Nursing Home Abuse and Neglect

Nursing home residents often require constant attention, and may not be able to communicate nursing home abuse or neglect from their caregivers. And they are unaware of elder care law. Nursing home neglect is often unreported because it isn’t always physical abuse. Emotional, psychological, and financial abuse or exploitation is all too frequent.Institutional entities include skilled nursing facility (SNF) or homes, foster homes, group homes, and board and care facilities. Abusers may be staff members, other patients and even visitors.If a staff member refuses to allow family or friends to see the resident or insists on being present during the visit, it is possible that abuse is taking place. Other examples of abuse are:

• Withholding food or not providing food according to prescribed schedule
• No access to water / dehydration
• Medication errors
• Poor toileting facilities
• Inadequate daily care and grooming, or abandonment
• Failure to diagnose or recognize heart attack or stroke
• Failure to treat or provide emergency care for stroke or heart attack
• Elopement or wandering, where the patient leaves the nursing home without authorization
• Intimidation or use of threats

Some Signs of abuse are:

Emotional: behavior and/or personality changes; withdrawn and uncommunicative; dementia; depression; anxiety and agitation.

Physical: Unexplained accident or injury; Decubitus Ulcers (Bedsores); Frozen joints; Contractures; Brittle bones or Fracture; Muscle atrophy; Burns; Fearfulness; Broken eyeglasses; Rapid, unexplained weight loss; Unwarranted use of physical restraints

Sexual: Unexplained venereal disease;Genital infections;Vaginal or anal bleeding;Torn or stained underclothing;Bruising around breasts, upper abdomen, or inner thighs

Nursing Home and Elder Law 

By law, nursing homes must provide care to maintain the highest practicable physical, mental and psycho-social well-being of each resident. Federal and state laws were designed to protect nursing home residents and the abuse or neglect that occurs there and in other assisted living facilities. Many states also require that nursing homes meet individual state standards relating to the type and quality of care required.

Failure to comply with elder law has resulted in abuse that in turn caused illness, discomfort and death. This abuse is often referred to as “institutional abuse”.

State Elder Law

Most states have addressed the institutional abuse issue with laws that require doctors, nurses and other health care professionals to report suspected neglect to a designated state office. Laws further require nursing homes to investigate and report any abuse incidents that occur within their facility. Physicians, hospitals, nurses, therapists, aides, orderlies and administrators must provide adequate care, medical treatment and protection to the residents and patients in their facility.

State laws typically require a nursing home to be licensed in order to operate, provides for annual inspections, sets up a procedure for handling complaints, prohibits discrimination, and imposes sanctions for violation, such as licensure suspension and revocation. The state regulatory agency investigates any reports of alleged abuse or violations.

Federal Elder Law

In 1987, the federal government passed the Nursing Home Reform Act (NRA), and nursing homes that receive federal funds must comply with the act. The NRA sets standards for care, establishes a list of rights for residents, such as the right to be treated with dignity and to exercise self-determination, sets up a monitoring system for nursing homes, and specifies sanctions for non-compliance. The Act covers resident care and rights, staffing, the quality of care, restraints, privacy, and record keeping. The law applies to all the various types of nursing homes who receive funds under Medicaid or Medicare programs.

Under the Nursing Home Reform Act, nursing homes must also do the following in order to meet the basic tenet of the Act:

• Employ sufficient nursing and other staff in order to provide nursing and related services
• Be administered in a way that enables the nursing home to use resources effectively and efficiently
• Within 14 days of admission, perform an initial comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity. After significant changes in the resident’s physical or mental status and/or at least once every 12 months, perform such an assessment.
• Develop comprehensive individualized care plans for residents. Care plans must include measurable objectives and schedules to meet each resident’s medical, nursing, mental and psychosocial needs as identified in the comprehensive assessment discussed above. The care plan must be developed within 7 days after completion of the comprehensive assessment. It must detail the services that are to be provided. The care plan must also be periodically reviewed and revised by a team of qualified persons after each assessment.
• Provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs) to meet the needs of each resident.
• Provide supervised medical care by a physician. The nursing home must provide or arrange for the services of a physician on a 24 hour per day basis in case of an emergency.
• Prevent the deterioration of a resident’s ability to bathe, dress, groom, transfer and ambulate, toilet, eat, speak or otherwise communicate.
• Provide necessary services and assistance in order to maintain good nutrition, grooming, and personal and oral hygiene if the resident suffers from any impairment daily living activities.
• Ensure that residents do not develop pressure sores. If a resident has pressure sores, the nursing home must provide the necessary treatment to promote healing and prevent infection and development of new sores.
• Provide treatment and services to incontinent residents to restore as much normal bladder functioning as possible and to prevent urinary tract infections.
• Ensure that residents receive proper treatment and any devices to maintain hearing and visual abilities.
• Ensure that residents receive adequate supervision and assistive devices to prevent falls.
• Ensure that residents maintain acceptable parameters of nutritional status, such as body weight and protein levels.
• Provide residents with enough fluid to maintain hydration and health.
• Prevent medication errors.
• Care for residents in a way that promotes maintenance or enhancement of their quality of life.
• Promote resident care in a way and in an environment that enhances each resident’s dignity and respect in full recognition of individuality.
• Ensure that residents can choose activities, schedules, and health care consistent with individual interests, assessments, and plans of care.
• Maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete, accurate, accessible, and systematically organized.

In 2008, The U.S. Department of Health and Human Services’ Office of the Inspector General released a report detailing the “Trends in Nursing Home Deficiencies and Complaints” that showed over 90 percent of that nation’s nursing homes were cited for federal violations from 2005-2007. The most common deficiency categories cited in each of the past 3 years were quality of care, resident assessment, and quality of life.

The report also showed a greater percentage of For-Profit nursing homes were cited for deficiencies than non-for-profit and government nursing homes from 2005-2007.