Article: Nursing Homes Routinely Mask Low Staff Levels

Via New York Times By Jordan Rau

ITHACA, N.Y. — Most nursing homes had fewer nurses and caretaking staff than they had reported to the government for years, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate.

The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends. On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest.

The data, analyzed by Kaiser Health News, come from daily payroll records Medicare only recently began gathering and publishing from more than 14,000 nursing homes, as required by the Affordable Care Act of 2010. Medicare previously had been rating each facility’s staffing levels based on the homes’ own unverified reports, making it possible to game the system.

The payroll records provide the strongest evidence that over the last decade, the government’s five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common. Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.

Stan Hugo with his wife, Donna, who is a resident at the Beechtree 
Center for Rehabilitation and Nursing in Ithaca, N.Y. Mr. Hugo 
tracks staffing levels at the skilled nursing facility.

At the Beechtree Center for Rehabilitation & Nursing here, Jay Vandemark, 47, who had a stroke last year, said he often roams the halls looking for an aide not already swamped with work when he needs help putting on his shirt.

Especially on weekends, he said, “It’s almost like a ghost town.”

Nearly 1.4 million people are cared for in skilled nursing facilities in the United States. When nursing homes are short of staff, nurses and aides scramble to deliver meals, ferry bedbound residents to the bathroom and answer calls for pain medication. Essential medical tasks such as repositioning a patient to avert bedsores can be overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations.

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“Volatility means there are gaps in care,” said David Stevenson, an associate professor of health policy at Vanderbilt University School of Medicine in Nashville, Tenn. “It’s not like the day-to-day life of nursing home residents and their needs vary substantially on a weekend and a weekday. They need to get dressed, to bathe and to eat every single day.”

David Gifford, a senior vice president at the American Health Care Association, a nursing home trade group, disagreed, saying there are legitimate reasons staffing varies. On weekends, for instance, there are fewer activities for residents and more family members around, he said.

“While staffing is important, what really matters is what the overall outcomes are,” he said.

While Medicare does not set a minimum resident-to-staff ratio, it does require the presence of a registered nurse for eight hours a day and a licensed nurse at all times.

The payroll records show that even facilities that Medicare rated positively for staffing levels on its Nursing Home Compare website, including Beechtree, were short nurses and aides on some days. On its best staffed days, Beechtree had one aide for every eight residents, while on its lowest staffed days, there was only one aide for 18 residents. Nursing levels also varied.

The Centers for Medicare & Medicaid Services, the federal agency that oversees nursing home inspections, said in a statement that it “is concerned and taking steps to address fluctuations in staffing levels” that have emerged from the new data. This month, it said it would lower ratings for nursing homes that had gone seven or more days without a registered nurse.

Beechtree’s payroll records showed similar staffing levels to those it had reported before. David Camerota, chief operating officer of Upstate Services Group, the for-profit chain that owns Beechtree, said in a statement that the facility has enough nurses and aides to properly care for its 120 residents. But, he said, like other nursing homes, Beechtree is in “a constant battle” to recruit and retain employees even as it has increased pay to be more competitive.

Mr. Camerota wrote that weekend staffing is a special challenge as employees are guaranteed every other weekend off. “This impacts our ability to have as many staff as we would really like to have,” he wrote.

New rating method is still flawed

In April, the government started using daily payroll reports to calculate average staffing ratings, replacing the old method, which relied on homes to report staffing for the two weeks before an inspection. The homes sometimes anticipated when an inspection would happen and could staff up before it.

Payroll records at Beechtree show that on its highest staffed days, it had one aide for every eight residents, but there was only one aide for 18 residents at the lowest staffing level.CreditHeather Ainsworth for The New York Times

“They get burned out and they quit,” said Adam Chandler, whose mother lived at Beachtree until her death earlier this year. “It’s been constant turmoil, and it never ends.”

