Putting your loved one in a nursing home is a difficult decision. You probably worked hard to find a place you trusted to take care of her. Unfortunately, despite their promises, many nursing homes don’t put resident care first: they are set up to generate revenue for the owners, and often sacrifice patient care for profit.
If your loved one has been hurt as a result of nursing home negligence, you may be able to recover compensation for that injury. For more information about your options, please speak with one of our nursing home negligence attorneys today.
Signs of Nursing Home Negligence
The best way to protect your loved one from nursing home negligence is to visit often and watch for the signs of neglect such as:Dehydration
- Changes in skin complexion or texture
- Complaints of hunger
- Clothes fitting poorly
- Catheter bag that is always full
- Bed sores (also called pressure sores or decubitus ulcers)
- Multiple falls
- Tendency to wander
- Inactivity and depression
These are often signs that your loved one is not being properly cared for or monitored.
Nursing Home Dehydration Claims
Largely because of misdiagnosis and inadequate staffing levels, up to half of all nursing home residents may be dangerously dehydrated.
Proper hydration is essential for everyone, but it is even more important among older people. Many nursing home residents already suffer from serious or chronic medical conditions, which cause their bodies to consume energy at a higher rate even if they are somewhat immobile. Furthermore, dehydrated elderly people usually have weak immune systems and muscles, leaving them vulnerable to illness and injury.
Nursing home negligence lawsuits focus attention on issues like nursing home dehydration and force facilities to pay attention to the needs of their residents.
Misdiagnosis of Dehydration in Nursing Home Residents
In this context, misdiagnosis usually means a failure to recognize the signs of a serious medical condition and properly diagnose that condition.
Some of the most common signs of dehydration, like dry mouth, dizziness, and dry skin, are also commonly associated with age. As a result, many caregivers dismiss the early symptoms, and the problem gets worse.
Misdiagnosis is a serious problem among the elderly that’s commonly associated with chronic conditions, like Alzheimer’s disease, dementia, and heart problems.
Understaffing Resulting in Dehydration of Nursing Home Residents
Industry standards require that, at a minimum, nursing homes must have at least one registered nurse on site for eight consecutive hours, seven days a week. Staffing levels are a significant component in nursing home neglect lawsuits, because low staffing often leads to serious problems, including dehydration. However, Medicaid and Medicare reimbursements are the lifeblood of many long-term care facilities, and as reimbursement levels have rather persistently declined since the 1990s, nursing home administrators have attempted to increase the patient population to make up the difference.
As a result, there are fewer staff members to check on residents. So, they do not come around as often and they do not stay as long. Understaffing essentially exacerbates the misdiagnosis problem, because rushed staff members either do not see dehydration symptoms or are quick to dismiss them as the effects of aging.
One study concluded that nine out of ten residents consume less than 1,500 milliliters of water a day, mostly because of low staffing levels.
The nursing home is legally responsible for both the negligence of its employees and the fact that they do not have the time to properly do their jobs. Consequently, in addition to compensation for actual injuries, many juries award substantial punitive damages in these cases.
Malnutrition in Nursing Homes
According to one study, low staff levels are the main reason that at least a third of nursing home residents in the United States are dangerously malnourished.
Malnutrition causes a wide range of serious conditions, particularly if the victim is already physically frail. Most nursing homes have individualized care plans in place that contain strict guidelines about daily calorie intake and the types of foods to be consumed. Failure to adhere to such a plan, or failure to make one in the first place, is evidence of negligence that creates liability for damages.
Elder Malnutrition
Poor nutrition weakens bones and muscles, increasing the risk of a serious fall. Malnutrition also weakens the immune system and retards wound healing. Some common causes include:
- Health Issues: Some conditions, like dementia, often decrease appetite, and some hygiene issues, like bad teeth, make it difficult to chew and swallow. In other instances, medication side effects may create similar issues.
- Limited Diets: On a related note, low salt or sugar diets to control heart problems and diabetes make food taste bland and restrict the number of food choices.
- Diminished Social Contact: This concern is very prevalent among new long-term care residents who recently left their homes and friends or residents in poor health confined to their rooms. People who do not enjoy eating as much do not eat as much.
- Alcoholism: Even small amounts of alcohol decrease an already light appetite, and too often, alcohol begins to replace meals altogether.
In addition to not eating, some other signs of malnutrition include weight loss, slow wound healing, and abnormal bruising.
Feeding Tube Injuries in Nursing Homes
For various reasons, many elderly people in nursing homes struggle with nutrition issues. In these cases, many facilities use feeding tubes to give these residents the nutrients they need to remain healthy. Unfortunately, there are a number of things that can go wrong with these procedures, causing serious injury to the vulnerable nursing home patients.
