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Nursing Home Abuse (Elder Abuse)

An increasing elderly population has led to an increased nursing home population, and with this has come an increased incidence of nursing home negligence and abuse. Governmental agencies such as the Center for Medicare & Medicaid Services help oversee the care and services provided by nursing homes and both federal and state governments have established uniform standards for nursing homes and ensure the protection and safety of patients.

Unfortunately, despite these governmental agencies, over one million nursing home residents are abused in some manner each year. Such actions can include negligence and active abuse. Whether the abuse consists of recurrent negligence or a single incident which causes injury, the victim has a right to damages. In most cases, the nursing home in question can lose its certification for failing to supply the expected care leading to a loss of federal funding.

Nursing home abuse can include physical damage from falls, malnutrition or dehydration, bed sores, gangrene, aspiration pneumonia, over-sedation, poor medical care, or wrong medication. Just as damaging but more subtle, are lack of supervision, theft, abandonment, defective equipment, sexual assault, coercion, physical or mental abuse. All of these can lead to injury or death of the nursing home patient.

HISTORY OF NURSING HOMES

In 1965, Medicare and Medicaid came into existence and along with it came federal nursing home regulation. Nursing homes that qualify and voluntarily elect Medicare and Medicaid to their facility must follow a set of guidelines put forth by federal standards. The Health Care Finance Administration that is part of the United States Department of Health and Human Services enforces these nursing home regulations. Congress authorized the first set of standards that were to be met by nursing facilities in 1967 and created classifications for the Skilled Nursing Facilities and Intermediate Care Facilities. Both in 1980 and again in 1987 these standards were updated with the most current nursing home regulations imposed under the Omnibus Reconciliation Act of 1987.

OBRA 87: Omnibus Budget Reconciliation Act of 1987 (OBRA 87)
OBRA 87 requires that the facility provide each patient with care that will enable the patient “to attain or maintain the highest practicable physical, mental and psychosocial well-being.”

  • Quality of life for patients is the goal. The facility must allow patient choice in activities, schedules and health care decisions.
  • OBRA 87 requires that SNFs and ICFs provide 24-hour licensed practical nurse care seven days a week, and have at least one RN on duty at least 8 hours per day, seven days a week. Nurse’s aides are required to undergo special training.
  • OBRA 87 makes it the State’s responsibility to establish, monitor and enforce state licensing and federal standards. States are required to maintain investigatory units and Ombudsman units, and to fund and staff them adequately.

OBRA 90: Omnibus Budget Reconciliation Act of 1990 (OBRA 90)
The Patient Self Determination Act covers all long-term care facilities that participate in Medicare or Medicaid. At the time of admission to a hospital or nursing home, at the time of enrollment with an HMO, Hospice, or Home Health Care Agency, the following must happen:

  • The facility must provide the patient written information concerning the patient’s rights under state law to participate in decisions concerning medical care, including the right to accept or refuse medical or surgical treatment, the right to formulate advance directives.
  • The facility must provide a written statement of its policy regarding implementation of these rights.
  • The facility must document in its records whether the patient has executed an advance directive. NOTE: The facility is not required to provide advance directives to patients.
  • The facility is forbidden to discriminate in the provision of medical care on the basis of whether a patient has or has not executed an advance directive.
  • The facility is required to comply with all state laws regarding advance directives.
  • The facility must provide for staff and community education on issues related to advance directives.

NURSING HOME REGULATIONS

Federal nursing home regulations first appeared in 1965 with the establishment of programs known as Medicare and Medicaid. All nursing homes that qualify and voluntarily elect to use Medicare and Medicaid must follow the federal nursing home regulations or they will lose their funding. The enforcement of these nursing home regulations is carried out by the Health Care Finance Administration section of the United States Department of Health and Human Services.

