January 2, 2020
Understaffing is the most common issue in nursing homes that can lead to abuse and neglect. Overworked and under supervised staff pose a greater risk to patients. Inadequate attention and frustration lead to mistakes and neglect.
This is a serious issue that plagues over 90% of nursing homes. Studies have proven that residents who live in understaffed nursing homes are at a greater risk of malnutrition, weight loss, bedsores, dehydration, infections, and pneumonia. Families of elderly patients are increasingly noticing this problem and are starting to hold nursing homes responsible for the abuses that occur as a result. (more…)
To resolve this issue there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Secondly, the barriers to staffing reform are economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality.
Nursing homes have been overstating their staffing levels when reporting numbers to the government, according to new federal data analyzed by Kaiser Health News and reported by the New York Times.
Analysis of payroll records of more than 14,000 nursing homes revealed many staff fluctuations – particularly on the weekends. “On the worst staffed days at an average facility, the new data show on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest,” the Times reported.
The payroll records were gathered and published by Medicare as a requirement of the Affordable Care Act of 2010. Prior to the ACA requirement, facility ratings were based on nursing homes reporting their own staffing levels.
The Times article includes a searchable map that contains the staffing rate of the 14,000 nursing homes that provided data. Staffing rates were ranked from “much above average” to “much below average.”
With fewer nurses and care taking staff available, the quality of care provided to residents is being called into question.
As reported in the Times: “Volatility means there are gaps in care,” said David Stevenson, an associate professor of health policy at Vanderbilt University School of Medicine in Nashville, Tenn. “It’s not like the day-to-day life of nursing home residents and their needs vary substantially on a weekend and a weekday. They need to get dressed, to bathe and to eat every single day.”
At the same time, there is no minimum resident-to-staff ratio set by Medicare. The only requirement is that a registered nurse be present eight hours a day and a licensed nurse 24/7. The Centers for Medicare & Medicaid Services (CMS), which oversees the government’s Five-Star Quality Rating System, uses staffing as one of the variables in determining a facility’s score.
The CMS said in a statement to the Times that it “is concerned and taking steps to address fluctuations in staffing levels” that have emerged from the new data. This month it said it would lower ratings for nursing homes that had gone seven or more days without a registered nurse.
Saponaro, Inc. is chosen every day by attorneys and insurance professionals to provide expert witness services and litigation support that help build strong legal cases.
Over 40 years helping attorneys win trials by placing the best expert witnesses in over 40,000 cases.
December 3, 2019
Thirty days after release from the hospital can pose a risky time for many people. A study found that nearly 20% of patients experience adverse events within 3 weeks of discharge, nearly three-quarters of which could have been prevented.
Early discharge dangers include:
- Adverse drug events are the most common post-discharge complication
- hospital-acquired infections
- procedural complications
- hazards arising from the fact that nearly 40% of patients are discharged with test results pending
- discharged with a plan to complete the diagnostic workup as an outpatient
In addition, there is increasing concern that the stressful hospital environment may lead to post-hospitalization syndrome— a patho-physiologic syndrome of weakness and increased stress that may leave patients vulnerable to clinical adverse events such as falls and infections. Nearly 20% of Medicare patients are re-hospitalized within 30 days of discharge.
Questions to consider in hospital discharge:
- Can patient get in and out of bed safely?
- Can patient eat and drink?
- Is patient able to self-administer medications and manage follow up visits?
- Is there any new symptoms or unresolved pain prior to discharge?
- Are all labs and test results completed?
Many re-admissions are done under emergency circumstances. These circumstances may harm a patient through:
- Protracted pain and suffering
- Prolonged recovery period
- Additional medical expenses
- Loss of time from work
Experts that assist in evaluation of early release cases include:
- Hospital Administrator
- Emergency Room Personnel
- Discharge Social Workers
Saponaro Inc., can assist with the right expert for your case.
We conduct a customized search for each expert requested.
All experts are replaced at no additional costs
All fees are quoted prior to work with the Expert. There is no mark up of expert fees. Once they are engaged you are free to work with the expert directly.
October 23, 2019
What is a breast implant?