Medicare’s payroll records for the nursing homes showed that there were, on average, 11 percent fewer nurses providing direct care on weekends and 8 percent fewer aides. Staffing levels fluctuated substantially during the week as well, when an aide at a typical home might have to care for as few as nine residents or as many as 14.

 

A family council forms

Beechtree actually gets its best Medicare rating in the category of staffing, with four stars. (Its inspection citations and the frequency of declines in residents’ health dragged its overall star rating down to two of five.)

To Stan Hugo, a retired math teacher whose wife, Donna, 80, lives at Beechtree, staffing levels have long seemed inadequate. In 2017, he and a handful of other residents and family members became so dissatisfied that they formed a council to scrutinize the home’s operation. Medicare requires nursing home administrators to listen to such councils’ grievances and recommendations.

Sandy Ferreira, who makes health care decisions for Effie Hamilton, a blind resident, said Ms. Hamilton broke her arm falling out of bed and has been hospitalized for dehydration and septic shock.

“Almost every problem we’ve had on the floor is one that could have been alleviated with enough and well-trained staff,” Mrs. Ferreira said.

Beechtree declined to discuss individual residents, but said it had investigated these complaints and did not find inadequate staffing on those days. Mr. Camerota also said that Medicare does not count assistants it hires to handle the simplest duties like making beds.

In recent months, Mr. Camerota said, Beechtree “has made major strides in listening to and addressing concerns related to staffing at the facility.”

Mr. Hugo agreed that Beechtree has increased daytime staffing during the week under the prodding of his council. On nights and weekends, he said, it still remained too low.

His wife has Alzheimer’s, uses a wheelchair and no longer talks. She enjoys music, and Mr. Hugo placed earphones on her head so she could listen to her favorite singers as he spoon-fed her lunch in the dining room on a recent Sunday.

As he does each day he visits, he counted each nursing assistant he saw tending residents, took a photograph of the official staffing log in the lobby and compared it to what he had observed. While he fed his wife, he noted two aides for the 40 residents on the floor — half what Medicare says is average at Beechtree.

“Weekends are terrible,” he said. While he’s regularly there overseeing his wife’s care, he wondered: “What about all these other residents? They don’t have people who come in.”

This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. The author is a reporter for Kaiser Health News.
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How To Spot Nursing Home Neglect Or Abuse?

justice engraved on courthouse

Nursing home neglect and abuse is often difficult to detect, and families should be on the lookout for common warning signs for physical, emotional and financial abuse.

Common warning signs of physical abuse are:

  • Untreated bedsores, pressure sores, wounds, cuts, bruises, or welts
  • Abnormally pale complexion
  • Bruises in a pattern that would suggest restraints
  • Excessive and sudden weight loss
  • Fleas, lice, or dirt on or in the room
  • Poor personal hygiene, unpleasant odors or other unattended health problems
  • Torn clothing or broken personal items
  • Bleeding around private parts
  • Bloody undergarments
  • Bruises around the breast/genital region
  • An unexpected look of fear from the elder when aide may be present

Common warning signs of emotional abuse are:

  • Intimidation through yelling and threats
  • Humiliation
  • Ignoring the patient
  • Isolating the patient from other residents and/or activities
  • Terrorizing the patient
  • Mocking the patient

Financial exploitation is another form of abuse. An unscrupulous caregiver may:

  • Misuse checks, accounts, or credit cards
  • Steal money, steal checks, or steal belongings
  • Forge signatures
  • Authorize withdrawals or transfer of monies
  • Steal the patient’s identity

No family is exempt from any of these possibilities. Abuse affects the rich and poor. Suffering sustained by the elderly ranges from financial, to emotional and physical. Abuse escalating to physical can result in severe infections, amputations, dehydration and, unfortunately, death. A lawsuit should be filed on behalf of your loved one to get the justice your family deserves. Compensation may cover the costs of treatment and recovery, as well as compensation for non-financial hardships such as pain and suffering.

If you suspect elder abuse of any kind speak up and demand answers of those in charge.