Congress authorized the first set of federal nursing home regulations in 1967, with updates in 1980 and 1987. These nursing home regulations require that each facility provide care that enables their patients “to attain or maintain the highest practicable physical, mental, and psychosocial well-being.” To remain in compliance with nursing home regulations, facilities must allow patients a choice in activities, schedules, and health care, must provide 24 hour license practical nurse care every day, with at least one RN on duty at least 8 hours every day. The federal nursing home regulations also mandate that the State must establish, monitor and enforce state licensing and federal standards.

In addition to federal nursing home regulations, many states and local authorities have their own specific nursing home regulations that are intended to protect the residents of nursing homes. Violation of state or federal nursing home regulations can lead to the shutdown of the nursing home facilities, or in less extreme cases, punitive measures such as fines.

If a nursing home is operating in violation of nursing home regulations, the residents may be eligible for some form of financial compensation, for pain and suffering, the cost of transferring to another facility, punitive fines, etc. If you suspect that a residential facility used by yourself or a loved one is not meeting nursing home regulations, please contact us for a free consultation.

NURSING HOME ABUSE FAQS

What are the causes of nursing home abuse?

Many times nursing homes do not hire enough, as well as qualified, staff. Under qualified, insufficiently trained, and overworked staff can result in nursing home neglect and abuse. Unfortunately, many living in nursing homes are unable to properly communicate instances of nursing home neglect and agues because of their physical or mental state.

What are the different types of nursing home and elder abuse?

Mental: fear, agitation, hesitancy, depression, withdrawal, sudden behavior changes, unusual behavior patterns, unwillingness to communicate, disorientation, confusion, unjustified isolation, rude, humiliating, derogatory comments by staff, specific complaints by residents

Physical: wounds, cuts, abrasions, burns, bruises, welts, swelling, broken bones, sudden, inexplicable weight loss, unexplained/hidden injuries, unwarranted restraints (either physical or chemical), specific complaints by residents

Nursing Home: bed sores (decubitis ulcers), unsanitary environment, malnutrition, dehydrations, smells of urine and/or feces, unkempt appearance, poor personal hygiene, untreated medical condition, specific complaints by residents

Exploitation / Financial: sudden unjustified selling of property, missing/stolen money or property, radical changed in handling personal/financial affairs, specific complaints by residents

What are some recognizable signs that nursing home abuse could be occurring?

Any of the following signs of nursing home neglect and abuse could warrant further investigation:
  • Unexplained bruises, cuts, burns, sprains, or fractures in various stages of healing
  • Bedsores or frozen joints
  • Unexplained venereal disease or genital infections; vaginal or anal bleeding; torn, stained, or bloody underclothing
  • Sudden changes in behavior
  • Staff refusing to allow visitors to see resident or delays in allowing visitors to see resident
  • Staff not allowing resident to be alone with visitor
  • Resident being kept in an over-medicated state
  • Loss of resident’s possessions
  • Sudden large withdrawals from bank accounts or changes in banking practices
  • Abrupt changes in will or other financial documents

How prevalent is nursing home abuse?

More than 1.6 million Americans reside in more than 16,000 nursing homes across this country. A 1998 study conducted by the U.S. General Accounting Office (GAO) concluded that more than half of the suspicious deaths studied in nursing homes were probably due to nursing home neglect, including malnutrition and dehydration.

How can I choose a safe nursing home?

Although there is not a fool proof way to choose a nursing home, there are steps you can take to better ensure the safety of your family members. By asking questions and looking for signs at the facility, you can better prevent unnecessary instances of nursing home neglect and abuse from occurring. Here are a few questions you can ask the facility (information from Medicare):

  1. Is the home and the current administrator licensed?
  2. Does the home conduct background checks on all staff?
  3. Does the home have special services units?
  4. Is there nursing home neglect and abuse prevention training?

