Nursing Home Abuse and Neglect

Nursing home neglect and abuse is a national disgrace. In fact, this is a widespread -- and increasing -- problem in the United States. An analysis of the death certificates of persons who died in California nursing homes between 1986 and 1993 revealed that over 7%, or 1 in 15, of the deaths of seniors in nursing homes, resulted at least in part, to utter neglect, lack of food or water, untreated bedsores, or other generally preventable ailments. Since that study, this nation's nursing home population has risen sharply. If the 1.6 million Americans now in nursing homes are dying of questionable causes at the same rate, then every year about 35,000 elderly citizens die prematurely or in unnecessary pain, or both. According to a survey published in the Journal of the American Geriatrics Society, 30% of those polled said they would rather perish than live in a nursing home.

The U.S. Congress and state legislatures have taken steps to make nursing homes accountable. The federal Nursing Home Reform Act states that a nursing home must provide "services and activities to attain or maintain the highest practicable physical, mental, and psycho-social well-being of each resident in accordance with a written plan of care." However, you still need to be alert to your own loved one's needs, and if necessary, demand that the nursing home respect all of his or her legal rights. Listed below are examples of positive steps you can take to prevent problems and ensure proper treatment in a nursing home for your relative or friend.

Signs of Nursing Home Abuse

It is important to watch for signs that your loved one may be a victim of abuse or neglect. Most nursing home residents must depend on the staff for most or all of their daily needs, including food, water, medicine, toileting, grooming, stimulation and turning.

Although most facilities provide good care, some cause needless suffering and death. Sadly, many nursing home residents are starved, dehydrated, over-medicated, and suffer painful pressure sores. In addition, they may be isolated, ignored, and deprived of social contact and stimulation.

The following is a list of some forms of nursing home abuse:

-Assault and battery
-Sexual assault and battery
-Rape
-Unreasonable physical constraint
-Prolonged deprivation of food or water
-Use of physical restraints, like straps or bels
-Use of chemical restraints, like sedatives or
sleeping medications
-Use of psychotropic or other medications for any purpose not authorized by a physician
-Excessive dosages of medication
-Withholding needed medication
-Confinement to a room or fixed location

Nursing home abuse victimizes the most vulnerable individuals. Although many residents can report mistreatment, some cannot even describe what happened. If your relative or friend is a nursing home resident, you can help by watching out for signs of abuse, including:

-Unexplained injuries
-Inability of nursing home staff to give an adequate explanation of a resident's condition
-Open wounds, cuts, bruises, welts, or bedsores
-Slapping, pushing, shaking or beating
-Non-verbal signs from the nursing home resident that something is wrong, such as:
-Unusual emotional outbursts or agitation
-Extreme withdrawal or lack of communication
-Unusual behavior, like sucking, biting, rocking, etc.
Humiliating, insulting, frightening, threatening or ignoring behavior towards family and friends
Desire to be isolated from other people

Signs of Nursing Home Neglect

Neglect means the negligent failure by any person with care or custody of an elderly or a dependent adult to exercise that degree of care that a reasonable person in a similar position would exercise.

Neglect includes, but is not limited to:


-Failure to provide food, clothing, shelter, or help with personal hygiene
-Failure to provide medical care for physical and mental health needs
-Failure to protect from health and safety hazards
-Failure to prevent malnutrition or dehydration
-Failure to provide the necessities of daily living
-Failure to prevent bed sores
-Failure to provide sanitary conditions
-Failure to prevent infections

Specific Examples of Common Nursing Home Abuse or Neglect Injuries

Bedsores

Bedsores are also known as pressure ulcers, pressure sores, and decubitus ulcers. The primary cause of bedsores is unrelieved pressure to a particular part of the body. They also may result from friction, like rubbing against something like a bed sheet, cast, brace, etc., or from prolonged exposure to cold.

