In the United States, hip fractures are the most common broken bone that requires hospitalization. In 2006, there were 316,000 hospital admissions for hip fractures in people age 65 and older–an increase of 7 percent from the previous year, according to the Centers for Disease Control and Prevention. Over 90 percent of hip fractures are caused by falling, most often by falling sideways onto the hip

THE BREAK

A broken hip is a break in the thigh bone (called the “femur”) near the hip joint. In older adults, a broken hip can occur from falling or from daily use if the femur is weak. The femur is one of the strongest bones in your body, but it may weaken with age. Even a minor injury may cause the bone to break.

People who have a bone-weakening condition called “osteoporosis” are more likely to break a hip.

A broken hip is a serious injury that is very painful and can keep you from walking. People with broken hips may be at risk for other problems, such as pneumonia, blood clots, and muscle weakness. Some problems can be life threatening.

THE TREATMENT

If possible, broken hips are treated with an operation to repair the hip, physical therapy to help you gain strength after the operation, and medicine to help ease the pain.

Over time, pain from a broken hip may cause: Delirium” (confusion, excessive sleepiness, agitation, talk that does not make sense, or seeing things that are not there), poor sleep and depression.

Uncontrolled pain can also interfere with treatments for your other medical conditions. Pain can also slow down your physical therapy and recovery. Your doctor, nurse, or physical therapist will ask you about your pain. They may ask you to rate your pain so that they can see if treatment is helping. It is important to let them know if you are still in pain.

The amount of pain and type of pain from a broken hip can change during your treatment. For example, the pain can be different before and after an operation, during rehabilitation, and after you come home from the hospital.

MEDICATION

Your doctor may give you medicines to treat the pain before or after an operation to repair the broken hip. Some of these include:

Acetaminophen. This non-aspirin pain medicine is often used for many types of pain, such as body aches and headaches. It usually is not strong enough by itself to relieve the pain.

Opioid analgesics. Some common names for these drugs are morphine, codeine, and oxycodone. You may get these medicines as a pill, a shot, or through a tube in your arm (called an “IV”). Common side effects of opioid analgesics include nausea, vomiting, constipation, sleepiness, confusion and itchiness.

Nonsteroidal anti-inflammatory drugs or NSAIDs. Some common names for these drugs are ibuprofen and naproxen. These medicines come as a pill or a liquid. Some of the common side effects of NSAIDs include dizziness, nausea, diarrhea, excess gas, irritation and bleeding of the stomach and intestines.

MORE OPTIONS

Researchers have studied other ways to manage pain, according to the Agency for Healthcare, Research and Quality. These other treatments include:

Nerve blocks: A nerve block uses a medicine called an “anesthetic” to numb the nerves so that you do not feel pain for a little while. Anesthetics are the same kind of medicine dentists use to numb teeth and gums. The nerve block will make a part of your body numb for a little while. Your doctor might use a nerve block to help ease your pain if you cannot take medicines like NSAIDs or opioids. Nerve blocks may be used before, during, or after an operation.

Traction: Traction is a treatment where a part of the body is pulled into a certain position. Traction is usually used before an operation.There  have been only a few studies on traction. They show that traction before an operation does not help relieve pain more than using pain medicines alone, but there is not enough research to know for sure.

Other treatment options include acupressure, muscle-relaxation therapy and  neurostimulation.

For more on medical issues, see the library of articles by Daytona Beach medical malpractice attorney.

According to the Institute of Medicine, as many as 98,000 people die every year from preventable medical errors, the sixth leading cause of death in America.  The bill introduced by the US House of Representatives (H.R. 5) not only ignores patient safety, but also imposes severe, one-size-fits-all caps on damages that patients can seek when injured by medical negligence, defective drugs, medical devices, or abuse suffered in nursing homes, according to AAJ. It even extends this cap to health care providers that intentionally harm or kill patients, as well as insurance companies that refuse to pay just claims for medical bills.

“This bill is simply dangerous for patients. Eliminating legal accountability destroys any incentive to focus on the real problem – preventable medical errors and patient safety,” said AAJ President Gibson Vance in a press release.

The AAJ primer examines the latest research to counter many of the myths and distortions heard from those seeking to take away the legal rights of patients – such as the real costs of the medical negligence system, the frequency and validity of lawsuits, and the dangers patient may face if policies such as H.R. 5 are enacted.

