Nursing Homes Abuse Blog - By Jonathan Rosenfeld

I hear the term ‘nursing home abuse’ tossed around with such frequency that it would appear the episodes of abuse are literally occurring around every turn.  While I would hope that the term is getting misapplied and overly utilized, I’m beginning to think otherwise.

As family and friends of people living in a nursing home, very rarely do we actually see abuse being perpetrated upon our loved ones in public view.  While we may have suspicions about the emblems of potential abuse, really determining the source of these suspicions--- and a step further-- in the criminal or civil prosecutions can be difficult in light of the victim’s emotional or physical state.

Fed up with suspicions of abuse that went ignored, I recently read about how the family of an Ohio nursing home patient installed both an exposed video camera as well as a hidden camera inside the room of their family member during her admission to MetroHealth Prentiss Center for Skilled Nursing Care in Cleveland.

Just two days after the cameras were installed, the cameras recorded what the family had long suspected--- their loved one was consistently being mishandled by staff at the facility.  Over the course of the next two months, the cameras continued to capture images of staff members rough handling--- or dare I say ‘abuse’ of their loved one.

The video recordings have taken on new significance, as they are the main piece of evidence used by prosecutors in the criminal trials of former employees at the nursing home who faces charges related to crimes stemming from the abuse of patients.

In the first trial MetroHealth employees facing criminal charges, the tapes proved to be such a powerful piece of evidence that the CNA, Virgen Carabello has pleaded guilty to seven counts of patient abuse or neglect she was facing. Similarly, in the coming months, other nursing home employees will face similar charges related to their abuse of this nursing home patient.

The content of the video tapes will again take front and center in an upcoming civil lawsuit that the family is pursuing against the nursing home related to the mistreatment of their loved one. 

Episodes such as this begin to make me re-question my original statements regarding the overuse of the term nursing home abuse.  While I am grateful that the employees responsible for this mistreatment will be held responsible, I shutter to think about the other patients whom may have similarly suffered--- but without any recordation.

Related Nursing Homes Abuse Blog Entries:

After Video Of Nursing Home Abuse, Attorney General Gets Involved

Criminal & Civil Charges Brought Against Sunrise Facility After Videotaped Abuse

Elder Abuse: Captured On Video At California Facility

Nursing Home Abuse: Hidden Camera Catches Nurse Yanking The Wheelchair Of A Disabled Patient

When state officials see an incident involving poor care at a nursing home, they really have several tools in their arsenal to eradicate the problem.  

Depending on the severity of the violation, state officials generally elect to cite and / or fine the facility.  If deemed necessary, officials may choose to conduct follow-up inspections at the facility to ensure that compliance is maintained.

In addition, state officials also have the ability to pull the license from the facility effectively forcing the facility to close its doors and cease operation.  While such procedures may seem to be under-utilized, nursing home closures are usually viewed as a last ditch effort. 

Apparently fed up with the ongoing problems at Las Vegas nursing home, Nevada officials shut down Las Vegas Home Sweet Home, after repeated problems had been reported at the facility.  

According to reports of the closure appearing in the Las Vegas Sun, a state investigation revealed that Nome Sweet Home employees were regularly taking more money out of patient accounts than was actually necessary for reimbursement of expenses related to the purchase of groceries and other necessities.   More abuse was confirmed at the facility when police investigated an incident where a patient was dragged down the hallway by her ankles after getting into an argument with a manager.

The residents from the facility have been relocated to other facilities in the area.

Related Nursing Homes Abuse Blog Articles:

It's Time To Yank Federal Funding From Dangerous Nursing Homes

Where Will Nursing Home Residents Go When Medicare Closes Dangerous Facilities?

Nursing Home Settles Lawsuit After Fraudulent Records Discovered

The saying goes, "something is better than nothing" may be quite applicable when it comes to getting a slice of cherry pie for desert--- or perhaps other innocently gluttonous activities.   But I'm not so sure if I want that phrase to apply to situations when it comes to punishment for those who have committed crimes involving abuse of the elderly.

Recently, we discussed how workers at a California Nursing Home covered their patients with slippery ointment to play a joke on the following shift who would have difficulty handling them.  The sophomorish prank may have appeared like innocent fun--- especially considered that none of the patients were seriously injured. 

Despite the lack of physical harm to the patients involved, four of the workers involved in the incident were criminally prosecuted on charges related to misdemeanor charges of injury to an elder or dependent adult, battery committed on an elder or dependent adult and battery committed on hospital property.

Now, two of the workers involved have been sentenced to 20 days in jail for orchestrating the prank and three other workers received community service for their respective roles. 

While there are those who may argue that such punishments are indeed acceptable--- or perhaps excessive given the innocent nature of the prank.  For me, punishment aside, I strongly feel that these individuals have no business ever working with the elderly again as they undoubtedly have no such poor judgement its only a matter of time before innocent pranks turn into real tragedies.

Related:

Elder Abuse Can Affect Anyone-- Even Mickey Rooney

Elder Abuse: Captured On Video At California Facility

Three Nursing Home Employees Fired After Abuse Is Discovered In Mass. Facility

When I first saw a recent news report about a Canadian nursing home patient that fell 45 times over a six-month period, I began to question my reading skills as the number seemed to be downright shocking!  As it turns out, my eyes are indeed in good order as are the journalistic skills of the Canadian reporter who prepared the story.

Hidden camera footage captured the man, who is afflicted with Parkinson's and Dementia, repeatedly falling at the nursing home where he was living.  In addition to the alarming pattern of falls, the videotape confirming abusive behavior on the part of the nurses who were to be assisted him.

Rather than providing assistance for the man, video footage showed the nurse mocking the man as he lay on the floor. 

As a result of the fall and abuse, the man's wife has filed a lawsuit against the facility.  Read more about the pending nursing home lawsuit here.

Repeated Falls

Repeated falls remain one of the biggest problems facing well-bodied and disabled nursing home patients and are the source of many nursing home injuries. Certainly, when patients begin to experience a pattern of falls, both the nursing care and medical diagnoses need to be evaluated to determine what can be done to reduce the patient's risk of falling.

Too often I see nursing homes minimize fall incidents and no investigation done with respect to evaluating how falls can be minimized in the future.  Similarly, some nursing homes never relay fall information to the patient's physician which protracts an in depth medical evaluation to see if a medication or medical complication may be responsible for the fall episodes.

Related Nursing Homes Abuse Blog Entries:

Some Medical Conditions Virtually Guarantee Elderly Of Falls In Nursing Homes

Falls In Nursing Homes Are A Serious Threat To The Safety Of Many Patients

Even Common Falls Put Elderly At Risk For Developing Subdural Hematomas

Acknowledging situations where 'accidential' or 'suspcious' nursing home deaths may have gone without any formal investigation, South Carolina officials are considering ways to effectively investigate these situations. 

Under the current system in South Carolina, after a nursing home patient dies from 'natural causes' the body may be transferred to a funeral home without any involvement from the local coroner.  

Given that in many circumstances the determination between natural vs. accidental death is likely to be made by a physician who is employed by the nursing home, some South Carolina coroners are calling for their offices to be notified every time a nursing home patient dies.  

Theoretically, the notification of the coroner would both help confirm the cause of death and trigger an investigation into a suspicious death quickly when the circumstances surrounding the death are both fresh in the minds of the people involved.  For the decedents family, a timely investigation would also help them get some piece of mind as to concerns of poor care or abuse at the nursing home.

Considering that an independent party would be able to make these important determinations regarding the cause of death, I can only believe that this procedural change is a good thing for grieving families and patient care.

Given that many nursing home abuse and neglect cases hinge upon physical evidence-- such as the condition of a decedents body-- I would hope that this policy would effectively root out cases where there indeed been a situation involving mistreatment.  

On the other hand, I would similarly think that many of the nursing homes would be in favor of a shift in policy as a determination as to the cause of death by an independent party would likely help reduce any wrongful allegations of poor care.  

Read more about this suggested policy impacting South Carolina Nursing Homes here.

Related:

Will Proposal Notifying Coroner Following Nursing Home Deaths Help Deter Abuse?

Autopsies May Help Families Determine If Their Loved One Was A Victim Of Nursing Home Neglect Or Abuse

Most Nursing Home Deaths Remain Uninvestigated

At some nursing homes, there seems to be a noticeable delay in providing outside care--- from a specialist or hospital when a patient becomes injured or sick.  Some of these delays may no doubt be attributed to the fact that the staff is optimistic that the patient's condition may improve, making such treatment unnecessary. 

Yet, in other circumstances that I encounter, a delay in seeking medical care for a patient is completely unjustified--- an in some cases downright cruel.  I mean if a patient complains of pain in his or her back following a fall, how long is it necessary to wait before requesting an x-ray service or taking the patient to a hospital?

Due to that fact that some skilled nursing facilities are notorious for poorly recording information in patients' charts, I imagine that many cases involving delayed medical care get rapidly brushed aside as the onset of the condition may be difficult to render from the patient's records.

Thankfully, some cases involving delayed medical care do get investigated.  Just recently, the Minnesota Department of Health investigated the care provided to an ill patient at Sunwood Good Samaritan Society of Redwood Falls.  It turns out that the facilities delay in obtaining medical care for the patient is at least partially to blame for her death last November.

In this case, staff at the nursing home documented the woman's strained breathing problems following supper, but used a fax machine to communicate the problem to the woman's physician.  Even as the woman's condition deteriorated to the point where her pulse became erratic and her fingers turned blue, the staff at the nursing home continued to continued to seek help from her doctor via the fax machine.

More than 24-hours after the woman's physician was contacted, she died from cardio-respiratory failure in the presence of paramedics who were in the process of transporting her to the hospital.

The woman's doctor was interviewed after the incident conceded that the facility should have sought medical attention for her quicker.

While I am uncertain if the staff involved in this incident were disciplined, these employees should take note that federal law requires nursing homes to notify patient's physician when a patient becomes ill or their condition changes. Failing to do so doesn't just jeopardize the patient's well-being, but is against the law!

Related:

State: Nursing home slow to act before resident died from cardiac arrest, Startribune by Paul Walsh, April 14, 2011.

Nursing Home Injury Laws: Minnesota

Are nursing home patients protected under federal law?

Arizona Nursing Home Fined For Multiple Safety Violations

For too long, the federal government has been subsidizing downright pathetic nursing homes.  Facilities that provide horrible care and dangerous living conditions are still permitted to keep their doors open.  As long as these facilities remain open, they will continue to provide a steady stream of income for their owners because of the government's generosity.  

Unfortunately, there's a complete double standard when it comes to government supported nursing homes v. privately funded facillites that provide shoddy care.  In a privately funded setting, these facilities would never exist as people would surely find alternative facilities that provide quality care.

Yet at many of the most troubled nursing homes, the main source of funding (over 99% at some facilities) is derived from governmental Medicare funding.  Take away the funding and there's little question that these facilities quickly close down.

Particularly, when many of these facilities care for the most vulnerable-- and challenging to care for-- patient, the argument can be made that if it weren't for these facilities, these people would have no place to go.  

The Chicago Tribune recently chronicled this dilemma when it chronicled the care provided at Wincrest Nursing Center in Chicago's north-side.  For years, federal and state agencies have chronicled troubling conditions at the facility including:

• Drug abuse amongst patients
• Violence amongst patients
• Felons living freely at the facility
• Staff unfamiliar with facility policies and procedures

Now, after the ongoing troubles and significant fines ($400,000), CMS is moving to terminate Wincrest's Medicare funding--- essentially closing the facility.

While I certainly sympathize with the stress created by re-locating patients, I suggest that an enterprising nursing home operator would eventually recognize the void created by the shuttered facilities (and the steady stream of government funds) and open a decent facility. Until then, operators of troubled nursing homes really have nothing to fear as they will undoubtedly continue to receive regular payments for their continual lackluster care.

Related:

Feds Yank Funding From Another Chicago Nursing Home With A Troubled Past

Where Will Nursing Home Residents Go When Medicare Closes Dangerous Facilities?

Nursing Home For Veterans To Shut Down

The California Department of Social Services revoked the residential care home license from Fair Oaks Care Home.  The revocation comes after the family of a patient at the facility came forth with a hidden video demonstrating staff abusing the elderly patient.

In addition to abusive living conditions, the state further alleges that the facility was unfit to care for patients due to:

• Fire code violations
• Improperly disposing dirty needles
• Forging prescription
• Dispensing expired prescriptions

Sadly, the abusive conditions in the video were not discovered until after the death of the woman at the facility.  Though the woman's death is still under investigation, an autopsy did determine that there were potentially toxic levels of narcotics in the woman's system and the presence of other medications for which a physician never prescribed.

Rosenfeld Injury Lawyers is dedicated to safeguarding elders in all living arrangements.  If you believe, your family member has been mistreated or abused in a nursing home, assisted living facility or group home we would honor the opportunity to speak with you to discuss your potential claims.

Related Nursing Homes Abuse Blog Entries:

Hidden Camera Catches Nursing Home Worker Abusing Paralyzed Stroke Patient

Video Demonstrates First-Hand Neglect At Hancock Park Rehabilitation Center, Los Angeles, CA

Videotape Confirms Resident Murdered By Peer At North Carolina Facility

District Attorney Endorses Use Of Video Cameras In Nursing Home

Nursing Home Injury Laws: California

I was sickened to see another report of a janitor at the MediLodge Nursing Home (Michigan) who was caught by his co-workers sexually assaulting a patient at the facility.  Perhaps the only positive aspect of this episode of nursing home abuse is that the man's co-workers immediately reported the incident to the police.

Presently, the janitor remains in police custody and formal charges will be forthcoming.

Episodes such as this serve as a reminder that we all need to be looking after all nursing home patients--- even those we may never suspect may be victims of sexual abuse. Hopefully, when the dust settles on this investigation, we will learn that the that the timely acts by the nursing home staff protected the safety of other patients at this facility.

Related Nursing Homes Abuse Blog Entries

Bye Bye Criminals

Nursing Home Supervisor Admits To Abusing 100 Residents

Nursing Home Operator And CNA's Named As Defendants In Civil Lawsuit After Sex Abuse Scandal

Sexual Abuse: Nursing Home Injury Laws

We've discussed problems at LaSalle County Nursing Home (Illinois) on several occasions here, here and here, but the bad news seems to just keep rolling out of the facility.  The New Tribune recently reported on an investigation at the facility conducted by authorities at the Illinois Department of Health (IDPH) following problems that occurred under the watch of facility administrator Amjad Hussain.

The IDPH investigations reveal a culture of poorly performing employees.  Among the recent incidents at the facility include:

• A registered nurse failed to timely perform CPR on a patient.  Instead of performing CPR the nurse went to request assistance from others.  As a result of the delay in performing CPR, the patient died.

