Respiratory Tract Infections—Pneumonia and Influenza
People ages 65 years and older are very susceptible to contracting and dying from pneumonia and the flu. In fact, people ages 65 years and older account for 71% to 85%% of all influenza and pneumonia related deaths.
The Dangers of Pneumonia and Influenza
Respiratory tract infections like influenza and pneumonia are very common in nursing homes and assisted living facilities. In 2013 both influenza and pneumonia claimed the lives of 56,832 people in the United States. Together, pneumonia and influenza combined caused 55,227 deaths in 2014. These two fatal infections together were the 8th leading cause of death in the United States in 2013.
People ages 65 years and older are very susceptible to contracting and dying from these infections. In fact, people ages 65 years and older account for 71% to 85%% of all influenza and pneumonia related deaths.
Influenza in Nursing Homes
Influenza (also known as “the flu”) is a common viral respiratory infection in nursing homes, assisted living facilities and other long-term care facilities. It is caused by the influenza virus and it is easily transmitted from person to person making it a very contagious virus.
This type of flu affects the respiratory system (i.e., the nose, throat, and lungs) and should not be confused with the other type of flu that attacks the stomach causing vomiting and diarrhea.
How and Why the Influenza Viruses Can Spread Rapidly and Aggressively
Symptoms usually appear 2 days after someone is infected with the virus. This makes influenza a very dangerous virus because anyone is capable of transmitting/passing the virus to someone else before they even know their sick. This leads people to unknowingly transmit the virus. The virus is most commonly transferred by body fluids that are expelled while sneezing or coughing.
The virus can also be transferred to inanimate objects like doorknobs, toilet seats and wheelchairs. The virus can then transfer to people that come in contact with these objects. The virus then infiltrates their body/system when an infected hand comes in contact with the eyes, ears, nose or mouth.
Nursing Home Duties to Prevent the Spread of Influenza Viruses
Nursing homes have a duty to prevent the influenza virus from infecting residents. Influenza vaccines are covered by Medicare Part B insurance so there is no reason for a nursing home not to order and administer them.
The Center for Disease Prevention (CDC), referencing a 2017 study published in the Journal of Infectious Diseases, stated that in 2012-2013 elderly patients with the influenza virus that received high-dose vaccines were 36.4% less likely to die in the thirty-day period following discharge from hospitalization than elderly patients that received a standard-dose vaccine.
Several followup studies have concluded that high dose vaccines are more effective at combating the H3N2 influenza virus which is the virus that spread during the 2012-2013 flue season. The H3N2 is more lethal in the elderly population than the H1N1 influenza virus. However, both the H1N1 and H3N2 virus are very common.
Nursing homes should order flu vaccines prior to influenza/flu season. Flu season goes from October to May. Nursing homes should start administering the vaccine in mid September because it takes a flu vaccine two weeks to work its way into the body and improve the immune system.
Pneumonia in Nursing Homes
Nursing home–acquired pneumonia (NHAP) is any pneumonia infection that is contracted by anyone living in a nursing home or other long-term care facility. Pneumonia is the second most common infection found in nursing homes. It causes more deaths in elderly nursing home residents than any other infection. Pneumonia is also one of the most common causes of hospitalizations among the nursing home population.
Pneumonia is a respiratory infection that results in inflammation of the lungs. It makes breathing difficult which can lead to potentially fatal consequences. Pneumonia is primarily caused by bacteria and viruses. Viral pneumonia primarily develops out of viruses like influenza, the common cold, adenovirus, respiratory syncytial virus (RSV).
Bacterial pneumonia is more common than viral pneumonia. The bacteria Streptococcus Pneumonia is the main cause of bacterial pneumonia while the bacteria Haemophilus influenzae is the second most common cause. These bacteria usually enter the body through the blood stream or lungs. Viral and bacterial pneumonia are different than aspiration pneumonia which results from breathing food, saliva, or stomach acid into the lungs.
Elderly residents that live in nursing homes or other long-term care facilities are at great risk of getting pneumonia. Pneumonia is common in nursing homes because it spreads very easy in congested living conditions where communal dinning, shared medical treatment, shared food preparation and poor hygiene all exist.
The following conditions, which are all common among the nursing home population, increase the risk for pneumonia: chronic conditions like heart disease, diabetes, asthma, or COPD (chronic obstructive pulmonary disease); ventilator use, nasogastric tube use, intravenous feeding tube use, decreased functional status, increased age, dementia, recent fall accident.
Nursing home–acquired pneumonia (NHAP) is very dangerous. Roughly 13% to 41% of nursing home residents with NHAP that are transferred to a hospital die. That is why it is important for nursing homes to develop and implement infection control programs that can:
(1) prevent bacterial infections from occurring and spreading; and
(2) properly diagnose and treat bacterial infections.
Most nursing homes are not equipped to treat serious cases of pneumonia. In those cases it is important for the nursing home to timely diagnose the pneumonia and transfer the resident to a hospital. In many cases pneumonia goes undiagnosed and untreated too long resulting in preventable deaths. A nursing home that fails to timely diagnose pneumonia in a resident also exposes all their residents to potential infection.
Nursing homes can be responsible for nursing home infection injuries if they fail to develop and implement proper infection prevention procedures, infection recognition procedures, infection treatment procedures, infection isolation procedures, infection monitoring and reporting procedures, immunization and vaccine programs.
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