Like our children, many in our elderly population need our help to make sure they are properly cared for. There are many levels of care for elderly adults. A lower level many include something such as all-inclusive apartment living. This type of facility would likely offer a step up to what is typically called assisted living, where the resident maintains some autonomy, but has an increased level of supervision and care. At the far end of the spectrum is long term nursing home care. The population of the long term nursing home generally consists of chronically ill elderly who have little to no choice in going into such a facility. As a result, these patients are the most vulnerable of all medically needy groups in that they have little to no voice in their care.
Unlike acute care hospitals, which are often not for profit organizations, nursing homes are typically for profit, private institutions. The evolution of nursing homes makes the reasoning for this obvious. Nursing homes sprang up from “mom and pop” operations wherein boarding homes were operated to care for elderly patients. This created a market that is largely for-profit.
Most nursing home residents suffer from chronic (long-term) problems rather than acute (immediate, but temporary) problems. The obvious problem with nursing home care, therefore, becomes a longer length of time within the facility and a continuing need for constant care. Many nursing home residents also require assistance in performing the daily living activities that most of us take for granted, such as dressing, bathing, and toileting. For many of these residents, an unaided trip to the bathroom could easily cause a fatal fall.
The nursing home population typically does not have a direct line of communication outside of the nursing home. Residents often suffer from mental infirmities, which limits their ability to communicate, are often medicated, which limits their pain level and therefore awareness. As a result, residents typically go unrepresented, enabling the neglect or abuse to continue. In these situations, family members are the best watchdogs of a nursing home patient’s well being, security, and rights.
What to Look for
When visiting your loved one in a nursing home facility, consider yourself a regulator of the facility and look for the following red flags which are evidence of poor management and likely neglect or abuse:
- Dirty or missing clothing
- Missing or stolen possessions
- Ignored requests for care
- Pressure Sores
- Skin Problems
- Missed Meals
- Weight Loss
- Improper restraints
- Signs of verbal or physical abuse
Regulation of Nursing Homes
Nursing homes are federally, as well as locally, regulated. The Federal standard for nursing homes, as well as the Patient’s Bill of Rights, can be found in the Omnibus Budget Reconciliation Act of 1987 (OBRA), 42 U.S.C. Section 1395-1396. These regulations, along with corresponding state law, create the required standard.
By definition, nursing homes provide a place where residents are served by nursing personnel in the assistance of daily living. Every nursing home must provide:
- Adequate number of nursing personnel to provide for the needs of residents;
- Adequate food and medication;
- Competent, screened, and maintained staff;
- Planning of care for each resident;
- Regular assessments of each resident;
- The keeping of accurate records that document the condition and progress of residents and their care;
- Safeguards that identify problems and resolutions to those problems.
These regulations force the nursing homes to adjust to the needs of each patient, rather than have the patient adjust to the facility. If the facility does not meet these basic requirements of care, the result can be a problem of neglect throughout the facility that can result in injury or death to the residents. The inability of many residents to communicate the abuse to parties outside the facility often enables the abuse or neglect to continue. This inability comes from many sources, which include, but are not limited to, lack of financial resources, lack of physical capabilities, lack of mental capacity, and other limitations.
There are many types of instances which can be defined as neglect or abuse. These include:
1. Wandering. While poorly defined, the problem includes excessive ambulation and excess movement. There are five behavioral patterns associated with wandering in persons with dementia. These are tactile wandering, environmentally cued wandering, reminiscent wandering, recreational wandering, and agitated purposeful wandering. At a minimum a nursing home must identify residents at risk for wandering. They must also develop a care plan that addresses the wandering, develop a program for preventing wandering, and keep the facility safe from accidents as well as modify the environment to discourage wandering Finally, there must be a comprehensive plan in place that is facility-wide to mobilize staff to look for a missing resident.
2. Daily Care. Proper nutrition is a basic necessity for the health and well being of young and old alike. Poor nutrition causes involuntary weight loss, dehydration, pressure sores, and reduced quality of life. With weight loss and dehydration comes a vulnerability to disease, pressure sores, decreased mobility, and increased mortality rates. The elderly require at least 1.5 liters of fluids per day. Pressure sores require treatment which includes adequate calories, protein, fluids, vitamins and minerals, and intervention. A facility is required to provide “sufficient fluid intake to maintain proper hydration and health.” 42 C.F.R. § 483.25(I)(j). In addition, facilities are required by law to ensure that a resident does not develop pressure sores unless they are clinically inevitable and that a resident that has pressure sores receives adequate treatment to promote healing and adequate safeguards to prevent new sores from developing. 42 C.F.R. § 483.25(c).
3. Falls. A fall is defined as a sudden, uncontrolled, unintentional, non-purposeful downward displacement of body to the floor /ground or other object. A facility is required to:
a. Ensure that the environment is as free as possible from accident hazards; and
b. Ensure that each resident is provided with the supervision and assistance, as well as fall prevention devices, to prevent falls. 42 C.F.R. § 483.25(h).
Falls may be caused by many factors. These factors include medication or physical limitations, as well as extrinsic factors such as defects in the facility structure. A higher rate of falls and fall related injuries occur among nursing home residents, especially for those residents with dementia. While not all falls result in injury, some result in fatal injuries. Because of the seriousness of falls, nursing homes are required to conduct a fall assessment for each resident and provide a plan for each resident to prevent such an event.
4. Medication Errors. The law requires that drugs be administered in accordance with the written orders of the attending physician. They must be given to the proper patient at the appropriate time, in the correct dosage, and via the proper route. Obviously, medication errors can cause numerous types of injuries, but it may also affect the patient’s control of their own faculties causing them to fall, be unable to eat or drink, or perform other necessary daily functions. Unfortunately, medications are often inappropriately used as a patient restraint.
If you or your loved one have experience nursing home abuse and neglect, please do not hesitate to contact us or call toll free at 800.351.3008 for your FREE CONSULTATION. We have handled nursing home abuse and neglect related cases throughout the United States and we look forward to the opportunity to serve your legal needs.