Nursing Home Negligence and Abuse: Just Who’s Minding the Store?
In our previous blogs on nursing home neglect and/or abuse, we emphasized the ailment most frequently associated with nursing home neglect, namely decubitus ulcers, commonly known as bedsores.
Though bedsores get the most publicity, there are many other serious medical outcomes resulting from nursing home neglect. This blog will focus on two (2) such outcomes: 1) injuries from falls; and 2) injuries resulting from failure to monitor eating limitations of elderly residents.
I. Falls in Nursing Homes. Of the approximately three million people who spend some time in nursing homes each year, most are elderly and may have actually ended up in a nursing home in the first place because of complications resulting from a fall at home. In addition, individuals who reside in nursing homes are generally more frail because of their generally advanced age, have poor eyesight and/or hearing, and suffer from chronic conditions such as diabetes. Many nursing home residents also suffer from senility, dementia, or Alzheimer’s.
Statistics compiled from clinical studies confirm the fact that nursing homes falls are not a rare event. For example, studies conducted by LZ Rubenstein and his colleagues demonstrate that as many as 3 out of 4 nursing home residents fall each year, or put another way, about two times as many nursing home residents fall each year as compared to adults living in the community. Other studies have shown that while 5% of adults 65 and older live in nursing homes, nursing home residents account for about 20% of deaths from falls in this age group. See Ref. 1.
Of course, as with any statistical results, the results must be viewed against the backdrop of the fact that individuals who reside in nursing homes are generally more frail because of their generally advanced age, have poor eyesight and/or hearing, and suffer to a greater extent from chronic conditions such as diabetes relative to their non-nursing home counterparts. Those residents who are not totally confined to a wheel chair will generally have difficulty walking and bending and have gait problems. Just being confined to beds and wheel chairs may in and of itself result in muscle atrophy and weakness, thereby making the elderly resident more susceptible to falling, for example, when moving from a bed to a chair. Moreover, the many nursing home residents who suffer from senility, dementia, or Alzheimer’s are often medications which affect the central nervous system, thereby making them further susceptible to falls. See Ref. 2. In other words, the typical nursing home resident is not living at the facility for fun and games but because of genuine old-age related health issues.
Most nursing homes are for-profit institutions. As with any for-profit institution, the management makes decisions concerning the funds they will spend on operating their institution. One would hope that the decision-making process would be based on the safety and health requirements of the very people they are licensed to serve, namely elderly adults no longer able to take care of themselves because they are suffering from a variety of limitations and ailments, both physical and mental.
Since falls frequently occur in nursing homes as a consequence of these limitations and ailments, the ideal nursing home facility will be pro-active in taking steps to try and prevent falls to its residents. The Centers for Disease Control states that “[f]all prevention takes a combination of medical treatment, rehabilitation, and environmental changes.” One of best ways to prevent falls would be to ensure that the staff members are formally trained on and educated about fall risk factors and prevention strategies on a scheduled basis. See Ref. 3. It is the day-to-day staff that has the most interaction with the facility’s patients, not high level managers ensconced in some suite of offices often off-site. Such staff members should of course also be trained and monitored in the detection and prevention of bedsores. And of course, the nursing home institution should hire a sufficient number of staff members to meet the needs of their elderly residents.
Other approaches include: 1) adding equipment and accessories specifically geared towards the special needs of elderly patient such as adding raised toilet suits and installing handrails in the hallways; and 2) using devices such as alarms that go off when patients try to get out of bed or move about without help. See Ref. 4
The old adage, “an ounce of prevention is worth a pound of cure” should certainly apply to nursing home institutions. This particular customer base served by nursing home institutions is challenging to say the least, but this customer base consists of parents, spouses, other family members, and friends and are among our most vulnerable citizens. One would hope that nursing home institutions do not merely look at the residents as contributors to their bottom line, but truly see the residents as individuals who once lived active, full lives, and who now must look to the nursing home to provide their day-to-day needs. Sometimes, simple common sense in the administration of a nursing home’s obligations to provide a safe environment could well go a long ways to preventing disastrous consequences for the elderly resident and a potential lawsuit against the facility.
For example, a recent case in Illinois involved a situation where an elderly woman was assigned to a room next to the back stairwell of a nursing home facility. The woman had been able to open the door to the stairwell and fallen down the stairs. Her son sued the home, alleging it failed to prevent his mother’s fall and negligently assigned her to a room next to the back stairwell. The case was settled for an undisclosed amount.
