Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Yesterday we discussed potential signs of mistreatment or abuse in a day care setting. Today we continue our discussion regarding child abuse as we consider the signs of various types of abuse.  

While many of these topics are exceptionally troubling, as parents it is important to pay attention to changes in the behavior of our children and recognize the importance of addressing these issues head on.

When it comes to unspeakable acts of sexual abuse of children there may or may not be any outwardly physical signs. Therefore, it is important to pay attention to any changes in the child’s behavior. In these situations, a mandated reporter or other person who is concerned about the child’s well-being should listen to the child closely and attentively in a calm and natural demeanor to put the child at ease. Because most sexual abuse is conducted in secrecy, the most important evidence in these cases is the testimony of the victim. 

If a child displays the following signs, they may be the victim of sexual abuse:

• Has difficulty walking or sitting
• Sudden refusal to participate in gym or physical activities
• Sudden change in appetite
• Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior
• Becomes pregnant or contracts an STD
• Runs away
• Reports sexual abuse by a parent or caregiver

Parents or adult caregivers who have sexually abused a child may be:

• Unusually protective of the child or limit the child’s interaction with others
• Secretive and isolated
• Jealous or controlling with family members

Signs of Neglect:

As with other forms of child abuse, there is no one indicator of neglect. Instead, it is a variety of signs that appear repeatedly or in combination. In a child, these signs may be when the child:

• Has frequent school absences
• Begs or steals money for food
• Lacks necessary medical or dental care
• Is dirty or has severe body odor
• Lacks weather appropriate clothing
• Abuses alcohol or other drugs
• Reports that there is no one at home to provide care

Neglect might be occurring, if the parent or caregiver:

• Is indifferent to the child
• Acts apathetic or depressed
• Behaves irrationally or in bizarre manner
• Is abusing drugs or alcohol

Signs of Emotional Abuse:

Children react in different ways to emotional abuse.   However, if you notice a child displaying any of the following behavior, it may be a sign of abuse:

• Shows extremes in behavior (overly compliant, demanding, passive, or aggressive)
• Is overly adult or overly infantile in behavior
• Has delays in physical or emotional development
• Has attempted suicide
• Reports a lack of attachment to parent or caregiver

The caregiver or parent may be emotionally abusing the child if they:

• Blame, belittle, or berate the child on a consistent basis
• Seem unconcerned about the child
• Overtly rejects the child

Impact of Child Abuse

Child abuse can have long lasting impacts on the child and cause physical, psychosocial, behavioral, and societal consequences and problems that can follow them into adolescence and adulthood. The harmful effects of child abuse and neglect depend on the circumstances surrounding the abuse (child’s age and development status when abuse occurred, the type of abuse, the frequency, duration, and severity of abuse, and the relationship between the victim and abuser) as well as the treatment and community options available after the abuse occurs. 

Physical health consequences can include:

• Minor injuries (bruises of cuts)
• Major injuries (broken bones, brain injuries, death)
• Recurring health problems
• Impaired brain development
• Poor physical health

Psychological consequences can include:

• Immediate emotional effects (isolation, fear, inability to trust)
• Lifelong consequences (low self-esteem, depression, relationship difficulties)
• Depression and withdrawal (even in children as young as 3)
• Poor mental and emotional health
• Cognitive disabilities
• Social difficulties

Behavioral consequences can include:

• Difficulties during adolescence (delinquency, teen pregnancy, low academic achievement, drug use, mental health problems)
• Juvenile delinquency and adult criminality
• Alcohol and drug abuse
• Abusive behavior

Child abuse and neglect results in direct and indirect social costs including direct costs associated with the child welfare system and child abuse investigations and indirect costs associated with criminal activity, mental illness, substance abuse, and domestic violence. It is not only in the children’s’ best interest, but in society’s best interest to strengthen child abuse laws and regulations and support programs to prevent child abuse and neglect. 

Your child getting hurt and suffering a serious injury is every parent’s worst fear. It is important to pay close attention to any injuries your child suffers or any changes in behavior in order to recognize signs that may indicate the possibility of abuse and neglect. Public awareness and prevention are some of the best tools in stopping child abuse and neglect. 

