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Pennsauken Township, NJ 08110

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Philadelphia, PA 19110

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Home Abuse Lawyer


The largest single cause of injury to nursing home residents is injury due to a preventable fall. A typical 100-bed nursing home reports at least 100 to 200 falls per year. Keep in mind these are only the reported falls. Another danger facing nursing home residents is the development of preventable bed sores. A bed sore or pressure ulcer usually develops over a bony prominence and can range from a small bruise to a gaping hole in the skin which goes all the way down to the bone. The sores can rapidly develop and can cause serious health issues including life-threatening infection. In an effort to protect nursing home residents, the State of New Jersey implemented a law that requires nursing homes to render care so that it’s residents can avoid developing a bed sore and if a bed sore develops, that it is properly treated so that the bed sore is resolved.

Nursing Home Injuries

Elder abuse, also known as nursing home abuse, involves damages incurred by an elderly individual/patient while under the complete or partial care of a nursing home involved in elderly care.

Types of Injuries:

Medical/Health Injuries include bed sores (pressure ulcers), rashes, malnutrition, dehydration, infectious disease, bacterial infections, fractures and other orthopedic injuries.

  • Wrongful Death which is often the result of prolonged neglect, physical abuse, prescription drug errors, failure to address existing medical issues as they arise which the elderly patient wants addressed.
  • Sexual Abuse which can lead to both medical and psychological damages.
  • Emotional Damages resulting from the vulnerable position faced by the elderly who are aware of the pain, suffering and abuse they experience.

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Definition of Nursing Home

United States Code: Title 42, Section 1395i-3:

(a)       Skilled nursing facility defined

In this subchapter, the term “skilled nursing facility” means an institution (or a distinct part of an institution) which –

          (1)        is primarily engaged in providing residents –

  • skilled nursing care and related services who require medical or nursing care, or
  • rehabilitation services for the rehabilitation of injured, disabled or sick persons,

And is not primarily for the care and treatment of mental disease^:

(2)        has in effect a transfer agreement (meeting the requirements of section 1395x (1) of this title) with one or more hospitals having agreements in effect under section 1395cc of this title; and

(3)       meets the requirements for a skilled nursing facility described in subsections (b), ©, and (d) of this section.

Stages of pressure sores

One Common Nursing Home Injury is Pressure Ulcers/Sores.

They range from a small bruise loa gaping hole in the skin which goes all the way down to the bone. They commonly occur in elderly people who are immobile or have limited mobility. The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure ulcer as “a localized injury to the skin and/or underlying tissue usually over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction.”

  • Stage I – redness without skin loss.
  • Stage II – blistering involving partial skin loss.
  • Stage III – full thickness skin loss without exposure to the bone.
  • Stage IV – full thickness skin loss with exposed bone which many times has necrotic tissue.


* In other words, the nursing home is responsible unless the bedsore is unavoidable. To be unavoidable, the nursing home must establish that the resident has a clinical condition that makes the resident susceptible to pressure ulcers and that the nursing home took all steps to render necessary treatment and promote healing, prevent infection and prevent new sores from developing.

What is a pressure injury?

A skin breakdown due to pressure.

The common areas of skin breakdown involve:

  • Head
  • Ear
  • Shoulder
  • Elbow
  • Sacrum
  • Buttocks
  • Gluteal fold
  • Heels


*Stage 3 and Stage 4 pressure ulcers are the worst types and the most common types that people have to file a lawsuit because of.

*Pressure ulcers are measured by length times width times depth.

Avoidable vs. Unavoidable Pressure Ulcers

  1. Properly evaluate condition and ulcer risk factors;
  2. Define and implement interventions;
  3. Monitor and evaluate the impact of the interventions; and
  4. Revise intervention approaches as appropriate.

Note – A provider must set up a care plan – which is a roadmap of what to do and they must follow it.

*A pressure ulcer can develop despite a provider following all the factors above (numbers 1 through 4 above).

Law Establishes the Standard of Care

42 CFR §483.25(c) states that a facility must:

  1. Insure that a resident without a pressure sore does not develop one; and
  2. If a resident enters with a pressure sore that it does not get worse.

How are Facilities Supposed to Assess the Risk for the Development of a Pressure Ulcer

The Braden Scale is the standard for assessment of pressure ulcer risk and involves the following:

  • Can the patient communicate?
  • Can the patient help themselves?
  • Can the patient understand?
  • Or does the patient have dementia?
  • How frequent is the patient wet?
  • To what degree is the patient’s skin exposed to moisture?
  • How soon is the diaper changed?
  • Is the patient able to get up and move?
  • What is the patient’s degree of physical activity?
  • Is the patient able to change and control their body position?
  • Is the patient bed bound?
  • Is the patient wheelchair bound?
  • Can the patient walk around?
  • What is the patient’s usual food intake pattern?
  • Is the patient subjected to friction and shear?
  • Example – Is the patient in a motorized bed that moved up and down thereby causing the patient to move or slide when the bed is moved up and down?
Diagram of where pressure sores can develop
Doctors treating pressure sores on an elderly patient

Documentation, Documentation, Documentation

The facilities’ own forms can be very helpful for the attorney and are not always easy to get:

  1. The forms will tell you whether the patient is a person at risk for pressure ulcers.
  2. The forms will tell you whether the patient has a pressure ulcer and if so, at what stage.

