Abuse and neglect in a nursing home can include assault, battery, sexual assault,
sexual battery, rape, unreasonable physical constraint, prolonged deprivation
of food and water, failure to give necessary medical care, use of physical
or chemical restraint or psychotropic medication for any purpose not
consistent with that authorized by physician, and many others.
Click
on the links below for a discussion on the three primary types of mistreatment:
Physical
Abuse
Mental / Emotional Abuse
Neglect
Physical
Abuse
Sadly, physical abuse
of senior citizens is not that uncommon. For their safety and protection,
we must understand the definition and signs of physical abuse. Physical
abuse is force that causes injury or pain. Striking, hitting,
beating, pushing, shoving, shaking, slapping, or kicking are considered
physical abuse. Abuse can also involve the inappropriate use of physical
restraints,which include tie–downs or straps. If restraints are
left in place too long, bruises may result. Freedom of movement becomes
limited, and over a period of time the use of restraints may result
in deconditioning and muscle atrophy.
Elders
should not be given drugs to restrain them, unless these medications
are necessary to treat their medical symptoms. Overmedicating a nursing
home resident with tranquilizing drugs for the convenience of the staff
is abusive. Employing psychotherapeutic or antipsychotic drugs for patient
discipline is abusive. If a nursing home or hospital patient is in severe
pain, providing inadequate pain medication may also constitute elder
abuse. Similarly, failing to administer prescribed drugs may be neglect
or physical abuse.
Mental/Emotional
Abuse
An elderly loved one can be harmed by words alone. Emotional
or psychological abuse is the infliction of pain or distress, usually
through insults, threats, intimidation, humiliation, or harassment.
If
emotional abuse in nursing homes is occurring,
the family members should
immediately notify the facility. The facility should amend the
situation at once, but if the emotional abuse
in the nursing home persists, the family
should take further action. The chances of the emotional abuse
in nursing homes occurring to just one resident
is very slim, so other residents
are probably suffering as well. Emotional abuse in nursing homes
can include humiliation, harassment, threat of
punishment, deprivation,
and intimidation, as well as other behaviors.
Neglect
Federal and State laws require that nursing homes develop a plan of
care and employ sufficient staffing to provide ALL the care listed on
the care plan. Because most corporate owned nursing homes today are
not sufficiently staffed, they cannot provide ALL the care listed on
the care plan. Consequently, residents are not taken to the toilet when
necessary, they are often left lying in urine and feces, develop painful
and life threatening pressure sores (decubitus ulcers), are not fed
properly, are not given sufficient fluids, are over-medicated or under-medicated,
are dropped causing painful bruises and fractures, are not cleaned or
groomed, are ignored and not included in activities, are left in bed
all day, are not turned, call lights not answered promptly or not at
all, etc., all forms of neglect.
Neglect
means the negligent failure of any person having the care or custody
of an elder or a dependent adult to exercise that degree of care which
a reasonable person in a like position would exercise.
Neglect
includes, but is not limited to:
- Failure
to assist in personal hygiene, or in the provision of
food, clothing,
or shelter;
- Failure
to provide medical care for physical and mental
health needs;
- Failure
to protect from health and safety hazards;
- Failure
to prevent malnutrition; and
- Failure
to prevent dehydration.
Click
on these links to read about a few common types of neglect:
Malnutrition
Dehydration
Bed Injuries
Pressure Ulcers
Falls & Fractures
Malnutrition
Nutritional well-being is an important part of successful aging. Improper
nutrition or malnutrition can lead to infections, confusion, and muscle
weakness resulting in immobility and falls, pressure ulcers, pneumonia,
and decreased immunity to bacteria and viruses. Malnutrition is costly,
lowers the quality of nursing home residents' lives, and is often avoidable.
Based on the nutritional assessment, the facility must take steps to
ensure that the resident maintains good nutritional health and must
provide residents with a well-balanced, palatable meal.
Many
things can cause malnutrition in nursing home residents. The following
are factors that may prevent a resident from receiving adequate amounts
of the vitamins, minerals, protein, and calories the resident needs:
Physical
Causes:
- Illness
- Adverse
drug effects such as nausea, vomiting, diarrhea, cognitive disturbances,
or sleepiness
- Food
and drug interactions which decrease the ability of the body to absorb
vitamins and minerals
- Depression
- Swallowing
disorders
- Mouth
problems such as tooth loss, dentures that do not fit properly, mouth
sores, and mouth pain
- Tremors,
which affect the residents' ability to feed themselves
Environmental
Causes:
- Inadequate attention
from staff for residents who need assistance eating
- Staff who are
uneducated about malnutrition and proper ways to feed residents who
need help
- Reliance on liquid
supplements
- Special diets
Signs That
A Resident is Malnourished:
Ask the following
questions to determine whether your loved one is demonstrating signs
of malnutrition:
- Do the
clothes fit more loosely than usual?