If your child has suffered injury, abuse, or in the worst situation, death, while in a day care home, day care center, group day care home, or any other child care arrangements, you may be entitled to compensation and the opportunity to hold the person responsible for the injury accountable. 

Resources:

ChildCare.gov

Child Welfare Information Gateway

U.S. Department of Health and Human Services: Administration for Children & Families

• DHHS: Child Care Development Fund (CCDF)
• DHHS: Temporary Assistance for Needy Families (TANF)
• DHHS: Child Welfare Information Gateway

Injury Prevention Policy: Child Care Safety

National Resource Center for Health and Safety in Child Care and Early Education

National Association of Child Care Resources & Referral Agencies

About.com: Child Care

Illinois Department of Children and Family Services: Day Care & Early Childhood

Illinois Early Learning Project: How Do I Start a Child Care Center in Illinois?

Illinois State Requirements: Daycare

Child Care Aware

National Child Care Information and Technical Assistance Center (NCCIC): Child care options

Nursing Home Abuse Blog: Trust Your Instinct When Placing a Child in Daycare with Potential Hazards

Nursing Home Abuse Blog: Children in Day Care Are Susceptible to Many of the Same Problems Our Elderly Nursing Home Patients Encounter

American Academy of Pediatrics: Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2^nd edition

While we usually think of older people in nursing homes, the reality is that there remains a sizable contingent of younger people who remain in nursing homes and other types of long-term care facilities.  Many of these younger people suffer from disabilities such as birth defects and other genetic disorders that require intensive medical care.

In some circumstances these younger patients have been admitted to these facilities simply because their families are unable to care for them at home.  Sadly, in some circumstances, many of these younger patients are highly susceptible to harm from both other patients and the staff at these facilities. 

On our sister blog, Child Injury Laws, we recently discussed such problems of abuse and neglect of younger patients at Alden Village North, a Chicagoland nursing home that caters to children and young adults. Apparently in response to these reports of ongoing abuse and neglect, Illinois Governor Pat Quinn is poised to sign legislation that will:

• Impose stiffer fines for poor care
• Ban on new admissions at troubled homes
• Use stricter rules on the use of psychotropic medications
• Make it easier for officials to close dangerous facilities
• Nursing home administrators would also be required to report all deaths to state authorities and to local coroners and medical examiners

The bill, passed by the House Monday, needs only a signature from Gov. Pat Quinn to become law.  

Certainly, as an advocate for injured and abused children, I am always reminded just how few supporters this group has on its side.  Hopefully, this new legislation will benefit this group both by bolstering the laws to protect them and by bringing these important issues into the public sphere of awareness so we can help spread the word about some of the atrocities committed at facilities licensed to care for this group.

Related:

Watchdog Group Confirms Trouble At Chicago Nursing Home Caring For Disabled Children

Nursing Home Abuse: The Deaths Of 13 Children Linked To Poor Care At Chicago Nursing Home

Children Are Frequently Targets Of Abuse In A Group Home Setting

Children In Nursing Homes: Truly The Most Vulnerable

New law requires stricter guidelines for nursing homes, Chicago Tribune, May 31, 2011 By Sam Roe and Jared S. Hopkins

Growing up in Chicago, I was always rooting for the Blackhawks of yesteryear---  when they were--- well, certainly average at best.  

As school kid, I no doubt was drawn to the fights and hard-hits-- but looking back on things, I really think I was drawn to the fact that the Hawks were the under-dogs and they really had to fight hard to win their games.

There's something not just exciting-- but a sense of fulfillment and-- what's just right--- when the little guy is able to overcome apparent deficits to take-on and take-down the big-guys.

Times have changed.  While my beloved Blackhawks have morphed into one of the most skilled teams on the ice, I still have retained my love of rooting for the under-dogs.  

As a lawyer, I can't think of anything more rewarding-- or important-- than to represent an injured or disabled person in a case against a big corporation.  

For too long I have observed powerful individuals and corporations try to create their own sets of rules that continually seek to insulate themselves when an error is made that significantly affects an individual or family.

