NURSING HOME (& REHAB CENTER) LIABILITY FOR NEGLIGENCE, ABUSE & NEGLECT

In some cases, nursing homes may be legally responsible for resident injury or death that occurs in the nursing home. Elderly victims and family members should be educated on nursing home liability laws and regulations. In cases where the nursing home is legally liable, victims or families may be eligible to earn financial compensation. This compensation may be used to cover medical bills and reimburse patients and families for pain and suffering from the incident. Those who have questions regarding nursing home liability should speak with an experienced nursing home abuse attorney as soon as possible.

Nursing Home Duty of Care

Just as in other legal agreements, a nursing home accepts a certain level of responsibility when accepting new residents. This is called the “duty of care.” The nursing home has a responsibility to provide residents with a level of reasonable care to protect residents and provide them with a safe environment. When a nursing home fails to provide this level of reasonable care, it may be liable for injuries that residents sustain while in the nursing home’s care.

Defining Reasonable Care

One of the main issues in nursing home liability is the definition of reasonable care. In order to be held liable for a resident’s injuries, the nursing home management or staff members must have violated their expected duty of care. This occurs when a nursing home individual acts in a negligent or careless manner when performing a duty expected of the facility, or completely fails to perform an expected duty that led to the resident’s injury. When examining nursing home liability, there must be evidence that the nursing home failed to meet the standard of care, and as a result, the resident suffered injury or death. Nursing home liability laws will typically hold a nursing home responsible in cases of medical errors and negligence.

Determining Nursing Home Liability

There are several factors to examine when determining nursing home liability. Nursing home liability generally holds that a nursing home is responsible for death or injury when management or staff members should have taken some action to prevent the incident from occurring. For example, consider a nursing home resident who is injured from falling. If the resident was properly monitored and items such as handrails and other safety precautions were present, the nursing home may not be liability. However, if the resident was unattended when he or she should have been, or if there were hazards in the area such as a spill on the floor, the nursing home may be held liable.

Proving Nursing Home Liability

When residents or family members of residents attempt to prove nursing home liability in a lawsuit, they hold the burden of proof. This means that they are responsible for providing sufficient evidence to prove that the nursing home failed to maintain the resident’s safety, and as a result, the resident experienced injury or death. In order to do this, the plaintiff, or suing party, must provide evidence such as documents and reports indicating the circumstances of the scenario. In some cases, an expert witness may be asked to testify that the nursing home violated the duty of care expected for residents who enter the home.

Types of Nursing Home Neglect

Nursing home neglect can vary among individual cases, but the four primary types of nursing home neglect involve:

1. Emotional or social neglect, where the elder person is repeatedly ignored, left alone, or accidentally snapped at by an over-stressed nursing home staff

2. Personal hygiene neglect, where patients do not receive adequate help with laundry, cleaning, bathing, brushing their teeth, or other forms of hygienic practices

3. Basic needs neglect, where the nursing home neglects to provide reasonable food, water, or a safe and clean environment

4. Medical neglect, where the nursing home fails to provide adequate attention, prevention, or medication for concerns such as bed sores, infections, cuts, diabetes, cognitive diseases, and mobility concerns

Signs of Nursing Home Neglect

Identifying nursing home neglect warning signs can be very difficult. Depending on the exact type of neglect, there may not be any physical signs of nursing home neglect present. Furthermore, behavioral changes are best identified when a nursing home patient lives close to family, friends, or loved ones. An elderly patient that does not see family regularly may have difficulty expressing concerns such as emotional or social neglect.

Warning signs of nursing home neglect include:

1. Sudden weight loss
2. Bedsores, or pressure ulcers
3. Injuries from nursing home falls
4. Dehydration
5. Malnutrition
6. Withdrawn elder behavior, or unusual changes in behavior
7. Changes in personal hygiene or appearance efforts
8. A growing lack of friendly interaction with the nursing home staff
9. A growing lack of friendly interaction with the other nursing home residents
10. Environmental hazards, such as poor lighting, slippery floors, unsafe mobility equipment, or unsafe furniture in the nursing home patient’s room.

Preventing Nursing Home Neglect

Nursing home falls and bed suffocation are forms of physical negligence that occur more suddenly. However, these negligent nursing home events can be prevented. The nursing staff should be readily available to assist patients with mobility issues. Patients that are identified as high-risk for nursing home falls should be checked on frequently.

