COVID-19 Update: How We Are Serving and Protecting Our Clients

Articles Tagged with Nursing Home Abuse

In a cohort already among society’s most vulnerable to abuse and neglect, disabled patients in nursing homes and assisted living facilities are even more susceptible to harm.

It is a problem that is hidden in plain sight, causing further grief to victims’ families, abetted by a lack of public awareness and sustained interest. A simple Google search on the abuse of disabled patients in nursing homes turns up few studies or widespread media attention.

Anyone who cannot carry out life functions for themselves is dependent on others, and thus in a position of vulnerability. A broad collection of long-term care residents could qualify as “disabled,” and many more will become so as they age. According to one study, some 68% of nursing home residents have a lifetime probability of becoming physically or cognitively impaired in at least two activities of daily living. These patients may suffer increased physical ailments or develop cognitive diseases such as dementia.

Patients or their loved ones understandably devote a generous amount of time to researching long-term care facilities before making a choice. Though some of the most objective facility performance information can be found from sources like the Centers for Medicare and Medicaid Services, it wasn’t long ago they acknowledged that not all of their data could be taken at face value.

Last summer, a CMS study revealed nursing homes all over the country under-reported cases of neglect and abuse at their facilities. The figures were staggering. In 2016, more than 6,000 high-risk cases that qualified as abuse or neglect were not properly reported, or about 18% of cases where a resident was both hurt under suspicious circumstances and hurt badly enough, they required emergency room treatment. The examples ran the gamut from careless, head-scratching neglect – a 65-year old’s “accidental” opioid poisoning due to a mix-up of patient records – to outright abuse – an incident caught on tape where a nursing home employee purposely smacked a resident in the back of the head while walking through the dining room.

Many people in the Mid-South will remember a nursing home in Memphis where one resident was so neglected, he had maggots eating away at open wounds, and another’s deteriorating physical condition due to cancer was left unreported to her medical team until it was ultimately too late to save her.

Nursing home residents are among the most vulnerable members of our communities and the most susceptible to illnesses like COVID-19. While these residents comprise just 1.2% of our country’s population, recent reporting shows they account for approximately 40% of COVID-19 deaths. The danger that poor infection control practices in nursing homes presents to tens of thousands of our fellow citizens is nothing new.

In an analysis from the Centers for Medicare and Medicaid Services (CMS), 82% of nursing homes across the country were cited for infection control problems between 2013 and 2017. Half were repeat offenders. Lack of consistent handwashing and infrequent disinfection of common areas were chief culprits. Such failures allowed illness like seasonal flu to sweep across numerous facilities. The statistics on COVID-19 infection and death rates in nursing homes illustrate the dangers to residents created by poor infection control practices.

Traditionally, there are three avenues of protection from harm for nursing home residents – (1) state level inspections and regulation required by CMS, (2) visits by family members and (3) civil liability in cases of neglect, resulting in injury and/or death. Each of these layers of protection have significantly eroded in recent months.

Nursing home residents tend to be frailer, have more functional limitations, and have more chronic and complex conditions than the general adult population. According to the Centers for Disease Control and Prevention, older adults and people who have severe underlying medical conditions, like heart or lung disease or diabetes, are likely to develop more serious complications from the novel coronavirus, or COVID-19. This fact puts nursing home residents at the highest risk for serious illness as a result of exposure, but it’s not the only risk.

Most nursing home residents require assistance with one or more activities of daily living, such as turning and repositioning, getting in and out of bed, using the toilet, bathing, feeding, incontinent care and more. In order to adequately provide these services, nursing homes must be sufficiently staffed. Unfortunately, inadequate staffing is one of the biggest problems associated with nursing homes. When attention/care is not sufficiently provided, there is often a rapid decline in residents’ health due to pressure sores, weight loss, infections and increased numbers of falls.

Federal and state regulations require that infection prevention, surveillance and management be part of new staff orientation and ongoing quality assurance and improvement efforts at nursing homes. However, infections are one of the leading adverse events that occur in these facilities, and a lack of infection control in long-term care settings has existed for years.

A systematic review conducted by the International Journal of Geriatric Psychiatry concluded that older adults living in long-term care facilities are at a higher risk of anxiety disorders than adults living in the community at large. It was estimated that anywhere from 3.2 percent to 20 percent of individuals in long-term care settings suffer from anxiety, compared with 1.4 percent to 17 percent living in the general community.

If you currently have a loved one living in a nursing home or other skilled facility, these statistics can be alarming. Fortunately, there are effective medications on the market that, when combined with therapy or other psychological support, can have profound effects for those suffering.

In order to treat anxiety, it is first necessary to identify the symptoms. Recognizing anxiety in older adults at times can be difficult, as some symptoms, such as avoidance, may be misconstrued as declining health or limited mobility. Other health complications, such as memory loss or an inability to speak clearly, may make it difficult for individuals to verbalize symptoms. However, knowing what to look for can help.

At Jehl Law Group, it is not uncommon for us to hear a client mention how his or her loved one is underweight, is not properly fed and is enduring the effects of malnutrition and dehydration in nursing homes. Sadly, our clients are not alone.

According to a study supported by The Commonwealth Fund, nearly one third of all 1.6 million nursing home residents suffer from malnutrition or dehydration. Moreover, it was found that roughly 85% of nursing home residents are malnourished, and 30% to 50% are underweight.

To suggest malnutrition and dehydration are minor problems is an understatement. One of the best ways to recognize malnutrition and dehydration in nursing homes is to know the signs and make dietary changes accordingly.
A 2016 Harvard University study found that nursing homes across America have been changing ownership at an alarming rate. On average, 1,500 nursing facilities were sold to a different corporation per year between 1993 and 2010. While change of ownership is not believed to directly cause turmoil and poor care, the study concluded that many nursing homes that already have a history of deficiencies and violations are more likely to be sold and rebranded.

David Grabowski, lead researcher and health care policy professor at Harvard Medical School, pointed out that nursing homes with a history of consistent, uniform ownership typically have fewer citations from inspectors, unlike their lower-quality counterparts, which more often have mergers, acquisitions or changes of ownership on their record.

More often than not, corporate chains are involved in the acquisition of failing health care facilities.

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