Obtaining Compensation in a Nursing Home Bedsore Claim

by | Jan 6, 2021 | Medical Malpractice, Nursing Home Abuse And Neglect

The roots of today’s pressure ulcer claims usually go back to 2015. In that year, Medicaid allowed individual states, including Kentucky, to switch to a Fee for Service model. This program reimburses providers flat rates for certain kinds of services. As a result, some areas of nursing home resident care suffered.

Assume 70-year-old Chris fell at home, and he is at a nursing home while he recovers. In the before times, under point of service reimbursement, Medicaid paid the nursing home every time a nurse or other employee checked on Chris. Under Fee for Service care, Medicaid pays the nursing home a flat fee based on Chris’ condition. 

In other words, the more times workers check on Chris, the less money the nursing home makes. So, many nursing home owners discourage repetitive patient contacts, like follow-up visits and frequent rounds, whenever possible.

Nursing home owners have a legal responsibility to care for residents. This responsibility does not change if Medicaid policies change. If the nursing home breaches its duty of care, a Lexington personal injury attorney might be able to obtain substantial compensation. Families and residents need this compensation so they can carry on after a serious injury.

What Causes Bedsores?

Discouraging resident contacts, especially regular nightly rounds, increases the risk of pressure ulcer development. 

Bedsores usually develop near the ankles, knees, and other bony areas of the body. Lack of blood flow to an area causes these ulcers, which can quickly become life-threatening. As long as people turn over in bed at least once every two hours, pressure ulcers cannot develop. But many nursing home residents cannot turn themselves over. Sometimes they are too physically weak. Sometimes they are almost in a comatose state, because of their medication.

Residents do not just rely on nursing home workers to turn them over in bed. They also rely on workers to spot early signs of bedsore development and take appropriate action.

An appropriate response is often a problem as well. Many nursing homes employ underqualified individuals. For example, a rehab center might require a patient care technician to do a job that a licensed vocational nurse should handle. PCTs do not have as much training as LVNs. So, technicians cannot always spot early stage pressure ulcers. As a result, the bedsore festers and gets worse.

Whether the issue is ignoring the resident or using underqualified workers, the nursing home is arguably negligent. To obtain compensation, a victim/plaintiff must simply establish negligence in court.

Establishing Liability

If no one performed rounds every two hours, the nursing home violated the industry standard of care. Violating an industry standard is clear evidence of negligence.

If the nursing home worker failed to properly address a developing bedsore, the nursing home could be responsible, because of the respondeat superior doctrine. This rule holds employers responsible for any negligent acts their employees commit during the scope of employment.

Kentucky law defines these key terms in broad, victim-friendly terms. Assume a night supervisor asks Ted, who is a PCT, to check on residents. Even though Ted is a PCT and patient rounds are not part of his normal job duties, Ted is acting within the scope of his employment.

Evidence is critical in these claims. Victims/plaintiffs must establish negligence by a preponderance of the evidence (more likely than not). Proof on this point includes patient care logs, witness statements, and the bedsore itself. If the nursing home does its job, no resident would ever develop a pressure ulcer.

Your Claim for Damages

Almost all civil claims settle out of court. Many nursing home bedsore claims settle shortly after medical treatment is substantially complete. At that point, the extent of injury is usually clear. If the case settles earlier than that, the settlement amount might not accurately reflect all the victim/plaintiff’s current and future medical expenses.

Frequently, the extent of injury is the only major issue in these claims. As discussed above, negligence is usually rather straightforward in these cases. If the insurance company contests the extent of injury, which normally happens, a Lexington personal injury attorney often partners with a medical expert.

On the issue of liability, most nursing home residents have pre-existing conditions which could contribute to bedsore development. Insurance companies cannot use these weaknesses to reduce or deny compensation.

This compensation usually includes money for economic losses, such as medical bills, and noneconomic losses, such as pain and suffering.

Nursing home owners have a responsibility to prevent bedsores. For a free consultation with an experienced personal injury lawyer in Lexington, contact the Goode Law Office, PLLC. Attorneys can connect victims with doctors, even if they have no insurance or money.