The staff should pay close attention to the nursing home environment, promptly resolving any sanitary and safety concerns. The nursing home resident’s mattress should be flush with the bed frame or bed rails, to prevent the patient from suffocating between the mattress and the railing. The nursing home patient should be monitored for changes in mobile or mental ability, as well as any developing medical concerns.

Types of Nursing Home Injuries

Death

If a resident dies in a nursing home as the result of neglect from the staff, your family may be entitled to compensation. Wrongful death occurs frequently in nursing homes across the United States because it can occur from a variety of different ways. Patients can die from dehydration, malnutrition, abuse, severe sepsis, wrong medication and more. If a loved one has died in a nursing home as the result of negligence, feel free to contact us for your free consultation.

Bedsores

Bedsores are the most common type of nursing home abuse injury. Bedsores are also commonly known as pressure sores. They can happen very easily and it’s important for the nursing home staff to be well educated on how to treat those patients who may already have bed sores. These injuries are very serious and can even become life threatening if not treated properly. Bedsores are so common that currently 1 in 10 nursing home patients has a bedsore.

Types of Bedsores
There are two main types of bedsores: stageable and unstageable.

1. Bedsores that are stageable are the type of routine sores which can be diagnosed by a medical professional.
2. Unstageable are generally more difficult to see (under the surface of the skin) and can be very difficult for nurses and medical professionals to diagnose.

Malnutrition

Malnutrition is a condition that is caused by the lack of proper nutrients from food. Malnutrition can be the lacking of nutrients, the excess of certain nutrients, or un-proportional meals. Malnutrition is one of the leading causes of nursing home neglect. Many residents are unable to feed themselves and residents also have a difficult time chewing and swallowing different types of food. Therefore, it is crucial that nursing home staffs are trained to feed their patients accordingly.

Dehydration

Dehydration means the removal of water. Patients are not given proper amounts of water on a daily basis. Dehydration occurs when someone does not ingest enough liquid for that day. One third of nursing home residents are unable to eat and drink on their own, it’s important that each nursing home staff is equipped to handle this.

Poor Hygiene

Poor hygiene is the result of poor care from nursing home staff. Staff members are supposed to make sure all conditions within the room, and the patient themselves are sanitary. Bedrooms and bathrooms in particular most be cleaned on a regular basis and meet specific sanitation guidelines. Patients should be on a formal cleaning schedule where they are bathed and washed down as well.

Sepsis

Sepsis infection occurs when certain chemicals that are released into the blood to fight an infection spark inflammation throughout the entire body. If septic shock occurs, and blood pressure continues to fall drastically, death may be possible.

Infections

Infections are very common injuries within nursing homes. Sometimes infections are preventable and are treated with proper care, but unfortunately many infections are overlooked or misdiagnosed by nursing home staff. Infections such as sepsis, can result in death if not treated properly. Staph infections are also very common in nursing homes.

Patients with Alzheimer’s

Alzheimer’s is a disease which is characterized by a loss of brain function which results in dementia. These patients within the nursing home generally need extra care because of their lack of memory. Nearly 75 percent of Alzheimer’s patients will be submitted to a nursing home by the age of 80.

Diabetic Care

Diabetes is a disease where high blood glucose levels hinder the body’s ability to produce insulin. Diabetes is becoming more prevalent in the United States particularly in the aging population (65+). Patients in nursing homes with diabetes need extra care to ensure their health and safety.

Physical Abuse

Physical abuse is the use of physical force or violence that causes bodily harm, injury, pain, or impairment to the victim. This can include battery, assault, or any inappropriate use of restraint between two people. Physical abuse can occur at any age and may be repetitive or a singular incident. Due to the nature of nursing homes and assisted living facilities, elderly physical abuse can be difficult to identify.

Types of Elder Physical Abuse

Forms of elderly physical abuse may include, but are not limited to, the following:

1. Scratches
2. Bites
3. Burns
4. Being pushed, hit, shoved, or slapped
5. Threats or assault with a weapon, including guns, knives, and other objects
6. Inappropriate use of restraints

Behavioral Signs of Elder Physical Abuse

Behavioral indicators of elderly physical abuse include:

1. Cigarette burns, scalding burns, or burns from appliances
2. Abrasions that resemble injuries from ropes or straps
3. Injuries that appear to be healing with “secondary attention,” which may indicate the elderly patient is attempting to treat the injury alone
4. Internal injuries that may be identified by pain or malfunctioning organs
5. Multicolored or “wrap around” bruises, particularly those encircling an elderly patient’s arms
6. Traumatic hair or tooth loss
7. Sprains, broken bones, fractures, or dislocated joints

