Nursing Home Neglect
The quality of care in the nursing home industry has declined alarmingly over the past decade.Why? Because the quickest way for nursing home owners to increase profits is to cut expenses. Cutting costs means cutting corners: paying low wages, skimping on meals and medication, and employing a bare bones staff.
In fact, government studies have shown that in the last ten years:
- More than 25 percent of nursing homes nationwide have been cited for violations that caused actual harm to residents or placed them at risk of death or serious injury.
- More than 40 percent of the homes were cited with violations that created a potential for “more than minimal” harm.
- More than 50 percent of nursing homes had fewer than the minimum number of staff required to properly care for the residents.
Too often elderly residents of nursing and rest homes cannot help themselves and need help from the people who have made a promise to take care of them.
When nursing and rest home residents are injured or killed from neglect, Gugenheim Law will be there to take on the nursing home and fight for the rights of those who cannot fight for themselves.
A pressure sore is a sore that occurs over a bony area of the body. Pressure sores are only caused by lying in the same position for too long. Pressure sores are usually found on the buttocks, over the tail bone, on the hips, and on the heels. Most pressure ulcers can be prevented by turning and repositioning the patient at least every two hours, keeping the patient clean and dry, giving the patient enough food and water, and using good mattresses.
If the resident is immobile or confined to bed, you need to find out what the nursing home is doing to prevent the resident from developing bed sores. There are a number of things that can be done to prevent bed sores, such as:
- Turning and repositioning the resident at least every two hours;
- Elevating or floating the heels;
- Using a special mattress;
- Good nutrition and hydration;
- Keeping the resident clean and dry.
If the resident gets a bed sore, it is important to make sure that the nursing home:
- Tells the doctor that the resident has a bed sore;
- Keeps all pressure off the bed sore;
- Checks the bed sore every day to make sure it is not getting any worse;
- Has in place a plan of care to make sure the bed sore does not get any worse;
- Has in place a plan of care to treat the bed sore;
- Ensures that the resident gets the proper nutrition;
- Ensures that urine or feces does come in contact with the bed sore.
If the resident gets a bed sore, you may want to take photographs of the bed sore during the times that the nursing home is changing the dressing. Do not ever remove a dressing on a bed sore. Simply ask the nurse when the dressing will be changed. Then, when the nurse is changing the dressing, take a picture of the sore.
A fall is defined as an incident, whether seen or not, where a patient is found on the floor.
Injuries from falls can be devastating to nursing home residents. Falls can result in fractures, dislocations, lacerations, and head injuries, including deadly subdural hematomas.
Many nursing home residents sustain hip fractures in falls. Hip fractures usually require surgical repairs. Statistics show that 50% of all nursing home residents die within one year of hip surgery. Many residents die much sooner as a result of surgical complications and pneumonia.
It is important that the nursing home immediately assesses the resident to see if the resident is at risk for falls. Many things place a resident at risk for falls including, a history of prior falls, medications, strokes, poor safety awareness, instability, a new and unfamiliar environment, poor lighting, improper shoes or socks, slippery floors, and the wrong equipment.
There are many things a nursing home can do to help those residents who are at risk for falls:
- Put the resident in a low bed;
- Use safety mats next to the bed;
- Put an alarm on the bed, wheelchair and resident;
- Place hip protectors on the resident;
- Take the resident to the bathroom every two hours;
- Timely answer the call light;
- Use a bedside commode;
- Seatbelt on the wheelchair.
The best plan is a PLAN. When the resident is at risk for falls, it is important to make sure that there is a plan in place to address the risk for falls. If the plan does not work, then the nursing home needs to come up with a new PLAN. Restraints should rarely, if ever, be used. Only after consultation with the doctor, the nursing home, and after all else fails, should you consider restraining the resident. If you do decide to restrain the resident, then there are many legal requirements for the use of the restraints.
Malnutrition occurs when a patient is not getting enough to eat or is not eating a proper diet. Malnutrition can occur because the patient is not eating, because the patient is not receiving the right diet, is not receiving proper dietary supplements, or is not being fed.
A nursing home cannot force a nursing home patient to eat. But, a nursing home has a responsibility to know how much a resident is eating, what a resident is eating, and why a resident is not eating. There could be a number of reasons why a resident is not eating. For example, the resident may not like the food, may not be able to chew the food, the food may be cold, or the resident may not be hungry when the food is served. The resident may have a medical condition that prevents him from eating.
On admission, the nursing home needs to assess the resident and determine their food preferences, diet restrictions, and other aspects of the resident that may affect what the resident can and cannot eat. If the resident begins to refuse food or not eat, the nursing home needs to find out why this is happening.
