Nursing Homes

Millions of individuals each year consider placing a loved one in a facility where their living needs and medical provisions can be met. Placing a loved one into an assisted living facility or nursing home can be a difficult and heart-wrenching decision. Unfortunately, the quality of care rendered in nursing homes across the country at times does not meet the standards of the individuals who are seeking its care or the individuals who placed their loved ones with the facility.

A number of governmental studies confirm that there is an epidemic of pain and suffering in our nation’s nursing homes. A special report prepared for a U.S. House of Representatives Committee on Government Reform concluded that there was institutionalized neglect and abuse occurring in too many nursing homes.[1]

Meritorious nursing home lawsuits serve as valuable tools for policing a nursing home industry rife with instances of negligence, malpractice, neglect and abuse.

Elder abuse comes in many forms. While some the more common forms of abuse result in:

Bedsores

Bedsores — also called pressure sores or pressure ulcers — are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. People most at risk of bedsores are those with a medical condition that limits their ability to change positions, requires them to use a wheelchair or confines them to a bed for a long time.

Bedsores are caused by pressure against the skin that limits blood flow to the skin and nearby tissues. Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores.

Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, defines each stage as follows:

Stage I

The beginning stage of a pressure sore has the following characteristics:

 The skin is not broken.

The skin appears red on people with lighter skin color, and the skin doesn’t briefly lighten (blanch) when touched.

On people with darker skin, the skin may show discoloration, and it doesn’t blanch when touched.

The site may be tender, painful, firm, soft, warm or cool compared with the surrounding skin.

 Stage II

At stage II:

 The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.

The wound may be shallow and pinkish or red.

The wound may look like a fluid-filled blister or a ruptured blister.

 Stage III

At stage III, the ulcer is a deep wound:

 The loss of skin usually exposes some fat.

The ulcer looks crater-like.

The bottom of the wound may have some yellowish dead tissue.

The damage may extend beyond the primary wound below layers of healthy skin.

Stage IV

A stage IV ulcer shows large-scale loss of tissue:

 The wound may expose muscle, bone or tendons.

The bottom of the wound likely contains dead tissue that’s yellowish or dark and crusty.

The damage often extends beyond the primary wound below layers of healthy skin.*

* Information taken from Mayo Clinic website

Unexplained Bruises and Cuts

Nursing home residents rely upon staff members to help them with the activities of daily living. Due to physical restrictions, it is often difficult for residents to move around on their own, feed themselves, use the bathroom or bathe without some level of assistance. However, many nursing homes are understaffed, and as a result, even the most caring nursing home workers have trouble attending to all of the residents who are under their care. When staff is stretched thin and cannot provide the appropriate level of care, it is more likely that accidents will happen and residents will suffer injuries.

When residents suffer life-altering or severe injuries due to nursing home negligence or abuse, families may seek justice to hold wrongdoers accountable. Nursing home lawsuits not only help victims seek compensation for the harms caused to them, they also send a message to facilities that abuse and neglect will not go unnoticed.

Prescription Errors

Medication errors pose serious risks to nursing home residents, many of whom already face compromised health conditions and require a number of prescription medications. These errors often occur when a nursing home does not employ enough properly trained and supervised staff to correctly administer medications to the residents under their care. When a resident suffers serious injuries, deterioration in his or her medical condition, or death as a result of a medication error, families have the right to take action to seek compensation and hold wrongdoers accountable.

The misappropriation of prescription medications is a frequent and serious problem in nursing homes.

Residents Wandering and Leaving the Facility

Nursing homes are required to provide each resident with the appropriate level of supervision to address elopement and wandering behaviors. If a resident has a tendency to wander or has tried to leave the nursing home on his or her own, the nursing homes must recognize these behaviors and implement a care plan with measures to prevent the resident from leaving or wandering.

When long-term care residents are not properly supervised and allowed to move about or away from a facility on their own, they are at risk for suffering serious injuries and even death. Nursing home elopement and wandering are related concepts, and in most cases are a result of poor supervision by staff.

When nursing home staff members fail to implement measures to address wandering or elopement behaviors, residents are at a higher risk for falls, exposure to harsh weather conditions, and other significant dangers.

Restraint Injuries

Nursing homes sometimes use restraints to control residents who are disruptive, have a history of falls, or who have mobility, cognitive or functional disabilities that make them need frequent assistance or supervision. Using restraints for these purposes is an improper and unlawful practice.

The Federal Nursing Home Reform Law of 1987 says nursing home residents have the right to be free from physical or chemical restraints imposed for purposes of discipline or convenience, or that are otherwise not required to treat the resident’s medical symptoms.

In some situations, nursing home patients may be properly restrained to ensure that they do not hurt themselves or others. However, nursing home residents should not be subject to physical, chemical (drugs) or psychological restraints as punishment or for the staff’s convenience.

