The Mid-west’s elderly population has skyrocketed, and continues
to grow. Nursing home populations are on the rise and pressures for entry
continue to grow, too. Yet, nursing home care is increasingly a matter
of legal concern. Altogether too often, nursing homes seem to lack staffs
with sufficient training, patience, or commitment to their work. Residents
in nursing homes often have difficulty communicating with their families
and friends when there is a problem with the care they are receiving.
Common Signs of Nursing Home Abuse
Abuse can occur in a number of different forms. In our nursing home practice,
we find that when problems arise, they typically fall into one of the
following four categories of nursing home abuse: physical abuse, sexual
or emotional abuse, financial abuse, and general neglect.
Nursing home patient neglect manifests itself in a myriad of ways. These include:
- Weight loss
- Deterioration in health
- Odor of feces or urine
- Inadequate staff supervision
- Lice, rashes, and sores
- Untreated medical conditions
- Urinary tract infections
- Injuries covered up
- Delay in communication after an incident
- Inadequate restraints
- Uncontrolled infections
- Behavior changes
Bed Sores May Be a Sign of Neglect
A common form of general neglect is the development of bed sores. These
are referred to as decubitus ulcers or pressure sores. Bed sores are lesions
caused by unrelieved pressure resulting in damage of the underlying tissue.
Bed sores usually develop over the bony prominences and are classified
by the degree of tissue. Most common areas for development are the buttocks,
hips, and heels, but are also known to develop on the shoulder blades,
ears, and ankles.
The unrelieved pressure, along with other contributing factors, leads to
the skin breakdown and persistent ulcerations. The presence of bed sores
does not necessarily suggest negligent care, but it is a strong indication
that family members should beware. Simply stated, bed sores should not
develop. The common cause of bed sores are failure to make sure that the
resident is moved, or turned.
Detecting Signs of Physical, Sexual & Financial Abuse
Open wounds, cuts, welts, bruises, or discoloration are equally strong
indications of physical abuse or indifference. Caretakers who are confronted
about such conditions present in patients should be able to offer spontaneous,
adequate explanations. They should be willing to share nursing home records
which disclose, in a professional record keeping style, that these conditions
have been noted in the patient; the date of detection and circumstances
of detection of such condition should be noted.
Where appropriate, an investigation within the nursing home should occur
- before the matter is brought to management’s attention. An elderly
resident’s sudden change in behavior or display of fear toward certain
staff members should be address as serious. Weight loss, or burns apparently
caused by cigarettes, caustics or acids should prompt immediate questions.
Sexual or emotional abuse of patients can occur too. Where caregivers
are overly affectionate, or the resident is socially isolated from others,
concern about such abuse should be registered.
Of course, financial abuse is a concern. Nursing home personnel should
be given charge over, or access to a residents financial records, bank
account information, credit card information, jewelry, or other valuables.
Family members, in careful, consultation with the elderly patient, must
assure that the patient is safeguarded against exposing staff members
to the temptation to commit theft. There are other signs to be alerted
to. Caregiver blame for the resident for acts such as incontinence, intemperance,
etc., all suggest an attitude that should put family members on guard.
A caregiver should never consider a nursing home resident as anything other
than a patient. Where the staff’s attitude suggests the resident
is a burden, serious management problems are present. Of course, most
facilities have training programs to protect against these problems. State
and federal governments have investigative agencies available for processing
complaints, although our experience is that complaining to government
officials is often unsatisfactory. Various state and federal statutes
exist to protect nursing home patients. Consultation with lawyers to explore
protective rights should occur.
Assisted Living Options
Assisted living facilities are a popular alternative to nursing home care.
Opportunities for physical or financial neglect are greatly diminished
in these facilities due to the resident’s autonomy. The National
Center for Assisted Living provides development and operational guidelines
for these facilities. Their data, including regulatory reviews from assisted
living facilities performed by the NCAL, can be obtained from licensing
authorities. Some of the safeguards concerning nursing home care apply
to assisted living facilities - family members should be on guard about
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