Under applicable negligence law, the nursing home is responsible for these medical errors, and is therefore liable for damages, including economic losses (such as medical bills) and noneconomic losses (such as emotional distress). Additionally, in some extreme cases, many jurors award substantial punitive damages.
Feeding Tube Dangers
Many older people have difficulties either chewing and swallowing or digesting food; certain diseases that affect older folks exacerbate these issues. But if the nursing home uses a feeding tube to deliver nutrition, several things can go wrong, including:
- Severe Gastrointestinal Pain: Diarrhea, nausea, and vomiting are some of the most common feeding tube side effects. In healthy adults, these side-effects are normally not a problem, but among frail elderly, they are much worse.
- Refeeding Syndrome: If the feeding tube is not calibrated properly, a starved individual gets too many nutrients at once. The shock often causes heart complications, high blood sugar, and even sudden death.
- Dislodgement: Nasal and oral tubes are easier to start, but they also have a high risk of loosening or even falling out entirely. Moreover, some Alzheimer’s and dementia patients sometimes pull out their own tubes out of panic, causing serious injury.
- Aspiration Pneumonia: Aspiration is fluid or food that accidentally goes to the lungs, and lying flat with a feeding tube or an excess formula amount significantly elevates the risk.
Other common complications include decreased social interaction, because the patient does not eat with friends, and possible infection.
Liability Issues with Feeding Tube Injuries in Nursing Homes
Nursing homes have a legal duty to provide an environment that is safe and facilitates wellness for their residents, and that includes avoiding dangerous medical procedures. If the care falls short of this standard, the nursing home is negligent and therefore liable for the damages specified above.
The nursing home is also negligent if its employees are either not qualified to perform their assigned duties, or if they are negligent during the course and scope of their employment. That includes improper feeding tube placement and use.
Sepsis Infections And Nursing Home Liability
If a nursing home resident exhibits at least two of the three preliminary symptoms (an increased breathing rate, some periods of unconsciousness, and decreased blood pressure) the resident probably has sepsis, which is basically a physical over-reaction to a bedsore or other infection. Sepsis is an incredibly dangerous condition which has a fatality rate of up to 80 percent, because organs essentially start shutting down one at a time if the condition is untreated.
Sepsis (which was once called blood poisoning) is treatable and curable, but caregivers must react quickly. In many nursing home environments, these reactions do not come quickly enough, serious complications develop, and the facility is legally responsible for the adverse result.
Treating Sepsis
Sepsis treatment is usually a delicate combination of adding vital fluids to the body and draining away infected fluids.
- Intravenous Fluids: Proper IV placement into a frail, elderly person is often difficult enough, and this difficulty is compounded by the fact that adults may need up to 10 liters of fluid.
- Antibiotics: Because of the dangers, many doctors are tempted to give older sepsis patients stronger antibiotics than they can medically tolerate.
- Steroids: If the fluids and antibiotics don’t work, or don’t work quickly enough to satisfy the doctor, the patient may receive large doses of dangerous and unproven steroids.
- Antihypotensive Agent: If the above efforts fail, doctors must try to artificially raise the patient’s blood pressure with a powerful drug that has considerable side effects.
In the most extreme cases, and largely to avoid a likely fatality, doctors must resort to advanced drug therapy, a ventilator, and a blood transfusion.
Legal Issues with Sepsis Infections in Nursing Homes
Over 50 percent of nursing homes are dangerously understaffed, a chronic problem which researchers have directly linked to bedsores, one of the most common sources of sepsis outbreaks in nursing homes. Understaffing leads to several kinds of inadequate care issues, including:
- Lack of Monitoring: In many facilities, there are simply not enough people available, especially at non-peak hours, to sufficiently watch and care for patients.
- Underqualification: Mostly to save money, many nursing home administrators hire semi-skilled patient care technicians to do the work that licensed vocational nurses should perform, so residents are shorted in terms of the quality of care.
- Nursing Home Bureaucracy: Rather than prompt followup on possible sepsis symptoms, the reports are sent through the chain of command, where they often get lost, at least temporarily.
The nursing home is responsible for lack of care related to understaffing, and damages include compensation for tangible and intangible losses, as well as possible punitive damages.
Fecal Impaction in Nursing Homes: Some Medical And Legal Issues
Mostly due to no fault of their own, many nursing home patients live relatively sedentary lives and have rather limited diets. Moreover, many residents take medications that cause constipation. This confluence of factors often leads to fetal impaction, which is one of the most severe forms of constipation known to medicine.
