How to Prevent, Identify, and Take Action Against Nursing Home Abuse
After making the decision to place a loved one in a nursing home, your worst fear may be that they will be mistreated or receive inadequate care. While the vast majority of nursing homes, assisted living facilities and other communities geared toward caring for seniors are reputable and trustworthy, instances of misconduct do happen.
During my legal career as Florida nursing home abuse and neglect attorney, I have seen what bad care looks like. I have also seen what causes bad care to occur. This background has given me insight into how to spot signs of abuse and neglect. By knowing what to look for, you can reduce the chances of a loved one being abused or neglected. I want to help you ensure your loved one gets the best care possible in a nursing home. But before I can do that, you have to know the cause of most bad care.
Identifying the Cause of the Problem
I continue to believe that most Florida nursing homes provide good care to their residents. In addition, most Florida nursing home staff are hardworking people with good moral character. They generally care about the residents and want to do the right thing. However, financial implications of running a what is essentially a business some smaller nursing homes do not have the financial resources to provide the necessary care. In addition, some larger nursing home chains are too focused on profits over people.
There is nothing wrong with making a profit. The profit motive built this country. But sometimes excessive profit can come at the expense of providing quality care. The bottom line is that there is a big difference between making a product and providing health care to sick and elderly people.
In a nursing home, there are some people who pay to stay out of their pocket, but most reimbursement is fixed by government-controlled Medicare and Medicaid programs or Long Term Health Care insurance companies. There is simply no way to make more money by raising prices. In fact, the only way most nursing homes can increase their profit is by cutting costs.
The largest component of cost in a nursing home is the cost of staff. By paying staff less or having fewer staff on duty each shift, the Nursing Home can substantially lower costs and therefore increase profits. The problem with this approach is that lower paid employees are often less qualified. Furthermore, having fewer staff members on duty often means they have to cut corners or simply not provide necessary care because there is not enough time to get everything done.
There may not be enough time to bathe all residents, clean incontinent residents, turn and reposition bed-bound residents, ensure unsteady residents have assistance when walking, and respond in a timely manner to resident call lights. This lack of time means not everyone gets the care they need. Sometimes this means the resident is inconvenienced. Other times it means real harm comes to the resident.
6 Tips to Help Keep Your Loved One Safe
There are a few key things you can do to keep your loved one safe while under the care of their nursing home.
1. Visit Frequently
The surest way to ensure your loved one is not the victim of abuse or neglect in a nursing home is to visit often and stay for long periods of time. When you’re present and there are not enough employees to get to all the residents, the staff will naturally choose to provide care to your loved one over a resident with no family members present. It’s that old saying, “Out of sight out of mind”. In the nursing home context, this means that when family does not visit a resident, staff members the resident will have no one to advocate for that resident.
2. Visit Different Times of Day
Nursing homes often have 3 shifts; 7 am to 3 pm, 3pm to 11 pm and 11 pm to 7 am. Each shift will have its own set of regular staff members. If you only visit during the same shift each time, then the staff members from the other shifts will not know you are an involved family member. I know it’s tough, especially if you’re working but try to show up from time to time on all shifts. Try to visit during meal time too.
3. Get to Know Staff Members on Each Shift
We all try harder to help people we know and like. It’s human nature. Nursing home staff members are no different. They gravitate to people they see frequently. By getting to know them and showing an interest in them, they will take notice. Engage them in conversation whenever you visit, take an interest in their lives and show your appreciation for their hard work and effort. If you do this on a regular basis, they will go out of their way to look out for your loved one.
4. Get to Know the Administrator and DON
What works for the staff works for management as well. After all, they are people too. The main management personnel in the building are the Administrator and the Director of Nursing. The Administrator is in charge of the building and all of the staff members. This is the person that runs things inside the building. The Director of Nursing is also called the DON. This person is in charge of all of the nursing staff. There are simply too many people for the Administrator and DON to know every resident and every family member. But if you take the time to get to know them, they will certainly know you and your loved one. And just like the staff members, they will be more likely to look after your loved one well.
5. Go to Care Plan Meetings
Florida law requires every nursing home to create an individualized written plan of care for every resident. The plan of care is put into place within days of your loved one entering the facility. During the care plan process, the nursing home staff identifies your loved one’s risks and needs. Then, they come up with a plan to minimize the risks and provide for the needs. In order to do this, they must evaluate your loved one to see what they need. As part of the process, there is a care plan meeting.
A representative of each discipline caring for your loved one attends the care plan meeting to discuss your loved one’s needs. A care plan meeting usually occurs every 90 days and when there is a significant change in condition. You can and should attend these meetings as you can provide your input on what your loved one needs. You can also relay any concerns you may have from your frequent visits.
6. Go to Resident Council Meetings
Many nursing homes have resident council meetings. These meetings are resident-run events to discuss concerns about the facility, develop suggested changes within the facility, and plan activities. Going to these meetings will give you an opportunity to discuss any concerns you may have about the facility and help develop solutions to your concerns. It will also give you an opportunity to identify other residents that may be experiencing similar issues.
Signs of Nursing Home Abuse and Neglect
While there’s no single marker that determines whether or not a facility is up to snuff, there are consistent red flags of substandard care that crop up time and again, and you’ll be much more likely to identify them if you’ve implemented the six tips above.
If you notice any of the following at your loved one’s residence, it may be time to start asking hard questions and begin taking action.
Rapid Negative Change
Your loved one’s overall health and wellness is the surest barometer of the care they’re receiving. If a once-social senior is suddenly withdrawn and uncommunicative, timid, or fearful, there could be cause for alarm. Similarly, if someone is consistently injured or unwell, they may not be receiving proper attention. Of course, it’s important to distinguish between decline that results from old age or disease and degeneration that results from abuse or neglect. So, if your loved one has a rapid negative change or is quickly growing worse, ask the staff what’s going on with them. If you do not get satisfactory answers, have them evaluated by a doctor.
