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Our skin is the largest organ in our body. While it can withstand a lot, it can also break down when it is under pressure over an extended period of time. This can cause injury to the skin and underlying tissues, also known as a bedsore.
Bedsores most often occur in older people or people with disabilities who have limited mobility. They are preventable with relatively simple precautions, such as moving a person so that all of the pressure of their body weight isn’t on one area of their skin for too long. If a person develops a bedsore while at a nursing home, their insurance may initially pay for treatment, but the nursing home can be held liable not only for these medical bills but for other losses.
At the Law Offices of Thomas L. Gallivan, our New York nursing home abuse and neglect lawyers work hard to help our clients get fair compensation for their injuries. We offer free initial consultations and never charge a fee unless we recover money for you. To learn more or to schedule an appointment with a New York bedsore attorney, contact our law firm today.
Determining Who Pays for Bedsore Treatment in Nursing Homes
Bedsores – also known as pressure ulcers or decubitus ulcers – are a breakdown of the skin and underlying tissue. They are caused by prolonged pressure on the skin, which often occurs when a person is immobile or spends a lot of time in bed or in a chair. Most frequently, bedsores happen on the skin that covers bony areas of the body (like the hips and tailbone).
Pressure ulcers are categorized by stages from least serious (Stage 1) to most serious (Stage 4). In the earlier stages, bedsores mostly affect the top layers of the skin. As a bedsore progresses, it can impact the fatty tissue under the skin as well as muscles and ligaments.
Bedsores are preventable with proper care. In particular, patients who are immobile must be repositioned regularly to reduce pressure on the skin. Keeping skin clean and dry can also help prevent bedsores. If there are any warning signs of bedsores, the skin should be treated immediately to prevent them from developing.
Because bedsores are preventable, they are often a direct result of nursing home abuse and neglect. If a pressure ulcer develops when a person is living at a nursing home, then they may be responsible for paying for the treatment.
Initially, bed sore treatment will likely be paid for by a resident’s insurance company. Most nursing home residents are older and will have Medicare as their primary insurance. As such, Medicare will typically pay for treatment.
If the patient is being treated at the nursing home or is transferred to a hospital, Medicare Part A will pay for the treatment. It will also pay for home health care. Keep in mind that stage 3 and 4 bedsores can require significant medical treatment, and in some cases, may even lead to death. It may be necessary for a resident with a more serious bedsore to be treated in a hospital or to receive palliative or hospice care as a result.
If a resident leaves their nursing home and isn’t admitted to the hospital, then Medicare Part B will pay for treatment through a doctor’s office. Alternatively, if a resident does not have Medicare, then their private insurance will cover the treatment.
Although health insurance may pay for nursing home bed sore treatment initially, that isn’t the end of the story. Because bedsores are often caused by abuse and neglect, a nursing home can still be held liable for the cost of treatment through a personal injury lawsuit.
Holding Nursing Homes Liable for Bedsores
If a nursing home resident develops a bedsore, it raises a serious question of negligence on the part of the nursing home. Nursing home facilities are required to follow a certain standard of care, which includes taking measures to prevent bedsores. This may involve using alternating pressure mattresses or regularly repositioning residents, plus keeping skin clean and dry and checking for any skin issues.
A bedsore indicates that a nursing home failed to follow this basic standard of care. A resident who develops a bedsore may pursue a personal injury claim against the nursing home. Through a lawsuit, they can recover financial compensation for their:
- Medical bills
- Future medical treatment
- Pain and suffering
- Emotional distress
- Loss of enjoyment of life
- Scarring
- Disfigurement
They may also recover money for other expenses, like the cost of moving to a new facility.
In most cases, the nursing home doesn’t pay for bedsore treatment on its own. Instead, the resident’s Medicare or private insurance will pay for treatment. If a victim of nursing home abuse and neglect files a lawsuit, then they will be required to repay their insurance company for the money that they spent on medical treatment. This money will come out of any settlement or verdict at trial.
Typically, the Centers for Medicare & Medicaid Services (CMS) will impose a lien on the settlement. Your New York nursing home neglect lawyer will resolve this lien as part of the legal process. In many situations, they are able to negotiate a reduction in the lien so that more money goes directly to you.
At the same time, your attorney will aggressively advocate with the nursing home and its insurance company to get you maximum compensation. This will include full compensation for past medical bills, as well as money for future treatment and other losses. Ultimately, while you will have to repay the insurance company for what it spent on treatment, you will still receive financial compensation for your losses.
It is important to understand that bedsores are not something that should ever happen when a person is at a nursing home. The staff should be providing them with proper care to make sure that their skin doesn’t break down. If they fail to do so, then the nursing home can and should be held liable for the resident’s losses.
Nursing homes will rarely admit that a resident’s bedsore was their fault. Instead, they may claim that it’s just something that happens with age or was caused by the resident’s other medical issues. They won’t offer on their own to pay for any medical treatment or for a resident’s pain and suffering related to a bedsore.
Our experienced nursing home and abuse neglect lawyers won’t simply accept a nursing home’s excuses for how a resident got a bedsore. We know that bedsores are avoidable with appropriate care, and we will help to hold nursing homes accountable. We will fight to make sure that your bedsore treatment is covered – and that you are also compensated for all of your other losses.
Help for Victims of Nursing Home Neglect
Bedsores are common among older people and people with disabilities, but they shouldn’t be. Simple steps like repositioning can help to prevent bedsores. Proper treatment can also reduce the risk of a bedsore progressing to a more serious stage. If a nursing home resident is diagnosed with a bedsore, then the facility can and should be held liable for their medical bills and other losses.
At the Law Offices of Thomas L. Gallivan, we are fierce advocates for nursing home residents who are harmed by abuse and neglect. When you make the decision to place a loved one in a nursing home, you shouldn’t have to worry that they will be injured because the nursing home failed to provide the appropriate level of care.
If your loved one is hurt as a result of nursing home abuse or neglect, we will work with you to help you get the compensation that you deserve. To learn more or to schedule a free initial consultation with a New York nursing home bedsore attorney, reach out to our law offices today by calling 914-220-1086 or filling out our online contact form.
