Case Sample: Nursing Home Abuse and Neglect
Plaintiff is an 88-year old female and is a resident of various skilled nursing facilities from 2000 till date.
She has got multiple medical conditions like diabetes, hypertension, dementia, arthritis, and osteomalacia
and has had various surgeries in the past. She has been in and out of hospitals at regular intervals. Most of
the information available related to the various bedsores and the care plan provided. Bedsores seem to
have formed and healed at various points. Client advised to include information such as time period of
stay at various hospitals and nursing homes, wound and ulcer care, bedsore assessments, nutrition,
weight loss, contractures
DATE
PROVIDER
02/17/2000 FL Senior
Living
Services
James
Richard, M.D.
Rose Mary,
R.N.
02/16/2001 FL Senior
Living
Services
James
Richard, M.D.
Rose Mary,
R.N.
Gladys Ross,
R.N.
08/20/2002 FL Senior
Living
Services
James
Richard, M.D.
OCCURRENCE/TREATMENT
Admission
Patient transferred via ambulance from Elder Care Facility and
admitted. Prior to placement she had several falls at home and
could no longer manage her care needs.
BATES
836
882-887
992
Status Assessment
Urinary Incontinence reported daily.
Psychosocial wellbeing - Patient could establish own goals
Nutritional Status
Weight loss noted. Patient complained about the taste of many
foods. Dietary supplement provided between meals.
Pressure Ulcers
Patient was in her room most of the times. Patient had Stage 2
decubitus ulcers to her left ankle and right buttock and her
participation in scheduled programs had declined. Patient received
room visits
Care Plan
Provision of bed rails
Ulcer care
Pressure relieving devices for chair and bed and heel pads. 16x18
high density Temper-Med foam recommended
Turning/Repositioning patient every 2 hour
Nutrition/hydration intervention to manage skin problem
Pain management with medication
Assessment of skin condition each shift
Foot Care
Nails/calluses trimmed. Protective foot care
Diet Alert
Weight increase of 6 lbs noted. Enjoyed sweets and family
brought sweets, chocolate, ice cream.
Family asked to avoid sweets and bring healthy snacks such as
fruits.
112-117
119-136
1500
DATE
2005
PROVIDER
FL Senior
Living
Services
James
Richard, M.D.
Rose Mary,
R.N.
Gladys Ross,
R.N.
09/23/2005 FL Senior
Living
Services
James
Richard, M.D.
Rose Mary,
R.N.
Gladys Ross,
R.N.
02/01/2007 FL Senior
Living
Services
James
Richard, M.D.
05/29/2007 Wound Care,
LLC
Paul Claude
Montenegro,
M.D.
OCCURRENCE/TREATMENT
Monthly Summary
Leg pain Score - 6/10
05/29/2005 - Soft, low fat, low residual bland diet.
10/21/2005 – NCS increased protein diet.
Pressure Sores
On 05/29/2005 rashes noted to both breasts and abdominal folds
On 09/23/2005 patient returned from hospital after surgical
procedure for gallbladder removal. Patient had acquired Stage IV
sacral ulcer.
Patient repositioned every 2 hours within bed.
Patient admitted to Skilled Nursing Facility after discharge from
acute care hospital.
Patient non-ambulatory. Total loss of voluntary movement to
lower legs. Muscle weakness and rigidity. Had frequent bowel and
bladder incontinence.
Patient reported daily pain to the back and joints.
Skin Evaluation
Patient had Pressure Ulcer Stage IV to right side inner buttock.
Skin rashes to right side abdomen and various surgical wounds.
Skin at Risk Score - Severe
Skin Treatment - pressure relieving devices for bed and chair,
ulcer care, surgical wound care.
Nursing staff are taking all necessary precautions however
contractures are the cause of pressure and causing the ulcers
Dietary Progress Notes
Significant weight loss noted contra indicatory to wound healing.
Poor glycemic control would impede wound healing. Ordered
HbA1C. Patient did not meet protein needs for healing of Stage IV
wound.
Wound Consultation
Patient seen for evaluation and management for multiple wounds
on lower extremities, hip, sacrum, abdomen and elbow. She was a
very debilitated. Blood sugars reported to be in good control.
Patient deemed to be an unreliable historian and information
was obtained from various records.
Wound Examination
Full thickness ulceration of the left and right trochanter (hip),
sacrum. Periwound without erythema, crepitus, edema or
induration. Moderate non-odorous serous drainage.
Partial thickness ulceration of the abdomen.
Foot wound
Full thickness ulceration of left medial knee
Right lateral foot - Stable eschar
Left lateral malleolus - left foot, left 5th toe
BATES
447-448
4
355-360, 949
1506
608-610
DATE
PROVIDER
OCCURRENCE/TREATMENT
Deep tissue injury in left heel and left medial foot. Blood blister
noted to right heel and right medial foot
Treatment
Full thickness wound of the bilateral hip - Stage IV
Wound was inflammatory. Site cleaned with NSS or wound
cleaner, medication applied and covered with gauze.
Pressure ulcer of the sacrum - Stage IV
Wound was proliferative. Cleaned with NSS, medication applied
and covered with gauze.
Full thickness ulcer of the left medial knee and right elbow Cleaned and dressed.
Foot wounds: Complicated by vascular disease
Ointment applied and dressed.
General Care Plan
Repositioning every 2 hours and off-load pressure on wound, float
heels off mattress with pillow positioning, foam wedges.
Monitoring of nutritional intake
BATES