DO YOU SUSPECT ABUSE OR NEGLECT? Contact Us for a Free Consultation

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We are frequently asked how nursing home neglect or abuse can be prevented. There is no magic answer, but there are things one can do to lessen the odds that a loved one will be subject to physical neglect, financial abuse, or suffer the decline in health caused by poor care. The California Advocates for Nursing Home Reform have published a guide for preventing abuse in long-term care facilities. How does one increase the odds there will be no abuse or neglect?

1. Be very supportive of the transfer to a nursing home. Under most circumstances, the initial entrance to a nursing facility will engender feelings of loss or abandonment. Visit frequently to help with the adjustment.

2. Make the most of visits. Visit frequently, and at different times. Also visit during meal time. This will give you a more complete picture of care and the performance of staff.

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Residential care facilities for the elderly (RCFE), or assisted living facilities, are typically board and care homes for individuals age 60 or older who can no longer live by themselves, but do not need 24-hour nursing care. Typically, a RCFE will provide a bed, all meals, and assistance with certain daily activities such as bathing, dressing, meals, and with medication distribution. The residents, however, must be able to take their own medications.

RCFEs and assisted living facilities are licensed by the State of California, and are limited under the code of regulations to the type of care they can provide. In addition, each facility must undergo periodic inspections by the Department of Social Services.

It is important to point out that RCFEs are not permitted to provide medical care. As a result, individuals with certain medical conditions may not be admitted or retained by a residential care facility. A few of those conditions include, but are not limited to, bed sores of a Stage III or larger, or people who require tube feedings. Other conditions are restricted and may not be permitted, such as individuals who require catheters or colostomies. RCFEs may admit people who suffer from dementia, but only after meeting certain regulatory requirements. Always check for the facility’s written plan for caring for individuals with memory impairment.

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Registered sex offenders, parolees, and individuals with violent pasts are living in nursing homes and assisted living facilities all over America according to the advocacy organization A Perfect Cause, which found 1,600 registered sex offenders in U.S. nursing facilities with senior citizens.

Wes Bledsoe, founder of the organizations, says that the group has documented over 60 rapes, murders, and assaults committed by criminal offenders inside these facilities. There is currently no federal or state law that keeps sexual offenders out of long term care facilities, and, in fact, many are sent to facilities by local judges, sheriffs, and county workers. Bledsoe is testifying before congress this week on the subject, and will call for the establishment of separate and secure nursing facilities for known sexual offenders, as well as a requirement of criminal background checks on all incoming residents.

“I hope that some of the congressional leaders don’t sleep soundly tomorrow,” said Bledsoe, “and that this makes an impression on them that right now, in this moment, we have people in harm’s way.”

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Walton Law Firm attorney Randy Walton was a guest presenter last weekend at the annual meeting of the California Association of Long Term Care Medicine in Los Angeles. Walton and San Diego attorney Bill Wilson spoke to a group of approximately 150 physicians, nurses, and administrators about legal liability in the long-term care setting. The title of the presentation was Long-Term Care Liability Crisis: Risk Management Update and Mock Trial.

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Elder abuse comes in a variety of forms. The abuse we hear about most frequently is physical abuse, which includes assault, battery, and sexual offenses, and financial abuse, which is usually a matter of fraud or undue influence upon a senior citizen. Both physical and financial abuse are very serous offenses that should be promptly reported to the police, and a private civil attorney.

Another, less discussed, form of abuse is abuse in the nursing home or assisted living setting. In California, there are approximately 100,000 nursing home beds, and probably an equal number of assisted living beds, and the health and well being inside these facilities usually depends on the quality of the care they are receiving. In truth, the word “abuse” is probably a bit misleading, as these occurrences are usually a matter of neglect of the elderly resident, not physical abuse.

Unfortunately, most instances of neglect or abuse are not reported. Elderly residents are often afraid to report an act of abuse or neglect for fear of retribution by staff, or simply because they cannot stand the thought of being transferred to a different facility. Or, more often, the decline in health caused by the neglect is attributed to some other cause, usually related to old age.

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I recently attended a nursing conference where the central theme was elder abuse and neglect. One of the presenters was Charlene Harrington, Ph.D. of UCSF, a professor of nursing and sociology, who is considered an expert on nursing home staffing.

According to Harrington the nursing home staffing picture in California isn’t pretty. She said that there are over 12 million deficiencies in U.S. nursing homes annually, and stated that approximately one-quarter to one-third of all nursing homes provide substandard care.

According to Harrington, sufficient staffing is the number one indicator of the quality of care one can expect to receive in a nursing home. California requires that a licensed skill nursing facility provide at a minimum of 3.2 hours of nursing, per patient, per day. While this is a minimum standard, most California facilities view it as the threshold, striving only to meet it. In fact, RN care has been declining in California, which now has one of the lowest RN per patient, per day ratios in the country.

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According to estimates, there are about 1.6 million people in the United States employed to provide home care for the elderly, and advocates for the elderly say the cases of abuse, neglect, and fraud by home caregivers is growing at an alarming rate. The increase is prompting calls for more government oversight as home-care assistance grows along side the aging baby boomers, and the desire of people to avoid nursing homes.

Because the bulk of home care is being provided by non-licensed or certified nurses, who are typically regulated under state, home caregiver frequently have no training, receive minimal pay, and loosely supervised. In California, home aides who do not provide medical care are not even required to pass a criminal background check.

To research the problem, the Centers for Medicare and Medicaid funded a study that screened 214,167 people who held jobs provided assistance to the elderly and discovered that over 5,000 of them had criminal histories. Advocates for the elderly are advising consumers to verify background checks from any agency that offers home care services, and those who hire directly are strongly encouraged to check references.

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About four years ago I had a very interesting case involving the death of a developmentally disabled adult in a San Bernardino care facility. In my case, the thirty-year old severely disabled man was found barely breathing on the floor next to his bed just after midnight. Medics were called, and tried to sustain his life, but sadly the man died. Staff and the family presumed it was a heart attack, since the decedent was very obese and had a history of some heart problems.

An autopsy, however, showed a different case of death. The medical examiner ruled the death a homicide, finding that the man died from blunt force trauma to his abdomen. The next question for use was Who did it?

Through the discovery process in a lawsuit we filed against the facility, we believed the death was caused by either a disgruntled employee, who was tired and angry at the resident for the demands he made on staff time, or an autistic room mate (who could not speak), who accidentally kicked the decedent in an act of self-defense. The case settled before trial, so those questions were never fully answered.

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Studies have suggested that approximately one-third of all nursing home residents suffer from some form of dehydration or malnutrition, a condition that can cause or aggravate more serious medical conditions, and may be caused by elder abuse or neglect.

Much of the problem can be attributed to poor staffing, whether inadequate numbers of staff, poor staff training, and a lack of individualized care. While California law requires 3.2 hours of certified nursing per patient, per day – a minimum number many nursing homes fail to meet – many experts believe the law is inadequate, advocating for an increase to 4.1 hours per resident, per day.

Karen Davis of the Commonwealth Fund, the funder of a report on nursing home care, says, “malnutrition, dehydration, and weight loss in nursing homes constitute one of the largest silent epidemics in this country.”

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The Robert Wood Johnson Foundation is donating millions of dollars to build small, home-like nursing homes as an alternative to the large institutional nursing homes we have come to know (and despise). Imagine what it would be like to have a country filled with nursing facilities like the one profiled in this video.

To read The Wall Street Journal article on the subject click here

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