In addition to continuing to write about issues impacting the primarily elderly population on the Nursing Homes Abuse Blog, I am really excited to begin work on a new project, Child Injury Law Blog.

The Child Injury Laws Blog, will in many ways mirror some of the issues that impact the elderly, yet will also focus on issues that impact the young--- and very-young including:

• ATV Injuries
• Burns
• Community News
• Dangerous Drugs
• Day Care
• Dog Attacks
• Foster Care
• Medical Malpractice
• Motor Vehicle Accidents
• Premises Liability
• Sexual Abuse
• Swimming Pools
• Trampolines

Choosing a high-quality day care facility is very important because you are entrusting that facility with your child’s safety and well-being. It is important that you feel comfortable with your child’s day care facility. Otherwise, you will spend the time that day care frees up worrying about your child. (See “Trust Your Instinct When Placing a Child in Daycare with Potential Hazards”)

There are specific qualities you should look for when choosing a day care facility:

• Adult caregivers with training or experience in child development
• A warm, nurturing, developmentally appropriate, and intellectually stimulating environment
• Small child to staff ratios with consistent, long-term adult caregivers
• Good parent-staff communication

Child Care Aware recommends five steps to choosing safe and healthy child care:

1) Start Early – Start looking at child care options early, so you can do research and take your time in choosing an appropriate facility. 

2) Make a Call – You can call your local child care resource and referral (CCR&R) agency to learn information about the availability of child care in your area and help you choose a quality child care program that meets regulatory standards as well as your personal needs. You can also contact your State’s child care licensing agency to find out whether a complaint has been filed against a regulated child care program

3) Visit and Ask Questions

• Look– You should visit the child care facility, make sure that children are being supervised at all times, ensure that workers follow hygiene guidelines, and make sure that the play are is safe for children to use.
• Check – While at the facility, you should make sure that dangerous substances such as medicine and cleaning supplies are out of children’s reach, and make sure the facility has a plan in place if a child is injured, suck, or lost
• Count – You need to count the number of adults and the number of children they supervise, and you should make a note of the children’s age. There should be no more than one caregiver per: 3-4 infants, 3-4 young toddlers, 4-6 older toddlers, and 6-9 preschoolers. 
• Ask – It is important that you ask questions about the caregivers training, CPR and first-aid training, criminal background checks, licensing, accreditation, turnover, and complaints.
• Be informed – The best thing you can do is be informed by doing research about the child care facility and doing a thorough check of the facility for yourself. 

4) Make a Choice

5) Stay Involved

Price is another factor to keep in mind when choosing a day care or child care option because child care can be expensive. It is estimated that 10.6% of a two-parent household’s annual income will be spent on child care. This can be a family’s largest expense after rent or mortgage. The price for child care depends on the type of care, child age, and community. 

The Child Care and Development Fund (CCDF) funds some state child care assistance programs, with each State having different guidelines. The CCDF program is a federally funded program that is in place to help low-income families, or families receiving Temporary Assistance for Needy Families (TANF). In addition, you may be eligible for tax benefits such as the Earned Income Tax Credit (EITC), Child Tax Credit, and Child and Dependent Care Credit. 

Related Child Injury Laws Blog Entries:

Almost A Year Later.... Confusion Still Surrounds Death Of Child In Chicagoland Day Care Center

Daycare Owner Faces Murder Charges Following Death Of Infant

Signs Of Childhood Abuse May Not Always Be Apparent

Child's Death At Day Care Demonstrates Need For Tighter Regulations

Last month was the National Child Abuse Prevention Month, so it is an appropriate time to talk about child care: child care options, how to choose a child care facility, national and state regulations, abuse/neglect, and common injuries. Just like the elderly, children represent a vulnerable population, requiring special regulations, protections, and oversight. (See “Children in Day Care Are Susceptible to Many of the Same Problems Our Elderly Nursing Home Patients Encounter”)

Child Care Options

Child Care is the regular, supervised, and paid care of children. In the United States, there are over 335,000 licensed child care facilities (state comparison of type and number of licensed facilities). There are a variety of child care options available for families:

-        Child Care Centers – These are nonresidential facilities that provide care to children typically in classrooms of children in different age groups. Some states have licensing requirements including minimum number of children and minimum number of hours the facility operates. 

