As the elderly population in the United States continues to grow, nursing homes are proliferating in tandem. Nursing homes are regulated by the U.S. Department of Health and Human Services, and by the Centers for Medicaid and Medicare Services. Federal guidelines (as established by the Nursing Home Reform Act of 1987) lay out various policies and procedures, such as residents’ rights and nursing, dietary, and medical requirements. Different U.S. states also have their own regulations and procedures, and inspections, usually conducted once a year, are intended to enforce compliance.
However, nursing home abuse still occurs all too frequently. There are many reasons for abuse. Staff are often underpaid and overworked, and have too little training; they make mistakes from carelessness or lack of knowledge, and can develop a jaded attitude about the residents in their care. Management may be aware of the problems but, paying too much attention to the bottom line, refuse to make positive changes. If problems are not corrected, a culture of abuse and neglect can develop, and the situation becomes intractable.
Compounding the problem, many residents are unwilling or unable to complain. They may already feel that they are an unwelcome burden, both on family and on society, and not want to oblige others to expend more energy on their behalf. They may be physically impaired from voicing a complaint. Or, in a worst-case scenario, a staff member who is willfully abusive can intimidate a resident into silence.
It’s important to closely monitor your loved one’s daily living conditions in a nursing home, and look for signs of nursing home abuse. Physical abuse can be extreme — cases of battery and rape have been reported — although bruises and cuts can also result from a bad fall, so don’t jump to conclusions. In either case, falls are almost as preventable as willful abuse, so bruises and cuts should be taken seriously.
Take the time to physically examine your love one during each visit; some bruises can be subtle — on the arms or legs, indicating that restraints were used, for instance. Or, if your loved one is not very mobile, check for bed sores, or pressure sores. These usually occur in places where the bone and skin are in close contact (the lower spine, the elbows, and the heels, for instance), and develop when the resident lies prone (or seated in a wheelchair) for long periods of time without moving. Bed sores can become infected, leading to serious complications.
Also, check your loved one’s weight regularly. Sudden weight loss can mean that he or she is not eating properly. Often, residents suffering from dementia can forget to eat, or refuse to eat food that’s put in front of them. Whatever the reason, it’s the responsibility of the nursing home staff to ensure that all residents eat and drink enough. Other signs of malnutrition might be hair loss, fatigue, and vitamin deficiency, although a blood test would be needed to detect the latter.
Poor hygiene at a nursing home is easily detectable; is your loved one bathing regularly, getting fresh changes of clothes, receiving proper dental care? Simple neglect can lead to nursing home staff shirking on their responsibilities in these areas. What does the overall facility look like — is it clean, or is it filthy? Look over the common eating areas critically and, if you can, the food preparation areas. If you see bugs or vermin, that’s not a good sign! Annual inspections should ensure a high standard of cleanliness, but inspectors make errors as well, not seeing the obvious or being persuaded by excuses offered by nursing home administration.
If you notice sudden changes in your loved one’s behavior or physical appearance, he or she may be receiving improper medication. If you suspect that this may be the case, discuss the administering process with nurses. You may want a doctor to examine the resident, and take blood tests if these might help determine improper medication. Occasionally, hard-to-handle residents are deliberately given excessive dosages of antipsychotics, which would result in radical behavioral changes. If you know that your resident is “difficult,” and even on low dosages of antipsychotics, then monitor his or her behavior frequently and request a medical examination if you feel that something’s wrong.
Residents often suffer from emotional abuse if they are ignored by staff members, or if social activities and physical activity are not offered. Signs of emotional abuse or trauma might include listlessness or unresponsiveness; physical or emotional withdrawal; and strange, unpredictable behavior. Try to gauge the overall vibe of the nursing home; are the staff themselves withdrawn and unfriendly? If the facility is in financial trouble, there may be rumors of salary cuts and firings, forcing staff members to worry more about their job security than about the residents they’re being paid to take care of.
Or, if staff members are uncooperative, restricting access to certain parts of the facility or hovering near you at all times, not leaving you alone with your loved one or other patients, that may be a sign that they’re trying to hide something. Don’t be paranoid, but take note of suspicious behavior.
If you have concerns about potential nursing home abuse, raise your concerns directly with management. There may be a logical explanation. However, if your discussion with management raises more questions than it answers, then consider filing a complaint with the appropriate government agency and hiring a lawyer to help you investigate the matter more deeply. Or, if there are alternatives in the area, consider moving your loved one to a different nursing home.