- Are there cracks
around the mouth?
- Do the
lips and mouth look pale?
- Has the resident
complained that his/her dentures no longer fit?
- Has the resident's
hair been thinning or growing more sparse?
- Do wounds seem
to take longer to heal?
- Does the resident
appear confused (not as a result of a disease such as Alzheimer's)?
- Is the resident's
skin breaking down?
- Does the resident's
eyes look sunken?
- Does the resident
appear to be losing weight?
Dehydration
Dehydration should be managed through an individualized daily
plan to promote adequate hydration based upon
identifying the risk factors, which
include:
- Alzheimer's,
or other dementia
- Major psychiatric
disorders
- Depression
- Stroke
- Repeated infections
- Diabetes
- Malnutrition
- Urinary incontinence
- History of dehydration
- 4 or more chronic
conditions
- Use of diuretics,
antidepressants, psychotropics, or anti-anxiety medications, laxatives,
or steroids
- Chronic cognitive
impairment
- Inadequate nutritional
status
- Acute situations:
vomiting, diarrhea and/or fevers
A facility may be
found guilty of neglect by either causing dehydration while the resident
is in their care, or failing to treat the problem of dehydration properly.
Bed
injuries
Between 1993 and 1996, there were 74 reports of death from strangulation
or suffocation involving hospital beds. The federal General Accounting
Office has concluded that many deaths go unreported.
Some siderails extend
the full length of the bed. Others, called half rails, are about 2-1/2
feet long. Some are metal, others plastic. Most can be raised or lowered.
Siderails are divided, either vertically or horizontally, with slats
spaced about six or more inches apart. This space can trap an elderly
person's head, causing him or her to strangle. A particularly thin,
frail person could potentially squeeze between the rails and fall to
the floor. Often mattresses fit loosely in the frame, leaving gaps large
enough to trap the resident between the mattress and siderail, also
leading to suffocation.
Pressure
ulcers
Pressure ulcers are also referred to as pressure sores, bedsores, and
decubitus ulcers. A pressure ulcer can range from a very mild pink coloration
to the skin which disappears in a few hours after the pressure is relieved,
to a very deep wound extending to and sometimes through a bone into
internal organs.
All pressure
ulcers have a course of injury similar to a burn
wound. This can be a mild
redness of the skin and/or blistering, such as a first degree
burn to a deep open wound with a lot of blackened
tissue in it, such as a third
or fourth degree burn.
The primary cause
of pressure ulcers is unrelieved pressure. It can also occur from friction
by rubbing against something such as a bed sheet, cast, brace, etc.
or from prolonged exposure to cold. Any area of tissue that lies just
over a bone is more likely to form a pressure ulcer. These areas include
the spine, coccyx or "tailbone", hips, heels, and elbows.
Other contributing factors to the development of pressure ulcers are
poor nutrition, weight loss, diabetes, poor hygiene, and dehydration.
The development
of pressure ulcers may be an indication of potential problems in the
care being delivered to the nursing home resident. Even in good nursing
homes, small wounds may develop, but with quick attention, these wounds
will heal and not progress to massive wounds. According to federal law,
in most situations there is no medically valid reason for a pressure
ulcer to progress to a Stage IV situation (a massive deep open wound).
Falls and
fractures
Falls are the most frequent causes of fractures in the elderly.
Nursing home residents are at increased risk for falls, primarily
due to advanced
age of the population. There are many other factors which place
individuals at risk for falls. Nursing home personnel are regularly
required to
assess patients to determine their risk for falling, and provide
safety devices and services to minimize the risk of injury to
the resident.
When nursing home staff members are negligent, these risks are
ignored and residents sustain physical injury as a result. Some
of the risk
factors for falls include:
- Previous falls
- Cardiac arrhythmias
- Stroke
- Central nervous
system disorders such as Alzheimer's disease, Parkinson's disease,
dementia and others
- Problems with
mobility and gait
- Low blood pressure
(orthostatic hypotension) on standing up
- Bowel or bladder
incontinence
- Dizziness
- Dehydration
- Visual impairment
- Use of restraints
- Medications
If
you suspect a loved one may be the victim of physical abuse, mental
abuse, or negligence while living in a nursing home, you need a strong
legal force to help you uncover the truth. Find out what you can do
if a loved one may be in danger.
Types of Nursing Home Abuse Injuries