-        Family Child Care or Day Care Home/Group Day Care Home – These are residential facilities where child care is usually provided in care provider’s residence. Typically, one child care provider cares for a small number of children. States have different definitions for this type of facility based on number of children. 

-        Family, Friend, and Neighbor Care – This is a situation where a relative, friend, neighbor, or other adult provides care in either the child’s home or their own home. 

-        Nanny/Au Pair – This is a setup where the family hires one person to either come to the child’s home or actually live in the child’s home. 

Early education programs can also provide an alternative to traditional child care options. They focus on school readiness and work on developing a child’s social, emotional, physical, intellectual, speech and language development with a variety of activities. Early education programs include:

-        Early Head Start (EHS) – This is a federally funded, community-based program for low-income families with infants and toddlers. It provides child development programs through EHS center-based programs, home-visit programs, or a combination of the two. (Head Start Locator)

-        Head Start – This is the same as Early Head Start Programs, but is intended for children 3-5 years old. The focus of Head Start is school readiness of young children from low-income families (family income is at or below the Federal Poverty Income Guidelines). 

-        State-funded prekindergarten programs – Some States actually fund prekindergarten programs for children 3-4 years old in order to give them the experiences they need to be ready for kindergarten. 

The Survey of Income and Program Participation (SIPP) collected information about child care arrangements for children younger than 15 years. The following table shows the percentage distribution of the primary child care arrangement. 

As you can see there are a broad array of child care arrangements available for families today based on the needs of both child and parents.  Rosenfeld Injury Lawyers is committed to the safety and well being of children in all care settings.  We welcome you to visit our Child Injury Laws Blog for the most recent developments related to child care and safety.

Recently, we settled a claim on behalf of a 11-month-old girl who fell from a high chair at a daycare center--- a mere four days after she began attending the facility.  The young girl slipped down from the chair and sustained a laceration and fracture to her face. 

An investigation by the state regulatory agency revealed that the high chair the girl was using was missing a crucial strap to ensure that the infant could sit securely without the risk of slipping out of the bottom.  The investigation further revealed that an employee at the facility had requested a replacement high chair three months before the incident occurred.

Should this type of incident been prevented?  Of course! 

While daycare facilities should (and usually do) maintain their facilities in the safest manner possible, I feel strongly about parents conducting regular safety inspections of their own. 

Certainly, it is not realistic to think that all daycare accidents can be avoided, but looking over the facility on a regular basis may help protect your child and his or her peers.  Should you notice a problem, alert the staff immediately.

The following are commonly encountered problems in daycare facilities that deserve immediate attention to prevent injury to children:

• Broken or defective chairs, tables, ladders and toys
• Slamming doors
• Defective door locks
• Dangling window drape pulls
• Missing or damaged protective mats under climbing equipment
• Unprotected sharp corners
• Small toys or parts that pose a choking hazard to infants and young children
• Flaking paint
• Unguarded radiators
• Missing window screens / unguarded windows
• Protruding screws or nails from toys, lockers or hardware
• Dirty areas
• Inappropriate or mismatched equipment -- particularly adult sized chairs and ladders in the room

Rosenfeld Injury Lawyers regularly represents children injured in a day care or babysitting facility.  If you believe that your child's injury is indeed related to poor care at a facility we invite you to discuss your legal options with our child injury attorneys.

Related:

Child's Death At Day Care Demonstrates Need For Tighter Regulations

Preventing Institutional Child Abuse By Carefully Selecting A Facility

Understanding The Regulations Pertaining To Day Care Facilities Is Crucial To Protecting Your Child

Toddler Receives Burns In Daycare Due To Caregiver's Poor Judgment

A client emailed my the above news clip regarding a day care worker at a gym that abandoned the children she was responsible for looking after in order to attend to a personal errand.  Of course, I was shocked and appalled by this blatant disregard to child safety, but what is most disturbing about this story is the fact that most quasi-day care facilities in... a gym, a church or any privately operated facility where the parents are on the premises are not subject to the same scrutiny -- and laws that a 'normal' day care facility obligated to abide.