• Verbal abuse of a 100-year-old patient at the facility by a CNA.  Another CNA witnessed the event, but failed to report it to the administration at the facility.

• Staff at the facility gave a patient food he has allergic to--- two times!  The allergic reaction was so severe that the patient required strong medications to alleviate the reaction.

Currently, Chris Csernus has replaced Mr. Hussain as the administrator of LaSalle County Nursing Home.  Hopefully, the change in personnel will result in better attention to patient care and eliminate cases of nursing home abuse and neglect.

The Lexington Herald Leader is reporting about proposed legislation that would require Kentucky nursing homes to notify coroners following the death of nursing home patients at the facility or shortly after their discharge.  The proposal is intended to assist families and prosecutors to identify and pursue situations involving suspected nursing home abuse and neglect.

Currently, Kentucky-- like many states has loose guidelines regarding the notification of coroners following the death of a nursing home patient.  Under the current laws in Kentucky, nursing homes are given broad discretion when to notify authorities as to a death that is believed to related to be "other than natural."

State-initiated autopsies of nursing home patients are relatively rare-- even when there is suspected mistreatment of the person.  In Kentucky, no autopsies have been performed by the state's medical examiner despite the fact that some facilities have received sanctions for their roles in nursing home patients deaths.

As we discussed, similar proposals for mandatory autopsies have moved forward in Illinois. As a nursing home lawyer, who has represented families in wrongful death lawsuits, I feel that timely performed autopsies have been effective in proving cases involving abuse and neglect.  However, families need to be mindful of the fact that just as an autopsy may help establish a case of poor care, it similarly can exonerate a facility in situations when such allegations are made.

Apparently, my support of such proposals is not unique, check out my colleague John Kormanik's reaction to this proposal here.

Related:

Autopsies May Help Families Determine If Their Loved One Was A Victim Of Nursing Home Neglect Or Abuse

Autopsy Confirms Man Was Murdered In Chicago Nursing Home

Nursing Home Injury Laws: Kentucky

Assessing the Autopsy (pdf) American Journal of Pathology, Vol. 128, No. 2, August 1987

Perhaps you've noticed?  We've done some major re-configuring here at the Nursing Homes Abuse Blog.  Of course, all of my original entries will remain, but the site has been reconfigured to make navigation easier both on the blog itself as well as on our sister sites: Nursing Home Injury Laws and Bed Sore FAQ. 

The most noticeable feature includes links to individual state resources for laws, support agencies as well as related blog entries pertaining to the state.  The response has been extremely positive, but as always I welcome additional suggestions to improve both the layout and content of my blog.  Thanks!

Tennessee authorities are now investigating what appears to be tell-tale signs of nursing home abuse following the hospitalization of a 100-year-old woman.  After the centenarian was admitted to the hospital with severe hemorrhaging, broken ribs and pressure sores, the hospital contacted the local police department as well as the Tennessee Adult Protective Services.

Prior to her hospitalization, the woman was a patient at Boulevard Terrace Nursing Home for treatment related to a fractured femur she sustained prior to her admission.

As authorities look into this patient's suspicious injuries, the woman's family has relocated her to another facility.

Most states have laws that require health care workers who are in contact with children or the elderly to report suspicious injuries to law enforcement agencies immediately for further investigation.  I have seen many cases of suspected mistreatment that get timely reported actually get verified through the diligent efforts of law enforcement.

In addition to determining the perpetrators, investigations completed by police, health departments and other applicable agencies has proved especially helpful in prosecuting nursing home abuse and neglect cases from a civil standpoint.  Many of these initial investigations prove crucial in the successful resolution of claims and lawsuits.  As a result, I encourage all families who suspect improper care to report the situation to authorities as soon as feasible to begin the investigative process.

Related:

MPD probes elder's injuries, The Daily News Journal, August 18, 2010

Medical Examiner Rules Tennessee Nursing Home Death A Homicide

Most Nursing Home Deaths Remain Un-investigated

Elder Abuse Is Widespread, Yet Only 4% of All Cases Get Reported To Authorities

As we age, our bones become weaker and are more susceptible to dangerous bone breaks. This is because older bones form small cracks more easily, which makes bone breaks more likely. 

In order to prevent dangerous bone breaks-- and to help determine fractures that may be the result from situations involving nursing home abuse-- it is helpful to understand the types of fractures and what causes them. Common types of bone fractures include:

• Stress fracture
• Spontaneous fracture
• Compression fracture
• Traumatic fracture

Stress Fracture

Stress fractures are actually tiny cracks in bones caused by overuse and repetitive motion. They occur mostly commonly in the lower-legs and feet because these are weight-bearing bones. Stress fractures may be barely noticeable at first, but the swelling and pain will intensity as they worsen. Therefore, it is important to receive proper care and treatment to prevent the stress fracture from becoming more serious. 

As with most bone breaks, osteoporosis or weak bones increases your chance of suffering from painful stress fractures. And, to further complicate matters, a study indicated that some post-menopausal women who take biophosphonate drugs such as Actonel, Boniva, Fosomax, and Reclast might actually have a higher risk for hip fractures. (See “Study Links Commonly Prescribed Osteoporosis Drugs To An Increase in Hip Fractures”) It is important to discuss any new medications with your doctor, who will help you weigh the benefits and risks of drug treatment. 

In a nursing home setting, staff members should be aware of the signs of stress fractures, so a resident’s care plan can be altered to prevent further damage and alleviate pain. Signs and symptoms are swelling and pain, especially in the lower legs and feet. Nursing home staff or doctors use x-rays to diagnose stress fractures. 

Early treatment of stress fractures is important, so the cracks do not worsen. Treatment includes reduced activity until the bone has a chance to heal. However, some stress fractures are harder to heal and are prone to re-injury. Therefore, it is important that nursing home staff monitor the resident’s injury to ensure that proper healing occurs.

Spontaneous Fracture

Spontaneous fractures (also known as compression fractures) are bone breaks that occur without trauma in what seem like normal bones. The spine and hips (bones that directly support your weight) are the bones most likely to be affected by spontaneous fractures. Older bones are more vulnerable to compression fractures because they lack the internal support structures to withstand impacts and pressure. Osteoporosis (weak and brittle bones) is the most common cause of spontaneous fracture. 

A 10% bone mass loss in the vertebrae can double the risk of vertebral fractures and a 10% loss of bone mass can increase your risk of hip fracture (2.5 times greater chance of hip fracture). Hip fractures are one of the most common injuries for elderly people. They usually occur because of a fall and can cause serious and even life-threatening medical complications. 

While walking exercises are often valuable tools to help maintain health (bone health) and promote strength, strenuous walking exercises can contribute to spontaneous hip fractures. Therefore, it is important to personalize individual walking plans for elderly residents according to their bone health, which can be determined by BMD (bone mineral density) tests. 

Hip fractures usually require surgery to realign the bones, often with surgical screws, metal rods, or plates. Then, after surgery the main focus is on controlling pain and preventing infection. The best thing to do after hip surgery is to start moving around as soon as possible. This helps reduce recovery time and prevent dangerous complications such as blood clots, lung congestion, and pressure sores. 

Oftentimes, a walking aid (walker, crutches, or cane) is used in the months following surgery. Physical therapy will help the resident regain their strength and independence. However, many elderly nursing home residents are never as independent as they were before their hip fracture. And, if the resident makes no improvements, physical therapy is often cut short. 

Elderly persons can also suffer from compression fractures in their spine, which occur when the vertebrae (back bones) become so weak that they compress or collapse. Again, osteoporosis is the main cause of vertebral compression fractures. A compression fracture of the spine can cause severe pain and a stooped posture or even a hunchback (kyphosis). While this type of compression fracture will often heal on its own after 8-12 weeks, previous spinal compression fractures increase your chance of suffering from additional compression fractures of the spine. 

Trauma Fracture

Elderly people are susceptible to dangerous falls because of poor balance and coordination, weakness, changes in gait, poor vision, illness, medications that cause sleepiness or dizziness. Over 11 million people over the age of 65 suffer dangerous falls every year. That is an astonishing one out of every three senior citizens. 

Your wrists and hips are the bones most likely to break if you suffer from a fall. Your wrists are susceptible to breaks from bracing yourself with your hands as you fall. And, your hips are more susceptible to breaks because as you age your bones (especially your hips) are less able to withstand impacts, and your hips often receive the brunt of the impact when you fall. 

After an accident or fall, nursing home staff members will examine the injured area to look for bone breaks, cuts, bruising, or other signs of injury. The staff will ask questions and investigate how the injury occurred. This investigation into the cause of the fall is very important to protect the resident and prevent future falls. 

If the resident lost consciousness, this could be a sign of a more serious condition, such as a stroke or heart attack. In the case of a possible bone break, the resident will be treated by a physician who will determine whether x-rays are necessary. The doctor will use a splint or case to immobilize bone breaks that occur on the arms, legs, hands, and feet.  However, as discussed above, hip fractures usually require surgery and post-operative physical therapy to help improve mobility. 

Understanding the significance of each type of fracture

Understanding the different types of bone fractures can help prevent dangerous bone breaks by avoiding dangerous situations and taking preventative measures. Nursing home facilities are required to keep the facility free from accident hazards and take preventive measures to prevent dangerous falls. 

Each resident should have an individual care plan specifically tailored to their strengths and weaknesses in order to provide the best care possible. If you or a loved one suffered a dangerous bone break while a resident at a nursing home facility, you may be entitled to compensation. 

Sources:

Nursing Homes Abuse Blog: Study Links Commonly Prescribed Osteoporosis Drugs to an Increase in Hip Fractures

Merck: Fractures

Amherst Bulletin: When Seniors Fall, Perilous but Preventable

e-Medicine: Lumbar Compression Fracture

Mayo Clinic: Stress Fractures

Journal of Orthopedic Surgery: Strenuous walking exercise and spontaneous fracture of the femoral neck in the elderly

Medicine Net: Fracture

WebMD: Understanding Fractures

Pub Med: Spontaneous fracture – multiple causes

I had to do a re-read of a recent article appearing in the Tennessean.com regarding the prevalence of elder abuse-- or perhaps more accurately the prevalence of un-reported elder abuse in Tennessee.  The article cites a report from The Tennessee Commission on Aging and Disability that estimate just 1 out of 23 cases of elder abuse get reported to authorities.

While there may be a number of reasons why elder abuse goes unreported, a primary reason the article points to is the fact that most elder abuse is perpetrated by caregivers who control the individuals access to the outside world-- and hence their ability to report the abusive situation to authorities and/or allow others to notice the abuse and report it to authorities.

Importantly, the article also points out that there are varying types of elder abuse aside from flat out assault or battery of an elder.  Other types of abuse such as intentional isolation or neglect are common situations encountered by the elderly reliant on a facility or caregiver for their daily living needs.

Similarly, many elders are frightened to report abusive situations involving caregivers because they fear they may be retaliated upon for coming forward with the abuse.

Hopefully, articles such as this will direct more attention to this important issue.  Too often, I see well-meaning caregivers and families living in denial with respect to the fact that their loved one is as risk for abuse or neglect.

Hopefully, articles such as this will provide a needed wake-up call for families and caregivers and perhaps cause them to be more aware of potentially abusive situations.  Common indicators of elder abuse include:

• Unknown bruising / fractured bones
• Sudden change in behavior
• Change in sleeping patterns
• Withdrawal
• Large withdrawals from financial accounts
• Dirty living conditions
• Bed sores

As I have been witness, when authorities are contacted as soon after a suspected incident as possible, they are most likely to be successful in determining the abusive perpetrators.  Unfortunately, as times goes on, memories fade and valuable evidence has a way of disappearing. 

Related:

Investigations May Not Always Hold The Answers To How A Nursing Home Injury Or Death Occurred

Elder Abuse: Why Bruises Can Be Tell-Tale Signs Of Poor Care

6 Most Common Causes Of Bed Sores & How Caregivers Can Help

The Real Devastation Associated With Sex Abuse In Nursing Home Will Never Be Known As Most Acts Go Un-reported & Un-prosecuted

Perhaps one of the more frustrating aspects of my job as a nursing home lawyer is the fact that so many nursing home employees forget to bring their common sense to work. 

Though there seems to be a never ending array of federal and and state nursing home regulations, the regulations really mean nothing if employees forget to use common sense and good judgment.

Though some nursing home abuse and neglect cases stem from extremely complex medical complications, a substantial number of injuries to nursing home patients occur simply due to the fact that some one made a stupid mistake.

If placing a space heater within inches of a bed-bound patient doesn't count as mark in the stupid category, then then I'm not sure what would.  Recently, the Star Tribune reported that five nursing home patients were seriously injured in portable heater mishaps in Minnesota nursing homes over the past year. 

The Star Tribune report highlights the following heater mishaps where the Department of Health confirmed the facilities acted in a negligent manner:

• January, 2009- An Alzheimer's patient at Golden Living-Meadow Lane sustained first and second degree burns after staff discovered the patient on a radiator.

• November, 2009- Nursing home staff discovered a nursing home patient suffering from dementia and restless leg syndrome who had managed to wiggle her leg out of bed an into contact the the electric heat register that was placed directly adjacent to her bed sore. When staff discovered the patient, her foot had become so severely blistered that the height of the foot had nearly doubled.

• December, 2009- A patient at Gracepointe Cross Gabled West suffered severe burns to her fingers after staff discovered a heat register that was paced within one inch from her bed.

• January, 2010- Second-degree burns were discovered on a hospice patient at Benedictine Health Center after her leg came into contact with a heating element.

• A patient at Redeemer Health and Rehab sustained second and third-degree burns after coming into contact with a radiator.  The patient died four weeks later.

Most of the above situations resulted in sanctions against the facility due to the fact that investigators in the above situations noted that facilities failed to "ensure that the resident environment was free of accident hazards."

Can we add a new citation category for just plain old 'bad judgment'?

Related Nursing Homes Abuse Blog Entries:

Burns In The Nursing Home Population Pose A Serious Threat Of Injury & Further Medical Complications

Even The Most Mundane Parts Of A Nursing Home Can Turn Deadly Without Proper Staff Supervision

Smoking-Related Fires Are A Real Threat To Nursing Home Patients. Is It Time To Put Out The Fire?

Manorcare of Rolling Meadows is a large, 155-bed, two-star (below average) Medicare rated nursing home facility. On December 31, 2009, the Illinois Department of Public Health (IDPH) fined Manorcare of Rolling Meadows $10,000 for fourth quarter Nursing Home Care Act violations relating to the area of nursing.   (see other stories on “HCR Manorcare”)

During a complaint investigation on October 29, 2009, IDPH investigators investigated two residents’ physical abuse by a staff member. (see “Nursing Home Abuse” and “Elder Abuse”) The nursing home’s failures put residents in immediate jeopardy until the accused staff member was finally terminated. 

