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Nursing Home Neglect / Abuse

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Bed Sores

How Bed Sores Develop

Most Common Areas

Risk Factors

Bed Sores and Neglect

Dehydration

The Elderly are much more prone to Dehydration that the rest of us

The Signs and Symptoms of Dehydration

Malnutrition

Falls are a Serious Hazard in Nursing Homes

Abuse

The symptoms of physical abuse are numerous. Some telltale signs include

 

Finding good nursing home facilities is difficult. Many of them are understaffed with underpaid employees in order to make them more profitable for the owners. Due to the low pay and undesirable working conditions, there is very high turnover among the employees, so the training and experience they do have is often lost. This can cause serious problems for your parents or loved ones, and legal action is an option you should consider when this occurs. Inadequate nursing home care can, and often does, result in:

  • Bed Sores
  • Dehydration
  • Malnutrition
  • Falls
  • Physical/Mental/Sexual Abuse

 

Bed Sores  - Also called "decubitus ulcers" or pressure ulcers", are one of the most common problems with patients who are bedridden, confined to wheelchairs,  or who have difficulty moving by themselves, unless they are "repositioned" every so often by nursing home staff, optimally every hour.

How Bed Sores Develop

Bed sores develop when skin is squeezed between bone and any surface for a long period of time.  This surface can be a mattress, a chair or wheelchair, or even other parts of the body.  The soft tissues of the body, such as skin and muscle, depend upon blood vessels to carry nutrition to these tissues, and to remove waste products.  Bed sores result when this pressure prevents sufficient blood flow to supply this soft tissue with nutrients.  The resulting bed sore represents the death of the involved soft tissue. 

Bed sores can result from one period of sustained pressure; however, most bed sores probably result from repeated periods of blood flow being interrupted without leaving enough time for recovery in between.  In fact, low pressure for long periods of time is believed to be more likely to produce bed sores than higher pressure for a shorter time.

Most Common Areas

It is important to note that bed sores do not always result from being in bed as the name would imply.  Some of the most severe bed sores can also result from sitting for long periods of time. Thus, the location of the bed sores can depend upon the position of the patient.  For individuals who are bed-bound, the sores are most likely to form on or around the heels, the hip-bone, and the lower back or tailbone.  These ulcers may also develop in a variety of other areas, including the spine, ankles, knees shoulders, and head, depending upon the position of the patient. 

Risk Factors

Pressure sores are more likely to develop persons who are at higher risk due to one or more risk factors.  A number of risk factors have been identified which put individuals at higher risk.  Once a person is identified as being at increased risk for pressure sores, measures should be undertaken to reduce or eliminate those risks.  Because of this, nursing home staff should be aware of these risk factors when caring for patients in order to prevent the unnecessary development of pressure sores.  While risk factors may vary depending upon the particular circumstances, the following represents a list of the most common:

  1. Confinement to bed, chair, or wheelchair.   Persons confined to beds, chairs, or wheelchairs who are unable to move themselves, can develop pressure-induced injuries in as little as 1-2 hours if the pressure is not relieved;
  2. Inability to change positions without help.  (Eg., an individual in a coma, who is paralyzed, or recovering from a hip fracture or other mobility limitation.)  
  3. Loss of bowel or bladder control.  Sources of moisture on the skin from urine, stool, or perspiration can irritate the skin.
  4. Poor nutrition and/or dehydration.  Bed sores are more likely to form when the skin is not properly nourished.
  5. Decreased mental awareness.  An individual with decreased mental awareness may not have the level of sensory perception or ability to act to prevent the development of pressure-induced injury.  The lack of mental awareness may arise from medications.

Bed Sores and Neglect

Most pressure sores can be prevented, and those which have formed need not necessarily get worse.  Each resident's individual circumstances must be taken into consideration by the caregiver in order to develop a plan of care which will best assure the patient will not unnecessarily suffer from a pressure sore.  The following generally represent some of the precautions which health care providers should, but too often fail to undertake:

  1. An appropriate and thorough and systematic assessment must be made of the patient's risk for developing a pressure sore;
  2. Appropriate periodic reassessment should be made of the patient's risk;
  3. The patient should be bathed appropriately;
  4. The patient's incontinence should be assessed and treated to assure that moisture on the skin does not contribute to the development of a pressure sore;
  5. Appropriate nutrition and hydration must be maintained;
  6. Repositioning of the patient should occur with a frequency to assure that the pressure is adequately relieved;
  7. Use of appropriate support devices should be maintained to relieve pressure from troublesome areas;
  8. Postural alignment, distribution of weight, balance and stability, and pressure relief should be considered when positioning persons in chairs or wheelchairs;
  9. Appropriate lifting devices and techniques should be used to assure that shear and friction related injuries are avoided;
  10. Education should be given to the patient and caregivers on measures to be taken to avoid pressure sores, and records of such measures should be kept.

 

Dehydration

The Elderly are Much More Prone to Dehydration that the Rest of Us

The system which makes us maintain adequate fluid intake is weakened with aging. Older people are not bothered by thirst as much. Normally chemicals in our brain will make the body work to preserve water, but as we age, we do not have as much of these chemicals in our system. Aging kidneys also cannot defend themselves and are unable to concentrate urine in order to save the water. On top of everything, many mature individuals are often on medications making them prone to dehydration, like water pills or mouth-drying medications. There are also some seniors who will not drink on purpose to avoid problems with urinary bladder control. This is well-known, but not often discussed. Finally, people with impaired memory may just forget to drink (or eat for that matter). Leaving fluids available for them is not enough - one has to WITNESS fluid being consumed to know that the person gets enough hydration.