Types of Forms:

Wound document sheets:

  1. Describes if a pressure ulcer exists and if so it’s size including length by width by depth.
  2. Describes a pressure ulcer’s location.
  3. Describes whether there is drainage from the pressure ulcer.

Care plans – these are fluid and revolving plans

A care plan may include the following:

  • Use pressure relieving cushions;
  • Have patient 2 hours in bed and then move 1 hour to chair;
  • Refer patient to a podiatrist;
  • Request a nutrition consultation for patient;
  • Use barrier cream for incontinent patients; and
  • Speak to turning and repositioning patients and the frequency of doing so.

Look to the Policies and Procedures of the Facility to Determine Standards of Care

Look at the Facility’s Clinical records pursuant to §483.75(1)(5) which must contain:

  • Information to identify the resident;

CNA’s write on a flow sheet and generally provide care of repositioning and assisting patients with their activities of daily living.  The attorney has to obtain and review all records, not just a shift or two. We ask:

  • Are the records consistent?
  • Have the patient’s needs changed?
  • Does the care plan reflect the fact that the patient’s needs have changed?
  • Care plan meetings are generally every 30 to 45 days.
  • Are there team meetings that can bring changes daily based upon a patient’s change in condition?

Depositions – We Sit Down with the Nursing Home Representas and Employees and Question them Under Oath

  1. CNA:
  • They do daily care.
  • Often instructed to do something and have to follow those instructions
  1. LPN/RN:
  • Many times there are not enough of them to cover all the patients
  1. Director of Nursing:
  • Knows the policies and procedures.
  1. Wound Care Nurse:
  • What did they see when they saw the wound?
  1. Dietician:
  • What is the patient’s nutrition?
  1. Administrator:
  • Surveys on how well or poor the facility is doing are done by the State and Federal levels.  Has to sign off on these surveys.
  • Give a plan to the State on how they are going to fix any identified violations.

Get Cost Reports

  • Cost reports keep track of expenditures, revenue, outside services and how much the facility is taking in.
  • For nutritional deficiency cases it will tell you food costs and more


There are various mattresses that can be utilized when a patient is at risk or is beginning to develop pressure ulcers.  They vary in effectiveness and cost and include:

  • Foam mattresses;
  • Low air loss mattresses;
  • Alternating air mattresses; and


The facility is required to make assessments of the patients which will be broken down into 4 groups below.  Pressure Ulcers do not heal if the patient lacks proper nutrition.

4 Assessment Groups:

  1. Intake and output.
  2. Weight of the patient over time.
  3. Labs.
  4. Dysphagia – trouble swallowing.

Treatment of Pressure Ulcers

  • Debridement of the wound generally for Grade 4 pressure ulcers.
  • Graph skin and place over the debridement/ulcer.
  • Vac to suck out infection from wound.

FEDERAL REGULATION 483.25 sets forth the duty of the nursing home as follows:

“Based on the comprehensive Assessment of a resident, the facility musi ensure that:

  1. A resident who enters the facility without pressure sores does noi develop pressure sores unless the individual’s clinical condition demonsirates that they were unavoidable; and
  2. A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.”
An older woman gazing out the window


Nursing Home Liability is based on Federal Regulations which are incorporated into the NJ Nursing Home Bill of Rights.

“Every resident of a nursing home shall:

  1. Have the right to manage his own financial affairs unless he or his guardian
    authorizes the administrator of the nursing home to manage such resident’s
    financial affairs….
  2. Have the right to wear his own clothing….
  3. Have the right to retain and use his personal property in his immediate living
  4. Have the right to receive and send unopened correspondence and. upon request, to
    obtain assistance in the reading and writing of such correspondence.
  5. Have the right to unaccompanied access to a telephone at a reasonable hour,
    including the right to a private phone at the resident’s expenxe.
  6. Have the right to privacy.
  7. Have the right to retain the services of his own personal physician at his own
    expense or under a health care plan….
  8. Have the right to unrestricted communication, including personal visitation with any persons of his choice, at any reasonable hour.
  9. Have the right to present grievances on behalf of himself or others to the nursing home administrator, State governmental agencies or other persons without threat of discharge or reprisal in any form or manner whatsoever….
  10. Have the right to a safe and decent living environment and considerate and respectful care that recognizes the dignity and individuality of the resident, including the right to expect and receive appropriate assessment, management and treatment of pain as an integral component of that person’s care consistent with sound nursing and medical practices.
  11. Have the right to refuse to perform services for the nursing home that are not included for therapeutic purposes in his plan of care as recorded in his medical record by his physician.
  12. Have the right to reasonable opportunity for interaction with members of the opposite sex..
  13. Not to be deprived of any constitutional, civil or legal right solely by reason of’ admission to a nursing home.”


