More than a million people in the United States wake up every day in nursing homes. Many of these individuals are helpless, vulnerable and completely dependent upon nursing home staff to meet most or all of their needs. After all, nursing homes are supposed to be in the business of providing skilled nursing care to elderly and disabled residents.
Unfortunately, the quality of care in the nursing home industry has increasingly declined over the past decade. A number of recent studies indicate that residents in nursing homes suffer abuse and neglect more and more frequently at the hands of nursing home corporations. In many cases residents have died or have been severely abused as a result of neglect.
Alarming Nursing Home Statistics
- 97% of nursing homes failed to have sufficient staff to meet one or more federal staffing requirements.
- 44% of residents were found to have been abused in nursing homes.
- 95% of nursing home residents report being neglected or have seen others neglected.
- 50% of nursing home staff admit to mistreating residents.
Source: Centers for Medicare & Medicaid Services / National Center on Elder Abuse
Nursing Home Arbitration Clauses
When being admitted to a nursing home, usually the last thing on the mind of the resident or their family is consequences if the resident is neglected, mistreated, or abused in the facility. But many nursing homes require the responsible party to sign a binding arbitration clause that deprives the resident and their loved ones from suing the facility regardless of the issue, whether it is sexual abuse, neglect, mismanaged medication or even wrongful death.
Binding arbitration is a method corporations favor to resolve disputes outside the court system and instead through negotiations with an arbitrator, not a judge or jury.
Those who are looking into nursing home care should ask before admission if the arbitration agreement can be omitted. If not, consider other facilities that do not require this condition of admission.
Nursing Home and Elder Abuse
According to the National Center on Elder Abuse (NCEA), elder abuse is a growing problem. Concerned people can spot the warning signs of a possible abuse problem and make a call for help if an elder is in need of assistance. Not all elder abuse is physical abuse, some is psychological or financial/fraud.
Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain or impairment. Physical abuse may include but is not limited to such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding and physical punishment of any kind also are examples of physical abuse. Signs and symptoms:
- bruises, black eyes, welts, lacerations, and rope marks;
- bone fractures, broken bones, and skull fractures;
- open wounds, cuts, punctures, untreated injuries in various stages of healing;
- sprains, dislocations, and internal injuries/bleeding;
- broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;
- laboratory findings of medication overdose or underutilization of prescribed drugs;
- an elder’s report of being hit, slapped, kicked, or mistreated;
- an elder’s sudden change in behavior; and
- the caregiver’s refusal to allow visitors to see an elder alone.
Sexual contact with any person incapable of giving consent is considered sexual abuse. It includes, but is not limited to, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity and sexually explicit photographing. Signs and symptoms:
- bruises around the breasts or genital area;
- unexplained venereal disease or genital infections;
- unexplained vaginal or anal bleeding;
- torn, stained, or bloody underclothing; and
- an elder’s report of being sexually assaulted or raped.
Emotional or Psychological Abuse
Emotional or psychological abuse is defined as the infliction of anguish, pain or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation and harassment. In addition, treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the “silent treatment;” and enforced social isolation are examples of emotional/psychological abuse. Signs and symptoms:
- being emotionally upset or agitated;
- being extremely withdrawn and non-communicative or non-responsive;
- unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking); and
- an elder’s report of being verbally or emotionally mistreated.
Nursing Home Neglect
Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide the necessary care.
Nursing home neglect can take on many forms:
Medical Neglect – includes the nursing home’s failure to provide adequate attention, prevention or medication to properly address a patient’s health concerns. This includes bed sores, infections or mental and mobility impairments.
Basic Needs Neglect – is the nursing home’s failure to provide for the resident adequate food and water or reasonably clean leaving environment.
Personal Hygiene Neglect – is when nursing home staff does not do an adequate job of helping the resident with cleaning, bathing, brushing teeth or other personal hygiene tasks.
Emotional or Social Neglect – occurs when a patient is repeatedly ignored, left alone, or verbally assaulted by nursing home staff.
Neglect may be evident in the following ways:
- dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
- unattended or untreated health problems;
- hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);
- unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and
- an elder’s report of being mistreated.
Most important is to be alert. The suffering is often in silence. If you notice changes in personality or behavior, you should start to question what is going on.
Nursing Home Injuries
Nursing home residents are at greater risk for falls for a variety of reasons. Some are patient factors, such as health conditions such as diabetes, heart disease, or problems with their thyroid, nerves, feet or blood vessels. Some medications can also make people unsteady on their feet.
Some falls are caused by environmental factors, such as cluttered public areas, dim lighting in hallways, wet or slippery floors, lack of safety equipment in bathrooms, and lack of anti-slip mats in showers.
- 75% of elderly nursing home residents suffer at least one fall a year – twice the rate compared to elderly people living within the community.
- Approximately 20% of nursing home falls result in a serious injury.
- Approximately 1,800 nursing home residents die from fall-related injuries each year.
- As many as 27% of nursing home falls are a result of environmental hazards.
Falls can cause serious injuries to residents. Some factors that contribute to nursing home falls include:
- Drugs – Many nursing homes give patients medications to keep them calm such as antipsychotics or tranquilizers. These can cause confusion, unsteady gait, and loss of balance.
- Inadequate Staffing – According to the Centers for Medicare & Medicaid Services, 97 percent of nursing homes lack adequate staff to properly care for residents. That means, staff can be unavailable when a resident needs assistance. One solution is to install bed alarms that alerts staff when a resident leaves the bed.
- Lack of Proper Equipment – Some nursing home beds are not equipped with bedrails and are adjusted too high off the ground.
