Keeping Your Loved Ones Safe
Spotting Elder Abuse and Neglect, and What to do About It
While the vast majority of nursing homes, assisted living facilities and in-home care agencies offer excellent care, provided by skilled and compassionate staff members, unfortunately there are some that do not. The goal of this article is to assist you in finding the best care, help you recognize signs of neglect and abuse, and offer information about what you can do if you suspect your loved one may be a victim.
When families face the difficult decision of placing a loved one in a nursing home or assisted living facility, they expect to receive top quality medical care and assistance with day-to-day living requirements. The first step is to determine which type of facility or in-home care is needed. To do this you will evaluate your loved one's needs based on their physical and mental condition and limitations. For example, will they require a facility that specializes in care for those suffering from Alzheimer's? Will they need dialysis machines, or a specialized wound care center? Are they relatively independent but have memory issues that may result in taking incorrect dosages of their medications? It will be important to get advice from their primary care, or geriatric specialist for advice about the type of care they need as well as asking for referrals. When choosing a facility or in-home care agency, speak with family, friends and neighbors who have been through a similar situation. Also, every state has a division of the Department of Health that is responsible for the oversight of nursing homes and enforcement of nursing home regulations. They conduct annual surveys for each facility and investigate all complaints filed against them. This information is available to the public at your state's Department of Health website.
How to Ensure Your Loved One is Receiving Proper Care
Even if you choose a top-rated facility or in-home care provider it is essential that you stay involved in your family member's care. Monitoring and observing changes in their condition will allow you to know that they are being cared for properly. If you live a distance that prevents your regular monitoring, be sure to have another relative or family friend regularly visit them and report back to you.
What are the Signs of Nursing Home Neglect & Abuse?
Every one assigned to monitor your loved one should be able to recognize the signs of neglect and abuse:
- Any open wounds or cuts
- Unexplained injuries such as broken bones, bruises, or welts
- Reports of being slapped, pushed, shaken or beaten
- Being physically restrained to the bed or chair
- Over-medication causing lethargy or unresponsiveness
- Weight Loss
- Sudden slurred speech
- Deprivation of food or water, for any amount of time
- Emotional upset or agitation
- Extremely withdrawn and non-communicative
- Displaying unusual behavior such as sucking, biting or rocking
- Displaying behavior that is: humiliating, insulting, frightening, threatening or ignoring towards family and friends
- Wanting to be isolated from other people
- Injuries requiring emergency treatment or hospitalization
What to Look for When Checking Up on a Loved One:
- Diet: Are they drinking enough water and eating well? Try to visit at mealtime to check what food your loved one is eating. Malnutrition and dehydration can cause life-threatening diseases, including urinary tract infections, kidney failure, and, skin breakdown that can lead to bedsores, dementia and a weakened immune system.
- Weight loss: Closely monitor for weight loss by your family member. Do not rely on the nursing home's stated weight, because they may try to hide weight loss. The upper arms and calves are often a good place to check for weight loss in the elderly.
- Dehydration: Skin tone and dryness of mouth and lips, as well as pinching the skin on the forehead or sternum are ways to check for dehydration. When the skin sticks together and leaves a ridge, there could be a dehydration problem.
- Bedsores: Being immobilized in a bed or wheel chair can lead to a risk of contracting bedsores. When you visit make sure to ask if they have any cuts or wounds. If they are unable to answer, be sure to check their entire body each time you visit. Common areas for bedsores are on the heels, hips and buttocks. If a bedsore is allowed to develop, it will cause serious illness, and even possibly death.
- Toilette Use: It is common for residents in nursing homes to need assistance in using the toilet. A facility with insufficient staffing may choose to put him or her in diapers to save work. This can lead to your loved one's dependence on the facility, and can be used as an excuse to keep them in the nursing home, instead of an assisted living facility. You should insist that your loved one is regularly taken to the toilet. If he or she is starting to have accidents, it may well be that the call light is not operating correctly or is not being answered, rather than it being an incontinence problem. Ask your family member, frequently, if he or she has any symptoms, such as burning urination, and dark, cloudy or foul smelling urine.
- Confusion/ Dementia: Should your loved one start showing signs of confusion and/or dementia after entering the nursing home, you should question these symptoms. They are most likely caused by some sort of disease, or may be triggered by malnutrition or dehydration. It is not uncommon for balance issues to be caused by dehydration in people of any age. Insist that the facility and the doctor run blood tests to rule out disease, malnutrition and dehydration.
- Rehabilitation & Exercise: Make sure that the facility is following through with any rehabilitation they have promised. Occasionally, you or your surrogate monitor should be present when your loved one is doing their exercises to ensure they are being effective.
- Bathing & Cleanliness: Make sure that your loved one is fully bathed, at least three times a week. Your family member should not have any body odor or scaling skin. Check for proper nail and dental care.
What Should You Do if you Suspect Neglect or Abuse?
If you believe that your loved one is suffering from abuse or neglect, TAKE ACTION IMMEDIATELY by calling 911, and if necessary, the police. Remove your family member from the facility to another facility, or if urgent care is needed, take them to a hospital.
What are your Rights? Federal Regulations Regarding Nursing Homes
For a further understanding of residents' rights in nursing homes you should know that the federal government requires all nursing homes that receive federal subsidies to comply with stated regulations for quality care. The federal law is known as the Nursing Home Reform Act. To receive Medicare and Medicaid funds nursing homes must comply with the federal requirements for long term care facilities as prescribed in the U.S. Code of Federal Regulations (42 CFR Part 483). To see all federal regulations visit the Nursing Home Abuse and Neglect Resource Center link at http://www.nursinghomealert.com/stoppingabuse/federalregulations.html
How to Make a Formal Complaint, and How Will it be Handled?
If you suspect your loved one is the victim of abuse or neglect you should make a complaint to the Licensing and Certification division of your State Health Department; they are required to investigate your claim. Be sure to gather as much information as you can to make your report as complete as possible. This would include all of the facts of the suspected abuse or neglect, as well as the names and ages of all people involved. They will assign an inspector to investigate, and normally will notify you of the inspector's name and the course of action. His/her onsite visit to the nursing home will be unannounced; the facility will not be notified in advance that an investigation is underway. The inspector will collect and evaluate all evidence, including his/her eyewitness observation, statements of witnesses, and will also review the facility's records. If they find evidence to substantiate your claim they can issue a citation against the facility, impose a fine and require action be taken to correct the situation. If you are not satisfied with the inspector's determination you can request an informal hearing. A representative of the facility may be present during the hearing. If you are still unsatisfied with the results of the hearing, you may appeal to an even higher level for review, which is normally handled by an appeals unit.
Another Legal Path: Civil Litigation
You may also decide to take private legal action against the nursing home in civil court. In this case it is best to consult an attorney who can give you guidance on the best course of action. Keep in mind that states determine their own time limitations for this type of legal action.
Where to Go for Help in Your Area
The National Center on Elder Abuse Administration on Aging has a comprehensive list of links to state helplines, hotlines and elder abuse prevention resources. You can search your state's links at www.ncea.aoa.gov/NCEAroot/main_site/find_help/state_resources.aspx
There are over 1 million cases of elder abuse reported every year and many others that go unreported. This number is bound to increase as a greater percentage of our aging population is trusted to the care of others. The best way to ensure your loved one is not another sad statistic is to stay involved with monitoring their care and not being afraid to question, or raise a red flag if you suspect there may be a problem with their care.