Whether inquiring about the status of your relative or asking about any other aspect of the care at the facility, you should receive direct, straightforward answers. Employees who give you the run-around have likely been trained that way, so it’s important to be persistent. A low-level staff member may not have all the answers, but they should be able to put you in touch with someone who does.
Making sure residents receive proper hygiene is a fundamental service. If the nursing home cannot get this right, you have to wonder what other things are not being done. Failure to provide this basic level of care is one of the most worrying signals you can observe. Things to look for include whether your loved one is showered, shaven, and smells clean. Their nails should be properly cut and if they are incontinent, their bed sheets should be regularly changed.
The same standards that apply to your loved one should also apply to the facility itself. The walls and floors should be free of spots, dirt, wear and tear, and it should always be clean and smell good. When you notice a lack of hygiene standards, it’s a good idea to question whether your loved one is in the right place.
Unusual Skin Tears, Discoloration or Bruising
Many elderly people have very thin skin that easily discolors or bruises. Simply helping the resident to get up or transfer can cause their skin to tear, discolor, or bruise. Furthermore, certain blood thinning medications like Coumadin, Lovenox, or Warfarin can create discolored pooling of blood under the skin. That said, skin tears, discoloration, and bruising could be signs of abuse.
Common types of abuse that can cause these skin findings include repeated falling, mishandling by staff, and physical altercations with violent dementia residents. For this reason, if you see any signs of skin changes, investigate immediately.
Rapid Weight Loss and Dehydration
Rapid weight loss and dehydration can occur because the resident does not have an appetite. Certain end-stage diseases can cause this including dementia and some forms of cancer. But not eating and drinking can also occur because there are not enough staff members to ensure residents are properly fed or offered water. This is most common with residents that cannot eat or drink without assistance. Sure signs of this kind of nursing home neglect include staff not bringing the resident to the cafeteria and/or just leaving the resident’s food in their room without providing the help they need to eat or drink.
Many elderly residents are unsteady on their feet, but they still insist on trying to walk. Because residents have the right to be free from unwarranted physical restraints, it can be difficult for nursing homes to prevent all falls, but they can still do a lot to minimize the number of falls a resident has. Most importantly, they can try and figure out why a resident is falling and come up with a plan to prevent them in the future.
For example, is the facility staff quickly responding to resident call bells? If not, the falls may be occurring because the resident has to go to the bathroom, the staff is not answering the call bell, and the resident chooses to get up to on their own.
The most common-sense solution is for the nursing home staff to do better in responding to call bells. Other less obvious solutions include lower the bed closer to the floor, putting a pad on the floor in front of the bed, and offering to toilet the resident every 2 hours. All of these solutions can be implemented before a resident breaks a bone in a fall.
As discussed above, facilities are not allowed to physically restrain residents. As a result, you should never see your loved one tied down to a wheelchair or bed. But physical restraints are not the only type. In fact, the more common type today is a chemical restraint. This means that the resident is overly medicated to the point they are lethargic, docile and or unable to communicate.
Pressure sores, also called bed sores, occur because the resident lies in one place too long. The pressure on the skin for an extended period of time means the skin does not get enough oxygen. As a result, the skin and underlying tissue begin to die. Most pressure sores can be avoided by turning and repositioning at-risk seniors before the pressure sore appears. If you suspect your loved one is at risk of developing a pressure sore, insist on the nursing home staff turning and repositioning them every 2 hours.
If you are not sure if your loved one is at risk, insist on the staff doing a pressure sore risk analysis. If you suspect your loved one has been the victim of elder care abuse or assisted living neglect, contact Distasio Law Firm. We’ll help you get the care and compensation your family deserves.
What Should You Do If You Identify Abuse?
How are you to know if you should report nursing home abuse? It may seem like a big step to take, especially when you are not 100% sure that abuse is actually taking place.
However, you do not need undeniable evidence in order to report abuse. It is well within your rights to raise concerns you have about your family member, so do not hesitate to let someone know about your worries. Unfortunately, the elder may not be able to clearly state what is going on. Whether it is due to decreased mental faculties or because they are afraid the caregiver will retaliate against them, just because the patient says everything is fine does not mean that it is. If you suspect your loved one is being abused or neglected in a nursing home, you need to act fast.
Write down in detail why you believe abuse or neglect is happening and everything you observe about the issue. Document your concerns in detail, take photographs if warranted, and then request to speak to the nursing home Administrator and or Director of Nursing.
During your meeting, make sure you describe in detail all of your complaints and politely demand the facility create a detailed written care plan to address your concerns. Get a copy of the care plan for your records. If you believe the nursing home can resolve the problem then use the written care plan to monitor the facility and make sure they do what they say they will do.
If you do not believe the facility is capable of resolving the problem and you believe your loved one is in immediate need of medical attention, then transport your them to the nearest hospital as soon as possible. If the problem is not a medical emergency, then look for another nursing home and get your loved one out of the facility as quickly as you can.
Report the Problem to AHCA
The Ombudsman and AHCA are in charge of monitoring nursing homes. Each of them can investigate, document what they find, and make the nursing home do the right thing. By reporting the problem to them you can ensure that a non-biased person will look into the problem.
Taking Things Further
Sometimes, depending on the individual case, you and your loved one may be able to make a claim for compensation against the nursing home facility. For these claims, ensure you contact an attorney experienced in helping victims of this type of abuse. At Distasio Law Firm, we help clients just like you get the justice they deserve for their loved one.