“Medical Negligence: The Role of America’s Civil Justice System in Protecting Patients’ Rights” can be found at www.justice.org/medicalnegligence.

As the world’s largest trial bar, the American Association for Justice (formerly known as the Association of Trial Lawyers of America) works to make sure people have a fair chance to receive justice through the legal system when they are injured by the negligence or misconduct of others–even when it means taking on the most powerful corporations.

The primer points to a study conducted by Harvard University in 2006 that shows that most negligence claims involve medical error and serious injury, and concluded “portraits of a malpractice system that is stricken with frivolous litigation are overblown.” The researchers found that few claims were without merit, and those that were generally did not receive any money.

Most negligence claims were meritorious, with 97 percent of claims involving medical injury and 80 percent involving physical injuries resulting in major disability or death. Few claims where there was not error were ever paid. In fact, researchers found the reverse – non-payment of claims where error was involved – was a bigger problem

The primer also points to research that shows that patients actually file claims because they are seeking answers. Too often, patients injured by preventable medical errors are left in the dark about what happened to them, and litigation is sometimes the only way to uncover what transpired. A Kaiser Family Foundation survey found that 70 percent of patients who experience medical errors are not told by their doctors.

The most frequently echoed myth concerning medical negligence, according to the primer, is the notion that doctors are fleeing states and retiring early, creating physician shortages. Anecdotal accounts of doctors fleeing states in response to increased insurance premiums have proved to be either unrepresentative isolated events, or flat out false. In fact, data from the AMA shows that physician numbers have been increasing across the board for many years.

The total number of physicians in the U.S. rose to a record high in 2009, the most recent year for which data are available. There were 972,376 physicians in the U.S., nearly 18,000 more than the year before.  In 2009, the increase in physicians outpaced the increase in population once again. The number of physicians per 100,000 population is at an all-time high of 317. The increase of physician numbers compared to population growth has climbed steadily for decades.

“Any discussion of medical negligence that does not involve preventable medical errors ignores the fundamental problem,” concludes the AAJ primer. “Preventing medical errors will dramatically lower health care costs, reduce doctors’ insurance premiums, and protect the health and well-being of patients. The accountability promoted by the civil justice system is the engine of patient safety. No other mechanism or proposed alternative encourages accountability as effectively as the civil justice system.”

For more on medical safety issues, see the medical malpractice library of articles by Daytona Beach medical malpractice attorney

In addition to record-high numbers of complaint investigations, volunteer and staff ombudsmen also completed 100 percent of the program’s prescribed facility assessments. Ombudsmen visit every long-term care facility in the state, including all nursing homes, at least once each year to listen to residents’ concerns in an effort to fix problems to the residents’ satisfaction.

The only organization of its kind in the state, the Ombudsman Program trains volunteers to advocate for people living in nursing homes, assisted living facilities and adult family care homes.

The annual report, released in December, also draws attention to the decline in volunteers from more than 400 the previous year to 380 this year. The slow economy was partially to blame.

“We certainly need more volunteers to advocate for residents, to make sure they’re getting the quality of care and life they deserve,” said Brian Lee, the Ombudsman program’s director, in a state department press release.

To get a free copy of this annual report or to find out more about becoming a volunteer, go to http://ombudsman.myflorida.com.

Find our more information in this Dangers of Nursing Homes video by Daytona Beach nursing home injury lawyer or check out the Frequently Asked Questions from this Daytona Beach Nursing Home and Medical Malpractice lawyer.

This all raises the question of how safe your family member is in a nursing home in Florida. Most of the headlines about assaults on nursing home residents involved nursing home staff abusing a resident. However, assaults on residents by other residents may be much more frequent.

Florida has a law that requires nursing homes to conduct criminal history background checks on its personnel. However there is no requirement that the nursing home conduct criminal history background checks on its residents.

Of course, residents may be dangerous even if they have not been convicted of some crime in the past.  For example, people might become violent because of dementia, Alzheimer’s disease or hallucinations even if they have lived long lives without any violent tendencies.

Nursing homes have a duty to take reasonable steps to protect its residents from the assaults of other residents. This should include a reasonable investigation into the behavior of a resident before coming to the nursing home.  Nursing homes should review previous medical records, talk to the family and complete a thorough assessment of a resident to determine if there is a risk of violence. Of course, it is also important that the nursing home carefully observe the behavior of all its residents while at the nursing home to determine if the resident could become violent.