Feel free to contact me for more information or inquire about a lawsuit.

Sincerely,

Brian

Secret data: Most VA nursing homes have more residents with bed sores, pain, than private facilities

Via Donovan Slack, USA TODAY, and Andrea Estes, The Boston Globe

Don Ruch’s family thought round-the-clock care would help him recuperate, but he ended up in intensive care in septic shock, suffering from “severe” malnutrition, bedsores on his pelvis and back, a burn on his right thigh and a trauma wound. USA TODAY

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An analysis of internal documents shows residents at more than two-thirds of Department of Veterans Affairs nursing homes last year were more likely to have serious bedsores, as well as suffer serious pain, than their counterparts in private nursing homes across the country.

The analysis suggests large numbers of veterans suffered potential neglect or medication mismanagement and provides a fuller picture of the state of care in the 133 VA nursing homes that serve 46,000 sick and infirm military veterans each year.

More than 100 VA nursing homes scored worse than private nursing homes on a majority of key quality indicators, which include rates of infection and decline in daily living skills, according to the analysis of data withheld by the VA from public view but obtained by USA TODAY and The Boston Globe.

The news organizations reported last week that 60 VA nursing homes received the agency’s lowest quality ranking of one out of five stars last year, but the data didn’t detail how individual facilities scored on specific measures. USA TODAY and The Globe are now publishing the full data, outlined in internal documents, for every VA nursing facility as of Dec. 31, 2017.

Four VA facilities – nursing homes in Bedford, Massachusetts; Chillicothe, Ohio; Tuscaloosa, Alabama; and Roseburg, Oregon – lagged private nursing home averages on 10 of 11 indicators. At all four, about a third of residents were given anti-psychotic drugs – almost twice as much as in the private sector. The FDA has said such drugs are associated with an increased risk of death in elderly patients with dementia.

“They should be assessing individuals and doing what they can to manage it,” said Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care. “And if it’s not working, they should be trying different things.”

The VA, which has argued that its residents are typically sicker than those in private facilities, has tracked the detailed quality data for more than two years but has kept it secret, depriving veterans of potentially crucial health care information.

VA ‘evaluating’ what information to release

VA Press Secretary Curt Cashour has declined to answer questions about whether or when the agency planned to release the quality information, as well as nursing home staff data the VA has compiled dating to 2004. He also declined to say when the VA would release inspection reports the agency has kept secret for more than a decade.

After the investigative report by USA TODAY and The Globe last week, Louisiana Republican Sen. Bill Cassidy and Alabama Democratic Sen. Doug Jones introduced legislation that would force the VA to release all of its nursing home quality information at least once a year.

“We cannot work with this administration or any administration to fix the VA if we don’t have the information,’’ Jones said.

Acting VA Secretary Peter O’Rourke told the CBS affiliate in Dallas last week that VA officials were “evaluating exactly what is the most appropriate for us to put out there and that will support continuous improvement and then also will provide good decision-making information for veterans.”

He called the USA TODAY and Globe reporting on the VA nursing home ratings “fake news.”

Federal regulations require private nursing homes to disclose voluminous data on the care they provide. The federal government uses the data to calculate quality measures and posts them on a federal website, along with inspection results and staffing information. But the rules don’t apply to the VA.

Playing ‘hide the ball’ with nursing home data

The VA has used similar data internally to track quality at its nursing homes as far back as 2011, according to a report in October that year from the nonpartisan Government Accountability Office. At that point, the agency monitored at least two dozen factors, including how many residents had bedsores or were in serious pain. But none of the information was released.

The 2011 review found that 80 percent of the agency’s nursing homes had problems with medication management, but VA headquarters wasn’t using the data “ to detect patterns and trends in the quality of care and quality of life within a (VA nursing home) or across many (of them).”

