American are entrusting more and more senior citizens — elderly loved ones — to the care of nursing homes. We trust that these facilities are safe — providing needed support, assistance with “Activities of Daily Living” (ADLs) that our seniors may no longer be capable of managing on their own, and medical care as necessary, not to mention friendship and respect. However, reports of abuse at nursing homes continue unabated. Elder abuse in nursing homes has become a primary concern for any family considering placing a family member in such an institution.
Elder abuse can take many forms: emotional or physical abuse as a result of negligence, physical abuse as a result of deliberate overmedication, theft of valuables by nursing home staff, forced confinement (considered by the law to be imprisonment), and even sexual abuse. A nursing home that allows employees to inflict such abuse on residents may be liable for malpractice or, in a worst-case scenario, wrongful death. However, by carefully monitoring your loved one’s situation in a nursing home, hopefully you can forestall any negligence or abuse before it gets out of hand.
According to a study conducted ten years ago (from 1999 to 2001), nearly one-third of all nursing homes in the United States had been cited for at least one violation of abuse against residents. And 10 percent of nursing homes inflicted abuse on residents that put them at risk of physical harm. More recent studies indicate that trends have not reversed; in fact, the proliferation of nursing homes, and the growing financial pressure felt by for-profit nursing homes (nearly 70 percent of all nursing homes), almost ensures that incidents of abuse will continue to rise.
Some forms of elder abuse in nursing homes are easy to detect — physical abuse that leaves scars or bruises, for instance, or overmedication that causes drastic behavioral changes and that can sometimes be verified by blood tests. However, other forms of abuse may be harder to detect.
Simple neglect is the most common form of abuse in nursing homes today; it is largely unreported and is often even unnoticed. For instance, if a resident is not eating — whether no one is moving that resident to the cafeteria during mealtime, or no one is ensuring that the resident eats at least something of each meal — the result can be malnutrition, illness, and death.
One type of abuse that is difficult to detect without observing long-term staff-resident dynamics is false imprisonment. This occurs when a staff member prevents a resident from moving out of a certain area, whether their room or a wing of the building. The staff member may remove equipment that that resident needs to self-propel — whether a wheelchair, walker, or crutches — or verbally threaten the resident. False imprisonment is punishable by law.
In other cases, a staff member might steal a resident’s property, or information allowing the employee to withdraw money from the resident’s bank account. There have also been cases in which a staff member has pressured a resident, usually by threat, to modify a will or trust agreement leaving that staff member as a beneficiary. Nursing home administrators can also engage in theft, entering fraudulent fees and charges that are then debited from the resident’s bank account. This is robbery, plain and simple, and punishable by law.
If you know what to look for, signs of negligence and abuse in nursing homes can be detected. Sudden weight loss, bruising, bed sores, bruises from arm or leg restraints, broken bones or other injuries from falls, and evidence of overmedication and oversedation are all obvious signs of physical abuse. Sexual abuse would be exhibited by bleeding and bruises in genital areas, torn or bloody undergarments, and evidence of sexually transmitted diseases. Your loved one may have been verbally abused if he or she is excessively fearful or apprehensive around certain staff members, is visibly depressed or angry, falls into chronic depression, or exhibits symptoms of a condition known as “false dementia”: rocking back and forth, sucking on fingers, and mumbling incoherently.
Financial abuse can be detected by simply monitoring your loved one’s bank accounts; as practical, you should arrange to obtain financial power of attorney over your loved one’s affairs, enabling you (or a trusted friend or relative) full access to bank accounts, investment accounts, loan agreements and credit card accounts, and the like. If you notice recent and frequent withdrawals of cash in excess of needs, missing personal property, or recent revisions to wills or trusts, then something is obviously amiss.
If you suspect abuse, first verify your suspicions. Even if your loved one tells you the story of abuse directly, go over the details a few times to ensure that they’re consistent, and check with other residents whom you trust and who may be able to confirm the charges. If there are signs of physical abuse, take photos, gather any relevant medical records, and if appropriate take your loved one to an independent doctor for a complete physical examination.
If you believe that the matter can be easily resolved, bring it up with the nursing home administration. Perhaps there’s just a misunderstanding; perhaps the administrators are aware of the problem and are already taking measures to rectify it. Sometimes it pays to give the benefit of the doubt. However, if the abusive conditions seem deep rooted, you may wish to consult with a lawyer before confronting management, and in the end you may wish to confront management only through a lawyer.
If the abuse appears to be ongoing and chronic, then consider removing your loved one immediately, either to another facility or, temporarily at least, to your home. You can sort through the paperwork later; the important thing is, get him or her out of an unsafe environment.
If there’s evidence of criminal behavior, inform the police or your local district attorney. The state may investigate on its own and file charges against the nursing home, or against individuals working at the nursing home. They may do your work for you.
Likewise, file a complaint with the appropriate government agencies. Your state’s Department of Social Services may be a good place to start; elder care advocacy organizations also may have advice on where you can most effectively lodge complaints. All nursing homes are required to follow government regulations and are subject to regular inspections (usually annual); find the local agency responsible for conducting these inspections, and pay a visit to their offices.
Finally, if the abuse is severe, consider hiring an attorney, one specializing in elder care and specifically nursing home abuse. You may be able to recover your legal costs in a successful malpractice suit.