Can someone die of pressure ulcers

Senior Sciences

More than 400,000 people in Germany suffer from pressure ulcers, known as pressure ulcers in specialist circles. Elderly people in need of care, bedridden and chronically ill are particularly at risk of developing such a painful and dangerous lesion. Pressure ulcers are generally considered to be avoidable and thus an indicator of the quality of care.
Pressure ulcer diseases not only lead to considerable physical and psychological impairments in the quality of life of those affected, but often have a fatal outcome.

On this subject, excerpts from a panorama program broadcast by NDR on January 14, 1999, 9 p.m.:

University Hospital Hamburg-Eppendorf. We meet the head of the Institute for Forensic Medicine. Professor Klaus Püschel examined ten thousand deceased in a large-scale study.

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PROF. KLAUS PÜSCHEL:
(Coroner)
"The musculature is symmetrically strong. Rigor mortis at the knee."

COMMENT:
He wanted to find out how many old people were sore before they died. The search for open pressure sores, in Latin decubitus, led to an alarming finding.

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PROF. KLAUS PÜSCHEL:
"Our results so far indicate that about three to four percent of the deceased people in need of care had a deeper sagging point on the back or on the heel at the time of death. For me this means that nationwide probably several thousand such cases can be assumed every year. And quite clearly: this gives rise to an urgent need for action.

COMMENT:
As hard as it sounds: every year in Germany several thousand old people lie on their bare flesh or bones for weeks and months.

Elli Sielemann was a nursing case at the end of her life. Her son Heiner accuses his mother's nursing staff of not treating the pressure ulcer properly. The police are investigating negligence

Mayhem.

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HEINER SIELEMANN:
"I have a tremendous anger in my stomach at the people who are responsible for my mother's death. And from my point of view that is primarily the nursing service that we commissioned to look after my mother."

COMMENT:
Pressure ulcers can almost always be prevented with proper care. But that requires a lot of effort: bedridden people have to be repositioned every two hours, day and night.

Special mattresses can help, but the most important thing is early detection.

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HARMUT SAUER:
(Diaconal work)
"Pressure ulcer is usually a care mistake. It occurs when there is a lack of knowledge about the development of the pressure ulcer or when there are not enough caregivers."

COMMENT:
Lack of knowledge, lack of specialist staff. Since the introduction of long-term care insurance, old people have been cared for according to economic criteria. More and more often this means: first the market, then people. Thirty billion marks annually - the windfall attracts businessmen.

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HARTMUT SAUER:
"With the Long-Term Care Insurance Act, there has been a clear economization, an opening of the market, which we consider very questionable. There are now no quality controls in order to then take black sheep, which I also romp about in this market, off the market."

COMMENT:
Voerde, North Rhine-Westphalia. Christel Götz has not got over the death of her mother to this day. She cared for the old woman for two years, then with a heavy heart she sent her to a nursing home. There you have it on your conscience, Ms. Götz believes. Too late she saw her mother's wounds.

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CHRISTEL GÖTZ:
"I was exhausted and then ran out of the room crying. I couldn't understand why the care was so bad. When I stand here, I often think about it, maybe she would even be alive if I did she would have continued to look after herself. "

COMMENT:
The daughter paid around 5,000 marks for care in the home. Today she believes that she used her money to finance her mother's death. The operator of the nursing home denies the allegations.

In the senior citizens' residence, Sigrid Gräfer's mother also fell ill with pressure ulcers. The purulent wounds led to fatal blood poisoning. Like many other relatives, Ms. Graefer has the feeling that she has abandoned her mother and that she is complicit in her end.

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SIGRID GRÄFER:
"I was fooled by the facade of the house, I'm sorry. I went in, beautiful, everything is inside. Only - I thought that old people actually don't need a swimming pool or a bowling alley, just a little bit Maintenance"

COMMENT:
Sigrid Gräfer's ideal world has cracked ever since. She still can't believe that the sore body in the photo is her mother's. She has filed a complaint against the nursing home owner.

Dr. Jürgen Heck documented the mother's condition after she was admitted to the hospital. Probably flawed, he told the daughter at the time. He remembers the case well.

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DR. JÜRGEN HECK:
(Head physician, EN-Süd-Klinikum)
"The extent of this finding was unusual. Of course, if you have a pressure ulcer of this - I want to say - monstrous extent, then you always have to ask the question: Is there a care deficit?"

COMMENT:
The public prosecutor in Hagen could not prove a care deficit. According to one expert, the maintenance protocols are in order. The preliminary investigation was suspended for the time being.

We meet Patrick Schuster. He was a geriatric nurse under the same nursing management who was previously responsible for Ms. Gräfer. He reports how the care protocols of a pressure ulcer patient are subsequently falsified

were. Patrick Schuster secretly copied the original and the forgery. The hand signals of the helpers in the original document when the bed was transferred. Sometimes only every four boxes, that is: every four hours -

much too little. This cutout was forged. The new hand signals now simulate camps that never took place. According to the protocol, the woman was cared for even after she died.

