The Nursing Home Investigation and Selection Process. Entrusting a loved one, such as a mother, father, sister or brother, to the care of a nursing home is one of the most difficult decisions many of us will ever make. In spite of a long, thorough investigation into suitable nursing and rest homes and assisted living centers, it is often difficult to get a true feel for the environment when you leave a loved one in the care of strangers. Often times it is not possible to witness the actual care being given so it is important to notice the overall state of care such as cleanliness, the quality and temperature of food items, how medications are delivered, changes in personality of the loved one, and missing personal items. When you arrive at the facility are the staff actually engaged in helping residents or are they out on the front porch in groups smoking, texting and checking social media on their cell phones? Has the rest home, nursing or assisted living facility changed ownership or administration often? Have medical directors changed or are they rarely or never present?What have State nursing home survey inspection findings been for the home?
Keeping Tabs on Conditions and Care
While it is likely impossible to meet the ideal conditions we would like to see for a loved one, some nursing, rest and assisted living homes fall well short of meeting even the most minimum standard of care. Sometimes failure to ensure proper staffing levels means the routine care of a loved one suffers. Pay careful attention to your loved one’s mood changes. Do they seem anxious or concerned when they see particular staff? Are you seeing a lot of different faces and are those faces less friendly than when the stay began? Do you hear yelling or exasperation from staff as you walk by other rooms, administration or the nursing station? Does your loved one exhibit signs of dehydration such as dry eyes, flaky skin or chapped lips? When you arrive, do they have a full or empty drinking cup in their room and within their reach and are they eating or refusing to eat reminiscing about home-cooked meals? Are they losing weight or exhibiting skin changes? Do you notice flies or uncleaned restroom facilities? If they had bedsores or pressure ulcers upon admission, have these gotten better or worse? If they were continent when they started are they now incontinent? Or, if they were incontinent when they started at the facility and were on a scheduled toileting program, has the facility now suggested they are continent to avoid the burden of scheduled toileting? Has your loved one fallen from a wheelchair, bed or been found wandering outside the facility?
The Domino Effect and Sudden Decline in Condition
Unless quickly corrected, inadequate staffing or poor care practices can lead to outright neglect and abuse, which can then lead to serious health declines and sometimes premature death. As conditions worsen, your loved one may not want to cooperate as readily with overworked staff who now have less time to spend before they must move on to the next resident. A domino effect can begin where only the neediest residents are attended to and others who were once healthy and adequately cared for lose the attention and focus they need to keep from a decline in condition. Tension can arise between staff and resident as pressure mounts to provide quicker, less adequate care. Abuse and a decline in condition may follow.
Abuse and Neglect
Abuse and neglect can take many forms, but the following are some of the most common:
- Dehydration leading to organ impairment or failure, such as acute renal failure;
- Small wounds or sores become infected or grow deeper as a result of inadequate turning or wound care practices, such as failing to change bandages;
- Improper toileting or cleaning techniques leading to urinary tract infections;
- The failure to monitor, dose or administer necessary and common medications such as antibiotics or blood thinners or an unwise combination of the medications;
- A fall and failure to administer care or pursue appropriate diagnostic imaging to diagnose internal bleeding, hematoma, hemorrhaging, or broken bones;
- Unexplained bruising; and
- Contracture of arms, legs, hands and fingers.
When to Consider Pursuing Legal Help
Sometimes a case of abuse or neglect is brought to the attention of family only after a loved one is urgently admitted to the hospital. You may have been away and unable to visit for several days or weeks, but upon your next visit, you find your loved one unresponsive and in need of urgent care. EMS is called and finds signs of severe wounds or sores, infection or broken bones or paralysis. Sometimes a debilitating condition is less obvious and hidden beneath dry eyes, chapped lips and sunken cheeks, but is the result of a failure to monitor fluid intake and output. Once at the hospital, a doctor or social worker inquires where the loved one was staying or how they got in this condition. Unfortunately, even if hospital personnel or a treating physician takes the courageous but appropriate step of alerting authorities, there may be inadequate information or an inadequate investigation to prove any actual abuse or neglect. The practices and efforts of investigators can vary substantially and your questions may never be answered or you may conclude that your loved one’s decline in health was inevitable. If your loved one’s sudden decline is serious or results in death, but you cannot obtain satisfactory answers to your questions, it may be time to seek help from an attorney with experience in nursing home abuse, neglect, and wrongful death.
What Attorneys Can Do to Help You Find Answers or Closure
An attorney with experience reviewing nursing home and medical records can attempt to pinpoint issues of abuse or neglect generally using the Long Term Care Survey published by the American Healthcare Association as a starting point. The Long Term Care Survey, sometimes referred to as the Watermelon Book for its color, is a three-ring binder (or e-book) and contains the regulations, protocols, forms, survey procedures and guidance to surveyors. The regulations arise out of the Omnibus Budget Reconciliation Act of 1987 (OBRA). The comprehensive regulations have been distilled into what are commonly known as F-Tags, which are akin to motor vehicle regulations, but for the context of the nursing home. Medicare (now known as the Centers for Medicare & Medicaid Services or CMS) provides these F-Tags as interpretive guidelines for surveyors tasked with investigating the long-term care industry.
For example, an attorney screening a possible dehydration leading to an acute renal failure situation will want to review the MDS, MAR, Progress Notes, Intake/Output records, Bladder/Bowel reports and other documentation to see how the resident’s condition progressed and declined to see if there were warning signs that should have been brought to the attention of a physician. F-Tag 327 addresses resident hydration and provides that a facility must provide each resident with sufficient fluid intake to maintain proper hydration and health. If the facility failed to follow this basic requirement by neglecting a resident’s needs, such failure may have been a substantial contributing factor to the resident’s decline and even death and a civil lawsuit may help hold the facility legally monetarily responsible for the pain, suffering and damages it caused and send a message so that future residents are not neglected in the same manner. An attorney can engage nursing home and medical experts to shed further light on the situation.
An attorney can work to summarize and communicate this information effectively. Below are graphs we prepared in a case to illustrate the resident’s dehydration evidenced by fluid intake and output records ultimately leading to hospital admission:
While not every sudden decline in condition is the result of abuse or neglect, an experienced attorney practicing in the area of nursing home abuse and neglect will often be willing to provide a free consultation to help you weigh your legal rights.
Time is of the Essence
When it comes to initiating legal action, laws often differ substantially from State to State. Some States may only have a one-year statute of limitations and others longer. Some may require you go through a medical review panel process before allowing you to bring suit against potentially responsible parties. Sometimes it may be necessary to give a tort claim notice to a county-owned facility. Because laws can differ greatly when crossing the State line between, for example, Indiana and Kentucky, it is important to seek an attorney licensed to practice in the State where the incident took place. If you fail to pursue legal help in a timely manner, any potential remedy may be barred on account of the passage of time or the failure to comply with legal or administrative prerequisites before filing suit.
When we were children, our parents and siblings did their best to protect us from harm. As adults, unfortunately it is sometimes necessary to stand up and fight for our parents and loved ones who cannot stand up for themselves so that they or others will not suffer from the same abuse or neglect.
© 2016 Barsumian Law LLC