If you recognize the signs of a nursing home resident having been restrained, you should ask staff and/or management why such measures are necessary and what options have been tried other than restraints. You should also consult a nursing home neglect and abuse attorney about your loved one’s rights and the possibility that he or she is being subjected to unlawful abuse.

Malnutrition and Dehydration

There are a variety of factors which can lead to malnutrition. Depression, an increasing problem among the elderly, is a potential cause of malnutrition because individuals suffering from depression have a tendency to eat less and in turn to do not receive appropriate vitamins and minerals to prevent malnutrition.  Other causes of malnutrition include difficulty swallowing and adverse drug effects such as vomiting and diarrhea. Nursing homes often fail to take steps to prevent malnutrition by not monitoring resident food intake and output, not providing a comfortable environment to promote eating and not providing food that is appetizing.

The elderly have less water content in their bodies than younger adults and a decreased thirst response which, among other factors, puts them at risk for dehydration.  Increasing fluid intake in the elderly is important and relatively simple. The nursing home should monitor the resident’s fluid intake and ensure that the resident drinks at least six cups of fluid each day.

Maintaining appropriate nutritional and hydrational status is important in the nursing home setting.  Residents who do not receive adequate nutrition and hydration in their diets are more at risk for the development of pressure ulcers, infection, muscle weakness leading to immobility and falls and poor nutrition and hydration make it more difficult for existing pressure ulcers and infections to heal.

Fall Accidents

When nursing homes fail to implement proper precautions to address a resident’s risk for falls, and the resident is injured, family members should take action. Although some falls are unavoidable, oftentimes falls in nursing homes are a sign of nursing home negligence.  When staff cannot properly supervise monitor residents, fall related injuries are more likely to occur.

Nursing home falls are common because residents are typically older and have difficulty walking due to muscle and bone density loss, medication side effects, poor vision and gait problems. However, nursing home falls are often preventable if employees take the proper steps to supervise and protect residents under their care. According to the Centers for Disease Control and Prevention, 1,800 nursing home residents die from fall related injuries every year, and those who survive often suffer debilitating injuries from which they never fully recover.

Nursing home staff plays an important role in protecting the safety of residents as they move about the facility. When a patient is admitted into a nursing home, staff must assess his or her risks for falls and identify and implement interventions to address these risks.  Reassessments should occur after any fall or change in medical condition. Residents at risk should be monitored closely and receive assistance with transfers to prevent them from falling. Bed rails, non-skid footwear, appropriate arm chair with wheels locked at bedside, walkers and canes can be used to help prevent falls.

Nursing Home Regulations

In order to receive Medicare and Medicaid funding, 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).

Under the regulations, the nursing home must:

• Promote each resident’s quality of life. (42 CFR § 483.15)
• Maintain dignity and respect of each resident. (42 CFR § 483.15)
• Conduct initially a comprehensive and accurate assessment of each resident’s functional capacity. (42 CFR § 483.20)
• Develop a comprehensive care plan for each resident. (42 CFR § 483.20)
• Prevent the deterioration of a resident’s ability to bathe, dress, groom, transfer and ambulate, toilet, eat and to communicate. (42 CFR § 483.25)
• Provide, if a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming and personal oral hygiene. (42 CFR § 483.25)
• Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities. (42 CFR § 483.25)
• Ensure that residents do not develop pressure sores and, if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. (42 CFR § 483.25)
• Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible. (42 CFR § 483.25)
• Maintain acceptable parameters of nutritional status. (42 CFR § 483.25)
• Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (42 CFR § 483.25)
• Provide each resident with sufficient fluid intake to maintain proper hydration and health. (42 CFR § 483.25)
• Ensure that residents are free of any significant medication errors. (42 CFR § 483.25)
• Have sufficient nursing staff. (42 CFR § 483.30)
• Ensure that the resident has the right to choose activities, schedules and health care. (42 CFR § 483.40)
• Provide pharmaceutical services to meet the needs of each resident. (42 CFR § 483.60)
• Be administered in a manner that enables it [the nursing home] to use its resources effectively and efficiently. (42 CFR § 483.75)
• Maintain accurate, complete, and easily accessible clinical records on each resident. (42 CFR § 483.75)

In order to protect individuals that are in nursing home, Congress enacted the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987), also known as the Nursing Home Reform Act, setting forth certain requirements for quality of care. These regulations(hyper link to section below) demand that a nursing home that receives Medicare and Medicaid funding “must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care…” States may pass even stricter standards if they choose.

Datsopoulos MacDonald & Lind has vast experience handling nursing home incidents and getting results for our clients. If you believe that a loved one may be the victim of nursing home neglect or abuse you should take action quickly and contact us online or call us at 406-728-0810 to set up a free consultation with an experienced injury lawyer.

[1] H. Comm. on Governmental Reform, Minority Staff Report, Abuse of Residents Is a Major Problem in U.S. Nursing Homes 1 (2001).