Physical Signs of Elder Physical Abuse

Physical indicators of elderly physical abuse include:

1. Delay between the actual injury occurring and the elderly patient seeking medical care
2. A history of injuries or hospitalizations, for similar elderly injuries
3. A varied or incongruent explanation of how the elderly injury occurred, especially when family members’ stories are not congruent
4. Unexplained, or unlikely explanations, of how the elderly patient’s injury happened
5. Visits to different medical institutions for injuries, even though the elderly patient has lived in the same area throughout the medical visits
6. Tense or strained relationships
7. Unexplained withdrawal from typical activities or social interaction that the elderly patient enjoys

Emotional Abuse

Elderly abuse can happen in many different forms. While elder physical abuse may be the most obvious type of elder abuse, elder emotional abuse may be the most common. Elder emotional abuse is also known as elder psychological abuse. It can be difficult to identify, because there aren’t necessarily any physical signs of elder emotional distress.
Elder emotional abuse can happen within a nursing home or assisted living facility. It could come from a caregiver, a volunteer, or any other person working at the elderly facility. Elder emotional abuse can also happen at home, with family members or an in-home nurse. Emotional abuse in nursing homes encompasses any psychological distress or emotional pain caused by a caregiver.

Types of Elder Emotional Abuse

Elder emotional abuse may be verbal or nonverbal, including:

1. Humiliation or ridicule of an elderly person – Verbal Abuse in Nursing Homes
2. Habitual blaming, scapegoating, or demeaning behavior toward the elderly person
3. Intimidation of an elderly person, through threatening behavior or yelling
4. Isolating the elderly person from social activities or friends
5. Terrorizing or menacing the elder
6. Ignoring the elder

Signs of Elder Emotional Abuse

1. An elderly person may display some of the following behaviors that can indicate the person is experiencing elder emotional abuse:
2. Low self esteem
3. Avoids eye contact
4. Doesn’t speak openly, which may indicate a fear of other people finding out about the elder emotional abuse
5. Often seems hopeless, disturbed, or scared
6. Seems withdrawn, depressed, or shy when the elderly person was more outgoing previously
7. May display a desire to hurt their own self, or another
8. Sudden changes in sleeping or eating patterns
9. Sudden mood swings
10. May be prevented from acting or making their own decisions
11. May be prevented from seeing other people, or from calling other people
12. Not allowed to join in social interactions
13. Psychological Abuse in Nursing Homes

Diagnosis and Treatment

If psychological or emotional elder abuse is suspected, it is important to report the suspicions to government officials. The state will assign a government-affiliated caregiver to evaluate the elderly person. The caregiver may ask the elder how they are cared for on a day-to-day basis, what the elder’s activities are, and who they interact with. The caregiver may also ask the elder who he or she enjoys spending time with the most, and why.

Medication Errors

Medication errors in nursing homes and other inpatient medical facilities are recognized as a common problem in the medical field. While minor medicine errors are inevitable, nursing home residents must remain free of any severe medication errors. By definition, medication errors are mistakes that occur while preparing or administering medicine.

The medication error occurs in a manner that contradicts the doctor’s orders, the manufacturer’s instructions, or the accepted professional standards regarding that medicine. When investigating medication errors within nursing facilities, state inspectors must identify each facility’s medication error rate. The nursing facility’s frequency of medication errors must be kept below a standard or acceptable percentage of medication errors. If the medication error rate rises above that standard, the nursing facility will be required to create and enact a plan for correction.

Bed Sores

Bedsores are also known as pressure sores, pressure ulcers, or decubitus ulcers. They occur when a person sits or lies down in the same position for extended periods of time. Elderly patients frequently contract bedsores due to their lack of mobility. There are primarily four stages of bedsores. During these four stages of bedsores, the elder patient’s health condition progresses from a mild discomfort to a severe pain. Ironically, in the worst stages of bedsores, elderly patients experience little to no pain due to the incredible amounts of tissue damage. Without healthy tissue, there aren’t any nerves left to feel the pain of the pressure ulcer.