In Illinois and many other states, gyms and other facilities where the parents remain on the premises, do not need to conduct the same facility inspections and employee background checks that more traditional day care facilities are subject to.

Thankfully, this episode of poor judgment resulted in minor injuries to a child.  However, as the parent of a toddler, I cringe to think of what may have occurred had the day care worker chosen to extend her break?  

In situations such as this-- if the child sustained a severe injury-- I think a powerful argument could certainly be made that the gym was negligent in both their staffing of their children's day care / babysitting facilities.  Certainly, I think situations such as this demonstrate there is a real need for more regulation of all facilities--- regardless of their location or the proximity of parents-- in order to ensure maximum child safety.

Related Nursing Homes Abuse Blog Entries:

Children In Nursing Homes: Truly The Most Vulnerable

Children In Day Care Are Susceptible To Many Of The Same Problems Our Elderly Nursing Home Patients Encounter

Sexual Abuse Of Children By Caregivers: A Varied & Widely Unknown Impact

Children Are Frequently Targets Of Abuse In A Group Home Setting

Child Injury Laws: Day Care

This year, more than 80,000 episodes of sexual abuse involving children will be reported to authorities. Take a deep breath....  

Because the actual number of instances sexual abuse in children is believed to be far greater, due to the fact that only a fraction of the childhood sexual abuse cases get reported to authorities.

While the sexual abuse may occur both inside the home-- at the hands of friends or family, research tells us that the incidence of sexual abuse in children increases outside the home.  

While thankfully, far from a commonplace occurrence, children in a day care, group home or institutional setting are at an increased risk of becoming victims of sexual abuse compared with their peers in a more traditional settings.

The impact of sexual abuse amongst children varies greatly dependent upon individual factors such as: the child's personality, their age and their living situation.  Similarly, victims of childhood sexual abuse manifest the effects of their abuse at different times of their lives.  In some cases, the sexual abuse victims may not even become aware of the full effects of their abuse until later in life-- when they begin to experience difficulties with relationships and intimacy.

Common manifestations of sexual abuse in children include:

• Sudden behavior changes
• Difficulty sleeping
• Withdrawal from friends and family
• Toileting accidents
• Behavioral problems
• Inappropriate sexual behavior
• Aggressiveness

Despite the obvious level of discomfort that accompanies sexual abuse topics, experts agree that some of the most productive part of sexual abuse treatment involves an open discussion of the incident itself and acknowledgment of related feelings.

Treatment for victims of sexual abuse usually incorporates various aspects of individual and group therapy.  Because family members may experience feelings of guilt and embarrassment, it is also important that counselors work with the family unit as well as the child. 

Pursuing A Childhood Sexual Abuse Case Against A Facility

In order to recover damages against a facility where sexual abuse have occurred, it may be important to establish that the management was in a position to prevent the act from occurring.  In some cases this means the facilities failure to screen its employees, while in other situations it may be necessary to establish that the facility failed to intervene when it should have known when the alleged conduct occurred.

As attorneys who are devoted to representing victims of sexual abuse and assault, we have developed contacts with medical and psychological professionals across the country to both assist our clients with the recovery process as well as assure that the full extent of their trauma gets conveyed in a compassionate, yet effective way to decision makers such as defense lawyers, insurance companies or to a court.  

At all times, we are mindful of the best interests of out clients and frequently work hard to resolve matters prior to litigation and before the individual is forced to re-live their trauma before a jury.  

You can always talk with an attorney experienced with representing victims of sexual abuse free of charge.  All contacts are kept in the strictest confidence. (888) 424-5757

Resources:

Responding To Child Sexual Abuse, American Academy of Child & Adolescent Psychiatry

Alleged sexual abuse at a day care center: impact on parents.

The spectrum of sexual abuse in daycare: An exploratory study, Journal of Family Violence 3 (4): 283-298.