Nursing home staff members have a high duty of care toward their patients, so they must be vigilant for the signs of residents that suffer from impacted bowels and take immediate corrective measures before complications develop. Many times, such vigilance is lacking, and an attorney must intervene to protect patient rights.
Symptoms and Complications of Fecal Impaction
When the body cannot purge waste, an individual may run the risk of sepsis and other possibly fatal infections. So, it’s important for staff to look for the signs of fecal impaction, including:
- Chronic or sudden bloating or cramping,
- Bloody stools or a bloody rectum,
- Severe strain when passing stools,
- Lower back pain,
- Accelerated heartbeat while passing stools, and
- Urinary incontinence.
Copious amounts of water, good nutrition, and moderate exercise are the best ways to prevent an impacted bowel.
Fecal Impaction Caused by Low Staff Levels
Nursing home understaffing is a fairly well-chronicled problem, and nursing home staff turnover is a significant concern as well. Insufficient staffing environments are often a predicate for medical malpractice and nursing home neglect claims.
In many assisted living facilities, turnover rates approach 100 percent. Most of the underpaid and overworked employees only stay at these facilities for a short time, so they may have little or no interest in building the relationships with their patients that help create a strong caregiver-charge bond.
If there is a new duty nurse every few months, patient records are often lost in translation. This situation has a direct impact on impacted bowel and constipation issues, because patient habits, trends, and preferences often get lots in translation as well.
The nursing home has a duty to its patients and also a duty to its employees to provide fair wages, a reasonable workload, and a positive environment. If patients are injured because of any failure in these areas, the injured victims may be entitled to compensation for their tangible losses, such as medical bills, along with their intangible losses, such as emotional distress. Large punitive damage awards are rather common in these cases as well.
Low Staff Levels and Legal Liability
During meal times, it is not enough for staff to serve food and then leave. Instead, they should spend time with residents to ensure that they are eating and not wasting their food.
However, many nursing homes do not have enough people to provide that kind of care. In fact, over half of nursing homes are dangerously understaffed, according to one study. In these environments, it is common for staff to serve a tray of food and then attend to other duties. Furthermore, there may be no full-time dieticians available to go over patient menus and examine residents to look for signs of malnutrition.
Damages in nursing home malnutrition claims may include money for medical bills and also compensation for pain and suffering.
Infographic: Nursing Home Abuse and Neglect
(Shapiro & Sternlieb, LLC)
Pressure Ulcers And Nursing Home Neglect
Bedsores are strong evidence of both a failure to use ordinary care and constructive knowledge of the dangerous condition, and these are the two main prongs in a nursing home neglect case.
If successful, nursing home negligence claims draw attention to the hazardous environment at the nursing home and generally force changes that benefit all other residents. Additionally, victims are entitled to compensation for their tangible losses, such as medical bills, and their intangible ones, such as pain and suffering. Some juries award substantial punitive damages in bedsore cases as well.
Bedsores and Ordinary Care in Nursing Homes
In nearly all circumstances, the industry standard is that nursing home patients should be turned and examined at least once every two hours. Strict adherence to this regimen, if it is followed by prompt and effective follow-up, reduces the risk of pressure ulcer development to almost zero.
Bedsores and Knowledge
Pressure ulcers rather quickly advance from stage one to stage two or three. According to Anjou v. Boston Elevated Railway Co., a landmark case in tort law, this progression is evidence of constructive knowledge (the nursing home should have known about the problem), which may form the basis for liability. In the Anjou case, Helen Anjou slipped on a banana peel at the train station; witnesses said the peel was black and gritty, as if it had been on the floor for quite some time. The company countered that it did not know about the banana peel and therefore had no duty to clean it up. The court concluded that the condition of the peel indicated “that it was not dropped a moment before by a passenger,” and therefore “the platform was suffered to remain in such condition as to be a menace to those rightfully walking upon it.”
A stage three bedsore (and arguably a stage two bedsore) is essentially the same thing as a black banana peel on the floor. Like the offending peel, the bedsore had festered for so long that constructive knowledge attached and therefore even if the nursing home did not actually know about the patient’s condition, the nursing home may still be liable for damages.
Dropped Patients At Nursing Homes
Each year, one in four people over 65 fall at least once, and many of these victims sustain serious injuries, like broken bones and head injuries. Certain physical issues, such as Vitamin D deficiency, limited vision, medication side-effects, and a hazardous walking surface, multiply the risks exponentially.