Elderly patients most frequently develop bedsores around or near the following body parts:

1. Back of the head
2. Shoulders
3. Elbows
4. Back, especially along the spine
5. Hips
6. Tailbone or buttocks
7. Ankles
8. Heels

Elder Malnutrition in Nursing Homes

Elderly malnutrition takes place when an elderly person is either not getting enough food or is not getting enough of the right sorts of food. If food does not contain enough vitamins and minerals to meet the recommended daily value for elderly people, malnutrition may come as a result. In nursing homes, malnutrition is a serious and wide-spread problem.

A number of common ailments come about as a result of elderly malnutrition. In the absence of malnutrition, many of these ailments would be easily avoidable. Elderly malnutrition is preventable. The presence of elderly malnutrition in the nursing home setting is often a sign of potential mismanagement or neglect by nursing home staff.

Elderly malnutrition can lead to a range of serious complications. Certain symptoms often accompany the onset of malnutrition and manifest themselves physically. Keeping an eye on the physical appearance of a loved one may be helpful in identifying elderly malnutrition.

Physical Symptoms of Elderly Malnutrition May Include:

1. Mouth Signs: In the presence of elderly malnutrition, a sufferer’s mouth may become a bright shade of red. Canker sores may be present. Additionally, thrush or a yeast infection can cause white patches to develop on the cheeks and tongue.

2. Muscular Problems: Elderly malnutrition can cause muscles to become flaccid. This is a result of the body using up nutrients stored in the muscle tissue in order to make up for a lack of incoming nourishment. Simple tasks may bring on fatigue.

3. Eye Signs: Red, glassy eyes or swollen corneas may also be symptoms of elderly malnutrition. Vision may worsen as well.

4. Cognitive Difficulties: Lack of proper nourishment will eventually affect a loved one’s ability to think clearly. They may appear listless or irritable. In advanced cases of elderly malnutrition, dementia and confusion present themselves.

5. Skin Issues: The skin may take on a yellowish color as a result of elderly malnutrition. The skin of darker-complexion individuals may appear dull. Additionally, skin may become heavily wrinkled, and the skin beneath fingernails can turn white.

Bedrails

There is a long record of bedrail injuries and deaths in the elderly population. Elderly care patients incur bedrail injuries when they become lodged and stuck into bedrails. The risk of bedrail injuries is also higher for elderly patients with incapacitating physical and mental illness.

Many elderly patients have died after the neck or chest is compressed between the rail and bed. In this situation, elderly care patients are not even able to call out for help because all of the air is squeezed out of their lungs; making bedrail injuries a serious cause for concern. The reason why many elderly care patients have incurred bedrail injuries is because of dangerous gaps that are left between the edges of the bed, the headboard, and bedrails. If the distance between parts of the bed and the bedrails is large enough then it is possible for an elderly care patient to become injured. This is especially a risk for portable bedrails since these usually do not fit well onto the sides of a bed.

Falls and Fractures

Many nursing home falls are preventable with the proper fall prevention programs in place. Nursing homes must take the time to assess new patients for falling risks and potential modifications to enable safer mobility of that patient. The nursing home staff must maintain a high degree of education on nursing home fall prevention. The staff should also be aware of any nursing home patients that have a particularly high risk for falling. Any necessary mobility devices should be easily used and well-maintained.

Environmental hazards that cause nursing home falls present a pronounced risk for patients. Nursing home negligence may result in dim lighting, making it hard for patients to see well enough to walk. Wet or slippery floors in nursing homes are extremely unsafe, as elderly patients frequently have preexisting mobility and balance problems. Items such as beds, chairs, or mobility devices must be easily accessible for the patient. Bathrooms should provide seats, handles along the walls, and no-slip flooring when possible. Failure to supply a safe environment for patients is grounds for a nursing home negligence lawsuit.

Negligent Wound Care

In nursing facilities, elderly patients may develop certain types of wounds due to negligence by the nursing home staff. Examples of wounds that elderly patients may experience include:

1. Bedsores or pressure ulcers
2. Diabetic ulcers
3. Venous and arterial ulcers
4. Scrapes or gashes from a falling incident
5. Open wounds from a burn incident
6. Amputation wounds
7. Post-operative wounds
8. Open wounds from a lack of circulation to a specific area of the body

When a patient receives improper elder wound care, a wound infection is likely to happen. Elder patients in nursing facilities are exposed to certain types of bacteria due to the nature of their environment. It also takes a longer time for elder patients’ wounds to heal. This is often a result of age, fragile skin, slow cell regeneration, medication, certain diseases, malnutrition, or dehydration. If an elder’s wound is infected, the infection must be treated.