What would have been the common sense thing to do to have substantially reduced the possibility of a fall by this elderly woman? Several cost-effective possibilities should come to mind.
II. Non-Compliance with Dietary Orders. It is not uncommon for nursing home residents to have a history of food allergies or perhaps chewing, swallowing and/or G.I. tract problems. In such cases, the resident may have special dietary needs designed to avoid distress and even more severe complications. The resident and his/her family will necessarily depend on the nursing home staff to abide by these dietary restrictions.
In a fairly recent Connecticut case, a nursing home resident died after choking on a piece of beef. His estate sued the nursing home and adduced evidence that the aide who had served the meal had failed to read the decedent’s name card. This card included information on his dietary requirement, a mechanical soft diet. The verdict was in favor of the nursing home resident’s estate.
The Connecticut case illustrates the importance of training staff members and providing a system for insuring good communication among staff members. For example, potential problems may occur with new aides particularly if they have not been provided with detailed information on the residents (e.g., dietary restrictions, the importance of reading the dietary card, etc.) they will be serving. Again common sense would tell us that one way to prevent a sad outcome would be to ensure that all aides, and especially new ones, are thoroughly trained in the special needs of the residents they were hired to serve. Also, where the aide is not fluent in English, instructions pertaining to the nursing home resident should be provided in the aide’s native language as well as English.
Despite the fact that this blog is written by attorneys, its focus has not been about pursuing legal action against nursing homes for negligence and abuse. Instead, it has attempted to emphasize that nursing home negligence and abuse, even if not totally preventable, certainly can be reduced by a pro-active management. In fact, such actions may reduce the number of law suits against nursing homes. Indeed, nobody should want to see a vulnerable nursing home resident become a victim of nursing negligence and abuse. As the children and friends of elderly people, we would emphasize that nursing home managers consider implementing quality control procedures for cutting down on injuries to its residents and developing a metrics system for monitoring the effect on those procedures on injuries. It just might be time to apply a “Deming-like” approach to combating nursing home negligence and abuse. As discussed above, “common sense” approaches which focus on preventing “preventable” accidents from occuring need not be cost prohibitive.
As discussed in our previous nursing home blogs, family member advocates play a critical role in monitoring the well-being of nursing home residents. Of particular concern for our aging baby boom population is that many future nursing home residents may not have family advocates who can be on the look out for negligence of abuse. Many baby boomers have chosen not to have children, generally the “first-in-line” defense for vulnerable nursing home residents. Moreover, people are living longer these days meaning that the nursing home population will at least increase over the next two decades or so and that parents may be more likely to outlive their children than in the past.
The current tight “economic” times also mean that states may well reduce nursing home oversight as a way to reduce costs due to severe budgetary constraints. For example, in Florida, Senate bill 1562, which is under consideration at this time, would eliminate annual “drop-in” inspections by Florida’s Long-Term Care Ombudsmen program.
We are unfortunately not particularly optimistic that incidents of nursing home negligence and abuse will decline substantially. Legal action will continue to be a viable recourse to protect nursing home residents who suffered from negligence and abuse. It is our hope that family members who seek legal recourse on behalf of their loved one through an attorney will at the very least eventually gain a sense of closure and to some extent, satisfaction in knowing that the negligent actions of nursing home were not “swept under the carpet” in the case of their own loved one.
In closing, we would recommend that those who are facing the often-times very difficult decision of placing a loved one in a nursing home should review the website launched by the Centers for Medicare and Medicaid Services which ranks nearly 16,000 nursing homes. The information should prove useful in helping family members select a nursing home facility that has evidenced a high level of care for its residents.
Ref. 1. Rubenstein, L.Z. Preventing Falls in Nursing Homes. Jr. Am. Med. Asso. 1997; 278(7):595-6.
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Ref. 2. Ray, W.A., et al. Benzodiazepenes and the Risk of Falls in Nursing Homes. Jr. Am. Geriatric Soc 2000; 48(6):682-5.
Ref. 3. Ray, W.A., et al . A Randomized Trial of Consultation Services to Reduce Falls in Nursing Homes. Jr. Am. Med. Asso. 1997; 278(7): 557-62.
Ref. 4. Rubenstein, L.Z., et al. Falls in the Nursing Home. Annals of Internal Medicine 1994; 121:442-51.