All residents have the right to be free from abuse (verbal, sexual, physical, and mental), corporal punishment, and involuntary seclusion. However, not all nurses and staff members employed by nursing homes abide by this rule. Unfortunately, there are too many stories and cases of abuse by staff, including the abuse by one certified nurse aid (CNA) at Manorcare of Rolling Meadows. 

On September 9, 2009, Manorcare initiated an investigation into the alleged abuse involving a 64 year-old female resident suffering from a right craniotomy (removal of a piece of person’s skull) because of a tumor, history of agitation, irritability, and combativeness.

During the September 9th nursing home survey, a nurse noticed that the resident’s finger was swollen and bruised; the finger was x-rayed but no fracture was found. The resident told the nurse that two female CNAs had harassed her by holding her down, twisting and wiggling her finger, and telling her they were stronger than she was. 

The nursing home’s investigation revealed that one of the nurses had witnessed another nurse get upset with the resident because she had gotten scratched when the resident was resisting. The nurse then wrapped the resident’s hand with a washcloth and told her not to fight her. 

The resident’s care plan acknowledged that the resident was often resistive to care from staff and the care plan addressed this problem (approach resident in gentle manner, explain what you are going to do, re-approach later and/or differently if resistant). Clearly, that is not how the resident was treated by the nurse in question. On September 11, the nurse was fired because of the allegations of abuse. The nurse, who witnessed the abuse but failed to report it to administration, was also fired. 

There was another incident of abuse involving the same CNA who was fired that was not reported until the day the investigation was initiated to look into the allegations of abuse discussed above. In this case, another CNA witnessed the same CNA, who had held down the resident in the incident discussed above, hold down a different female resident’s hands and then slapped the resident’s hand because the resident pinched the CNA’s hand. 

This resident also had a specific care plan to address the resident’s resistance to treatment and care (resident can be verbally and physically aggressive to caregivers by biting and scratching). The care plan indicated that nurses should approach calmly, maintain distance until resident is calm, and if resident is resistive to return at a later time. Again, the CNA in question clearly did not follow the care plan. Instead, the CNA resorted to retaliatory behavior. To make matters even worse, the resident who was slapped is unable to communicate and, therefore, couldn’t even offer a statement to investigators. 

The nursing home administration did not investigate this allegation of abuse until four days after the incident. Administrative staff said that the allegations could not be substantiated because there was no redness or change in resident’s mood, even though the abuse was reported by another staff member. 

However, the CNA who allegedly abused this resident was fired for allegations of abuse that were substantiated regarding another resident. However, it seems alarming that a delayed investigation that returned no physical indicators of abuse could clear the CNA of wrongdoing, especially in a situation where the resident is noncommunicative. 

An earlier complaint investigation on August 12, 2009 looked into the fall and injury of a resident. The resident in question was a 100 year-old female resident, who was admitted to the facility with syncope (temporary loss of consciousness) with fall, brain tumor, anemia, hypertension, CRF (chronic renal failure), osteoporosis, and osteoarthritis of knees. She was admitted to the nursing home facility after suffering injuries after a fall at home that required hospitalization. 

Upon being admitted to Manorcare, the resident was assessed as a risk for fall due to history of falls, weakness, impaired balance and mobility, brain tumor, and forgetfulness. Physical therapy evaluation revealed that she required two people (maximum assistance) to help during toilet and transfer needs, and that she had an unsteady gait and was considered a falling risk. 

A nurse left this resident alone, sitting on the toilet, despite being aware that the resident needed assistance during toilet needs. Not unexpectedly, the resident fell and hit her head, resulting in a head contusion and cut, requiring her to be transferred to the ER. This resident never should have been left alone because she was a high risk for fall because of compromised medical condition and forgetfulness that she required assistance during transfers. 

The 100 year-old female resident died only four days after her fall. In the days between the fall and her death, she was noted to be lethargic and less responsive. The cause of death was ruled to be from the brain tumor which could have also affected her responsiveness. Regardless of the cause of death, in the days before her death, this resident suffered from a preventable fall and head injuries due to the nursing home’s lack of supervision for a resident who was a known fall risk. 

The nursing home must ensure that the resident environment remains free of accident hazards and also ensure that each resident receives adequate supervision and assistance to prevent accidents. In the case of the female resident discussed above, the nursing home failed to meet this standard of care.

The nursing home’s failures resulted in the injury and abuse of several of its residents. It is only natural that family members of other residents at Manorcare would be worried about the well-being of their loved ones and the quality of treatment they are receiving. If you or a family member suffered from an injury while a resident at Manorcare of Rolling Meadows, you may be entitled to compensation. 

Thank you to Heather Keil, J.D. for her assistance with this Nursing Homes Abuse Blog Entry

Sources:

IDPH: Manorcare of Rolling Meadows

IDPH: Manorcare of Rolling Meadows – Fourth Quarter Violations

Medicare Nursing Home Compare: Manorcare of Rolling Meadows

HCR ManorCare: ManorCare Health Services – Rolling Meadows

Nursing Home Abuse Blog: HCR Manorcare

Nursing Home Abuse Blog: Nursing Home Abuse

Nursing Home Abuse Blog: Elder Abuse

Since its inception, Nursing Home Injury Laws has become a trusted resource for caregivers and families seeking reliable information in a time of need.  Nursing home injury laws provides a comprehensive compilation of state-by-state nursing home contacts, a glossary for common legal terms, resources and legal information should the need arise.

In addition to important links to important developments within each state, Nursing Home Injury Laws provides has important information on the following commonly encountered nursing home injuries:

• Bed sores / decubitus ulcers / pressure ulcers / pressure sores
• Falls
• Medication errors
• Neglect
• Sexual abuse
• Wandering
• Wrongful death
• Physical abuse
• Nursing home FAQ

Continue to check out Nursing Home Injury Laws on a regular basis as more information continually gets added.

A widely publicized Chicago Tribune investigation revealed that authorities have investigated at least 86 cases of sexual violence against elderly and disabled nursing home residents since July 2007, but only one case has led to an arrest. This casts doubt on whether nursing home residents are safe from sexual abuse. 

While hardly an easy topic to discuss, the prevalence of sexual abuse amongst nursing home patients is a sad topic that must be addressed-- if for nothing else than to spread awareness of this topic.

Sexual Abuse in Nursing Homes

Sexual abuse is touching, fondling, intercourse, or any other sexual activity with an older adult who is unable to understand, unwilling to consent, threatened, or physically forced. The abuser can be a fellow resident or even a nursing home staff member. Elderly nursing home residents are more vulnerable to and at increased risk for sexual abuse because of:

• Dependence on family members, caretakers, agency staff
• Physical frailty or weakness
• Restricted mobility
• Alterations in mental status

The Illinois Elder Abuse and Neglect Act (320 ILCS 20/1 et seq.) established the Elder Abuse and Neglect Program in order to respond to allegations of abuse, including sexual abuse. Illinois law requires that persons delivering professional services to older adults (social services, adult care, law enforcement, education, medicine, state service to seniors, and social workers) report suspected abuse of older persons who are unable to report for themselves. This mandatory reporting requirement only applies if the reporter believes that the older person is not capable of reporting the abuse themselves. Any physician who willfully fails to report as required by the Act is referred to the Illinois State Medical Disciplinary Board. Any other mandated reporter required by the Act who willfully fails to report is guilty of a Class A misdemeanor. The Department also encourages people to report suspected elder abuse even when not required. If the older person is a nursing home resident, reports are made to the Illinois Department of Public Health’s Nursing Home Hotline (1-800-252-4343). (Previous article on Elder Abuse and Neglect Act)

Nursing home facilities are required to complete criminal background checks and risk assessments for all new residents. However, nursing homes are making errors and omissions, which put vulnerable nursing home residents at risk. The Illinois Department of Public Health (IDPH) is responsible for enforcing current safety regulations. However, Illinois Attorney General Lisa Madigan said that IDPH needs to do a better job of preventing safety breaches in Illinois’ nursing homes. 

In Chicago, a quarter of the city’s 119 nursing homes have suffered from rape allegations since July 2007. Of the 86 cases that authorities have investigated, only one arrest has been made. In January 2010, the authorities made arrests at two Chicago nursing homes for residents with outstanding arrest warrants. Twenty people were wanted for charges including assault, domestic battery, and indecent exposure. As a result of these raids, eight people were arrested. 

There are a shocking number of nursing home residents with outstanding arrest warrants and felony convictions. At facilities with large numbers of felon residents, there were high numbers of assault and battery allegations. Rainbow Beach Care Center, a South Side nursing home, had eleven people with outstanding arrest warrants, which led to three arrests. Rainbow Beach has about 193 residents, of which 18 are listed felons suffering from mental illness. There were 17 police reports of assault or battery, three reports of narcotics possession, and two cases of sexual violence between March 2008 and July 2009. At Kenwood Healthcare Center, another South Side nursing home, there were 95 reported felons among the 172 person resident population. During the same March 2008 to July 2009 time period, there were 30 alleged assaults or batteries and six narcotics cases. 

As discussed in a previous article, younger, mentally ill felons are being housed with vulnerable elderly nursing home residents, which leads to increased violence in nursing homes. Illinois has the highest number of mentally ill adults under age 65 living in nursing homes. As a result, cases of assault or battery and sexual assault are all too common in Illinois nursing homes. In December 2009, a 22 year-old convicted felon who was a resident at Maplewood Care Nursing Home in Elgin pled guilty to aggravated criminal sexual assault for raping a 69 year-old resident. 

Governor Pat Quinn’s Nursing Home Safety Task Force issued a final report that set out a timetable and road map for an overhaul of the state’s long-term care system. The Task Force made proposals to reduce the number of psychiatric patients and convicted felons housed in nursing homes, hoping that these measures will help reduce violent assaults against elderly and disabled nursing home residents. The Task Force hopes to segregate the most dangerous residents into more secure settings and to move mentally disabled people into smaller residential programs that will provide intense supervision and therapy for those people who require it. The report lists an April 30 deadline for implementing many of the major reforms including a more rigorous assessment and screening of new nursing home residents. Hopefully, these reforms will lead to safer nursing home facilities, where older adults can live without fear of brutal violence and sexual assault. 

Proving Damages

The first step of proving damages is proving that sexual abuse actually occurred. In many situations, nursing home residents might be unable or unwilling to report allegations of sexual abuse. Many nursing home residents are unable to report sexual abuse because of mental illness or disability or they might be unwilling to report abuse because of fear or shame. Impaired memory, often caused by dementia or brain injury, is a common barrier in the reporting and investigation of suspected sexual abuse. Some elderly victims might be unaware that abuse ever occurred or they may be unable to communicate clearly. Therefore, it is just as important that investigators are trained in techniques that assist older adults with their memory. 

Oftentimes, the responsibility to notice and report sexual abuse falls to nursing home staff members. In order to reduce the risk of sexual abuse in nursing homes and report allegations of abuse, nursing home staff members must be aware of signs and symptoms of abuse. Nursing home staff must be vigilant in monitoring residents for unexplained injuries, sudden depression, withdrawing, appetite change and other symptoms of abuse. These incidents must be thoroughly investigated and reported to the IDPH in order to ensure that residents who are victims of sexual assault receive appropriate treatment and counseling and that the alleged offender is removed or better monitored in order to prevent future attacks. 

Proper training in recognizing symptoms of abuse is necessary because sometimes these symptoms can be different to differentiate from the aging process, restraints, and rough care. Bruises can sometimes be attributed to the aging process or restraints even though they can also be a symptom of assault. Genital injury in the elderly can also be difficult to differentiate from genital bruising and bleeding caused by improper catheterization or rough perineal care. Common symptoms of sexual abuse include:

• Bruising around genitals or breasts
• Unexplained vaginal or anal bleeding
• Unexplained venereal disease or genital infections
• Torn, stained, or bloody underclothes

If a family member is the victim of sexual abuse, they can bring a claim for injuries. If they are unable to bring a claim on their own, you may bring a suit on their behalf. Damages (compensatory and punitive damages) can include: pain and suffering, disfigurement, mental anguish, medical expenses, loss of enjoyment in life, and shortened life expectancy. 

 How Sexual Abuse Affects Elderly Residents

Sexual abuse causes physical and psychological damage to the victim. Nursing home residents who are victims of sexual abuse often suffer from: fear, depression, acting out, withdrawing, decreased appetite, and mental health changes. Because many nursing home residents suffer from underlying medical conditions, any additional onslaught (physical or mental) to their weakened bodies can exacerbate underlying conditions or cause other serious health problems. In addition, elderly persons are more at risk for infections because of weakened immune systems. If injuries are not properly treated, these infections can be life-threatening. Therefore, if a nursing home suspects that a resident has been sexually abused, the resident should receive immediate medical attention and counseling. 

If you suspect that a family member has been the victim of sexual abuse while living in a nursing home, immediately alert nursing home staff and the Illinois Department of Public Health in order to ensure that the matter is thoroughly investigated. Sexual abuse can have many negative and long-lasting repercussions, and it is best that the victim receive medical treatment and therapy as soon as possible. 

Thank you to Heather Keil, J.D. for her assistance with this important topic.

Sources:

National Criminal Justice Reference Service – Elderly Victims of Sexual Abuse and Their Offenders
Chicago Tribune: Nursing Home Sexual Violence; 86 Chicago Cases Since July 2007, but Only One Arrest  

FindArticles.com: Thinking About the Unthinkable: Staff sexual abuse of residents

Chicago Breaking News Center: Felon Pleads Guilty to Nursing Home Sex Assault

Chicago Tribune: Nursing home Raids Net 8 Arrests

Chicago Tribune: Nursing Home Safety Reforms Get Deadline

In times of need, locating necessary information regarding the legal rights and resources for nursing home patients can be difficult and imposing.  In this respect, we are proud to introduce a new resource for patients, families and practitioners looking for a concise compilation of information regarding nursing home laws.  Nursing Home Injury Laws, provides every states':

• Nursing Home Laws
• Medical Malpractice Laws
• State Resources
• Applicable State Code
• Common Nursing Home Injuries
• Glossary
• Recognized Books & Journals
• Nursing Home FAQ

Additionally, we will be posting regular updates regarding important developments relevant to nursing home care within each state.  Here is a link to Nursing Home Injury Laws.

After the well publicized abuse of elderly patients at the Good Samaritan Nursing Home in Minnesota, some of the patients who were victimized have filed a civil lawsuit against the nursing home and the individual nurses involved. 

Prosecutors have already filed criminal charges against two young woman who tormented many of the Alzheimer's and dementia patients they were responsible for caring for.  The criminal investigation revealed that these derelict CNA's were repeatedly abusing Good Samaritan patients over a six month period in 2008.

While employers are generally not responsible for the intentional acts of their employees, lawyers for the nursing home patients will argue that the abuse instituted by the nurses continued for such a long period that the nursing home knew or should have know of the sexual abuse taking place at their facility.

Given the fact that many of the young women who were involved in this situation were 18-years-old, I find any argument by the nursing home operator that these women were acting on their own and did not require supervision laughable. 

As a lawyer who has represented victims of sexual abuse, I find these "I didn't know" arguments made by employers heartless and insincere.  I'll bet that if these young women were working a cash-register at this facility and were regularly taking money from the company coffers, the company would have stopped their conduct a lot quicker!

Read more about this nursing home lawsuit here.

Related Nursing Homes Abuse Blog Entries:

Girls Gone Wild In Minnesota Nursing Home

Nursing Home Abuse Charges Filed Against Teenage Workers

Forwarded Email From A Perfect Cause Re: Abuse At Albert Lea Nursing Home

Lawsuit Claims That Nursing Home Failed To Intervene In Case Involving The Sexual Abuse Of A Patient

People who suffer from mental impairments are particularly vulnerable to abuse and exploitation including physical abuse, sexual abuse, neglect, and financial exploitation. 

A mental impairment is any mental or psychological disorder, such as mental retardation, organic brain syndrome (diseases that cause decreased mental functions), emotional or mental illness, and specific learning disabilities. 

Caregiving can be very stressful because caring for a person with a mental impairment can require a lot of time, work, and money. Sometimes this stress can cause caregivers to provide inadequate care or even abuse the mentally impaired person. This can put the mentally impaired at increased risk for neglect and abuse compared with other nursing home patients. 

In 2001, President Bush established the President’s New Freedom Commission on Mental Health. The Commission’s Interim Report to the President, it declared that “the mental health delivery system is fragmented and in disarray” and described the lack of care for older adults with mental illnesses. The Final Report contains an entire chapter on older adults and mental health. The Report states that “a substantial proportion of the population 55 and older – almost 20 percent of this age group – experience specific mental disorders that are not part of ‘normal’ aging.” 

There are several laws and programs in place to protect this vulnerable population of people who suffer from mental impairments in order to ensure that their rights are protected and they receive the best quality of care possible.

The Americans with Disabilities Act (“ADA”) is in place to ensure that people with disabilities have legal protection against discrimination in the workplace, housing, and residential settings, public programs, and telecommunications. According to the ADA, you have a disability if you have at least one of the following:

• A physical or mental impairment that substantially limits one or more major life activities
• A record of such an impairment
• You are regarded as having such an impairment

In Illinois, there are several laws and programs in place to help protect people with disabilities. These include:

• The Illinois Guardianship & Advocacy Commission
• The Domestic Abuse Project
• Illinois Domestic Violence Act
• Illinois Criminal Code

The Illinois Guardianship and Advocacy Commission protects the rights and promotes the welfare of people with disabilities. There are three divisions: Office of the State Guardian (“OSG”), the Legal Advocacy Service (“LAS”), and the Human Rights Authority (“HRA”). The OSG is appointed by the courts as a guardian for persons with disabilities as a last resort, when no other guardian is available. The LAS represents people with disabilities and hearings to enforce their rights. Lastly, the HRA investigates alleged rights violations by providers against people with disabilities. 

The Domestic Abuse Program is administered by the Illinois Department of Human Services-Office of Rehabilitation Services (“ORS”). It provides a telephone number for people to report alleged or suspected abuse, neglect, or exploitation of an adult with disabilities. The program then investigates the reports and provides assistance to the abused person.   

The Illinois Domestic Violence Act (750 ILCS 60) protects adults with disabilities from abuse, neglect, or exploitation from a family member, household member, personal assistant, or any other person who has assumed responsibility to provide care. A judge can enter an Order of Protection (“OOP”) if they determine that abuse, neglect, or exploitation has occurred in order to prevent further abuse and provide compensation or other remedies. 

The Illinois Criminal Code (720 ILCS 5) provides criminal penalties for offenses including neglect, financial exploitation, assault, battery, sexual abuse, and home repair fraud. If certain crimes are committed against persons with disabilities, more severe penalties may be imposed (examples include: 720 ILCS 5/9-1(b)(17) murder of a person with a disability; 720 ILCS 5/11-9.5 Sexual Misconduct with a person with a disability; 720 ILCS 5/12-7.1 Hate Crime; 720 ILCS 5/12-19 Abuse and Criminal Neglect of a Long Term Care Facility Resident; 720 ILCS 5/12-21 Criminal abuse or neglect of an elderly person or person with a disability; 720 ILCS 5/16-1.3 Financial exploitation of an elderly person or a person with a disability). The Code also includes laws which make certain actions against persons with disabilities a crime, where those same actions when committed against persons without disabilities are not considered a crime. 

In addition, each State has a protection and advocacy agency that receives funding from the federal Center for Mental Health Services (“CMS”) (Protection and Advocacy for Individuals with Mental Illness Program (“PAIMI”)) in order to protect and advocate for the rights of people with mental illness and to investigate reports of abuse and neglect in facilities that care for and treat mental illnesses. In Illinois, this program is Equip for Equality. This program has its own Abuse Investigation Unit whose purpose is to prevent the abuse, neglect, and deaths of individuals with disabilities receiving services in any setting including community-based facilities and programs, nursing homes, hospitals, and state-run mental health and developmental disability facilities in Illinois. 

In Illinois, residents of long-term care facilities have the right to continue living in the facility (210 ILCS 45/3-401; 42 CFR 483.12). Involuntary discharge can only occur if:

• Your medical needs cannot be met by the facility
• Your health has improved so that you no longer require the facility’s services
• Your physical health or safety is at risk
• The safety of others is at risk if you remain
• You have not paid or are late paying the facility’s bill
• The facility closes

If a facility requests that a resident be discharged, it must provide written notice to the resident or the resident’s representative. Then, you still have the right to meet with the facility to discuss the discharge and appeal the discharge to the Illinois Department of Public Health. Therefore, a facility cannot discharge a person simply because of a mental impairment. 

Mental Retardation (Developmental Disability)

An intellectual disability (or developmental disability) is a condition which causes substantial mental impairment attributable to mental retardation or a condition similar to mental retardation. People with intellectual disabilities display a significantly below-average score on a test of mental ability or intelligence and face limitations in areas of daily life. Mental retardation can result from a number of conditions including Down Syndrome (extra copy of Chromosome 21) and Fragile X Syndrome (the most common form of inherited mental retardation). 

Most developmental disabilities have no cure, but therapy can help treat symptoms. If you are a caregiver for someone who has mental retardation, you may be performing the following activities for that person: bathing, dressing, feeding, cooking, shopping, paying bills, running errands, giving medicine, and providing company and emotional support. 

In Illinois, the Mental Health and Developmental Disabilities Code ensures that people with developmental disabilities receive adequate and humane care in the least restrictive setting. The Code governs the procedure for the admission, transfer, and discharge of people with developmental disabilities from “developmental disability facilities” (licensed or operated by or under contract with the State of Illinois) to ensure that people with developmental disabilities receive appropriate care in the least restrictive environment. 

A “developmental disability” is defined as a condition which causes a substantial impairment and which is attributable to mental retardation (intelligence quotient (IQ) of 70 or below), cerebral palsy, epilepsy, autism, or any other condition which results in impairment similar to that caused by mental retardation. These developmental disabilities must originate before the age of 18 and be expected to continue indefinitely.

People with mental retardation should not be cared for in facilities designed to care for people with mental illness. When a person is admitted into a mental health facility, the facility must evaluate the person for mental retardation. If the person has severe mental retardation, they must be transferred to a developmental disability facility within 72 hours unless they also have a mental illness and the mental health facility can provide appropriate mental health treatment and habilitation services. 

A common source of abuse is the use of restraints in inappropriate situations. People with developmental disabilities have the right to be free of restraints unless used as a therapeutic measure to prevent the person from causing physical harm to themselves or physical abuse to others. In addition, restraints require the written order of a physician, psychologist, social worker or registered nurse, unless there is an emergency requiring the immediate use of restraints. 

Oftentimes, facilities use restraints on persons with developmental disabilities so they are more manageable and require less work. Developmental disability facilities and other health facilities are often understaffed, which leads staff members to resort to unnecessarily severe measures, such as restraints, to control patients. However, this constitutes abuse, unless the restraints are medically necessary.

Financial exploitation is sadly another common source of abuse when dealing with people with mental retardation. A recipient of developmental disability services has the right to possess and use their personal belongings, unless necessary to protect the resident and others from harm. In addition, a recipient of services may use his money as he chooses. More often than should be allowed, people financially exploit these vulnerable adults, who lack the mental capacity to make well-informed decisions. The Illinois Criminal Code includes a provision for the financial exploitation of an elderly person or a person with a disability (720 ILCS 5/16-1.3).

Organic Brain Syndrome

Organic Brain Syndrome (“OBS”) is a general term that refers to diseases that cause decreased mental function. Symptoms include agitation, confusion, dementia (long-term loss of brain function; Alzheimer’s disease is the most common type of dementia), and delirium (severe, short-term loss of brain function). OBS is very common in the elderly, but it is not a part of the normal aging process. Alzheimer’s disease affects about 5% of people between the ages of 65 and 74 and nearly 50% of people over the age 85. Doctors do not fully understand the cause of Alzheimer’s, but it appears to be a combination of genetic, lifestyle, and environmental factors. 

Many disorders are associated with OBS including: brain injury caused by trauma, breathing conditions, cardiovascular disorders, degenerative disorders, drug and alcohol-related conditions, infections, and other medical disorders. Treatment of OBS depends on the disorder, but it mostly consists of supportive care to assist the person in areas where brain function is lost. Some disorders cause aggressive behavior which can be treated with medications. 

Mentally disabled nursing home residents might be unaware of abuse or unable to report abuse because of cognitive impairment. Also, residents with moderate or severe dementia may be unable to give an accurate description of abuse or neglect.

Mental Illness

Mental illness is a mental or emotional disorder which substantially impairs a person’s cognitive, emotional, and/or behavioral functioning. Common mental illnesses include depression, bipolar disorder, and schizophrenia. 

Illinois has the highest number of mentally ill adults under age 65 living in nursing homes. This is in part because Illinois only has 1,480 public hospital beds for mentally ill patients since the state shut down seven state-run mental hospitals since 1980. Under federal law, nursing homes may only admit mentally ill patients if the state has determined that the person needs the high level of care the nursing home can provide. Governor Pat Quinn formed the Illinois Nursing Home Safety Task Force to improve Illinois’ nursing home system and ensure the safety of residents. The task force will address the welfare of mentally ill nursing home residents after a series of assaults, rapes, and murders by mentally ill residents. 

The Illinois Department of Health and Human Services’ Division of Mental Health offers services ranging from intensive in-patient hospitalization to outpatient care backed by supportive housing and employment programs. The goal of the Division is to ensure that Illinois residents have access to publicly funded mental health services. 

A study by researchers Brown University found that in the United States, nursing home admission rates for people with mental illness varied between the States. These variations in services and how they are admitted may result in longer-than-average stays for those individuals with mental illnesses (46% of people with mental illnesses remained in the nursing home facility 90 days after admission compared to only 24% of people who did not have a mental illness). The study suggests that this might be because Medicaid pays nursing homes a higher rate for people with mental illness who have minimal physical problems, which might provide an incentive for nursing homes to admit these patients. It also suggests that patients with mental illnesses lack a safety net, which may explain why many of them become long term care residents. 

Another report from the Agency for Healthcare Research and Quality revealed that nursing home residents are likely to diagnose and treat depression. However, disparities were found in both depression diagnosis and treatment, which may indicate that certain groups of nursing home residents are not receiving the care they need. Furthermore, nursing homes usually treated depression with antidepressants rather than psychotherapy, which the study suggested might be because antidepressants are cheaper.

Learning Disabilities

Learning disabilities also put a person at risk for abuse and exploitation depending on the severity of the disability. Older adults suffering from learning disabilities might not be able to read, fully understand conversation, or have difficulty speaking and expressing their thoughts.

Learning disability (“LD”) is a term that describes specific kinds of learning problems (trouble learning and using certain skills). Oftentimes, the skills most affected are: reading, writing, listening, speaking, reasoning, and doing math. Learning disabilities are life-long disabilities and there is no cure. As many as 1 in 5 people in the United States have a learning disability, but they vary from person to person. 

The federal Individuals with Disabilities Education Act (“IDEA”) defines learning disability as “a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia."  Learning disabilities do not include “learning problems that are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage." (34 Code of Federal Regulations §300)

Cases of abuse, neglect, and exploitation of people with mental impairments are all too frequent despite the myriad of programs in place to protect people who suffer from mental impairments. If a family member has suffered from abuse or exploitation at the hands of a caregiver, facility, or hospital, you have legal options to seek a remedy appropriate for your case. Mental health facilities and caregivers owe a duty of care to the mentally impaired, and when this duty is breached, the person hurt by this neglect might be entitled to damages.  

For two generations we have advocated on behalf of the mentally disabled who are victims of abuse.  Our experience in these these cases allows us to represent the mentally disabled as compassionately and effectively as possible.  We would honor the opportunity to speak to you regarding a friend or loved one who was mistreated in a: group home, mental institution, assisted living facility or any communal living arrangement.  All consultations are kept in the strictest confidence. (888) 424-5757

Many thanks to Heather Keil, J.D. for her thorough research in these areas.

Resources:

Centers for Disease Control and Prevention: Intellectual Disability

Mayo Clinic: Mental Illness

Illinois General Assembly: 405 ILCS Mental Health and Developmental Disabilities Code

Illinois Department of Health and Human Services: Division of Mental Health

Illinois General Assembly: 720 ILCS 5 Criminal Code

Cerebral Palsy Lawyers FAQ

Illinois Guardianship and Advocacy Commission

U.S. Surgeon General: Mental Health Report: Chapter 5 – Older Adults and Mental Health

I am grateful to our readers who continually supply me some great topics to write about.  I also receive questions from readers regarding a particular situation they may be experiencing.  I try to answer every question I get or direct readers to a resource to get more information.  I have put many of commonly encountered questions in our FAQ category for easy access. Don't worry, I never disclose your personal information.

Here are some of the most popular FAQ's:

• How do I get a copy of medical records from a nursing home?

One of the most important steps in determining if a cause of action exists against a nursing home or hospital is to review the medical records. The records will help determine what-- if any-- mistakes were made by the facility in the care of the individual.

Getting medical records from a nursing home, physician or hospital can be a daunting task due to privacy regulations (HIPPA) and misunderstanding of the laws that apply to obtaining the records-- both on the part of the person requesting the records and on the part of the medical facility.

• Who is responsible for deciding whether an assisted living facility can properly care for a resident?

Assisted living facilities are generally governed by state law. In Illinois, assisted living facilities (ALF's) are licensed, regulated, and inspected by the Illinois Department of Health (IDPH). The IDPH ensures that all ALF's in Illinois comply with the provisions of the state Illinois Nursing Home Care Act (210 ILCS 45). IDPH is responsible for the initial licensing and continued re-certification and inspection of the facility.

If a patient feels that his or her resident rights are being violated, a complaint may be filed with IDPH, which may prompt a complaint investigation to ensure that the facility is properly caring for all residents.

• What is an advance directive and should I have one?

 An Advance Directive is a written statement about how you want medical decisions to be made in the future if you can no longer make them yourself. Federal law requires that you be told of your right to make an advance directive when you are admitted to a health care facility.

• Are nursing home patients protected under federal law?

Although many nursing home patients frequently feel trapped within the situation they are currently in, nursing home patients actually have many rights granted to them under federal law. Federal law empowers nursing home patients to make decisions with respect to their medical treatment and personal care.

Who Regulates Nursing Homes?

In most states, nursing homes are regulated by a combination of state (Department of Health) and federal authorities (U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services [CMS]). Each agency has its own regulations that control all aspects of the nursing home including: resident care, staffing, policies and procedures and medical equipment.

Because nursing homes are responsible for complying with state and federal regulations, agents from either agency conduct inspections of the facility to assure compliance with the regulations. These inspections are called 'surveys' and are generally done unannounced at least one time per year. Surveys may be conducted more frequently at facilities with a history of prior violations or in response to a complaint regarding resident care.

• What Are Signs Of Nursing Home Abuse?

Physical, mental and sexual abuse are forms of abuse encountered by nursing home residents across the country. Sadly, some of the most commonly abused nursing home residents include those who are physically or mentally disabled and have no way of fighting off a perpetrator.

Remember, you know your loved one better than anyone else. If you suspect mistreatment or abuse immediately report the situation to local police and/or ombudsmen. The reality is that most episodes of elder abuse go unreported.

• What Steps Should I Take Before Meeting With A Nursing Home Lawyer?

When you become aware of mistreatment of a nursing facility it is important to get your loved one the medical treatment they need and then get into ‘fact collection mode’. In fact collection mode, you are beginning to collect information about the incident, acts of the nursing home staff and medical condition of your loved one. Doing some preliminary work before you meet with a lawyer will prove for a more effective meeting.

Don’t assume you will remember all facts regarding the incident. As time goes on, your memory will begin to fade. The following steps will help you organize your thoughts during a stressful time and to give an attorney the information he needs to work best on your behalf.

Have a question regarding nursing home injury or patient rights?  Give me a call or use our contact form to discuss.  (888) 424-5757
 

Perhaps there is no more visual reminder of abuse or mistreatment than a bruise.  The discoloration is not only ugly in appearance, but it can also be a source of pain for the individual.  Because bruising can be a relatively common occurrence in the elderly, I think its important to learn more about this medical condition and hopefully become better at identifying a bruise due to mistreatment vs. the normal aging process.

What is a bruise?

Bruises can result after an injury, a fall, or even bumping into something. A bruise (contusion) is an injury to the soft tissue that results in broken capillaries which leak red blood cells. As the heart pumps, the blood escapes to the surrounding tissues, creating a bruise. 

Bruises can surface hours or even days after an injury and can also show up on a different part of the body than was injured. Bruises are usually reddish in color at first, turning bluish-black or purple after a couple hours, then yellow, green, or brown as they heal. Because bruises involve skin trauma, they are usually painful for at least the first few couple days. 

How bruises heal.

Bruises fade gradually as your body reabsorbs the blood that leaked from your blood vessels. After an injury, you can take steps to prevent or minimize bruising. This includes applying a cold compress to the injured area, elevating the injured area, and avoiding blood thinning medications if possible. During the healing process, a bruise will fade in color, from bluish-black or purple to a yellowish green to a lighter brown before disappearing. This color change occurs as the body’s white blood cells remove the decayed blood products little by little. In most cases, bruises heal in one to two weeks, but deeper, more severe bruises can last longer. 

Bruising in the Elderly.

Older adults bruise more easily and heal more slowly than younger adults because they have fragile capillaries and thinner skin. This is because as you age, your skin becomes thinner and you lose some of the protective fatty layer that helps cushion your blood vessels. In addition, bruises in older adults can last longer than the usual 1-2 weeks, sometimes lasting for months. 

Certain drugs can also make you more susceptible to bruises, many of which are common medications for older adults. Many older adults take non-steroidal anti-inflammatory medication for arthritis including ibuprofen (Advil, Nuprin) and naproxen (Aleve), which can interfere with blood clotting. Blood-thinning medication such as aspirin, Coumadin (warfarin), and Plavix (clopidogrel) reduce your body’s ability to clot, which can cause increased bruising. In addition, corticosteroids can make your skin thinner, making you more susceptible to bruises. 

Signs of abuse?

Bruises are one of the most common indicators of nursing home abuse and neglect. This is important to note because elder abuse, including physical abuse, is on the rise. Elderly nursing home residents are vulnerable to injuries and abuse because of weakness, illness, and decreased mental cognition. 

Many times the elderly residents who are victims of abuse are unable to alert family or staff of the abuse. They might be too scared to report the abuse or too embarrassed, or even unable to remember the abuse that they were forced to endure because of a cognitive impairment. 

Residents with moderate or severe dementia may be unable to give an accurate description of abuse or neglect. Oftentimes, the context in which an injury occurs is just as important as the injury itself in screening for elder abuse and mistreatment. Because of the serious risks associated with elder abuse, nursing home staff must be properly trained to recognize signs of abuse and closely monitor residents for common signs of injury or abuse, such as bruising. 

In Illinois, if a nursing home suspects that a resident’s injury might have been caused by abuse, the facility must report the matter to the Illinois Department of Public Health, investigate the alleged abuse, and provide a copy of the investigation to the Department. (Illinois Administrative Code: Long-term care facilities – 77 Administrative Code 300.3240 Abuse and Neglect). Nursing home facilities must take all injuries seriously, especially bruises that might indicate abuse (because of bruise location, size, or re-occurrence). 

Oftentimes, it is difficult to determine if bruising is normal, accidental bruising or something worse. In order for facilities to better be able to recognize abuse, the literature must be improved by documenting normal bruising in the geriatric population. This could then provide a point of comparison for nursing home facilities and caregivers when they encounter suspicious bruises. Until then, nursing homes must err on the side of caution, investigating all injuries that seem even slightly suspicious in order to protect our elderly population. 

Although older adults bruise more easily, staff should still be concerned when residents have bruises, especially if they are in patterns or clusters, or the bruises reappear.  The pattern or shape of the bruise can sometimes provide clues as to the cause of an injury (bruises can occur in the shape of knuckles or fingers). Bruises in patterns can indicate the use of restraints (bruises on hips and arms can indicate the use of bed rails, and bruises on the wrists can indicate the use of cuffs). Frequent or serious falls are another common cause of bruising, and can indicate improper supervision of a resident. In order to provide the best possible care, nursing homes must have care plans in place to prevent residents from suffering from accidents and abuse. 

The location of the bruising may also indicate abuse. The most common locations for non-accidental injury are the face, neck, chest wall, abdomen, and the buttocks. A study in the Journal of American Geriatrics Society, Bruising as a Marker of Physical Elder Abuse, reported that bruises occurring as a result of physical elder mistreatment are often large (> 5 cm) and occur on the face, lateral right arm, and back of the torso. 

In another study published in the same Journal, The Life Cycle of Bruises in Older Adults, the study revealed that almost 90% of accidentally acquired bruises in adults aged 65 or older occur on the extremities. In a sample of one hundred adults aged 65 and older, there were no accidental bruises on the neck, ears, genitalia, buttocks, or soles of the feet. And, if the bruise was on the trunk (torso) of the body, the subjects were more likely to know the cause of the bruise. 

Therefore, nursing home staff should pay particular attention to bruises that occur on a resident’s face, arm, and back because these areas have been shown to have the greatest incidence of bruising in cases of mistreatment. 

If you notice bruising on a family member who lives in a nursing home, you should ask the staff members about the cause of the bruising. Elderly adults are vulnerable to abuse and neglect and every effort should be made to prevent or stop mistreatment. 

Resources:

Mayo Clinic: Easy Bruising, Common As You Age

Medicine Net: Bumps and Bruises

Kansas University Law School: Elder Abuse in Nursing Homes, Does Bruising Tell a Story?

Journal of the American Geriatrics Society: Bruising as a Forensic Marker of Physical Elder Abuse

Sure, I may be a little groggy from my Thanksgiving gluttony, but this story regarding the placement of former inmates into nursing homes and assisted living facilities caught my eye.  The Georgia Department of Corrections (DOC) is holding a series of meetings with nursing homes, assisted living facilities and other organizations for the purpose of recruiting them to house criminals who have served their jail time and need housing or specialized care.

I'm sure many of these felons genuinely need medical assistance and psychological support after serving time in jail, but this just seems like a recipe for danger.  Feel free to tell the residential coordinator for the DOC, La Trese Schofield, how you feel about placing felons in nursing homes. Telephone: (404) 463-2947 / Email: schofl00@dcor.state.ga.us

Related:

Atleast 50 Convicted Sex-Offenders Living Freely In Illinois Nursing Homes

New Nursing Home To Be Built For Sex Offenders

Attorney Jonathan Rosenfeld Discusses Nursing Home Violence In AARP Article

Chicago nursing home attorney, Jonathan Rosenfeld, recently discussed the escalation of violence in nursing homes in a recent AARP article, 'Outrage: Murder in the Nursing home, Budget woes prompt placement of sometimes-violent mentally ill in ling-term care."

In addition to financial pressure to keep facilities operating at a maximum capacity, many mentally disabled people are forced into nursing homes simply due to a lack of other alternatives. Unfortunately, as we have discussed, when the mentally disabled are placed in a nursing home the results can be tragic.

Young, Mentally Ill Residents Pose Significant Threat To Nursing Home Residents

In Wake Of Sexual Assault Of Elderly Woman, Chicago Nursing Home & Administrator Named In Civil Lawsuit

Nursing Home Crimes Go Unreported

Authorities are investigating the strangulation death of a 100 year-old patient at Brandon Woods Long Term Care.  According to early reports, Elizabeth Barrow was strangled by her roommate possibly in retaliation for her receiving 'too many visitors'.  

While we learn more about the specifics of this tragedy, it now appears that this Massachusetts Nursing Home has a poor track record of providing quality patient care.  According to state nursing home surveys Brandon Woods scored in the lowest quarter based on factors relating to: cleanliness, quality and safety.

State inspectors have repeatedly cited, Brandon Woods staff for inadequate care.  For example, in 2009, staff were cited for:

• Failing to provide immediate treatment to a patient who was having a seizure
• Providing a patient with an extra dose of unnecessary medication
• Failing to document patients with dangerous infections
• Calling a patient a 'pain' because she asked for help too frequently

Is the fact that this Centenarian was murdered at a poorly performing facility a coincidence?

Possibly.  We will probably never know what-- if anything could have been done on the part of the staff to prevent or intervene in this brutal attack, but if the prior threats by the roommate are indeed true, then someone should have taken necessary steps to prevent this matter.  Nevertheless, this incident should be a reminder for all nursing home staff and visitors to take seriously any threats of violence against anyone.

Resource:

Report: Murdered woman’s nursing home got low grade, Boston Herald, October 10, 2009

Son: Slain 100-year-old mom had been subject of threatening remarks from nursing home roommate, Duluth News Tribune

Related Nursing Homes Abuse Blog Entries:

Videotape Confirms Resident Murdered By Peer At North Carolina Facility

Autopsy Confirms Man Was Murdered In Chicago Nursing Home

For Mama's Sake, Sign The Petition To End Nursing Home Abuse.

Last month was our busiest month in terms of visitors to our site.  Thank you for taking the time to visit, ask a question or leave a comment.  Your suggestions allow us to continually improve our site and make the Nursing Homes Abuse Blog an important Internet destination.  Many suggestions have turned into great ideas blog posts.

As always, I make it a point to answer each question personally. 

Below are last month's five most popular entries:

Failure To Monitor Bowel Movements In Nursing Home Patients Can Lead To Impacted Bowels

In addition to monitoring food and liquid intake of nursing home patients, staff need to pay attention to the elimination of the wastes.   When urine and feces are not produced on a regular basis, nursing home staff must bring these problems to the attention of physicians.

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

The results from a five-year study addressing the ability of care-givers and family to perceive pain in nursing home patients has revealed both parties fail to accurately assess chronic pain levels. In reaching this conclusion, researchers in the Netherlands studied 174 nursing home patients with and without cognitive impairments.  The study also concluded that family members were better at accurately assessing pain levels in their loved ones compared with nursing home staff.

Smoking-Related Fires Are A Real Threat To Nursing Home Patients. Is It Time To Put Out The Fire?

It only is a matter of time before another nursing home fire claims the life of another patient. While less publicized, hundreds of elderly people receive burns every year during their admission to skilled nursing facilities. Anyway you look at the situation, fires in nursing homes remain a real-- yet under-appreciated threat to nursing home patient safety.

Nursing Home Negligence Lawsuit Claims New York Facility Allowed Advanced Bed Sore To Develop In Rehab Patient

As nursing home lawyers, one of the situations we commonly encounter involve relatively healthy people who enter nursing homes for rehabilitation due to an orthopedic or cardiac conditions--- only to encounter more problems during their admission to a facility.  In some of these situations, nursing home staff wrongfully assume that many of the prevention programs used for more disabled patients are not necessary.

Illinois Nursing Home That Turned 'Blind Eye' To Sexual Assaults Now Faces Fines

The LaSalle County Nursing Home is a medium-sized 99 bed nursing home facility in Ottawa, Illinois.  On June 6, 2009, the Illinois Department of Public Health (“IDPH”) released a report following an investigation, revealing that a male resident at LaSalle County had molested ten female residents.

One of the more sobering parts of my job is when I tell someone about a nursing home negligence case that I'm working on--  only to get a response of 'so what' or the ever compassionate 'that guy was going to die anyway'.  Of course, death is an inevitable part of life, but older people have just as much right to live as younger people. 

For too long our culture has accepted poor nursing home care as an inevitable part of the the aging process.  Regardless of a person's age or physical condition, they deserve the best feasible care. Cutting a person's life short due to neglect or abuse can not be tolerated in our society.

With these quality of life thoughts in mind, I was pleased to see an article in the TheSunNews.com detailing South Carolina's new State Law Enforcement Divisions Vulnerable Adults Investigative Unit (SLED) to 'investigate abuse, neglect, exploitation and deaths in government nursing homes.'

SLED was created by legislators in 2007 in response to a report from a non-profit group, Protection and Advocacy for People with Disabilities that demonstrated the state's existing state agencies ineffectively investigated the deaths of nursing home patients allegedly due to abuse. 

According to SLED agent Matt Brown,

"A patient might be 105, but maybe he wasn't supposed to die that day. He has the same right to live as 5-year-olds with their whole lives head of them."

Since the creation of the SLED, 725 complaints of suspicious deaths were reported to the unit. 474 deaths were investigated and determined to be related to natural causes. 12 deaths were related to accidents.  One of the investigated deaths was related to suicide.  231 of the reported death cases remain open or have yet to be investigated due to time time constraints.

I'm all for any program to help families get answers as to what may have happened to their loved one.  However, in the case of the SLED program, it seems substantially under-funded to adequately investigate the cases pending before it.  The fact that a substantial portion of the reported claims remain uninvestigated-- years after they have been reported-- is particularly disheartening because many of the key witnesses will likely be impossible to locate given the long lag time.

Abuse In South Carolina Nursing Homes

If you suspect a South Carolina Nursing Home has abused or mistreated your loved one, there are several agencies to report the conduct to.  In addition, you may contact a nursing home attorney to act as your 'private investigator'.  Rosenfeld Injury Lawyers proudly represents individuals and families in nursing home negligence matters throughout the country.  We would honor the opportunity to speak with you.  (888) 424-5757

• State Law Enforcement Divisions Vulnerable Adults Investigative Unit (SLED) (866) 200-6066
• South Carolina Long Term Care Ombudsman, (800) 868-9095
• South Carolina Department of Social Services, (803) 898-7318
• South Carolina Attorney General, (888) 662-4328

I know some blog readers think that I just re-post the same entries about nursing home employees abusing their patients--- but I'm not.  The reality is that nursing home abuse is a problem encountered by an untold number of patients in nursing homes across the country. 

Out of New York, another case of abuse by a nurse's aide has recently made headlines when a nurses aide became irritated after a disabled patient repeatedly used a call light for assistance in the early morning hours in May, 2008.  Rather than tend to the patient's needs, the aide chose to put an end to the calls by tying the patient to a wheelchair with a bed sheet and putting her into a darkened room.

The nursing home's video surveillance cameras captured the aide sleeping next to the forcibly restrained patient. 

The aid involved in this incident pleaded guilty to violation of public health laws involving the abuse, neglect and mistreatment of a person.  Additionally, the aide was required to surrender his nursing certificate and is banned from working as an aide for one year.

"Think about this individual being put in a dark room.  This is not what you do to a human being," said Cynthia Rudder, Director of Special Projects for the Long Term Care Community Coalition.  "How does and aide go into a common room, turn off the light and nobody notices?" 

Good point Cynthia.  Where were the other nursing home staff members (and I certainly hope there was other staff on duty) when this obvious abuse was occurring?  I hope the the video surveillance is reviewed to determine the identities of the other individuals who did nothing to intervene in this situation involving obvious abuse.

Read more about this episode of improper use of restraints and abuse in a New York nursing home here.

Related Nursing Homes Abuse Blog Entries

'Dignity Training' Ordered For Staff In New York Nursing Home After They Humiliate Residents Who Need Assistance With Toileting

Caregivers Charged With Abusing Elderly In New York Nursing Homes

Nursing Home Worker Faces 25 Years In Jail Following Molestation Of Disabled Patient

Lawsuit Filed Against New York Nursing Home In Relation To Nun's Death

Officials from the North Carolina Department of Health and Medicare slapped a $210,000 fine on Sunnybrook Healthcare and Rehabilitation following an investigation that determined the facility failed to identify and report serious bruising of a resident.  As we discussed, authorities were alerted after 88-year-old Della Jarrett was found with multiple facial bruises. 

Staff at Sunnybrook offered no explanation for the bruising despite the fact that Weaver was bed-bound, making any self-inflicted injury virtually impossible. 

Jarrett's daughter's complaint triggered an investigation into the matter by North Carolina officials.   Despite the visible bruising, officials were unable to confirm if the bruises were indeed related to abuse.  Nonetheless, investigators cited the facility for multiple violations that put residents at risk for 'immediate risk of harm'.  Read more about this substantial fine against a Kindred operated nursing home here.

Nursing Homes Responsibility To Investigate & Report Abuse

Nursing homes have a non-delegable duty to provide all necessary care to help patients maintain their highest level of physical and psychological well being (F-Tag 309).  Obviously, this means facilities must an environment free from all forms of abuse (F-Tag 309 and F-Tag 223).

Especially when caring for disabled patients, nursing homes must take maximum precautions to ensure their well being.  Relatively, simple preventative measures on the part of the facility can ensure a safe environment for patients.  Nursing homes should:

• Conduct a pre-employment background check of all employees
• Have staff routinely check on bed-bound or disabled residents
• Restrict visitors to those who are approved by family
• Keep younger residents away from more fragile residents
• Investigate all allegations and signs of physical and psychological abuse
  

Related Nursing Homes Abuse Blog Entries

When Bruises Can't Speak For Themselves: The Difficulty Proving Abuse Of Disabled Nursing Home Residents

Nursing Home Attorney, Jonathan Rosenfeld, Discusses Elder Abuse In News Article

Where Will Nursing Home Residents Go When Medicare Closes Dangerous Facilities?

Here's a suggestion for nursing home owners, who wish to ensure the safety and privacy of their patients--- take your employee's cell phones away from them. While 'on the job' there is no use for them other than a source of distraction and an invasion of privacy.

The most recent situation involving inappropriate use of a cell phose comes from Kentucky.  A CNA at Dawson Pointe Nursing Home was indicted by a grand jury on charges of video voyeurism and adult abuse following two episodes where she took videos of a naked resident.  State officials cited Dawson Point for improper cell phone use earlier this year.

Why on earth are do facilities allow CNA's and other nursing home workers to carry personal cell phone in the first place?

Read more about the invasion of privacy at a Kentucky nursing home here.

Another nursing home employee faces criminal sexual assault charges following the alleged rape of a 56-year-old paraplegic patient at Charlesgate Nursing Center in Rhode Island.  According to nursing home administrators, this employee passed a criminal background check prior to his employment.  The patient asserts that this was at least the second occasion she was raped by this employee.  If this is the case, this facility may open itself to civil liability for inadequately supervising this employee.

Charlesgate owns seven nursing homes, assisted living centers, and independent living centers in Rhode Island.

• Charlesgate Nursing Center
• Charlesgate Assisted Living
• Charlesgate Independent Living
• Charlesgate North
• Charlesgate South
• Charlesgate East
• Charlesgate Park West
• Parkis Place

Related Nursing Homes Abuse Blog Entries

Nursing Home Worker Charged With Sexually Assaulting Resident In Virginia Facility

CNA Sexually Assaults Two Residents In North Carolina Nursing Home

Nursing Homes Failure To Screen Visitor Results In Sexual Assault Of Resident

Nursing Home Abuse: Texas Nursing Home Worker Caught Punching Resident

The News & Observer, had an article about the difficulty proving physical abuse in disabled nursing home residents who are unable to communicate any information about the act. The article focuses on an 88-year-old disabled woman who sustained bruises to her face(consistent with abuse) while a resident at Sunnybrook Healthcare and Rehabilitation in Raleigh, N.C. The woman suffered from advanced dementia and was unable to walk or roll over-- therefore bruising due to a fall could immediately be ruled out.  Read the full article about the abuse of disabled nursing home residents here.

Elder abuse in North Carolina

Complaints of elder abuse in North Carolina increased 20% between 2007 and 2008.  According to Sharon Wilder, a state ombudsman for long-term care, reports of abuse, neglect and exploitation will continue to increase both as a function of the rise in the numbers of the elderly population and as a result of caregivers demand to get answers following an incident.

"We now have baby boomers emerging as the sandwich generation and as caregivers for their elders," Wilder added.  "Their nature is to ask more questions and to want more answers.  There are more willing to contact whoever they need to get answers." 

According to North Carolina nursing home surveys, just 15% of the reports of elder abuse occurred in a long-term care setting, with the remainder of alleged abuse occurring in private homes and reported by relatives, neighbors or health care professionals.

Abuse of the elderly in long-term care settings

Despite a seemingly endless supply of news headlines, directing attention to this despicable act, most cases of elder abuse go unreported.  Remember, you know your loved one better than anyone else.  If you suspect mistreatment or abuse, immediately report the situation to local police and/or ombudsmen.  A timely investigation can go a long way towards identifying the individuals responsible for the abuse and hold them accountable.

The following conditions warrant investigation:

• Unexplained bruises, cuts, burns, sprains, or fractures
• Frozen joints
• Unexplained venereal disease or genital infections, vaginal or anal bleeding
• Bloody clothing
• Sudden changes in behavior
• Staff refusing to allow visitors to see resident or delays in allowing visitors to see resident
• Resident being kept in an over-medicated state
• Sudden loss of an appetite

Over the course of the the past 30 years, lawyers at Rosenfeld Injury Lawyers, have helped families coping with the fallout from elder abuse.  In many cases, we have successfully recovered damages from the facilities where the abuse occurred.  If you have a question related to abuse in a long-term care setting, we would honor the opportunity to speak with you.  (888) 424-5757

Web Resources:

The National Center On Elder Abuse

World Elder Abuse Awareness Day

Homer C. Valdez, 35, an employee of Manassas Nursing Home and Rehab has been charged with 'object sexual penetration' of a 72-year-old resident at the facility.  Mr. Valdez's co-workers reported his behavior to police on May 27.

According to officials at Commonwealth Care, the parent company of Manassas, Valdez has been suspended from his position at the facility pending the outcome of the criminal case. Commonwealth Care officials would not reveal how long Valdez had worked at Manassas or the capacity in which he was employed.

"This is something that we take very seriously and he will not be back working until after an investigation by law enforcement and a subsequent trial is completed,” said David Tucker an administrator at Commonwealth Care.

In the meantime Valdez remains in custody without bond.  Read more about this sex crime at a Virginia nursing home here.

About Manassas Nursing Home

Manassas Nursing Home is a Virginia facility that is certified to care for 120 residents.  According to Medicare records, Manassas rates just one out of five stars when it comes to overall care provided to residents.  Commonwealth Care has managed the facility since December 2006 and employs about 100 people. Commonwealth also manages Gainesville Health and Rehab.

Violence In Nursing Homes By Employees

Nursing home residents have a right to live in an environment free from violence.  When it comes to providing a safe environment, nursing home owners and administrators must do sufficient background checks to assure the people they hire do not have criminal backgrounds.  

Additionally, nursing homes have a responsibility to supervise employees.  This generally means having an adequate number of other workers in the facility to provide random 'spot checks' of all employees.  Additionally, nursing homes must investigate every allegation of employee misconduct to assure the safety of other residents.  Nonetheless, if you suspect abuse of resident at a nursing home, report the incident to law enforcement officials immediately.  Do not let nursing homes do their own investigation on their own time and terms.

Two Kentucky nursing homes have been cited by the Cabinet for Health and Family Services after employees improperly used their cell phones to take photos of residents. The most recent incident took place at Dawson Point.  Although the specifics of the incident have not been disclosed, Dawson Point administrator, Margaret Curtis, said she was forced to take immediate action to protect residents after she learned of behavior she deemed appalling.

A CNA at Northwoods Rehabilitation Center, a New York nursing home, is being charged multiple felony charges related to an alleged sexual assault of a 78-year-old resident.  The New York Attorney General has filed criminal charges against Robert Gunderson for sexual assaults that occurred at Northwoods between December, 2007 and January 2008.

Gunderson faces similar charges for sexually assaulting a 28-year-old resident with multiple sclerosis at Eddy Ford Nursing Home.  In that incident Gunderson allegedly inappropriately touched the wheelchair bound resident between August and September, 2008.

Both of these incidents are the the result of New York Attorney General's crackdown on nursing home abuse.  Attorney General Cuomo is an outspoken proponent of use of video cameras in patient rooms to capture inappropriate behavior on tape.  Since Cuomo has initiated the program more than 70 nursing home employees have been arrested or convicted of for abusing nursing home residents.

Read more about this case of nursing home abuse in New York here.

Nursing Homes' Responsibility To Residents

Facilities have a duty to protect residents from physical and psychological harm.  In this sense, preventative measures such as background checks should be conducted for all employees.  If a facility fails to properly screen its employees and the worker physically harms a resident, the facility may be responsible for paying damages from a nursing home lawsuit.

Frequent visits to a nursing home to check on loved ones can be the best defense to situations involving abuse.  Families and friends should be aware of potential signs of nursing home abuse:

• Broken bones
• Bloody clothing
• Sudden emotional withdrawl
• Bruises

If you suspect abuse of a loved one, contact law enforcement officials immediately in order to get help and to secure potential evidence of the crime. 

Related Nursing Homes Abuse Blog Entries

Ohio Nurse Sentenced To 12 and 1/2 Years For Sexually Abusing 100 Nursing Home Residents

Caught On Tape: 90-Year-Old Man Beaten By Home Nurse

Failure To Properly Screen CNA Could Cost Facility 3.5 Million

This past weekend a West Virgina nursing home resident was sexually assaulted by a visitor.  A manager of the Valley Haven Geriatric Center in Brook County called police when they noticed an elderly man acting inappropriately towards a female resident.  The man identified as 81-year-old William Jones was arrested for sexual assault but remains free on bond.

According to Brooke County Sheriff, Richard Ferguson, Jones and the victim were relatives.

Was this perpetrator a known problem?  Did the resident actually want to see him?

Visitors In Nursing Homes

Visiting a nursing home resident is a privilege-- not a right.  Nursing home staff can and should restrict individuals who pose a treat to the physical and psychological well-being of residents.  One of the most basic things nursing homes can do to protect their residents is to have a sign in system for every person who enters the facility.  In cases where a resident is disabled or unable to manage her affairs, the person's family should decide who can and can not see her. 

Facilities should also periodically check-in during the visitors stay.  Not only does this safeguard the residents', but it also gives visitors an opportunity to connect with staff who provide ongoing care.

No word regarding this perpetrators history of visits at Valley Haven.

Read more about this sexual assault of a nursing home resident here.

Resources For Nursing Home Visits

Tips When Visiting A Nursing Home, Ohio Department On Aging

Health Tips for Visiting Nurisng Homes And Hospitals, Centers For Disease Control

Nursing Home Visits. An Opportunity To Conduct Your Own Inspection. Nursing Homes Abuse Blog

Can someone please let me know what drives a person to physically abuse a defenseless elder? Is it empowering?  Is it done out of frustration? Does it just feel good?