- Lack of Comprehensive Fall Prevention Plan – This includes the proper placement and installation of bed alarms, chair alarms, and fall mats, as well as improved lighting, rooms and hallways kept free of clutter, having medications re-assessment, the use of sitters, and increased overall staffing. Staff should also evaluate and assess new patients for falling risks.
Approximately 1 in 10 nursing home residents is currently suffering from bedsores.
Bedsores, also known as pressure ulcers, pressure sores, and decubitus ulcers, are a painful and gruesome sign of nursing home abuse and neglect. Bedsores are the result of prolonged pressure applied to an area of the body that limits blood flow to the skin. Bedsores are often caused from lack of attention and improper medical care in nursing homes, specifically when the patient is immobile or bedridden and not kept clean and dry and not periodically repositioned.
Bedsores are serious health concerns and require immediate treatment.
Bedsores – especially later stage ulcers – are preventable. To prevent them, nursing home staff should turn residents every two hours, get a resident out of bed to walk or sit, ensure the resident has sufficient nutrition and water intake, keep the resident dry, change their adult diapers at least every four hours, and conduct regular skin audits to detect new or worsening ulcers.
Without proper treatment and care, pressure ulcers can progress rapidly. As the progression continues, the resident becomes more susceptible to serious, potentially life-threatening complications including:
- Sepsis, a potentially life-threatening condition caused by the body’s response to infection that can lead to organ failure.
- Cellulitis, an infection of the skin and connected soft tissues that causes pain, redness and swelling.
- Bone and joint infections, which can damage cartilage and tissue.
- Cancer, specifically a type of squamous cell carcinoma that develops in chronic, nonhealing wounds.
Choking problems, or dysphagia, is more common among the elderly than any other age group, including young children. Choking occurs when medications or food enter the windpipe instead of traveling down the esophagus. Choking restricts air supply and, if not handled immediately and correctly, can lead to brain damage or death.
Conditions that can cause swallowing difficulty include neurological disorders including:
- Parkinson’s disease and dementia;
- Neurological damage such as brain or spine injuries or stroke; cancer;
- Alzheimer’s disease;
- Reduced saliva production due to aging or medication;
- Age-related muscle weakness;
- Bone spurs in the spinal column that push into the esophagus.
Dehydration is a common sign of nursing home neglect and can lead to serious and life-threatening complications. Some studies estimate that as many as one-third of all nursing home residents suffer from dehydration.
Symptoms of dehydration in elderly residents include:
- Sticky or dry mouth
- Being thirsty or expressing thirst
- Having dry, papery skin that tents when pressed
- Having decrease in urine output and frequency
Symptoms of late-stage dehydration include:
- Confusion and irritability
- Inability to sweat
- Sunken eyes and cheeks
- Low blood pressure
- Breathing fast
In serious cases, dehydration can lead to high levels of sodium in the blood, a serious and life-threatening condition called hypernatremia.
Up to 85% of nursing home residents suffer from malnutrition. Malnutrition occurs when a nursing home resident doesn’t get enough food of is not being provided with sufficiently nutritious food to provide enough vitamins and minerals to keep their bodies functioning properly. Oftentimes, malnutrition is the result of understaffing, carelessness, and lack of concern by nursing home staff to ensure residents have enough nutritional food.
Malnutrition can cause a variety of health problems including weakening an elderly resident’s immune system, thereby creating a higher risk for infections or other illnesses. It also makes them at higher risk for developing bedsores.
Symptoms of malnutrition include:
- Mouth problems such as reddening or sores in the mouth;
- Muscle weakness or loss of strength;
- Glassy eyes or swollen corneas;
- Mental difficulties such as listlessness, irritability, confusion;
- Skin changes, such as yellowing of the skin or a dull appearance.
Medication errors are a preventable nursing home negligence that occurs with alarming frequency. They are among the most common health-threatening mistakes made in nursing homes with an estimated 800,000 medication errors occurring each year in nursing homes and long-term care facilities. The most common type of medication error is dose omission, or failing to give a resident necessary medication.
Medication errors are most commonly caused by human influences such as human error, faulty documentation, and poor communication. This is often a result of understaffing.
Addressing Nursing Home Abuse or neglect
If a nursing home resident is in imminent danger of injury or death, call 911 or the local police for immediate help.
In cases where a resident is not in imminent danger, the following steps should be considered:
- If possible, talk with the resident to determine the cause of their distress. Even if they are of sound mind, it is common for an abused or neglected resident to be hesitant to admit or discuss their situation because of fear, embarrassment, or depression.
- Address concerns with nursing home staff or administration. Depending on the severity of the situation.
- If concerns have not been satisfactorily resolved by the nursing home, consider filing a complaint and/or report the suspected abuse or neglect to the appropriate government authorities. Be sure to include specific details.
Medicare fraud occurs when a health care facility, like a nursing home, claims a Medicare reimbursement for which it is not entitled. Some examples of Medicare fraud include:
- Billing Medicare for unnecessary services or items;
- Billing for procedures that were never performed;
- Billing for multiple codes for a group of procedures that are covered in a single global billing code;
- Billing for services at a higher level of complexity than provided;
- Knowingly treating and claiming reimbursement for someone other than the eligible beneficiary.
Nursing Home Abuse Attorney
Nursing home abuse and neglect is a particularly emotional practice area. Beasley Allen attorney Alyssa Baskam and her team work closely with clients and their loved ones to swiftly and effectively resolve their claims. They are actively pursuing cases involving nursing home abuse and neglect. For a free consultation, contact us today.