The VA launched another tracking system in May 2016. It now measures 11 indicators – the same as those used for private nursing homes – and assigns star ratings based on the indicators, which can be clues to larger problems with overall quality. For example, high rates of falls or bedsores may indicate neglect.

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Bedsore Lawsuits: FAQs

WHEN IT COMES TO BEDSORES, PRESSURE SORES, DECUBITUS ULCERS IT’S OFTEN HELPFUL TO READ WHAT OTHERS HAVE ASKED. YOU MAY BE ABLE TO BENEFIT FROM SOME OF OUR FREQUENTLY ASKED QUESTIONS BELOW.

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Helpful and Free easy-to-read Legal Guides for Senior Citizens.

Written in easy to understand language

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“My mom is in a nursing home and I noticed some bruises and sores. I think they are bedsores—what should I do?”

Bedsores are often a sign of neglect and sometimes a sign of abuse. The first thing you should do is speak to a nurse on duty and begin to remedy the situation. Be aware that the nurse may not have a full understanding of these injuries and you will likely need the attention of a wound care specialist and medical doctor. If you have a cell phone take some pictures of the wound for documentation. Bedsores and Pressure Sores, also known as Decubitus Ulcers can progress quickly and can be deadly. They occur when someone is immobile and there is not adequate blood flow. Then the affected tissue dies and an ulcerated sore develops. In a nursing home, hospital or other care facility it is their responsibility to check and turn the patient regularly. There are laws in place that protect patients and you should know that these injuries are not the fault of the patient. The patient is the victim. If a loved one you know is suffering they may have a significant, financially rewarding lawsuit. Read more about this on our website, http://www.RaphanLaw.com.

As an Elder Law firm we see these cases often. Whether malpractice, abuse or neglect it is simply unjust for it to happen to an innocent victim. Do not put off addressing the issue. Call me for a free consultation (212-268-8200, 800-278-2960) or even to just guide you through the process of getting the proper medical and legal attention.

Visual Stages of Bedsores:

Image

Read our Frequently Asked Bedsore Lawsuit Questions here>

By Brian A. Raphan, Esq.

Free Downloads: Easy to read elder guides for families and seniors.

Probate, Estate Planning, Healthcare Proxies, Medicaid Planning, etc. Get informed and find many of the answers to your existing questions in these guides. Download and save as reference for free.

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Pressures Sores: Frequently Asked legal questions

 

Asking questions is important for any consultation. When it comes to pressure sores and bedsores it’s often helpful to read what others have asked via BedsoreHotline.com

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  • If the patient was at a hospital first and then a nursing home which do we sue?

    It always depends on individual and medical circumstances but the possibility exists that both are liable. Often an injury begins in a hospital, may not be reported and/or is overlooked or neglected on intake at the second facility where it may get worse or lead to infection and other medical issues.

  • Do I have a malpractice case?

    A case may be medical malpractice on behalf of a facility or doctor. There may be hospital negligence and nursing home liability as well. In unfortunate and sad circumstances it may be a wrongful death lawsuit, where a family member or loved one may have the right to recover losses. Our team of experts will help determine the best options for for your bedsore or pressure sore, decubitis ulcer lawsuit.

  • What if the patient is too ill to appear in court?

This is not an issue and often the case with bedsore victims. For bedsore and pressure sore lawsuits there’s a legal team that includes experienced bedsore litigators, and medical professionals that can testify based on patient medical records and treatment or lack of and improper treatment. As well as other expert witnesses that look into hospital procedures, policy  and practices and determine if any federal violations were evident or standards of procedure were not met. Medical records and pictures of wounds are used.

  • How much does it cost to sue?

    There is no fee to you unless we win. When we accept a case we put in the resources and hours of our bedsores legal team because we are confident of a successful outcome based on the facts of the case. If we take on your case it’s because we see huge upside financial potential for the victim or family of the victim. We work on contingency—no upfront fee or time billed to you. When you win we get an agreed upon portion of the award.

  • Will beginning a lawsuit get better care for the victim?