Child Injury Laws Blog

Related:

Children In Nursing Homes: Truly The Most Vulnerable

Children In Day Care Are Susceptible To Many Of The Same Problems Our Elderly Nursing Home Patients Encounter

Are Group Homes A Viable Alternative To Nursing Homes?

Victim Of Sexual Abuse To Receive $3.2 Million From Chicago Archdiocese

Many families are forced to institutionalize their disabled children in nursing homes because of many states don’t have the resources to pay for in-home care. 

This puts parents in the difficult position of funding expensive home care on their own or having their child live in a nursing home, surrounded by elderly adults, and many families simply cannot afford the cost of in-home care workers and nurses. 

The Centers for Medicare and Medicaid Services estimates that about 4,000 children live in nursing homes in the U.S. and that number is steadily growing as health care resources are increasingly spread thin.

Thousands of children with disabilities end up living in nursing homes because of insufficient coverage for in-home care by state governments and a shortage of skilled home care workers. In 2000, the Centers for Medicaid and Medicare Services estimated that 4,886 children lived in nursing homes; of these children, 1,222 suffered from mental retardation or a developmental disability. 

Medicaid guarantees long-term care for all people with disabilities, including children. However, many disabled children, who would be adequately served by proper in-home care, end up in nursing homes despite higher costs for nursing home care than in-home care. 

The University of Minnesota Research and Training Center on Community Living reported that home and community care cost about $26,000 per year while the state of Georgia spends about $81,000 per year on each patient in nursing homes. Although some federal and some state funding has been increased to help remove disabled children from facilities with four or more disabled persons (congregate settings), the number of institutionalized children has remained largely unchanged. 

Many disabled children end up in nursing homes because of insufficient state resources. About 93,000 special needs people are on waiting lists for home and community based services. However, there are not enough skilled nurses, therapists, and home health care workers to support the people who most need their help. In many cases, the family’s private insurance won’t cover the cost of medical equipment, and in-home nursing and therapy. This leaves many families with only one choice, nursing home care. 

Most nursing home care is focused on older adults because elderly residents constitute the majority of the resident population. As expected, treatment and health concerns differ for older adults and children. Also, children often spend more years living in nursing homes than the elderly adults they are surrounded by because of the age difference. This means more years spent living in a nursing home, away from their family, usually costing Medicare more money than if the child were able to live at home receiving in-home support services. 

However, until states step up funding to improve in-home care resources, these children will remain stuck in nursing homes, hardly a suitable environment for most children, especially when their families would prefer them to be living at home. 

Nursing Homes, Group Homes & Day Care Facilities Responsibility To Care For Children

The foreign environment of a nursing-home-world created for adults, leaves many children at risk for abuse and mistreatment at the hands of caregivers and other patients.  I have successfully prosecuted cases on behalf of many of these children and young-adults in the following types of cases:

• Sexual Abuse
• Physical Abuse
• Neglect
• Molestation
• Food Poisoning
• Medication Errors

Working side-by-side with some of the most respected authorities on the long-term effects of abuse on young people, we have successfully secured money to provide for the future.  Many of the sexual abuse and molestation cases we work on can be resolved prior to the filing of a lawsuit, in a confidential manner-- with minimal impact on the individual. 

If you believe a young person suffered from an injury, abuse or neglect in a nursing home, foster home, day care, group home or any other structured setting, we would honor the opportunity to speak with you.  As always our services are free if we do not recover on your behalf. (888) 424-5757

Resources:

Medical News Today: Wall Street Journal Examines Nursing Home Care for Children with Disabilities

VirginiaSpecialNeeds.com: Thousands of Children with Special Needs Are Living in Nursing Homes 

Research and Training Center on Community Living: Number of Children in Nursing Homes 2002

Wall Street Journal: Babes Among Elders, Nursing-Home Kids

Related Nursing Homes Abuse Blog Entries:

Alden Village North Charged With Neglect After Child Dies Due To Inadequate Nursing Care

Home Care Nurse Has License Suspended In Connection To Death Of Disabled Boy

Child Injury Laws: Nursing Home Abuse: The Deaths Of 13 Children Linked To Poor Care At Chicago Nursing Home