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PATRICK SCHUSTER:
(Caregiver)
"In that case it was a resident who was not able to report herself or even to ring to give an emergency call. That means that this resident is completely dependent on the nursing staff in this case and is actually - after the minutes - three hours left alone. "

INTERVIEWER:
"And died alone?"

PATRICK SCHUSTER:
"Also died alone, yes."

COMMENT:
Hamburg, apparently a care paradise, nationwide the city with the most outpatient care services. There were multiple fights for potential customers between rival traders.

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REINHARD FALLAK:
(Hamburg Police)
"The Hamburg police set up an investigation team at the end of 1996 and beginning of 1997, and since then we have 176 cases that we deal with. And these 176 cases concern about forty percent of all nursing services that work in Hamburg."

COMMENT:
And this is what the controls look like. The medical service of the health insurance companies is only allowed to carry out its inspection rounds with advance notice. Of course, it is then rather unlikely to find out any lack of care.

Nationwide, independent and effective quality control has been required for years in order to catch fraudulent care services in the act.

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REINHARD FALLAK:
"Ten percent of all operators of the care services have already appeared to the criminal police, mostly with fraud cases, and there are two categories of action The second case is, you hire qualified nurses, you have to have at least four, dismiss them after a short time and then continue to employ unqualified workers who cannot provide professional nursing at all. "

COMMENT:
Two former nurses report from their everyday life:

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ANONYMOUS NURSERS:
"Injections are used by household workers, insulin in particular. This whole system, I think this is a scam that is just unbelievable, on these old people. When you consider that we could all be nursing cases tomorrow and one such person into that Falling hands, I think it's madness, a criminal energy and a fraud that is simply looking for its equals. "

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HARTMUT SAUER:
(Diaconal work)
"; I find it extremely problematic that politicians have put their faith in the market and believed that the market laws would fix it all. This is a capital mistake. It can be seen in the many excesses that we now have in the care market that Inadequate planning has been made here. That urgently needs to be improved. And here we expect a clear position from politicians. "

COMMENT:
The care service Wendel and Fischer in Hamburg. Here, too, the police are investigating an unexplained death. We asked for an interview, but the nursing manager wants to call the lawyer first.

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MICHAEL THOMSEN:
(Nursing service Wendel and Fischer)
"We will - I have just consulted with the lawyer - not comment on the matter now."

INTERVIEWER:
"Why not?"

MICHAEL THOMSEN:
"I can not do that."

INTERVIEWER:
"So you cannot say whether it was correct maintenance or whether there were mistakes."

MICHAEL THOMSEN:
"I don't want to say anything about that. So it is a mystery to me how you got the information because - as I said - this is still an ongoing procedure. And we also reserve the right to file charges against relatives for defamation, because there were really tough things going on. "

COMMENT:
Marietta Gertz considers the nursing service to be jointly responsible for the death of her mother. Meanwhile, he denies the allegations. She trusted the nurses. Case in point. Many relatives prefer to avoid looking below

the ceiling.

Elfriede Brust, the mother. Her family doctor referred her to the nursing service. From this point on, the care protocols of Wendel and Fischer give an insight into the agonizing death of the old woman .. Entry of the

Nursing staff on November 21: Left half of the buttocks, below, small vesicles have formed. Looks very strange.

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MARIETTA GERTZ:
"I was only told that my mother has a job that doesn't look very good. And then I asked: What are you doing with it? Yes, I spray something…. I spray something on it, the carer has said. "

COMMENT:
Martyrdom. For months Elfriede Brust sat on her open wounds. The nurses put creams and anoints - in vain. The handover book shows how overwhelmed the nursing staff were. The entries of the last few days:

June 10th: She complains of pain all over her body. Greetings Dana. Jonny, is the pressure ulcer mattress working? Feels very flat.

A week later: Should you change your dressing every evening? I was not sure.
Greetings Dana.

June 21st: Ms. Brust received an emergency doctor's visit. Admitted to the hospital. Jonny.

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MARIETTA GERTZ:
& quot; My mother came straight to the hospital for an examination. It took a lot of time. And then the doctor called my sister and me in and asked what about my mother, what the woman looks like, he can't understand that. "

COMMENT:
One day later Elfriede Brust was dead. The doctors at the Hamburg-Barmbek hospital determined that the cause of death was blood poisoning and sepsis caused by multiple decubita ulcera. Cause of death unclear. The forensic medical examination showed: Ms. Breast died of pressure ulcers.

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MARIETTA GERTZ:
"I still feel miserable and still have a lot of pictures in front of my eyes when I think about the pain my mother endured. When you see the wounds, you know everything."
Pressure ulcers are generally considered avoidable and therefore an indicator of the quality of care.