressure ulcer include that it presents as a shiny or dry shallow ulcer without slough or bruising. Bruising indicates suspected deep tissue injury. This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration, or denudement.
Stage III. The NPUAP goal for updating of Stage III pressure ulcers was to address the idea of variations in the appearance of a Stage III ulcer. The updated definition of Stage III pressure ulcers is "Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling." The depth of a Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue and Stage III ulcers can be shallow in these locations. In contrast, areas of significant adiposity can develop extremely deep Stage III pressure ulcers. Bone/tendon is not visible or directly palpable.
Another common clinical issue is describing the healing pressure ulcer over time. While staging represents what can be seen, it cannot describe history nor should it be used to describe healing (reversed staging). Healing of pressure ulcers is more accurately monitored through the Pressure Ulcer Scale for Healing (PUSH Tool) (Stotts et al., 2001). There is a continuing need to communicate about the history of the wound, including the past stages of the pressure ulcer to enhance patient care in all settings. Stage IV pressure ulcers may appear to be Stage III ulcers while they are healing, but they should be classified as healing Stage IV ulcers. Stage IV pressure ulcers often require a full year to heal and once healed, the ulcer site remains an area of risk because the scar tissue has only 40% of the original tissue tensile strength.
Stage IV. The Stage IV pressure ulcer definition required the least amount of revision. The updated definition is "Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling." Further description of a Stage IV is included to help discriminate it from Stage III pressure ulcers and includes "The depth of a Stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteo myelitis possible. Exposed bone/tendon is visible or directly palpable." NPUAP recognizes that palpation of bone is outside the scope of practice for some clinicians.
Unstageable Pressure Ulcers
The goal for revising the definition of unstageable ulcers was to reduce the tendency to classify an ulcer with any necrotic tissue as unstageable, when the depth of the ulcer can be seen. The new definition is "Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed." Note the phrase "the base of the ulcer" is used to denote the inability to determine the depth. If necrotic tissue is present, for example, on the edge of the ulcer, but the base is bone, the ulcer should be staged as a Stage IV. Further description of Stage IV ulcers include these phrases: "Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as 'the body's natural (biological) cover' and should not be removed."
Wounds that are obscured from view by dressings, braces, or casts should not be staged as unstageable. Likewise, do not assume the previous stage persists until the ulcer is visualized. Documentation should denote that the wound was not staged due to these products/devices. It is recommended that upon admission, every attempt be made to see the wound and not rely solely on the history of the wound.
Future Plans
Further basic science and clinical research is needed in order to validate the NPUAP pressure ulcer staging system and evaluate the effectiveness of educational programs aimed at enhancing inter-rater and intra-rater reliability of the staging system. Issues related to public policy, research, and education related to the updated staging definitions were discussed at the Consensus Conference. Atten dees rated the issues in public policy, education, and research and these ratings will guide NPUAP's future plans. Future Consensus Conferences will address this continuing agenda.
As you can see, NPUAP has updated the staging system for pressure ulcers to improve clinical accuracy, clinical utility, and discrimination from other dermal wounds. Accurate staging is critical for care planning and communication. While staging represents what can be seen, it cannot describe history nor should it be used to describe healing (reversed staging). In addition, greater emphasis has been placed on developing DTI as an independent wound classification, which may act as a "double-edged sword" to health care providers. On one hand, the introduction of a new classification category will allow doctors and nurses to better assess and customize a care plan for patients with these types of wounds. However, this new category also places a greater burden on health care professionals to be as accurate as possible both in diagnosing DTI as well as implementing the correct care plan to alleviate the problem before it develops into a more severe injury.

Originally posted at InjuryBoard by Jacob Diesselhorst

Nursing Homes & Felons: A Dangerous Mix

Kristina Labanauskas — Mon, 09 Nov 2009 16:33:00 GMT

Mentally ill criminals and others on society's fringes housed in nursing homes pose a threat to other residents, especially if they are not carefully assessed, treated and monitored.

In January, 21-year-old Christopher Shelton allegedly raped a 69-year-old woman in her own room. Both were residents at Maplewood Care in Elgin, one of 13 nursing facilities in which Bryan Barrish and Michael Giannini, longtime nursing home executives, have either an ownership stake or consulting role.

Those facilities hold just over 2 percent of the state's nursing home population, the most recent state records show, but they include nearly 10 percent of Illinois' mentally ill nursing home patients and, as of June, almost 6 percent of the 3,000 felons living in the state's nursing facilities.

Shelton was diagnosed with bipolar disorder and had been shuttled between jail cells, psychiatric wards and shelters until nursing facilities became home. After being paroled from prison for a 2004 aggravated battery conviction, Shelton continued down a destructive path. He was arrested at least half-dozen times more, and in 2008 he was arrested three more times on alleged offenses including punching a man in the face at a West Chicago nursing home in which he was living. In November of last year, he requested to be readmitted to Maplewood Care in Elgin, where he had lived earlier in 2008 until he was removed and jailed on prior battery charges.

According to a state health department investigation, Maplewood did not adequately check Shelton's criminal background. However, Barrish and Giannini said the facilities assign professionals to thoroughly assess the risks that younger mentally ill criminals may pose to other residents and don't admit anyone considered a danger to others.

In late June, Maplewood Care held 15 felons among its roughly 200 residents.

About half the population was younger than 65, and more than 40 percent had a primary diagnosis of mental illness, according to the most recent figures on the state public health department's Web site.

Shelton now awaits trial on charges of aggravated criminal sexual assault. The woman no longer lives at Maplewood.

Originally posted at InjuryBoard by Kristina Labanauskas