Nursing homes have a duty of care to prevent their patients from being injured, especially when it comes to everyday activities like moving from a bed to a wheelchair. So, many nursing homes follow legal protocols, such as this three-point plan from the National Institutes of Health, when performing such operations. A failure to follow established guidelines is clear evidence of fault in negligence cases.
Types of Transfers
Many residents are in long-term care facilities, at least in part, due to mobility impairment. Therefore, staff members must do whatever possible to prevent falls during procedures like:
- Bed to Wheelchair: Inspecting the surroundings, like the physical condition of the wheelchair and the rugs on the floor, is one of the most important, and most overlooked, steps in these transfers.
- Wheelchair to Bath: Many falls occur in bathrooms, so staff must be especially diligent during such transfers.
- Hoyer Lift Falls: To lessen the physical strain on staff and residents, many nursing homes use hydraulic lifts to move patients, at least in some situations. If they are not used properly or working properly, these devices can cause serious injury.
- Chair to Chair: Many residents break their hips when they stand because they use their legs for additional leverage, and many staff members are not as cognizant of this danger as they should be.
In many cases, normal medical protocol requires that two or more staff members assist a resident during these and other transfers.
Possible Injuries from Drops and Falls in Nursing Homes
Many nursing home fall victims are already in a somewhat frail physical condition before the incident. To make matters worse, they are often in elevated positions and sometimes unable to break their falls. This combination usually results in serious injuries like:
- Broken Bones: These wounds often require extensive and painful surgical correction and long-term physical therapy.
- Brain Injury: Often, the jostling alone (like a raw egg sloshing against an eggshell) is sufficient to cause permanent injury, including personality changes, loss of function, and even death.
- Internal Bleeding: Emergency responders are often preoccupied with outside trauma injuries to the point that they neglect internal injuries.
In addition to compensation for medical bills, victims and their families normally receive compensation for their pain and suffering.
Nursing Home Sexual Abuse
Since 2000, officials have received over 16,000 complaints about sexual abuse in nursing homes. Only a fraction of these incidents are investigated, because police officers and even family members are often skeptical about the claims. Indeed, out of all these complaints, only about 200 facilities received any discipline whatsoever, and that action was nearly always a rather small fine.
When it comes to elder sexual abuse, someone must stand up for victims and not only obtain compensation for their injuries but also advocate for their rights. That someone is nearly always a personal injury attorney.
Signs of Sexual Abuse
Elder sexual abuse is any unconsented sexual contact involving a person over 60; that contact could be physical or emotional. Some signs of abuse include:
- New signs of a sexually transmitted disease,
- Bleeding, pain, or irritation in the pelvic or genital area,
- Torn or stained undergarments,
- More pronounced difficulty walking or sitting,
- Withdrawal,
- Agitation, and
- Inappropriate sexual comments.
Somewhat surprisingly, nearly all elder sexual abuse cases occur in nursing homes or long-term care facilities.
Legal Responsibility
Sexual abuse is quite clearly outside the course and scope of employment, so some traditional vicarious liability theories, like respondeat superior, do not apply to nursing homes in these situations. However, the facility is usually still responsible for damages under negligent hiring or a similar theory.
Typically, employers are liable if they employ persons that create a high risk of harm in a certain area and they eventually injure someone in that way. For example, it is typically not a problem for an employer to hire someone with a DUI conviction as a warehouse worker, but liability may attach if the employer hired the person to be a delivery driver.
Damages in sexual abuse cases normally include compensation for both tangible losses, such as medical bills, and intangible losses, like pain and suffering. Punitive damages are available as well, in many cases.
Causes of Nursing Home Negligence
Nursing home negligence may be due to a simple understaffing of the facility or it may be due to the lack of qualified staff in the nursing home. Unfortunately, this often comes down to a simple question of profit.
For-profit nursing homes seek to maximize revenue by filling their beds, and minimize cost by reducing their staff. The result is that the staff is too small to handle the burden of caring for all residents. Staff may be stressed and distracted, which makes it harder for them to maintain an appropriate standard of care for all residents.
You and Your Attorney Can Make a Difference
Nursing homes should not be pure profit centers. They should put resident care first, and profit second. However, when a nursing home loses sight of these priorities, a nursing home negligence lawsuit can help remind them that they can only profit if they provide quality care for all residents.
When pursuing a nursing home negligence lawsuit, you need the help of a skilled attorney to give your case the best chance of success. At AccidentAttorneys.org, we have assembled a nationwide group of lawyers that have been recognized by their peers and independent ratings agencies as being leaders in their profession.
To talk to a leading attorney in your area, please contact AccidentAttorneys.org today.
Related Articles:
