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A Special Report to Those with Loved Ones in Nursing Home Residences OFTEN OVERLOOKED WARNING SIGNS OF NURSING HOME NEGLIGENCE OR ABUSE and What To Do About It If you have a loved one in a nursing home, YOU may be the only one who can help, should there be signs of NEGLIGENCE or ABUSE Edwards & Patterson Law Firm 321 S Third Street McAlester, OK 74501 & 1831 East 71st St. Tulsa, OK, 74136 918-302-3700 or1-877-761-5059 A nursing home can be a life-saver for persons of any age who are recovering from surgery, an illness or an accident. Or for those who are incapable of caring for themselves, due to some physical or mental condition, or simply old age. If you’re a casual or infrequent visitor, the nursing home your loved one is in may appear to be an excellent, well-run facility, with an efficient and caring staff on duty 24/7/365. However, appearances can be deceiving. As major periodicals, elder care associations and relevant government agencies have reported, again and again and again, thousands of nursing homes throughout America do not measure up to the high standards you would expect. And the nursing home your loved one is in—whether it’s a for-profit, not-for-profit or government-owned facility—may be one of them. 2 | Often Overlooked Warning Signs of Nursing Home Negligence or Abuse Be alert to see possible problems at your loved one’s nursing home residence. Published reports have stated the following: • Nursing homes are typically inspected only once a year. Therefore, if incidents of negligence or abuse occurred weeks or months before an inspection, it may be difficult or impossible to gather the facts and interview witnesses. • One in five nursing homes fail to report incidents of abuse, or even make sure that prospective staffers have no history of abuse. • False charting,“charting by rote,” is common, especially where facilities are severely understaffed. Staffers do not actually chart the care as they give it,” one report noted. “They sit down at the end of the week and just fill in the boxes.” • The majority of aides are overworked. They have too many patients to take care of at one time. It’s a money thing. Nursing homes don’t want to hire. As one investigator said in his report: “Most families are unaware that the gravest threat facing nursing home residents is not what’s done to them. It’s what is NOT done for them.” • Neglect is the silent killer in nursing homes. By some estimates, neglect accounts for half of nursing home deaths and injuries. • Many nursing homes systematically fail to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents. © 2015 SunTelemedia LLC • Nursing homes must meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents. Often Overlooked Warning Signs of Nursing Home Negligence or Abuse | 3 5 STEPS you should consider taking, if at all possible, to help guard against nursing home NEGLIGENCE, ABUSE, THEFT OR OTHER CONCERNS your loved one frequently and vary your visits. Depending on the nursing home’s • Visit visiting hours, how strictly they’re enforced, and how far you live or work from the facility, try to have friends and family visit at least two or three times a week— on different days and at different times, so staffers are never sure when to expect visitors. Nursing home residents who rarely or never get visitors may be more likely to become victims of negligence and abuse. yourself known. When you visit, let the nursing home’s director and relevant • Make staffers know that you’re there, once again, to see your loved one. Mention his/her name and room number, so they’ll take note of your concern. Notice who is visiting the other patients, and become familiar with those you see frequently. It is helpful to compare notes on the level of care, and have another set of eyes to watch for anything amiss. close-up photos of your loved one, whenever you visit. Look for and photograph • Take any bruises, scratches, bedsores, fractures, etc. Include the front page of that day’s daily newspaper, to mark the date. If a lawsuit should ever prove necessary, some dated photos, showing how your loved one looked before and after an incident of negligence or abuse, could prove invaluable. friendly with your loved one’s attendants. The more they like you, the more • Become they’re likely to take good care of your loved one. Be cheerful, and encourage your loved one to be polite but wary. (If your loved one is a particularly difficult person, encourage them to be selectively critical and