If a resident poses a threat to others, the nursing home staff should either take reasonable steps to keep the resident from hurting anyone or transfer the resident to a facility that has the expertise to adequately control the resident.

If one of your family members is in a nursing home we recommend that you talk to the administrator to get a full explanation about what the nursing home does to protect its residents from assaults by other residents. For much more information about protecting your family member in a nursing home, see our videos and articles at zqlawyers.com.

The authors contend the evidence demonstrates that nursing home residents in the United States would have 7,000 fewer pressure ulcers if they were cared for by not-for-profit homes. This is a significant number because bedsores can become life threatening when infected and are always painful.

Unfortunately, the decision about whether your family members will be safe in a particular nursing home is simply too difficult. The study results do suggest that one of the factors you should take into consideration in making your decision is whether the nursing home is for profit or not-for-profit. Unfortunately the study’s results were based on statistics relating to a wide population of nursing homes and its conclusions are less helpful when considering a particular nursing home.

For example two not-for-profit nursing homes in the Daytona Beach area are rated for quality quite differently by state government inspectors.  Good Samaritan Society-Daytona is affiliated with the not-for-profit Lutheran Good Samaritan Society. Bishops Glen Retirement Center is affiliated with the not-for-profit United Church of Christ.

As of the date of this article while Bishop’s Glen is rated three stars out of 5 for overall inspection by the State of Florida it has the highest five-star rating for items important in the study results, pressure ulcers and restraints and abuse. Good Samaritan Society, on the other hand, has the lowest ranking, only one star, for overall inspection, the lowest ranking for pressure ulcers and the lowest ranking for restraints and abuse. Thus, one of the not for profits is in the bottom 20% for quality of care while the other is highly ranked.

For much more information about how to choose a nursing home visit our website at zqlawyers.com.

The Legislature does in fact require that nursing homes have an insurance policy to protect victims of the nursing home’s negligence.  However, and this is a big “however,” the Legislature does not require any specific amount of insurance. So the nursing homes buy pretend insurance.

One form of pretend insurance is known as a “wasting policy.”  With this type of “insurance” the nursing home buys a low policy limit such as $25,000 or $50,000.  The trick though is that the amount of the $25,000-$50,000 left to pay the victims of the home’s negligence is reduced by the cost of defending the lawsuit.

The costs include attorneys’ fees and expert witness fees along with a variety of other expenses.  Litigating nursing home lawsuits is expensive.  Attorneys spend a great deal of time working on the case and expert witnesses charge very large fees, sometimes $1,000 an hour.  Thus by the time a case has proceeded through trial, there is most often no money left from the insurance company to pay the nursing home resident who was injured.

Therefore, when you are choosing a nursing home ask the administrator to show you a copy of their professional liability insurance policy.  If the nursing home has only pretend insurance it is a sign that it does not want to protect its residents and does not want to be accountable for its negligence.

For much more information about nursing homes and protecting your family members, see our nursing home practice section on our website zqlawyers.com.

Despite the fact that nursing homes employ people who are more than two years old, the federal government has to tell them to play nice. In fact the Centers for Medicare and Medicaid Services have to publish new rules about how to play nice all the time.  The government creates these rules in response to observations that nursing home employees are not treating residents respectfully. In June of this year the government again had to publish some new rules about playing nice.  Here are some examples of the rules.  They are just like your mom’s rules although they are phrased in more grown-up language:

1. Each resident has the right to be free from mistreatment, neglect and misappropriation of property.

2. Staff [should not] interact/converse only with each other rather than with residents while assisting residents.

3. [Staff should] respect residents’ private space and property (e.g., not changing radio or television station without resident’s permission.

4. [Staff should] respect residents by speaking respectfully, addressing the resident with a name of the resident’s choice, [and]  avoid use of labels for residents such as “feeders.”

 5. [Staff should] maintain resident privacy of body including keeping residents sufficiently covered, such as with a robe, while      being taken to areas outside their room.

That last rule means that nursing homes should not leave a resident in a public area in a wheelchair uncovered without any clothes. Even when you were two years old, you didn’t do that.  Unfortunately in our nursing home abuse practice in Daytona Beach we see just this type of thing happening. The law does allow the resident or family to sue the nursing home for violation of resident rights, but our clients would rather be treated with dignity and respect than go to court.

