Q: What are some common warning signs of nursing home abuse and neglect? What laws are in place regarding nursing home care?
A: These eight warning signs of nursing care abuse are often interrelated, and they provide an introductory framework to help detect outward signs of nursing home abuse and neglect.
1. Skin Condition. Skin condition reveals much about the treatment or mistreatment of a resident. Burns, cuts, and bruises are obvious outward signs that a resident may not be receiving appropriate care, treatment, or supervision. In addition, decubitus ulcers, more commonly referred to as bedsores or pressure sores, often point to substandard care. Again the federal government passed important rules on this subject that include the following:
(c) Pressure sores. Based on the comprehensive assessment of a resident, the facility must ensure that
(1) A resident who enters the facility does not develop pressure sores unless the individual's clinical condition demonstrates 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.
Decubitus ulcers are usually noticeable as red spots that show up on the skin bones are prominent like on the tailbone, heels, and hips. If these pressure sores aren't properly treated right away, they can turn into open wounds and severely compromise a resident's health and ultimately cause death.
The existence of decubitus ulcers may be especially useful in determining the degree of care that a resident is receiving; ulcers are often caused, at least in part, by poor or inadequate nutrition and hydration, failure to turn and reposition residents at the appropriate intervals, and several other factors that could be signs of improper staffing, training, and supervision.
2. Weight Loss/Dehydration. Often times, vulnerable individuals have difficulty feeding themselves or drinking without assistance. In fact, 47% of residents receive help with eating and drinking. A battery of medications together with debilitating physical conditions can also contribute to weight loss or dehydration. The federal regulations set forth the nutrition and hydration standards that a facility must maintain. The federal government set forth important rules on this subject as set forth below.
(i) Nutrition. Based on a resident's comprehensive assessment, the facility must ensure that a resident
(1) Maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and
(2) Receives a therapeutic diet when there is a nutritional problem.
(j) Hydration. The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.
Despite these clear regulations, some sources indicate that it is estimated that 35 to 85 percent of long-term care residents are malnourished. Given these statistics and other available information, it is important that residents, family members, and others, pay particular attention to nutritional adequacy and proper hydration.
3. Falls. Falls are a common occurrence in long-term care facilities, but can be extremely difficult to address. In analyzing falls, one should look for the cause, frequency, and number of falls for a particular resident. This doesn't always indicate physical abuse, however, falls can be caused by a wide range of preventable factors such as facility design or maintenance, improper assessment of residents, improper staffing such that assistance is not readily available to residents. To the extent a resident falls, a facility is required to reassess the resident, and if certain protocols are triggered, adopt fall prevention protocols, and implement them.
4. Broken Bones. Broken bones may be the most obvious sign of abuse and neglect. Unfortunately, incidents causing broken bones are sometimes viewed by family members as inevitable. Broken bones may occur as a result of falls or other unwitnessed incidents. Not all incidents causing broken bones can be prevented. However, many such incidents are predictable and preventable. Again, the key to analyzing incidents causing broken bones is to find the cause or causes of the incident. Importantly, the federal regulations impose requirements on facilities regarding the prevention of accidents.
5. Restraints. Restraints come in a variety of forms ranging from tie downs and various garments that restrict movement to medication. The federal government set forth the standard that facilities must follow regarding restraints.
(a) Restraints. The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms. Lawyers, advocates, and consumers should be particularly mindful of the use of restraints because they may appear relatively non-invasive, such as in the case of psychotropic or antipsychotic medications. However, use of restraints for improper purposes is unlawful and should be addressed so that the resident may function at the highest practicable level.
6. Medication Errors. The federal government set forth the standards for medication errors.
(m) Medication Errors. The facility must ensure that
(1) It is free of medication error rates of five percent or greater; and
(2) Residents are free of any significant medication errors. Medication errors are important indicia of the quality of care that a resident receives. In the event of a medication error, one should review the charting and seek to determine the cause of the medication error to help determine whether it was simply a mistake or is a manifestation of a chronic problem within the facility.
7. Sexual Assault. Sexual assaults should never occur in long-term care facilities. The perpetrators may be facility staff, visitors, and even family members. The federal regulations require the facility to prevent sexual assault of residents.
(b) Abuse. The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.
Abuse and neglect in general and sexual assault in particular usually produces traumatic effects sometimes including death of the resident.
8. Elopement/Wandering. Elopement and wandering are behaviors that can also lead to injuries and death. The term elopement relates to behavior by which a resident who is not capable of self-preservation leaves the facility unsupervised. However, wandering generally describes the resident's movement within the facility often without purpose or appreciation for his or her safety.
There are multiple federal regulations that may set the standard for a facility's care of a resident who is an elopement/wandering risk. There are many interventions that can be used to prevent the detrimental effects of elopement/wandering. Importantly, if a facility believes that it cannot meet a resident's needs, the federal regulations do not require a facility to admit or retain a resident. In fact, the federal regulations prohibit a facility from admitting or retaining a resident whose needs it cannot meet. These warning signs are not all inclusive. However, they provide a good framework to assess whether your loved one is getting appropriate treatment at a long-term care facility.