In addition, there are a number of nutritional supplements and stimulants that can be given to the resident to assist with eating.
If the resident gets to the point that she is physically unable to eat, then the family, doctor and nursing home need to decide whether a feeding tube will be used. Perhaps the resident has already made the decision that he does not want a feeding tube. If so, then the nursing home must still try to encourage the resident to eat. Again, the important thing is that there is a PLAN.
URINARY TRACT INFECTIONS AND UROSPSIS
A urinary tract infection usually results from bacteria getting into the urinary tract. This can occur from the nursing home?s failure to keep the resident clean and dry.
Yes, it is common for nursing home residents to develop urinary tract infections. But, these usually occur because the nursing home does not keep the resident clean and dry. If the resident is kept clean and dry, they should not develop a urinary tract infection.
Urinary tract infections are difficult to identify. If you notice a change in mental status or a fever, that is usually the first sign or symptom of a urinary tract infection. If those signs are present, the nursing home should notify the doctor, perform a blood test, and take a urine culture. Untreated urinary tract infections can lead to deadly blood infections. So, it is important that urinary tract infections are identified and quickly treated.
Dehydration happens when the patient is losing more water than they are taking in.
Many nursing home residents do not drink enough water. Mostly, they do not recognize how much water they need. So, it is important that the nursing home encourage nursing home residents to drink as much water as possible. Again, this requires a PLAN by the nursing home. That plan should include:
- Making sure water is available;
- Making sure the nursing home resident can drink the water (can they reach the cup; use the straw, pour the water; physically drink the water);
- Making sure the nursing home is recording how much water the resident is drinking;
- Making sure the nursing home is assisting the resident drink the water.
Signs and symptoms of dehydration include:
- Decrease in urine output or constipation
- Increase in falls or problems with walking
- Significant weight loss
- Inability to sweat
- Dizziness or headaches
- Dry mouth and tongue
- Significant drop in blood pressure
INJURIES FROM RESTRAINTS
A restraint is any device that prevents a patient from freely moving.
Restraints can include bed rails, lap buddies, table tops, geri-chairs, and any other device that prevents the resident from moving. Many studies have shown that restraints cause more injuries than they prevent. Thus, before the nursing home uses a restraint, all other possible methods should have been attempted and then, only after consultation with the physician and family, should a restraint be considered.
A nursing home may not restrain a resident except in cases of emergency (24 hours only) and then only upon receipt of a written physician?s order.
CLOSTRIDIUM DIFFICILE (C. DIFF)
Clostridium difficile [pronounced Klo-STRID-ee-um dif-uh-SEEL], also known as “C. diff” [See-dif], is a germ that can cause diarrhea. Most cases of C. diff infection occur in patients taking antibiotics.
The most common symptoms of a C. diff infection include:
- Watery diarrhea
- Loss of appetite
- Belly pain and tenderness
To prevent C. diff. infections, doctors, nurses, and other healthcare providers are supposed to:
Clean their hands with soap and water or an alcohol-based hand rub before and after caring for every patient. This can prevent C. diff and other germs from being passed from one patient to another on their hands.
Carefully clean rooms and medical equipment that have been used for patients with C. diff.
Use Contact Precautions to prevent C. diff from spreading to other patients. Contact Precautions mean: Whenever possible, patients with C. diff will have a single room or share a room only with someone else who also has C. diff. Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with C. diff. Visitors may also be asked to wear a gown and gloves. When leaving the room, nurses and visitors remove their gown and gloves and clean their hands. Patients on Contact Precautions are asked to stay in their rooms as much as possible. They should not go to common areas, such as the gift shop or cafeteria. They can go to other areas of the hospital for treatments and tests. • Only give patients antibiotics when it is necessary.
What can you do to help prevent C. diff infections?
Make sure that all doctors, nurses, and other healthcare providers clean their hands with soap and water or an alcohol-based hand rub before and after caring for you. If you do not see your providers clean their hands, please ask them to do so. Only take antibiotics as prescribed by your doctor. Be sure to clean your own hands often, especially after using the bathroom and before eating.
- IMPROPER FEEDING TUBE PLACEMENT AND PERITONITIS
- ASPIRATION AND PNEUMONIA
- IMPROPER PAIN MANAGEMENT
- UNEXPLAINED FRACTURES
- SEXUAL ASSAULT
- IMPROPER PHYSICIAN NOTIFICATION
- BED RAIL ENTRAPMENT
- IMPROPER MEDICATION