So what we have to say to some nursing home employees is, “Play nice and grow up!”

For more information about nursing home abuse see the nursing home section of our website zqlawyers.com

Of course no one likes to think about feeding tubes.  And, no one thinks they will need a feeding tube.  However, if you are in an accident and are seriously injured you may become so debilitated that you cannot swallow.  If you are elderly and suffer from dementia you may become so seriously debilitated that you cannot swallow.  That’s when the doctors ask you or your family to make a decision.

The issue then is how you want to balance extending life with quality of life.  That’s a decision you should make after careful thought, after talking to your family and after becoming fully informed.

One common form of feeding tube used for long-term care is the PEG tube. PEG stands for percutaneous endoscopic gastrostomy tube. The surgeon cuts a hole in your abdomen and inserts the tube directly into your stomach.

A study published in April, 2009 indicates that there is little evidence feeding tubes benefit patients with advanced dementia. The study author says that tube feedings in the elderly with dementia may not even prolong life and that physical restraints were used for 71% of the patients studied.

In our nursing home neglect practice in Daytona Beach we often see elderly patients restrained because they forcibly take out their feeding tubes. This usually happens because the patient is too confused to understand what the feeding tube is.

The use of feeding tubes can be extremely controversial without clear direction from the patient.  You may remember the case of the unfortunate Florida woman who had been on a feeding tube for a long time.  Her husband directed the doctors to remove the feeding tube but politicians and the media intervened creating what could only be described as a media circus that was emotionally wrenching for everybody involved.

Therefore, we recommend that you sign a living will making it clear whether you want a feeding tube.  We will have more on feeding tubes and living wills in a later posting.

The problem is that because these programs taken together do not pay well they make it difficult for nursing homes to both make a profit and to provide quality care. Thus, many nursing homes choose to limit staffing in order to make a profit. Inadequate staffing in turn results in abuse and neglect of nursing home residents.

Medicare taken alone reimburses nursing homes at a profitable rate. However, Medicaid can pay at a rate that causes a loss for the nursing home.  Nursing homes try to offset losses from Medicaid patients with profits from Medicare patients.

Medicare, however, pays for only a limited time and only for those who meet specific guidelines.   Medicare does not pay for “custodial care,” including help with your activities of daily living such as getting dressed, feeding yourself and bathing. If you do not need  “skilled nursing care” Medicare will not pay. “Skilled nursing” includes care such as intravenous injections and physical therapy and requires staff such as registered nurses and physical therapists.

Medicare pays “full cost” for only 20 days. After that the patient pays a large copayment up to 100 days and then Medicare pays nothing. Once the 20 days is up, nursing homes know their profit margins will go down.

Tragically we have seen many cases in our Daytona Beach-based nursing home neglect practice where the nursing home discharges a patient home on the 20th day even if the patient is terribly sick. Sometimes the patient dies because of the discharge.

Therefore, one of the most important conversations you will have with nursing home staff will be with the discharge planner. We recommend that you make it clear to the planner that the choice of healthcare providers after 20 days should be based on the patient’s condition rather than Medicare’s ending reimbursement.

Assisted living facilities are supposed to provide residential care for the elderly or disabled who need some minor assistance with their activities of daily living but do not need skilled nursing care.  For example assisted living facilities appropriately provide services to people who just need help getting dressed or reminders to take the right medication.

Administrators at assisted living facilities cause needless suffering and death when they keep people who need more care than the facility is capable of providing.  A critical problem is that assisted living facilities have a built-in conflict of interest.  The longer a resident stays at the facility, the longer the facility has a paying customer filling a bed.  Thus, assisted-living administrators have a financial incentive to resolve any doubt about whether a resident’s condition has deteriorated beyond the ability of the facility to provide quality care in favor of keeping the resident.

Of course, the safest approach is to transfer the resident whose condition has deteriorated to an emergency room for evaluation or if the situation is not an emergency to get a timely evaluation from the resident’s primary care physician.  Tragically we have seen too many cases in Daytona Beach, New Smyrna Beach and other Central Florida assisted-living facilities in which the administrator does not follow the safe approach and the resident dies without proper medical care.  Thus, if you have a family member in an assisted living facility it is important to be in close contact with the administrator to make sure that the administrator takes the safe approach to protect your family member.