Out of Texas, Lufkin Police have arrested a certified nurses aide (CNA) in connection with an episode of abuse witnessed by co-workers.  The incident took place on March 22, 2009 at Castle Pines Health and Rehabilitation Center. Apparently, the CNA took an 80-year-old CNA into her room, closed the door and began striking resident.

Staff at the facility were alerted to a potential problem when the resident activated a call light by the bed.  When staff arrived to check on the situation, they witnessed the CNA striking the resident.  A closer inspection of the situation revealed the resident's blood spattered on her bed.  Bruises were also observed on the resident's arms and legs.

Shortly after she was confronted by co-workers, the CNA admitted to 'popping the victim.'

Currently, the CNA is out and about in the community as she posted the necessary $5,000 bond shortly after she was taken into custody.

About Castle Pines

We make it our top priority to care for seniors with the respect, compassion and dignity they deserve. We understand that caring is what makes a community and without a sense of caring, there can be no sense of community. It's what sets us apart from any other long-term care facility.

Here at Castle Pines Health & Rehabilitation our nursing staff is overly-courteous, respectful and maintains a high level of professionalism at all times. Our primary goal is to get you back in a condition to be independent once again while maintaining a friendly environment and providing nutritionally enhanced meals.

I guess the CNA involved in this incident missed orientation?

"I suspect my grandmother may be getting abused at her nursing home.  What are common signs of abuse I can look for in confirming this situation?" -- Sherri, Atlanta, Georgia

Physical, mental and sexual abuse are forms of abuse encountered by nursing home residents across the country.  Sadly, some of the most commonly abused nursing home residents include those who are physically or mentally disabled and have no way of fighting off a perpetrator.

Remember, you know your loved one better than anyone else.  If you suspect mistreatment or abuse immediately report the situation to local police and/or ombudsmen.  The reality is that most episodes of elder abuse go unreported.

The following situations warrant further investigation:

• Unexplained bruises, cuts, burns, sprains, or fractures
• Bed sores
• Frozen joints
• Unexplained venereal disease or genital infections, vaginal or anal bleeding
• Bloody clothing
• Sudden changes in behavior
• Staff refusing to allow visitors to see resident or delays in allowing visitors to see resident
• Staff not allowing resident to be alone with visitor
• Resident being kept in an over-medicated state
• Loss of resident's possessions
• Sudden large withdrawals from bank accounts or changes in banking practices
• Sudden loss of appetite

Depending on the severity of the findings, you may wish to report the situation to the local department of health, police or pursue the matter against the facility civilly.  In our nursing home litigation practice, many civil lawsuits come about after an investigation by the state authorities.  Many times, the evidence secured by state authorities proves especially valuable because it was secured immediately after the incident was noted.

Nursing Home Injury Laws: Georgia

Amy Quaintance Vega's great-grandmother was beaten to death by another resident with a violent history.  Since then, Amy has taken it upon herself to spread the word of not only what happened to her great-grandmother, but to help improve nursing home safety for others.  Here is her well-written petition.  Please take a moment to show your support for this case and sign the petition to end nursing home abuse.

On November 9, 2006, my great-grandmother, Bernice Mayeaux, was brutally beaten to death inside of the Pontchartrain Health Care Center in Mandeville, Louisiana. Karoline Glover, who had a violent history at the center, used the handle of a drawer to repeatedly hit Bernice. The day before she murdered Bernice, she struck a resident with her fist during a dispute over a cup of coffee. Instead of confining Karoline Glover to an isolated section of the home, the staff decided to move her into the room of a bedridden, ninety-five year old woman. Recovering from a broken hip and complications from a viral infection, Bernice was unable to move nor call for help during the time of the attack.

This horrific incident has produced an outpouring of support, sympathy and concern from people all across the country. The signatures below are proof that the people of the United States share the same common cause: ultimately ending abuse in nursing homes and protecting those who are unable to protect themselves.

We, the people, are demanding that, first and foremost, this “health care center” be extensively investigated and dealt with accordingly, in order to ensure that the health and well being of the residents are of top priority.

Lastly, we are dissatisfied with the quality of care that these insufficient establishments are administering to their residents. We insist that you, our Representatives, enforce rigorous laws that include, but are not limited to:

• Protecting the well being of the residents in the homes

• Strict and unwavering expectations of those employed at the homes

• Implementation of thorough background checks, not only on all employees of the nursing home, but also on all potential residents of the nursing home.

• A fully staffed establishment at all shifts where the ratio of caretaker to resident is one that can allow the resident to be in complete care and comfort at all times.

• Quarterly inspections from the state. The results of the inspections must be posted on the nursing home and state website, allowing all potential residents the opportunity of gathering as much information as possible. Should the nursing home fail any component of the state inspection on a quarterly basis, it will be made public.

• Last but not least, providing a clear and concise mission statement that all nursing homes are expected to abide by. The following declaration is a direct quote from the Pontchartrain Health Care Center: “The mission of our staff is to offer the highest quality of care for our residents within a clean, safe environment.” You can arrive at your own conclusion, based on the testimonial provided, whether or not this establishment stood by and supported their main cause and purpose.

The day of awakening for those who provide care for the elderly, particularly those whose family members have entrusted such care to be provided, is long overdue. The voices of those who find themselves in such helpless and uncontrolled situations are begging to be heard. Please allow this petition to serve as a united voice whose conviction is to demand and implement change as it relates to all issues surrounding nursing home care.

After ignoring two bench warrants and months on the run, Pennsylvania authorities have captured Henrietta Sprual, an self-admitted elder abuser.  Sprual pleaded guilty to multiple charges of elder abuse including: simple assault, recklessly endangering another person, possession of and instrument of crime and making false statements to authorities in connection to an incident where she beat an Alzheimer's patient she was responsible for caring for at the Arden Court assisted living facility.

An investigation into the incident revealed Sprual struck the elderly man six to eight times with a belt. Prosecutors have photographs of the man's bruises on his arms, elbow, shoulder, knee and thigh.  The bruises were so severe, an imprint of the buckle could be seen.

Sprual's confession comes after she told authorities the man found the belt in the nurses station and was 'out of control' swinging the belt around and striking himself.  A forensic pathologist advised authorities that the man's injuries were not self-inflicted and it was obvious force was used to inflict them.

"I'll know where you are now," Montgomery County President Judge Richard J. Hodgson told Sprual as he revoked her bail and ordered her held in jail until the sentencing hearing.  Sprual faces a possible sentence of three to seven years in prison.  

Photographing Nursing Home Injuries

This case highlights the importance of taking photographs as soon as feasible of both the injured person as well as any injury causing instrumentality.  Many times nursing home residents are physically unable to describe a situation involving nursing home abuse or nursing home neglect. Photographing the injury provides valuable evidence for both criminal and civil cases.

Related Articles

Convicted Elder Abuser Captured By Authorities, The Times Herald, February 4, 2009

Woman Accused Of Beating Elderly Man Skips Court ... Again, The Reporter, February 1, 2009

The New York Attorney General is on a roll-- prosecuting abusive nursing home workers.  Two certified nursing aide's (CNA's) represent Mr. Cuomo's latest arrests.

Monique Jones, 32 of Rochester, is accused of kicking and 88-year-old resident in his ribs at Kirkhaven Nursing Home.

Nellie Weller, 47 of Rochester, is accused of tying a 76-year-old resident's nightgown around his neck and legs, leaving him unable to move or use his urinal while working at Edna Tina Wilson Living Center.  

Both Jones and Weller were charged with endangering the welfare of an incompetent or physically disabled person and willful violations of the health laws of New York.  Both were also terminated from their positions at their respective facilities once the charges were revealed.

"Thousands of New Yorkers and their families depend on nursing home aides and healthcare professionals to provide vital services to their loved ones.  For any of these caregivers to abuse the trust we place in them is reprehensible, and my office will continue to intervene on behalf of vulnerable New Yorkers to ensure safe and quality care," said Cuomo regarding the recent arrests.

Hopefully Attorney General Cuomo's recent arrests will send a message to nursing home workers to clean up their behavior.  Am I the only one who thinks that this pattern of abusive behavior is accepted in the nursing home culture?  I mean there should be any number of co-workers in the nursing home environment to help report--or better yet stop these situations from occurring?

Related articles on abusive employees in New York Nursing Homes:

Two Healthcare Workers Arrested On Abuse Allegations

Three New York Nursing Home Workers Charged With Abusing The Elderly

New York Nurses Charged With Criminal Neglect

I was reviewing the AARPBulletintoday, and they ran a story about Kentucky nursing home that was cited for reports of alleged nursing home abuse and neglect by nursing state nursing home inspectors.  Winchester Centre for Health and Rehabilitation received a Type A citation- the most serious nursing home citation a state can give-- for problems related to 'medical errors' and consequently the federal government will terminate its Medicare / Medicaid funding.

According to Kathy Gannoe, executive director of the Nursing Home Ombudsman Agency of the Bluegrass, prior to issuance of the Type A citation, the Winchester received 31 resident complaints in the past three months, and that 86% of the complaints had apparently been resolved.

Winchester is a 183-bed facility that has received 1 out of 5 stars from according to Medicare ratings, putting the facility in the 'much below average' category.  Winchester Centre for Health and Rehabilitation is owned by Kindred Healthcare.  To those who may not be familiar with Kindred, it is a multi-service health care conglomerate that owns and operates hospitals, nursing centers, rehabilitation centers, and long-term care facilities throughout the country.

As of February 7th, when the Medicare contract with Kindred officially terminates, Winchester will no longer be certified to provide care to government aid recipients.  Consequently, the Medicare recipients at Winchester will have to relocate to other Medicare approved facilities.

But where will the residents go? The closure of facility deemed to have safety violations may seem like a good idea, but the closure of a Medicare-funded facility really just puts additional strain other other facilities forced to pick up the slack.  In Kentucky, more than 400 nursing home beds allocated for Medicaid recipients have been lost over the past year.  According to Gannoe, the closing of another facility would be "a very serious problem for consumers," and "a disaster for Central Kentucky."

About Medicare / Medicaid Funding Of Nursing Homes

Medicare provides an essential service for both residents and facilities.  For residents, Medicare (and Medicaid) provide not only the the funding for their stay at the facility, but the government's involvement also assures residents that the facility meets the standards set forth by the federal government.  Federal Regulations control all aspects of nursing homes from the type of nursing care provided to residents to the temperature of the food the kitchen prepares. The bottom line is that the regulation is in place to protect the well being of each resident.

In exchange for meeting the standards set forth by the government, nursing homes are paid a daily rate for providing quality care to its residents.  In most cases, government funding comprises close to 90% of a nursing homes stream of revenue.

A janitor at the Normandy Nursing Center, a St. Louis, Missouri nursing home, was arrested and charged with raping a resident at the facility.  The victim is a 36-year-old woman suffering from Cerebal Palsy and seizure disorder.  The alleged incident took place on December 21st when the janitor attacked the woman in a stairwell and raped her.  The alleged perpetrator is being held in the St. Louis County Jail on $200,000 cash only bond.  According to the administrator at Normandy Nursing Center, the alleged perpetrator has worked at the facility for a year and a half and passed a background check. Read more about this nursing home rape here.

Normandy Nursing Center received 2 out of 5 starts as a total rating for the facility according to Medicare's Nursing Home Compare website.  The for-profit facility is capable for 116 residents.  When it comes to staffing levels at the facility, Normandy rated poorly receiving just 1 out of 5 stars.  Normandy's staffing levels were significantly below the staffing levels for both national and Missouri nursing home averages.  Dare I say that had Normandy provided more staff to look after residents, this nursing home rape may have been prevented?

A dementia patient has been removed from The Shore Winds Nursing Home following a report of alleged sex abuse by a nurse at the facility.  The complaint was reported to the New York State Health Department of Health and a preliminary investigation by the agency determined the claim to be serious enough to merit a full investigation.  The nurse has been suspended pending the results of the investigation.  Shore Winds Nursing Home has been investigated 46 times in the last three years. Read more about this allegation of sex abuse in a New York Nursing Home here.

Minnesotans have a reputation for being kind, compassionate people.  However, several employees in Minnesota nursing homes are doing a fine job trashing the state's reputation.  After, the reports of abusive teenagers at Good Samaritan Nursing Home, a new report of nursing home abuse by a nurses aide has emerged from a different Minnesota Nursing Home.  

The allegations involve one nurses aide who reportedly abused six nursing home residents afflicted with dementia, over the course of several months earlier this year.  According to the Minnesota Health Department, the nurses aide reportedly:

• Stuck a finger in the cancerous vulva of a resident until she screamed
• Intentionally dropped a resident from four feet
• Tossed stuffed toys on the floor in front of a resident who thought the toys were her children
• Gave lap dances to two male residents 
• Slapped a female resident in the face after the woman called her an offensive name

The nursing home abuse was witnessed by another nurses aid at the facility for several months before the abuse was reported to the administrators.  Minnesota, like many states, has a vulnerable-adult law that requires nursing home workers to report suspected maltreatment to the nursing home administration where they work. Obviously, this nursing home needs to re-educate its employees as to their legal responsibilities to their residents.

Read more about this brutal case of nursing home abuse here.

Unsatisfied with the nursing home's explanation for the dozens of bruises on their 84-year-old grandmother, the family of Armeda Thomas, an 84-year-old resident at Madison Manor Nursing Home decided to place a video camera in the disabled woman's room.  The video tape confirmed that Thomas was the victim of physical and verbal abuse from the staff at the facility.  The video revealed the following evidence of abusive behavior on the part of nursing home staff:

• Failed to bathe Thomas
• Failed to feed Thomas. 
• Taunting and mocking the disabled woman
• Pulled residents out of bed by their neck
• Let Thomas lay on the floor for an hour before any aid was provided

Following the discovery of the videotaped abuse, the Attorney General began a criminal investigation which revealed the nursing home failed to investigate injuries of 'unknown origin' to 17 cognitively impaired residents at the facility.  Kentucky nursing home investigators issued a Type-A citation to the nursing home determining the conditions at the facility posed immediate danger to the residents. 

According to Kentucky nursing home records, the facility has corrected the violations posing immediate jeopardy to residents and is working to correct the less serious violations.  Madison Manor is part of the Richmond Health and Rehabilitation Complex and is owned by Extendicare, a national nursing home operator.

Although the nursing home employees behavior is inexcusable, blame for this barbaric treatment also falls on Extendicare.  The fact that there are multiple episodes of abusive behavior can only mean that Extendicare has failed to provide adequate training and supervision for its employees.   

The Oklahoma Health Department has fined the Whispering Pines Nursing Center for multiple instances of nursing home abuse and neglect.  Among the allegations, the nursing home was cited for:

• Forcing a patient into a shower while fully clothed
• Failing to investigate complaints of physical abuse among residents
• Failing to provide adequate training to nursing home staff
• Failing to provide condoms to sexually active HIV positive nursing home residents

The health department is recommending Whispering Pines immediately correct its dangerous conditions or the facility will not be permitted to accept new Medicare and Medicaid patients.  Read more about this Oklahoma nursing home here.