focus complaints on truly urgent matters!) note of your loved one’s surroundings, personal property and (if possible) finances. • Take When visiting, look around you. Notice if, for example, the room is too hot, too cold or drafty…if window coverings are torn or missing…if there are enough pillows and blankets…and if there’s a reasonably safe place to keep your loved one’s wallet or purse, checkbook, credit cards and petty cash. If you have access to his or her monthly credit card and checking account statements, see if there are any suspicious payments, charges or deductions. Have a question about Nursing Home negligence or abuse? Call Toll Free: 1-877-761-5059 3 4 | Often Overlooked Warning Signs of Nursing Home Negligence or Abuse 13 Common Warning Signs of Nursing Home NEGLIGENCE or ABUSE PRESSURE ULCERS (bedsores) These can be found on about 25% of nursing home residents, most often because they’ve been left unattended for too long in their bed, a wheelchair, a bathroom or elsewhere. Bedsores usually appear on the buttocks, lower back, ankles, heels or backs of the knees. They may also appear on the elbows, upper back, back of the head or even the ears. They result from prolonged pressure (for as little as two hours,) usually when the skin is pressed between a bone and a bed, wheelchair, cast or other surface. Typically, they start with redness of the skin, and if undetected or untreated may penetrate through the layers of the skin all the way to underlying muscles and bone, and can become infected, perhaps very seriously. POOR HYGIENE Your loved one doesn’t look, smell or feel clean. For obvious reasons, this is more prevalent when residents are unable to care for themselves and, when noted earlier, they rarely or never have visitors checking up on their care. SEXUAL ABUSE Bruises on or around “private parts.” Notice if your loved one acts fearful or pulls back at the appearance of certain staff members or other residents, or if they complain about a certain person bothering them but aren’t specific as to why, as they might be embarrassed to say. VERBAL ABUSE Belittling, threats or other uses of power and control by nursing home employees, other residents or visitors (theirs or their roommate’s.) STRAINED OR TENSE RELATIONSHIPS Becomes increasingly argumentative, or becomes uncharacteristically withdrawn. CHANGES (SHORTAGES) in your loved one’s financial situation, including cash in a wallet, purse or bedside drawer, or funds in a checking or savings account. INJURIES Bruises, pressure marks, broken or fractured bones, abrasions, scratches, burns, a black eye, a bloody nose, ripped clothing, etc. UNEXPLAINED WITHDRAWAL from normal activities, a sudden change in alertness, and unusual depression. (Continued on page 5) Have a question about Nursing Home negligence or abuse? Call Toll Free1-877-761-5059 Often Overlooked Warning Signs of Nursing Home Negligence or Abuse | 5 MALNUTRITION (a.k.a. UNDERNOURISHMENT) One out of every six older adults is undernourished, especially those who live in a nursing home. As one elder care specialist explained it: “Under-nutrition may result from eating too little food (i.e., too few calories) or foods that do not contain enough of the needed nutrients, particularly protein, vitamins and minerals…. Residents of nursing homes usually do not get to choose the foods they are served, and cannot get food when they want it. Meals may be served and taken away at specific times, without any consideration of whether a person is hungry. (Or even awake.) Occasionally, residents are neglected—not given the help or the time they need to eat. ‘Hot’ food may be cold when it arrives, or become cold while the resident is waiting for someone to help them eat it. Consequently, they may not eat enough.” There may also be other reasons; e.g., certain disorders cause symptoms that interfere with a person’s ability to meet nutritional needs. Or, your loved one may be suffering from malnutrition simply because the food is terrible and he or she would rather starve than eat it! If you can visit during meal times, taste the food yourself and judge it. FILTHY CONDITIONS Filth has no place anywhere in a nursing home. It needs to be as clean as possible, for both medical reasons and appearance. If you notice that a loved one’s room and bathroom, the dining hall, the kitchen (if you can gain access) or any other part of the nursing home is not clean, take action. If necessary, report it to the appropriate authorities. LIGHT-HEADEDNESS; DRY SKIN, EYES OR NASAL