Any area of skin tissue directly over a bone is a potential site for a bedsore. These areas include the spine, coccyx or "tailbone," hips, heels, and elbows. The factors that contribute to formation of a bedsore include poor nutrition, poor hygiene, weight loss, diabetes, and dehydration. The least serious kind of bedsore looks like skin discoloration, and may disappear within a few hours after relieving pressure on that area. However, more severe bedsores are profound wounds, which can extend through skin tissue into internal organs or bones.

Medical professionals have identified similarities between bedsores and burns. Like a first-degree burn, a mild bedsore may involve mild redness of the skin and/or blisters. A third-degree or fourth-degree burn, or severe bedsore, may have a deep open wound with a lot of blackened tissue, which is called "eschar." The primary treatment for bedsores starts with removing all pressure from the affected area, to prevent further tissue decay and promote healing. The victim must be turned or repositioned frequently and get enriched nutrition. The affected area must be kept clean, and dead or necrotic tissue should be removed to minimize the risk of infection. The worst bedsores often require a surgical procedure, known as debridement of dead tissue.

If you suspect that a relative or friend is suffering from a bedsore, you need to get immediate medical attention for that individual. In addition, help your loved one get legal assistance. Very frequently, severe bedsores result from abuse and neglect. Federal regulations confirm that there rarely is a valid medical reason for a bedsore to develop into a massive deep wound, which is known as the stage 4 level.

Suffocation and Strangulation

A frail nursing home resident can suffocate or strangle to death in a hospital bed, if ignored or neglected by nursing home staff. Between 1993 and 1996, there were 74 of these cases reported, and probably many more went unreported.

The design of the side rails on a nursing home bed may contribute to the danger. Often side rails have slats that are spaced six or more inches apart. That space may trap an elderly person's head, causing him or her to strangle, or allow a thin individual to squeeze between the rails and fall to the floor. If the mattress on a nursing home bed does not fit properly in the bed frame, a patient may be trapped and strangle in a gap between the mattress and side-rails.

Broken Bones or Fractures

For the elderly, falling is the most frequent cause of fractures. Nursing home staff must regularly evaluate each patient; determine his or her risk for falling, and provide safety devices and services that each individual needs to minimize the risk of injury. Some of the risk factors for harmful falls include:

-Previous falls
-Cardiac arrhythmias (irregular heartbeat)
-Stroke
-Central nervous system disorders, such as Alzheimer's disease, Parkinson's disease, or dementia
-Problems with mobility and gait
-Low blood pressure (orthostatic hypotension) when trying to stand up
-Bowel or bladder incontinence
-Dizziness
-Dehydration
-Visual impairment (i.e. macular degeneration, cataracts, etc.)
-Use of restraints
-Medication side effects
-Slipping or tripping hazards, like torn or loose rugs or mats

The Cost of Nursing Home Abuse or Neglect

The cost can be quite high for the treatment of a victim of nursing home abuse or neglect. Often the resulting injuries are permanent, and may require hospitalization or a higher level of medical treatment and nursing care than your loved one previously needed. This can be an extreme hardship for the victim and his or her family. If the injuries are the fault of a nursing home, then it should have insurance to pay for those substantial bills, other expenses, and damages for pain and suffering. Proving a nursing home abuse or neglect case is a complex process. To succeed, you need a lawyer who is well versed in the complicated laws that govern these legal actions.

Attorney Marya Sieminski joined the Law Offices of Sam Bernstein in 2003. She is admitted to practice law in Michigan state courts and in the U.S. District Court for the Eastern District of Michigan. She earned her Bachelor of Science degree at the Massachusetts Institute of Technology and graduated magna cum laude from Wayne State University Law School. Marya has worked as a trial lawyer for 10 years and exclusively represented victims in personal injury litigation and in workers compensation claims. She also was appointed by the Governor to serve on the State of Michigan Workers Compensation Qualifications Advisory Committee.

The Law Offices of Samuel I. Bernstein, our Michigan personal injury and nursing home abuse law firm, has championed the cause of seriously injured victims for three generations.