As with any important decision, by doing your homework, you can help put your mind at ease with your final decision. Some other useful tips include:

  • The nursing home and its administrator should be licensed by the State to operate
  • Do the nursing home’s procedures to screen potential employees for a history of abuse meet your State’s requirements? Your State’s Ombudsman program might be able to help you with this information. In New Jersey, the number to call is 609-943-4023
  • Some nursing homes have special service units like rehabilitation, Alzheimer’s, and hospice. Learn if there are separate waiting periods or facility guidelines for when residents would be moved on or off the special unit.
  • Do the nursing home’s training programs educate employees about how to recognize resident abuse and neglect, how to deal with aggressive or difficult residents, and how to deal with the stress of caring for so many needs? Are there clear procedures to identify events or trends that might lead to abuse and neglect, and on how to investigate, report, and resolve your complaints?
  • Are there policies or procedures to safeguard resident possessions?

If I suspect nursing home abuse, what can I do?

Many serious health problems and deaths have occurred because of nursing home neglect and abuse. If you suspect that your family member may be the victim of nursing home neglect, immediate action can save any further tragedies from happening. The problem should be brought to the attention of the nursing home, and if problems do not cease then government assistance and legal assistance is available. Contracting your state attorney general’s office to report nursing home neglect or abuse and using private attorneys can bring the matter to light and to justice. If you have any questions regarding the nursing home neglect or abuse of a family member in a nursing home, please contact us for a free consultation.

ELDER ABUSE DEFINITIONS

Elder abuse is any act, failure to act, or incitement to act done willfully, knowingly or recklessly though words or physical action which causes or could cause mental or physical injury or death to a nursing home resident. This includes verbal, sexual, mental/psychological, or physical elder abuse, including corporal punishment, involuntary seclusion, or any other actions within this definition.

Other definitions of elder abuse:

Involuntary seclusion: Separation of a resident from others or from his room against the resident’s will or the will of the resident’s legal representative. Temporary monitored separation from other residents will not be considered involuntary seclusion and may be permitted if used as a therapeutic intervention as determined by professional staff and consistent with the resident’s plan of care.

Mental/psychological elder abuse: Mistreatment within the definition of “abuse” not resulting in physical harm, including, but not limited to, humiliation, harassment, threats of punishment, deprivation, or intimidation.

Physical elder abuse: Physical action within the definition of “abuse,” including, but not limited to, hitting, slapping, pinching, and kicking. It also includes controlling behavior through corporal punishment.

Sexual elder abuse: Any touching or exposure of the anus, breast, or any part of the genitals of a resident without the voluntary, informed consent of the resident and with the intent to arouse or gratify the desire of any person and includes, but is not limited to, sexual harassment, sexual coercion, or sexual assault.

Verbal elder abuse: The use of any oral, written, or gestured language that includes disparaging or derogatory terms to a resident or within the resident’s hearing distance, regardless of the resident’s age, ability to comprehend, or disability.

SIGNS OF ELDERLY ABUSE IN NURSING HOMES

Some people are afraid of disclosing the experiences of elderly abuse in nursing homes for fear it will become worse or because they do not wish to cause worry. Nursing home residents are also often the victims of horrible elderly abuse because they may have physical or mental restrictions that leave them unable to communicate what is going on. For these reasons, it is important to notice if there are any visible signs of elderly abuse that your loved one might not be verbally communicating. Following, is a list of common elderly abuse signs. If you see any of the following signs of elderly abuse, they should be immediately investigated.

If you see any of these signs, they should be immediately investigated:

  • Unexplained bruises, cuts, burns, sprains, or fractures in various stages of healing
  • Bedsores or frozen joints
  • Unexplained venereal disease or genital infections; vaginal or anal bleeding; torn, stained, or bloody underclothing
  • Sudden changes in behavior
  • Staff refusing to allow visitors to see resident or delays in allowing visitors to see resident
  • Staff not allowing resident to be alone with visitor
  • Resident being kept in an over-medicated state
  • Loss of resident’s possessions
  • Sudden large withdrawals from bank accounts or changes in banking practices
  • Abrupt changes in will or other financial documents

In addition to these 10 warning signs, elderly abuse in nursing homes can occur on all different levels.

