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.

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.