 

The Signs and Symptoms of Dehydration

Symptoms of dehydration usually begin with thirst and progress to more alarming manifestations as the need for water becomes more dire. The initial signs and symptoms of mild dehydration in adults appear when the body has lost about 2% of it's total fluid. These mild dehydration symptoms are often (but not limited to):

If the dehydration is allowed to continue unabated, when the total fluid loss reaches 5% the following effects of dehydration are normally experienced:

  • Increased heart rate
  • Increased respiration
  • Decreased sweating
  • Decreased urination
  • Increased body temperature
  • Extreme fatigue
  • Muscle cramps
  • Headaches
  • Nausea
  • Tingling of the limbs

When the body reaches 10% fluid loss emergency help is needed IMMEDIATELY! 10% fluid loss and above is often fatal! Symptoms of severe dehydration include:

  • Muscle spasms
  • Vomiting
  • Racing pulse
  • Shriveled skin
  • Dim vision
  • Painful urination
  • Confusion
  • Difficulty breathing
  • Seizures
  • Chest and Abdominal pain
  • Unconsciousness

Be aware that these are not the only symptoms of severe dehydration that may manifest in response to dehydration; these are simply the most common.

 

Malnutrition

Malnutrition in nursing homes, which often goes hand in hand with dehydration, has reached epidemic proportions. The factors which contribute to this are:

  • Taste, smell and appetite normally decrease as people reach more advanced age.
  • A large percentage of nursing home residents also suffer from depression, which commonly leads or contributes to decreased appetite.
  • Many nursing home residents have difficulty swallowing, (this is called dysphagia), from problems in nerve or muscle control. This is very commonly seen after a stroke, as well as in residents with dementia, Parkinson's, or other neuromuscular disorders. These residents have great difficulty eating without assistance, and special training is needed for the staff to do this.
  • Many residents have untreated dental decay, few or no teeth, or dentures which are poorly fitted, making chewing food difficult.
  • Failure to create an environment conducive to eating is often a significant factor. This involves circumstances such as "homelike surroundings" at mealtimes, allowing the resident to eat in smaller groups together with his/her preferred companions, and respecting the resident's lifelong food preferences, particularly if required for religious or cultural reasons.
  • Some medications will decrease appetite or irritate the stomach, making eating unpleasant.

 

All of this is known in the nursing home industry, and they know and should expect that a high percentage of residents will suffer from malnutrition if they are not only encouraged and assisted to eat. It is also necessary that the eating habits of all residents be carefully monitored; so that malnutrition can be prevented before extreme loss of body mass occurs, causing a serious life-threatening problem. While the residents are eating, the staff should not be watching television or reading the newspaper.

 

Falls are a Serious Hazard in Nursing Homes

Each year, an average nursing home with 100 beds reports 100 to 200 falls. About 1,800 older adults living in nursing homes die each year from fall-related injuries. Those who experience non-fatal falls can suffer injuries, have difficulty getting around and have a reduced quality of life.

According to the Centers for Disease Control and Prevention, Environmental hazards in nursing homes cause up to 27% of falls among residents.Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs.

About 35% of fall injuries occur among residents who cannot walk. Virtually every one of these falls involves negligence that the nursing home should answer for, because a resident who cannot walk should never be walking by him/herself. Residents that can walk may also need assistance to get to the toilet, and if a bell or other request is not answered within a reasonable period of time, they will attempt to walk unassisted, often resulting in a fall and serious injury.

 

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 (Falls in the Nursing Home, Ann Intern Med 1994 Sep 15; 121(6):442-51; Preventing Falls in the Nursing Home, JAMA 1997; 278(7):595-6).

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.

The symptoms of physical abuse are numerous. Some telltale signs include:

  • bruises, especially in clusters or regular patterns in areas such as the neck or groin;
  • black eyes, welts, lacerations, rope marks, bone fractures, broken bones, skull fractures, open wounds, cuts, punctures and untreated injuries in various stages of healing;
  • burns (commonly on soles, palms, or buttocks);
  • laboratory evidence of medication overdose or failure to administer prescribed drugs;
  • an elder's report of abuse;
  • an elder's sudden withdrawn behavior, or the refusal of the caretaker to allow visitors to see the elder alone

Even though the abuse may appear obvious to you, in order to prove that your parents or loved ones have suffered from abuse, as opposed to injury from some other source, it will normally necessary to find a qualified expert. This expert will have to review all the documents, testimony and photographs in the case, and then give an expert opinion in court. In order to get justice, you need experienced attorneys on your side, so call our offices right away if you feel someone close to you has been a victim of Nursing Home Abuse or Neglect.

 

Disclaimer: These materials are intended to help explain some of the principles and concepts involved in these types of cases. Please remember that these are general rules, all of which involve exceptions which would be impossible to detail on this or any other website. In the same way that a doctor cannot give medical advice without examining the patient, the attorney cannot give legal advice without an opportunity to interview the client or the witnesses, and to review the documents involved in the case. Therefore, while we hope these materials are helpful, please remember that they are not intended as a substitute for legal consultation, and they cannot be taken as legal advice.