    Once a hospital or nursing home knows a bedsore lawsuit is possible, often the care and treatment of the patient improves. This is because now they know they are under scrutiny and may be even further liable legally if not giving the proper care and medical attention after the sores have been documented by family and bedsore lawyers. Additionally, our law firm will let you know the standards of care that is necessary for you or your loved one. We can even help guide you on the best way to discuss issues with the doctor or staff and get the desired results.

  • I want to sue – does it take long? Does my dad have to appear in court?

    Timing of a case varies. With expertise and experience and a hands-on approach we move swiftly. The size of our firm allows us to focus on cases so they don’t get lost in the shuffle. Unlike some other law firms, our legal team of attorneys, paralegals, research assistants, medical experts and more, have the experience and knowledge to avoid time lags. Many times cases are seåttled before even going to court. Of course, the plaintiff has a say in this decision and we do what is best for our client.

  •  Do I need money to sue-what does contingency mean?

    You will not need to lay out any money. We handle all of our bedsore and pressure sore negligence or malpractice cases on a contingency fee basis. That means that we only charge a legal fee if we are successful and recover money for you. Our fee is typically 33 1/3% of the net recovery after the costs and disbursements that we advance are deducted. The contingency fee may be even lower depending on the facts of the case and the reason the sores happened. With a free consultation, a bedsore law firm that advances all of the necessary costs, and a contingency fee arrangement, you get our reputable law firm with no out of pocket expenses.

  • How do I know if I have a good bedsore lawsuit? The nurse said the sores were caused by my father and existed?

    Don’t put much credence in the opinion of anyone that isn’t a legal expert. Even a medical professional or doctor doesn’t have the legal knowledge and they or facility administrator may even try to persuade you against a bedsore or pressure sore lawsuit. Such tactics aren’t new. Don’t be a victim twice. Consult with legal professionals when medical ones let you down. Then you can use your best judgement on how to proceed with your lawsuit.

  • What happens if my case loses-will i have any fees to pay?

    Absoultely not. We will not charge you one dime if we lose. No matter how much time or money we invest in your case we only get paid when we win. We do not accept every case offered to us. We use our expertise and team approach for cases of value to the victim and the firm.

 

Ask your own question here> bedsores@raphanlaw.com

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What Rights Do Bedsore Victims Have?

You’d be surprised how many times we hear the following from clients…”the nursing home said our dad’s skin condition was broken down and poor health led to bedsores”, or some similar version of this. These comments  inappropriately lead people to believe they or there loved ones do not have legal rights when it comes to bedsores or pressure sores (decubitus ulcers). Of course they are not the fault of the bedsore victim. Especially when they are in the care of professionals of a hospital, medical or nursing facility. Patients, elders, unhealthy or not do have legal rights–which also includes the right to sue for bedsores. Read more about the Rights of Bedsore Victims below:

bedsore treatment, bed sore malpractice

  1. The defendants insurance company may ask you for a recorded statement describing the appearance of bedsores and your treatment. Remember you have no obligation to give them such a statement, nor is it wise to do so.

  2. The defendant’s insurance company will ask you for authorizations to obtain your medical records. Let your attorney release your records after he or she has reviewed them. It’s best not to offer information by yourself. 

  3. Some insurance companies will offer you money to settle the case before you contact an attorney. In this situation the insurance company knows they will have to pay out money and they hope to settle the claim before you hire an attorney who can negotiate and demand a higher amount. Always consult an attorney if an insurance company is offering you money. By doing so you will in all likelihood increase your net recovery even after taking out the lawyers fee.

  4. Once a bedsore case is settled and the defendant is released, regardless of whether you make a full recovery or not, the money you received cannot be taken away, it is your money…tax free.

  5. If you need surgery, it is important to go forward with that before you settle your pressure sore or bedsore lawsuit.

  6. If you are persuaded by a hospital or nursing home and settle a case on your own, only to find out 6 months later you have more serious conditions than first thought, you have forfeited your rights to recover additional money. That is why it is so important to contact an experienced bedsore attorney before you sign anything.