MEMBRANES; A DECREASE IN URINE; DARK URINE; OR A FALL IN BLOOD PRESSURE Any of these symptoms may be a warning sign of dehydration—not having enough fluid (especially water) in the body. If the condition is not diagnosed and treated, it might even result in death. The relatively simple treatment includes replacing lost fluids with water, dilute broth, or a fluid containing some sodium or other electrolytes. DIRTY BANDAGES, UNTREATED CUTS OR BRUISES, SCRATCHES, FRACTURED OR BROKEN BONES, ETC. Dirty dressings and untreated injuries are obviously signs of neglect. Staff members not have examined your loved one often enough and/or have ignored the need for medical care. Fractured or broken bones are common in nursing homes that house older residents, who are often prone to falls and other physical injuries. But they may also be caused by altercations with other residents, staffers or even visitors. If your loved one shows any of these warning signs, identify the cause. UNUSUAL WEIGHT LOSS If not due to any the above, this may be the result of not having enough food to eat (a roommate or staffer might be stealing some), loose or missing teeth, poorly fitting dentures, liver failure, lactose intolerance, taking drugs that decrease appetite, cancer, infections, smoking, etc. Perhaps they need help eating, and are reluctant to ask to be fed. Again, if you can visit during a mealtime, check on the quantity and quality of the food being provided, and notice any difficulty in eating. Have a question about Nursing Home negligence or abuse? Call Toll Free: 1-877-761-5059 6 | Often Overlooked Warning Signs of Nursing Home Negligence or Abuse TYPES of Nursing Home ABUSE or NEGLECT You Should Be Aware of PHYSICAL ABUSE Inflicting, or threatening to inflict, physical pain or injury on residents, or depriving them of one or more basic needs; sub-standard care; over-crowding; inappropriate restraint; failure to protect residents against untrained, troubled or predatory workers; failure to restrict roommates from smoking, yelling, loud TVs, etc.; frequent room changes, with little or no advance notice; being forced to share a room with a seriously-ill, deranged or unclean resident. FAILURE TO PROVIDE THE PROPER FOOD, SHELTER, PERSONAL CARE OR OTHER NEEDS Nursing home residents should certainly not be treated like prisoners without any rights or consideration. But many are, especially if they rarely or never get visitors and/or are unable to voice their grievances. Many residents fear retaliation if they regularly (even if justifiably) complain about their food, clothing, bedding, room temperature, mail, phone, reading materials, roommate, TV set, unwanted visitors, required activities, room location, bathroom facilities, etc., or when they call for assistance but the response usually takes too long…or never comes. EMOTIONAL ABUSE Inflicting mental pain, anguish or distress through verbal or nonverbal acts, such as threats or intimidation; denying residents the right to exercise personal choice in such matters as when they want to eat, get up or go to bed; exclusion; isolation; denial of privacy when bathing; "labeling" troublesome individuals, resulting in depersonalized treatment and exclusion. EXPLOITATION Illegal taking, misuse or concealment of a resident’s funds, property or other assets. In extreme cases, a lonely resident is befriended by a nursing home employee and, over a period of months or years, the resident’s will is changed and/or the resident’s funds are taken, by various means, by the staffer. Patients themselves may naively start to give away items, such as jewelry or clothes, when complimented on them, or be intimidated when asked if they can have them. FAILURE TO PROVIDE THE CORRECT MEDICINES AT THE CORRECT TIMES AND DOSAGES. FAILURE TO CHANGE DRESSINGS AS OFTEN AS NECESSARY TO PREVENT INFECTION These failures can quickly worsen a medical condition and, depending on what the condition is, might even prove fatal. Some nursing homes (particularly those that are understaffed) may falsify a resident’s medical records to hide these failures. Have a question about Nursing Home negligence or abuse? Call Toll Free1-877-761-5059 Often Overlooked Warning Signs of Nursing Home Negligence or Abuse | 7 The Rights of Nursing Home residents As noted by Medicare and other sources, neglect and abuse are not the only concerns faced by nursing home residents. Residents have rights that are usually part of their residence contract, but these rights are often trampled on. For example: nursing home