A breast implant is an implanted device used to augment existing breast tissue for cosmetic purposes or to reconstruct the breast after surgery such as mastectomy. Litigation from alleged harm due to breast implants is not new, but recently a new form of lymphoma thought to be associated with implants added to concerns over the safety of these devices, which have also included implant rupture and contracture.
In 2018, silicone implant breast augmentation was the #1 performed plastic surgery for women in the United States, with 928,914 procedures performed. Implants range from round to oval to teardrop shape to best approximate the patient’s natural shape and may contain silicone or saline. Both silicone and saline implants have an outer shell made from silicone. Some implants have a smooth surface, others have a textured surface thought to stabilize the implant and decrease scar tissue formation.
Fig 1 Breast implants (image courtesy FDA; https://www.fda.gov/medical-devices/implants-and-prosthetics/breast-implants, accessed 6/1/19)
October 14, 2019
Credibility is critical to the success of an expert witness. You should be able to rely on your expert for honesty, and a case that is articulately and assertively presented. There are many factors to consider when engaging an expert and to make sure that the opinion you receive is objective and will stand up to cross-examination.
Juries are required to sift through vast amounts of information. The reliance on an expert witness to assist in understanding the facts is crucial and appearance of bias can negate an expert’s testimony with the jury. Saponaro, Inc., employs several safeguards against unreliable and unethical expert witness testimony with the following guidelines:
September 12, 2019
It can happen even if you are treated by the most skilled physician at best hospital the state has to offer. Leaving lasting scars, disabilities, a lifetime of pain or even death, medical malpractice can destroy a patient’s life. It is little wonder why tragic mistakes lead to serious lawsuits.
Here are recent medical malpractice cases that have resulted in large settlements: (more…)
August 2, 2019
The Choice of Experts for Certificate or Affidavit of Merit
The expert that will review your case for merit will be matched to the specific board-certification of the defendant, or will match the certification of the licensed healthcare professional in question. The expert will be actively practicing or actively working in an academic capacity, and will meet your State requirements in qualifying as an expert witness. The expert will be checked for any potential conflicts, since they have agreed to support their opinion through deposition and/or trial, if warranted.
June 28, 2019
Medical errors happen every day. They occur in alarming numbers and are extremely costly. Some areas of inpatient and outpatient healthcare are particularly unsafe, such as pediatrics, surgery centers, emergency rooms, hospice care, intensive care units (ICUs), lower-volume hospitals, nursing homes/rehabilitation facilities, and more.
The average person may think because medical errors happen so frequently, that medical malpractice lawsuits are abundant and that these cases are clogging up the courts. But these are just two in a long list of medical malpractice myths that need to be cleared up.
June 20, 2019
Product recalls happen as a result of consumer safety concerns not originally detected when the product was released, or because of an undetected malfunction that requires repair. But injuries or even death can occur when a product is recalled off the market too late.
Even if a product is for sale and being purchased by thousands or millions of consumers, it’s not necessarily safe. It could be a best-seller for a manufacturer, resulting in millions of dollars in profits, but it may not be safe.
Fisher-Price Rock ‘n Play Sleeper Deaths & Injuries
June 11, 2019
As an attorney, your expertise is in pursuing and winning legal cases, whether it’s medical malpractice, personal injury, or others. That’s why when cases involve a medical component, you need medical experts to assist you with building a winning case.
Nurse consultants guide attorneys through all the medical aspects of their case. This service, also known as concierge nursing, utilizes practicing nurses and/or nurse practitioners as expert witnesses in legal cases.
How do you know if your case could benefit from the help of a nurse consultant? Or should you turn to another type of expert? Let’s examine the ways a nurse consultant can help.
A nurse consultant can organize and interpret medical records and charts.
June 6, 2019
Misdiagnosis is more common than many people think, especially among pediatric patients. In a study that examined over 1,200 pediatric medical malpractice claims, the most common patient assessment issue was “failure to appreciate and reconcile relevant signs, symptoms and test results.”
The providers in the study failed to see the bigger clinical picture by looking at all available information (such as patient history, reported symptoms, a physical exam, and test results) to properly diagnose the patient.