  7. You are able to sue for and recover a monetary award from new injuries and infections and the aggravation of old ones caused by bedsores or pressure ulcers.

Additional Bedsore information & Guides:

THE DOCTOR WEIGHS IN BEDSORE ARTICLE by Attorney Brian A. Raphan

HOW MUCH IS A BEDSORE LAWSUIT WORTH: CASE EVALUATOR

DOWNLOAD: BEDSORE LEGAL & MEDICAL GUIDE

Grades of pressure sores
If a person is bedridden for long enough, the areas of skin constantly in contact with the mattress
or chair will start to discolor. This shows that the skin is in danger of ulcerating.
Pressure sores are graded to four levels, including:
• Grade I – skin discoloration, usually red, blue, purple or black
• Grade II – some skin loss or damage involving the top-most skin layers
• Grade III – necrosis (death) or damage to the skin patch, limited to the skin layers
• Grade IV – necrosis (death) or damage to the skin patch and underlying structures, such as tendon, joint or bone.

Complications of pressure sores
Untreated pressure sores can lead to a wide variety of secondary conditions, including: • Sepsis (bacteria entering the bloodstream)
• Cellulitis (inflammation of body tissue, causing swelling and redness)
• Bone and joint infections
• Abscess (a collection of pus).

For more helpful information  or a free consultation you may contact me by email here: Contact

Regards, Brian A. Raphan

‘Smart bandage’ detects bedsores before they are visible to doctors

BERKELEY — Engineers at UC Berkeley are developing a new type of bandage that does far more than stanch the bleeding from a paper cut or scraped knee.

Thanks to advances in flexible electronics, the researchers, in collaboration with colleagues at UC San Francisco, have created a new “smart bandage” that uses electrical currents to detect early tissue damage from pressure ulcers, or bedsores, before they can be seen by human eyes – and while recovery is still possible.

Associate professor Michel Maharbiz explains how the smart bandage works to detect bedsores. (UC Berkeley video by Roxanne Makasdjian and Phil Ebiner)

“We set out to create a type of bandage that could detect bedsores as they are forming, before the damage reaches the surface of the skin,” said Michel Maharbiz, a UC Berkeley associate professor of electrical engineering and computer sciences and head of the smart-bandage project. “We can imagine this being carried by a nurse for spot-checking target areas on a patient, or it could be incorporated into a wound dressing to regularly monitor how it’s healing.”

The researchers exploited the electrical changes that occur when a healthy cell starts dying. They tested the thin, non-invasive bandage on the skin of rats and found that the device was able to detect varying degrees of tissue damage consistently across multiple animals.

The smart bandage is fabricated by printing gold electrodes onto a thin piece of plastic. This flexible sensor uses impedance spectroscopy to detect bedsores that are invisible to the naked eye. (Image courtesy of UC Berkeley)
The smart bandage is fabricated by printing gold electrodes onto a thin piece of plastic. This flexible sensor uses impedance spectroscopy to detect bedsores that are invisible to the naked eye. (UC Berkeley image)

Tackling a growing health problem

The findings, published today (Tuesday, March 17) in the journal Nature Communications, could provide a major boost to efforts to stem a health problem that affects an estimated 2.5 million U.S. residents at an annual cost of $11 billion.

Pressure ulcers, or bedsores, are injuries that can result after prolonged pressure cuts off adequate blood supply to the skin. Areas that cover bony parts of the body, such as the heels, hips and tailbone, are common sites for bedsores. Patients who are bedridden or otherwise lack mobility are most at risk.

“By the time you see signs of a bedsore on the surface of the skin, it’s usually too late,” said Dr. Michael Harrison, a professor of surgery at UCSF and a co-investigator  of the study. “This bandage could provide an easy early-warning system that would allow intervention before the injury is permanent. If you can detect bedsores early on, the solution is easy. Just take the pressure off.”