N.J.S.A.30:18-8 creates a private right cause of action on behalf of a resident of a nursing home whose rights have been violated under the New Jersey Home Bill of Righis (above).

Attorney Fees and Costs: This statute entitles a prevailing party to reasonable attorney fees and costs.

Punitive Damages: Punitive Damages are available if there is clear and convincing evidence that the Nursing Home’s violations of the NJ Bill of Rights constitutetl “deliberate acts or omissions with knowledge of a high degree of probability of harm and reckless indifference to the consequences.”

A nursing home assistant abusing an elderly woman

New Jersey Nursing Home Abuse Attorneys

Ciecka Law, a New Jersey-based law firm, has extensive experience representing those who have experienced nursing home neglect or abuse. Our experienced team of nursing home abuse attorneys are committed to zealously advocating for the victims of nursing home neglect since we are prestigious members of a nationwide network that specializes in elder law. Our expertise and resources can make the legal process easier for nursing home abuse victims and their families so that justice can be served. Our greatest priority is to support our clients every step of the way and work diligently for the best possible outcome for each nursing home abuse case. If you or a loved one has been the victim of nursing home abuse, please contact us to discuss your rights and options under the law.

Nursing Home Abuse Law

As nursing home abuse lawyers, Ciecka Law understands how devastating nursing home neglect and abuse can be on elderly victims. Our team of experienced nursing home abuse attorneys is committed to representing clients who have been harmed by such nursing home negligence. We strive to provide the highest quality legal service and will fight passionately for justice when nursing home abuse occurs, so that you can receive the justice and compensation that you are entitled to. With years of expertise in nursing home abuse law, we have a track record of success in providing comprehensive advice and counsel related to nursing home abuse cases.

Nursing Home Abuse Cases

At Ciecka Law, we provide nursing home abuse attorney services that can give legal protection to nursing home residents and their loved ones in the event of personal injury. Our nursing home abuse lawyers understand the nuances of nursing home rights and have extensive experience legally representing clients who have experienced this kind of abuse. We offer a free consultation to talk through potential legal action with one of our attorneys and begin the process of holding those accountable for nursing home abuse cases. Don’t let nursing care neglect continue unchecked – take advantage of our free consultation to make sure that your loved one is being taken care of properly in their nursing home environment.

Nursing Home Abuse Lawsuit

At Ciecka Law, we understand the heartbreaking effects nursing home abuse can have on victims and their families. Our nursing home abuse attorneys are dedicated to helping victims achieve justice. We proactively investigate nursing home abuse cases and engage the appropriate parties to collect evidence for litigation. Our attorneys apply skillful legal strategies so that victims are successful in filing a nursing home abuse lawsuit and recovering damages. With more than 15 years of trial experience, our nursing home abuse attorneys will vigorously represent your rights and get you the best possible outcome for your case.

Ciecka Law specializes in wrongful death lawsuits related to nursing home abuse. Our experienced attorneys understand the complexity of these cases and can provide you with the best legal representation. We will fight for your loved one, ensure they receive adequate medical treatment and fight for financial compensation. To discuss your specific case, we offer a free case review with no obligations. Contact us today to explore your options.

Types of Nursing Home Abuse

Nursing home abuse and neglect can take place in assisted living facilities when the rights and safety of a resident are disregarded or violated. Ciecka Law is dedicated to advocating for the elderly at risk of nursing home abuse, which can range from physical, financial, verbal, or sexual exploitation as well as medical malpractice. Our trained legal team works efficiently to secure justice for our clients and to hold assisted living facilities accountable for any instances of nursing home abuse that may arise. When considering assisted care options for yourself or a loved one, it is critical to understand your rights as an assisted care recipient and vigilantly monitor the services provided.

Elder abuse is a serious issue that affects many individuals and their families in the United States. At Ciecka Law, we are dedicated to providing legal advice and guidance for those affected by elder abuse and holding those responsible for elder abuse accountable. Types of elder abuse in nursing homes include medical neglect leading to lack of medical care, broken bones from abusive staff behavior, unexplained bruises or injuries, especially in women, and sexual assault by other residents or staff members. Our team of knowledgeable elder abuse lawyers is here to stand up for your rights if you have been a victim of any type of elder abuse at a nursing home.