residents have patient rights and certain protections under federal or state law. The nursing home is required to list and give all new residents a copy of these rights, which usually include: Respect The right to be treated with dignity and respect. Money The right to manage your own money or choose someone you trust to do it for you. Privacy The right to reasonable privacy, and to keep and use your personal belongings and property, if it doesn't interfere with the rights or safety of others. Medical Care The right to be informed about your medical condition and your medications, to see you own doctor, and to refuse medications and treatments. Your loved one, as a nursing home resident, has the legal right to be free of abuse, negligence and other concerns, since they can seriously affect his or her comfort, peace of mind, safety and well-being. What Should You Do, If You Notice or Suspect That Your Loved One is a Victim of Nursing Home NEGLIGENCE or ABUSE? You should know that—depending on the particulars and the severity—nursing home negligence or abuse may be classified as a crime…as grounds for a civil lawsuit…or both. By definition: “NEGLIGENCE is the failure to exercise that degree of care that, in the circumstances, the law requires for the protection of other persons or those interests of other persons that may be injuriously affected by the want of such care.” A definition of ABUSE is: “to treat in a harmful, injurious, or offensive way.” Whether or not the authorities (if notified) consider it a criminal offense, when nursing home negligence or abuse results in an injury or loss to your loved one, one or both of you may decide to file a civil action for compensation—a negligence suit or a damage suit. (Continued on page 8) Have a question about Nursing Home negligence or abuse? Call Toll Free: 1-877-761-5059 8 | Often Overlooked Warning Signs of Nursing Home Negligence or Abuse But first, you may want to meet with the nursing home director, to express your concerns and request corrective action. The director may claim to be unaware of the situation, and promise to take the necessary action. You may be told that the staffer who was negligent or abusive is no longer with the facility, but that should not relieve the nursing home from any responsibility. The injury or loss did occur, your loved one has suffered because of it, and a civil lawsuit may be the only way to fight back and receive the compensation your loved one rightfully deserves. But, like most legal endeavors, it should not be a do-it-yourself activity. You’ll need an attorney with years of experience in handling nursing home cases. That’s because many nursing homes are no stranger to lawsuits. Some have been sued dozens or hundreds of times—by federal or state agencies and/or by residents or their loved ones. They have skillful attorneys on retainer or even on salary, full time. And they know that it’s difficult or impossible to prove negligence or abuse without some proof, along with knowledge of how nursing homes operate. To guard against losing a lawsuit, some nursing homes may falsify or destroy relevant medical records…“lose” residents or staff who are key witnesses, by moving them elsewhere or threaten employees who have knowledge of the incident(s) with undesirable duties, pay cuts, or dismissal if they plan to testify in court. You’ll need an attorney with expert knowledge of: federal and state nursing home laws and regulations; abuse and negligence case law; medical record research techniques; elder care; nursing home operations, personnel and equipment; safety hazards; employee background checks; government agencies and associations dealing with nursing homes; witness interviewing; schemes and crimes involving personal finances; and the newest strategies and techniques for maximum recovery. Obviously, most attorneys in general practice— handling everything from DUI cases to real estate transactions— do not have this kind of expertise. You’ll want to choose a law firm that handles nursing home cases on a contingency basis. That is, no upfront costs (except for minor expenses) and no fee (an agreed-upon percentage of the award) unless you win the lawsuit. For more information, and a free, no-obligation phone consultation, please call: Edwards & Patterson Law Firm 321 S Third Street & 1831 East 71st Street McAlester, OK 74501 Tulsa, OK, 74136 918-302-3700 or 1-877-761-5059 We handle cases involving nursing homes in Oklahoma Attorney Advertising. Past results do not guarantee a similar outcome.