Bedsores are associated with deadly septic infections, and recent research has shown that odds of a patient dying are 2.8 times higher when they have pressure ulcers. The growing prevalence of diabetes and obesity has increased the risk factors for bedsores.

“The genius of this device is that it’s looking at the electrical properties of the tissue to assess damage. We currently have no other way to do that in clinical practice,” said Harrison. “It’s tackling a big problem that many people have been trying to solve in the last 50 years. As a clinician and someone who has struggled with this clinical problem, this bandage is great.”

Cells as capacitors and resistors

The researchers printed an array of dozens of electrodes onto a thin, flexible film. They discharged a very small current between the electrodes to create a spatial map of the underlying tissue based upon the flow of electricity at different frequencies, a technique called impedance spectroscopy.

Researchers varied the amount of pressure applied to the skin, creating bedsores ranging in severity. The orange hexagon marks where the bandage was placed on the skin, and the dotted blue circle highlights where pressure was applied to the tissue. The "reversible damage" example highlights sensitivity of the "smart bandage" impedance sensor since the wound is not visible at the surface of the skin. (Schematic courtesy of UC Berkeley)
Researchers varied the amount of pressure applied to the skin, creating bedsores ranging in severity. The orange hexagon marks where the bandage was placed on the skin, and the dotted blue circle highlights where pressure was applied to the tissue. The “reversible damage” example highlights the sensitivity of the “smart bandage” impedance sensor since the wound is not visible at the surface of the skin. (Schematic courtesy of UC Berkeley)

The researchers pointed out that a cell’s membrane is relatively impermeable when functioning properly, thus acting like an insulator to the cell’s conductive contents and drawing the comparison to a capacitor. As a cell starts to die, the integrity of the cell wall starts to break down, allowing electrical signals to leak through, much like a resistor.

“Our device is a comprehensive demonstration that tissue health in a living organism can be locally mapped using impedance spectroscopy,” said study lead author Sarah Swisher, a Ph.D. candidate in electrical engineering and computer sciences at UC Berkeley.

To mimic a pressure wound, the researchers gently squeezed the bare skin of rats between two magnets. They left the magnets in place for one or three hours while the rats resumed normal activity. The resumption of blood flow after the magnets were removed caused inflammation and oxidative damage that accelerated cell death. The smart bandage was used to collect data once a day for at least three days to track the progress of the wounds.

The smart bandage was able to detect changes in electrical resistance consistent with increased membrane permeability, a mark of a dying cell. Not surprisingly, one hour of pressure produced mild, reversible tissue damage while three hours of pressure produced more serious, permanent injury.

Promising future

“One of the things that makes this work novel is that we took a comprehensive approach to understanding how the technique could be used to observe developing wounds in complex tissue,” said Swisher. “In the past, people have used impedance spectroscopy for cell cultures or relatively simple measurements in tissue. What makes this unique is extending that to detect and extract useful information from wounds developing in the body. That’s a big leap.”

Maharbiz said the outlook for this and other smart bandage research is bright.

“As technology gets more and more miniaturized, and as we learn more and more about the responses the body has to disease and injury, we’re able to build bandages that are very intelligent,” he said. “You can imagine a future where the bandage you or a physician puts on could actually report a lot of interesting information that could be used to improve patient care.”

Other lead researchers on the project include Vivek Subramanian and Ana Claudia Arias, both faculty members in UC Berkeley’s Department of Electrical Engineering and Computer Sciences; and Shuvo Roy, a UCSF professor of bioengineering. Additional co-authors include Amy Liao and Monica Lin, both UC Berkeley Ph.D. students in bioengineering; and Yasser Khan, a UC Berkeley Ph.D. student in electrical engineering and computer sciences, who fabricated the sensor array.

Study co-author Dr. David Young, UCSF professor of surgery, is now heading up a clinical trial of this bandage.

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