There are more senior citizens in nursing homes than ever before. In large part, this is due to the Baby Boomer generation, some of whom have reached nursing home age, with many more to follow in the coming years. In addition, we live in a highly mobile society, where seniors in nursing homes don’t necessarily have family members who live nearby. These two factors raise the specter of the possible abuse or neglect of nursing home residents.
There is a difference between elder abuse and neglect. While both are undesirable, it’s important to know the difference between the two. Abuse in a nursing home occurs when a senior citizen is harmed or is placed in at risk, and where serious harm or injury could occur. This can happen at the hands of a doctor, nurse, or nursing aide. Whether intentional or not, it is never justifiable and could even result in a lawsuit, or worse, death. What compounds abuse is that nursing home residents are often weak and/or ill, making them easier targets who are less able to defend themselves. Abuse is often―though not always―active, in that it occurs as the result of an act that could be harmful. Neglect tends to be considered passive, partly because it can occur just by doing nothing.
Neglect can occur when staff do nothing, not enough, or when they are overworked and understaffed. Neglect can be intentional or innocent, but it is still harmful because it means that necessary services are not given to patients who need them. This can result in a senior citizen who develops painful bedsores from being in one position for too long because there were not enough nursing assistants to go around, perhaps because three called in sick that day. On the other hand, if a nursing home employee with bad intentions deliberately sets out to cause neglect or abuse, the population of nursing home residents are generally vulnerable, since it is easy prey for those who might have something other than high quality care in mind.
Types of Nursing Home Abuse
There is more than one type of abuse that can occur in a setting such as a nursing home, where the elderly are dependent on others to supply many of their basic needs. Among these are emotional abuse, sexual abuse, financial mismanagement or outright theft of belongings. Most of these are not immediately obvious, which delays treatment, remediation, or the removal of employees who do not belong in the nursing home setting.
Emotional abuse consists of derision, belittling, or isolation, all of which can change how an individual feels about himself, even to the point of feeling responsible for causing those feelings. Sexual abuse may not be immediately apparent, as there may be no physical signs to see, and the senior citizen may not be able to explain what happened, either from shame or inability to communicate. Financial mismanagement may occur from manipulation of nursing home records, which could include a sudden increase in expenses, or the outright theft of money or belongings. Theft of belongings can even include the removal of rings directly from a resident’s fingers.
The scenarios described above certainly warrant concern on the part of family members, and no one wants to envision anything but the best of care for their elderly family members. So how does a son or daughter living multiple states away ascertain whether a parent is receiving the good care that was promised at the outset of the nursing care arrangement? Unfortunately, this can be very hard to determine, for the typically weaker and more susceptible nursing home resident may not be able to report it credibly. Nevertheless, it is still important to know the warning signs of abuse and neglect.
Signs of Nursing Home Neglect
Some of the signs to be aware of are increased incidences of bruises or broken bones, and more trips to the infirmary for medical care or even to the hospital emergency room. Possible signs of sexual abuse include unexplained bleeding and complaints of pain without an event they can be traced to.
Signs of neglect are easier to spot. They include deteriorating hygiene, soiled bedding, evidence of malnourishment and dirty or missing clothing. The appearance of bedsores is a prominent red flag that should be investigated right away.
Emotional abuse is more difficult to spot and sort out, but some indicators are fearful behavior, mood swings, fear of specific members of the nursing home staff, and general withdrawal from those who were previously trusted―including family members. This can be complicated by the fact that many among the nursing home population also suffer from mental conditions, which can make a convenient scapegoat for altered behavior that is actually due to emotional abuse.
Nursing Home Patient Rights
What are the rights of seniors in nursing homes? They are legally entitled to be free from the following types of abuse: physical, verbal, mental and sexual. In addition, physical or chemical restraints may not be used for the purpose of punishment or the convenience of staff. There are times when restraints are allowable, but that is only when it is required for the treatment of a medical condition and/or for the safety of the patient, staff, or other residents.
Unfortunately, neglect and abuse of the elderly in nursing homes is not an isolated instance that occasionally occurs here or there. According to the U.S. Department of Justice, greater than 11 percent of senior citizens suffer from some type of abuse or neglect annually. Put another way, more than four million senior citizens suffer some form of abuse or neglect in the U.S. every year. Worst of all, up to 70 percent of nursing home abuse cases go unreported.
What to do if you suspect abuse or neglect
If you suspect abuse or neglect, you have some options to use to get the situation corrected. First, your decision will depend on the facts of the specific case. Sometimes the proper step to take is speaking with the nursing home administrators. This may be enough to correct the problem. You should also know whether the facility is accredited by a standard of care body, such as the Joint Commission, which certifies hospitals and other healthcare organizations. If so, you may contact that organization if your concern is not addressed to your satisfaction.
However, if you are aware of a situation that has just occurred, is urgent and involves injury, calling 911 for outside help is an appropriate response. If an injury has happened, proper help will be given outside the nursing home setting. This could include bringing in local adult protective services, which would be the legal duty of the doctors and emergency team that are involved. This is also an option for you when a situation is not necessarily urgent, but you suspect that abuse or neglect is taking place. This is definitely a time when being safe rather than sorry is the applicable rule.
Another option is filing a civil suit. Even if your case is in the hands of local law enforcement officials, you may still proceed with a civil claim against the facility and people responsible for the abuse. This is true whether or not the state eventually pursues criminal charges. A civil suit allows the victim to request damages for the abuse or neglect suffered. Interestingly, the standard of proof required in a civil case is significantly lower than in a criminal case. This means that it is easier to hold the abusers accountable for their actions than in the criminal justice system. If in the worst case, abuse or neglect leads to death, proceeding with a civil suit helps expose facilities and people whose behavior resulted in deadly harm.
Ultimately, it is important to know that the nursing home facility is responsible for the care of its residents, even if abuse or neglect is perpetrated by an individual. The facility and the company that owns it are responsible for setting the working conditions that lead to good care, or its opposite. Sometimes something as seemingly removed as a budget is at the heart of less-than-proper care. The size or alteration of a budget can easily dictate decisions about policies, staffing, background checks and other conditions that can jeopardize the well-being of the residents in the nursing home’s care.
Why does abuse and neglect occur in the nursing home setting in the first place? The answer is complicated, but a large percentage of blame can be placed on the fact that many facilities are understaffed. A shocking 54 percent of all U.S. nursing homes are understaffed, according to a congressional subcommittee report. This leads, of course, to the question of why this situation exists. There are nursing homes that inexplicably fail to train staff properly (which could be the result of budget constraints). Lack of training, in addition to the fact that staff are overworked and the work often requires strenuous physical labor, leads to high turnover. The hiring of new workers can involve inadequate screening, which can bring unsuitable individuals into contact with nursing home residents, thus allowing abuse to proliferate. When a facility is understaffed, workers are spread too thin, and even those with the best of intentions can’t be everywhere at once. Again, due to the nature of the frailty of the nursing home population, that vulnerability, combined with overworked staff, can lead to unfortunate and unforeseen results.
The best way to ensure the proper care of your loved ones in long-term care facilities is to research the facility well before making a commitment to it. This should include talking to residents and even their family members, if possible. After your family member becomes a resident, staying in frequent contact, if at all possible, is another good way to get to know the staff and be aware of the level of care administered to residents. Staying informed and asking questions lets the administration and staff know that you are seriously involved in the care of your loved one, and can help prevent him or her from becoming a statistic of less-than-desirable care in a nursing home.