Mental Elderly Abuse

  • Fear, agitation, hesitance
  • Depressions, withdrawal
  • Sudden behavior changes
  • Unusual behavior patterns
  • Unwillingness to communicate
  • Disorientation, confusion
  • Unjustified isolation
  • Rude, humiliating, derogatory comments by staff
  • Specific complaints by residents

Physical Elderly Abuse

  • Wounds, cuts, abrasions, burns
  • Bruises, welts, swelling
  • Broken bones, sudden inexplicable weight loss
  • Unexplained/hidden injuries
  • Unwarranted restraints (either physical or chemical)
  • Specific complaints by residents

Elderly Abuse and Neglect

  • Bed sores (decubitus ulcers)
  • Unsanitary environment
  • Malnutrition, dehydration
  • Smells of urine and/or feces
  • Unkempt appearance
  • Poor personal hygiene
  • Untreated medical condition
  • Exploitation/financial abuse
  • Sudden, unjustified selling of property
  • Missing/stolen money or property
  • Radical changes in handling personal/financial affairs
  • Specific complaints by residents

NURSING HOME ABUSE STATISTICS

People put their elderly parents or grandparents in nursing homes so that they can be taken care of. Many people choose to live in nursing homes, as they want to alleviate their loneliness and have someone look after them in their old age. However, with the rise in nursing home abuse, these residents do not get the necessary care, but are in fact subjected to all kinds of nursing home abuse.

The National Center On Elder Abuse in the United States regularly collects data and information about nursing home residents and any instances of nursing home abuse. They scrutinize such data and then publish nursing home abuse statistics regarding abuse of the elderly in nursing homes and other care giving facilities in America.

According to these statistics, more than 30% of all nursing homes in America indulge in some form of resident abuse, with the numbers on an ever increasing trend. As per published statistics, more than 50% of all nursing homes are short staffed and do not have enough staff to help care for the residents. Due to this, the existing staff is often overburdened, which in turn leads to nursing home neglect and abuse.

The nursing home abuse statistics have caused much alarm in the minds of Americans who have their loved ones living in nursing homes. The published statistics are already high enough so as to cause concern, but add to that the fact that these statistics do not account for all nursing home abuse cases. The statistics show that only about 20% of nursing home abuse ever gets reported, and thus, the majority of instances do not even figure in nursing home abuse statistics.

Nursing home abuse statistics show that residents of nursing homes are not just abused by the staff at such facilities, but also by other residents and occupants. The statistics reveal that nursing home abuse consists of different forms of abuse such as, physical abuse, sexual abuse, psychological distress, malnutrition, financial exploitation, and neglect.

It is estimated that by 2007, the demand for beds in nursing homes will rise to such an extent that it will far outweigh the supply. With more and more elderly people going to live in nursing homes, the nursing home abuse statistics are expected to reach very alarming levels, much more so than what is currently prevalent.

Nursing home abuse has injured and killed many a nursing home occupant and has left several people and families in devastation and bereavement. The nursing home abuse statistics have finally forced people and the authorities to think on what can be done to reduce abuse in nursing homes and make them safer for the elderly.

Even with such distressing statistics on nursing home abuse, it still remains one area which is not getting its due consideration. With the low salary packets available to nursing home staff, and the high turnover rate of staff at nursing homes, the problem of abuse does not look like it is going to get any better. We, as Americans, probably need to brace ourselves for more shocking nursing home abuse statistics in the future.

If you or a loved one has been a victim of nursing home abuse, and has been reduced to a mere nursing home abuse statistic, you need to consult with an experienced and qualified attorney right away.

Under the law, nursing home residents have certain rights. If any of these rights have been violated, you can sue for legal damages and compensation.

If you or a loved one is in need of legal assistance, call Sluka & Minasian, LLC at (201) 798-6500 or submit an online questionnaire. The initial consultation is free of charge, and if we agree to handle your case, we will work on a contingency fee basis, which means we get paid for our services only if there is a monetary recovery of funds. In many cases, a lawsuit must be filed before an applicable expiration date, known as a statute of limitations. Please call right away to ensure that you do not waive your right to possible compensation.