84-year-old Raul Saldivar was recently beaten to death in a Texas nursing home.  Police say Mr. Saldivar was in his bed, when a significantly younger nursing home resident entered his room and beat him to death with medical equipment.  The younger resident  apparently had left his confined area and entered Mr. Saldivar's room.  According to nursing home, the perpetrator was not permitted to be in an area with older residents.  Mr. Saldivar died from complications related to suffered a skull fracture at Valley Baptist Medical Center.
 

Did the young perpetrator have a criminal record?  Did the younger nursing home resident have a history of violence?  Nursing home staff have a duty to keep their residents safe from intruders as well as from violence from other residents.  Unfortunately, problems continually arise when nursing homes fail to segregate nursing home residents with drastic age differences and physical abilities. 

Read more about this preventable nurisng home death here.

I just did a double-take.  Four nursing home employees charged with abusing residents at the Good Samaritan Nursing Home in Minnesota will soon be released from custody.  The Minnesota Attorney General blames the the nursing home employees release on a lack of hard evidence and hearsay testimony.

Blog readers may recall these four 'Minnesota girls gone wild' from my earlier post.  The charges stem from a report where the nursing home employees victimized residents suffer from dementia or related disorders such as Alzheimer’s disease. The report alleges the following incidents of physical abuse and neglect:

• spitting in mouths
• poking breasts and nipples
• putting fingers in mouths
• touching and tapping genitals
• sticking rear ends in faces
• rubbing buttocks
• rubbing penises
• touching perinea
• anal insertion
• holding residents down
• teasing residents

If convicted the nursing home employees could face charges of gross misdemeanor and felony.

The fact that this Attorney General remains unable to prosecute this incident involving nursing home abuse highlights similar problems encountered in civil lawsuits.  As a victim of nursing home abuse, it is important to report the situation as quickly as possible to authorities so they may secure necessary statements and physical evidence.  As this case demonstrates, many situations of nursing home abuse will go unprosecuted without necessary evidence.

In a new twist on the widely reported under-staffing in many nursing homes, some families of nursing home residents have chosen to provide supplemental care for their family members by hiring private sitters.  Similar to baby sitters, the senior sitters are intended to provide additional supervision and assistance for individual nursing home residents.  Because these senior sitters are not employees of the nursing homes, they are not regulated or subject to background checks.

The story of a senior sitter, who sexually assaulted several nursing home residents made headlines, recently.  The incident will hopefully increase public awareness about all visitors to nursing homes.  No matter how harmless or well intentioned a visitor may seem, nursing homes must take basic steps to safeguard the well being of their residents.  Nursing homes should not only keep an accurate record of visitors, but they should also keep track of the visitors whereabouts while they are in the facility.  Read more about this sad incident involving sexual assault in a nursing home here.

Eyes On Living had an interesting blog post recently 'Florida Nursing Home Abuse Lawsuits Increasing Thanks To Aggressive Lawyers.'  The article is a little tongue in cheek with respect to how attorneys want to help victims out of the kindness of their own heart, but the author does acknowledge that lawsuits filed in states with a substantial elderly population has actually improved the quality of nursing home care.

This got me thinking about the impact of nursing home litigation has on the overall care received by nursing home residents.  Do nursing home lawsuits have an impact on the quality of nursing home care?  The answer, in my eyes, is a resounding 'yes'. 

Sure, we all hear about juries awarding people with superficial injuries large awards and the recipients going out and spending their awards on lavish things.  The reality of the overriding majority of nursing home injury cases, it that many of these people have been downright neglected or abused and their lives have been forever changed by the acts of nursing homes for the worse.

For many victims of nursing home abuse and neglect their golden years have become anything but happy and satisfying.  Too often, the lives of seniors have been cut short or painfully altered by the acts of facilities that were intended to care for them.  

The purpose of the Nursing Home Care Act in Illinois is similar to laws in place in Florida and Texas--it is intended to help residents of nursing homes and other long-term care facilities from being taken advantage of and ultimately injured.  These laws also allows for attorneys to recover their legal fees if they are successful in their case against the nursing home.

Bad nursing homes are being forced to change their ways.  Many facilities that once cut corners with respect to patient safety can longer do so or they face claims and lawsuits for serious injury.  If improving patient safety and care means that some facilities are forced to close their doors, in the long run we all will be better off.  

Excuse me while I go look look for a billboard...

This article in the New Press, a fort Myers, Florida, newspaper caught my attention.  The article by Janine Zeitlin, uses statistics to prove what many close to to the elderly already know- elder abuse and elder neglect is a dirty little secret.  Most cases of elder abuse and elder neglect go unreported. When cases are discovered they are difficult to prove.

According to the article, the Florida Department of Children and Families found that adults make up about 18 percent of their abuse cases.  The real extent of abused senior abuse may never be known. Unlike minors where the state may forcefully intervene in a potentially abusive situations, if elders refuse to get help there is little authorities can do.

Another complicating factor in learning the full extent to elder abuse is that many elderly don’t go to the doctors that often, and that might be the only time they’re out of their homes. Elders in nursing homes and long-term care facilities are similarly isolated from the general population.  Rarely do nursing home residents venture into the community.  

Even with obstacles in place authorities do what they can to discover situations involving elder abuse and neglect.   The Department of Children and Families discovered a case of nursing home abuse and neglect involving a 90-year-old woman at Johnson Hall Home.  Although the woman had a large infected sacral wound that had evolved, the facility did not provide her medical attention. The department also used its investigative resources to discover a case of neglect which lead to death involving a 95-year-old nursing home resident.

The above situations demonstrate the need to report nursing home abuse and neglect.  If you suspect the mistreatment of a nursing home resident, you can contact your local department of public health and make a report.  In most situations, the report may be done anonymously.

Nursing home visits are great for both residents and their friends and families.  Everyone is usually happy to see each other and discuss current world topics, the weather, baseball or food.  However, don't let the smiles distract you from what should be a secondary reason for visiting friends and family members in nursing home--doing a mini inspection. 

I'm not talking about getting up on the roof of the nursing home and looking at the quality of the shingles or heading down to the basement to look at the hot water heater.  Rather, when visiting don't be shy about prodding around both the facility itself and on your loved one.  Look at the: cleanliness of the facility, look at the food, pay attention to the temperature of the room, look for familiar faces, look at the schedule of activities, chat with the staff--keeping track of all the small parts of your loved one's environment is the best it can be.

If your family member is bed-bound, pull the sheets back and peek under the robe.  Is everything clean?  Are their any dry or cracked areas of skin?  Is there any unpleasant smell?  Does everything look ok?  Even the sharpest elderly may lack sensation in areas of their bodies to detect skin irregularities.  If something looks wrong-- it probably is.  Early detection of potentially deadly conditions, such as pressure sores, may save your loved one from pain and embarrassment down the road.  You're not being a pest, you're being a caring friend or family member looking out for your loved one's best interest.

A 22-year-old Certified Nurses Aide (CNA) has plead guilty to multiple charges involving nursing home abuse and neglect. Christine Borasky plead guilty to felony charges of second-degree endangering the welfare of a vulnerable person.  Ms. Borasky admitted to spraying foam into the face of an 82-year-old nursing home resident.  Additionally, this CNA pulled the woman's hair and squeezed the nursing home resident's hand so hard that it broke.  Under the terms of the plea agreement, this CNA must surrender her license and will be on probation for 5 years.  Read more about this bad nurse here.

What in the world draws people like this to nursing care?  With valuable skills like pulling hair and breaking hands this young lady should send her resume to the World Wrestling Federation.

A certified nursing assistant (CNA) at Forestview Nursing Home has been charged with assault and battery of a disabled nursing home resident.  The charges stem from a May incident in which the CNA verbally abused and physically assaulted a disabled male patient.  The incident was witnessed by another CNA who reported the incident to nursing home administrators.

At her arraignment, the CNA entered a plea of not guilty and was released on personal recognizance with the condition that she not be employed in a setting involving elder care or services. She must also verify her employment with the Department of Probation and was further ordered not to have any contact with the victim.  Read more about this abusive CNA here.
 

A certified nurses assistant (CNA) is now behind bars following a brutal episode at Ashley Manor, a Colorado nursing home.  According to local police, 23-year-old Kalen Randolph stuck an Alzheimer's patient multiple times before fleeing the facility altogether and leaving all the residents of the facility unattended.  The 74-year-old victim suffered injuries to his head, ear and hand.  Mr. Randolph is charged with eight counts of neglect and one count of second degree assault.  Read more about this incident of nursing home abuse here.

How do things like this happen in facilities today?  How can a facility allow one person to care for all the residents by themselves?  What would happen if this were a medical emergency or fire and the sole nursing home employee was responsible for the care and safety of all residents?  No one is asking me, but having a facility staffed by one person seems like trouble on so many fronts.

Jacob Mut Bolith, was sentenced by a Utah Judge to 15 years in jail and to pay restitution for the sex crimes he committed on nursing home residents. Bolith plead guilty to second-degree felony forcible sex abuse of an 85-year-old woman in a nursing home where he was employed.

Bolith's attorney Clayton Simms asked the Judge to sentence his client for 365 days in addition to the 389 days he has already served. He asked for leniency because Bolith is a Sudanese refugee who was displaced from his home and spent time in Ethiopia and Kenya before he came to the United States. Consequently, he said, Bolith had a difficult childhood that may have led to his behavior, despite Bolith learning English and getting his certified nursing assistant license to better his life.

Simms took issue with the pre-sentence report that said there was sexual penetration — he said there was only fondling and touching and Bolith's patients misunderstood his intentions. However, Simms said his client takes full responsibility for his actions.

Crimes like this are universal in any language and should not be tolerated anywhere.  I hope Utah has a law similar to Illinois that prevents convicted felons from working in nursing homes.  Read more about this case of nursing home sex abuse here.

Forget about asking a nursing home resident to be quiet or actually attending to what may resident needs- just stick a pillow on their face and hope that quiets them.  That is the approach used by Jesse Bodey, an employee at Life Care nursing home used with an 85-year-old man when he was screaming in the nursing home.  Witnesses say Bodey then placed a pillow over the patients head. A co-worker reported the incident, but when the supervisor checked on the patient, the pillow was gone.

The staff at the home told Police that Bodey wasn't trying to suffocate the patient. They say he was trying to quiet him down but went about it in an unorthodox way.  Bodey is facing several charges, including one count of reckless endangerment and two counts of offensive touching. He is out on bond. No court date has been set. He has been suspended without pay from the nursing home. The staff says the patient is doing okay.  Read more about this case of nursing home abuse here.

You've got to hand it to this guy, he did a nice job fabricating a story to get himself out of murder charges.  What would have happened if he would have spent more time 'quieting' the patient?

40-year-old, Roberto Cruz Recendes, was extradited to the United States and placed under arrest for the 2002 beating and rape of a 94-year-old woman in a Palo Alto assisted living center, according to Palo Alto Police.  The arrest stems from a May 10, 2002 incident at an assisted living facility.   Police responded after a resident reported she had been beaten and raped by an intruder, agent Dan Ryan said.  Recendes lived near the facility at the time of the incident and since relocated to Mexico.

Currently, Recendes is charged with one count of sexual assault during the commission of a burglary and one count of elder abuse with great bodily injury, according to Ryan. He is being held in the Santa Clara County main jail without bail.  Read more about this case of elder abuse here.

It is great that law enforcement officials were able to work together to track down this guy.  The question remains: Was this incident preventable in the first place?  The answer most likely is a resounding 'yes.'  Nursing homes and assisted living facilities have a duty to provide safe environments for their residents.  This includes screening all people who enter the facility, securing all windows and doors and most importantly--carefully monitoring the residents.

Recent congressional testimony has highlighted the presence of sex offenders and other violent offenders amongst the general nursing home population. The American Health Care Association asked Congress to help improve the tracking of sex offenders and develop a definition of "sex offender" in an effort to improve residents' safety.

Oklahoma State Representative Kris Steele, who recently spoke before Congress, has come up with a solution to ensure the safety of the elderly in nursing homes. Representative Steele has authored a bill designed to establish separate long-term care facilities for sex offenders. The state Legislature passed the bill and Oklahoma is currently seeking contractors to build a facility.  For further information on Oklahoma's plan look here.

This is a simple solution for an increasingly dangerous problem for our elderly.  Unfortunately for the more than 1.6 million people living in nursing homes, they have no choice as to who they live with.  Under the current system most nursing homes are 'forced' to accept any person who qualifies under the Medicare / Medicaid system--violent offenders included.

Related: Nursing Home Injury Laws: Oklahoma

Unlike nursing home employees, home aides remain a largely unregulated entity.  Many home aides are unlicensed and are not subject to the same criminal background checks as nursing home employees.  The number of home health care workers for the elderly is on the rise.  Currently, there are 1.6 million people employed in the home health care industry.

An incident involving an 85-year-old Priscilla Stovall, who was lethally drugged by her home care aid, draws attention to the need for extensive criminal background checks and ongoing monitoring of home aids who work with the elderly.  Although Ms. Stovall's aid was hired by an agency which specializes in providing home care workers for the elderly, the worker had an extensive criminal background.   The worker had a criminal background involving domestic assault, drug smuggling and had done time in prison.

Conducting criminal background checks for the health care workers can be difficult because there is no centralized database with employee information.  In a recent Michigan State University study sponsored by Centers for Medicare & Medicaid Services, researchers screened 214,167 people who held or sought jobs working with the elderly.  Of the sample group, 5,462 had criminal histories which should have excluded them from the position.  Read more about abuse among home care aids amongst the elderly in the Wall Street Journal here.

Before hiring a home care worker for an elderly person or yourself, keep the following in mind:

• Do a criminal background check through a local police department or licensed investigator
• Check all references
• Conduct face-to-face interviews
• Look to the U.S. Administration on Agings website
• Check names in the national sex-offender registry website

A 44-year old woman was raped in Kent Nursing Home in Seattle.  The victim was particularly vulnerable with mental and physical impairments.  The rape was not discovered until the woman had a miscarriage and DNA testing confirmed that the act was done by an employee of the nursing home.

'We entrust caregivers for dependent adults with tremendous responsibility for the health and well-being of the patient,' said Prosecutor Dan Satterberg. 

Long-term facilities, hospitals, and nursing homes have a duty to provide a safe facility for all residents and employees.   Part of providing a safe facility requires a full criminal background check for all employees.  The background check also involves checking references. 

Most instances of physical abuse are preventable.  Had a facility performed an adequate search, they would have discovered the employees criminal propensities.

Read the full article here.
Watch the news video of this story here.