In our effort to help you understand the perils your older relatives and friends may face when they move into a long-term care facility, we continue our discussion of the most deadly nursing home hazards.
As we’ve said previously, neglect is the mother of all nursing home abuses. Very often neglect begins when facilities attempt to improve their bottom line by cutting costs. When staffing cuts happen, personalized care suffers and neglect gains a foothold. Among the most common signs of such neglect is the far-too-common condition of malnourishment and dehydration among nursing home residents. It is estimated that about 40 percent of nursing home residents across the nation suffer from malnutrition.
While the statistic seems staggering, we shouldn’t be surprised. In our nursing homes certified nursing assistants (CNAs,) are expected to assist 7 to 9 residents with meals and hydration during the daytime hours. During evening meals, a CNA may work with 12 to 15 patients. National guidelines suggest that the ideal staff to resident ratio is 1 employee to a maximum of 3 patients who need assistance in order to eat and drink. Obviously, with the situation as it is neglect is unavoidable.
Some staff members have been known to take the stress of their impossible job out on the residents by feeding them hurriedly, forcefully, or sometimes, not at all. This is decidedly NOT what we have in mind when we relegate our loved ones to a care facility.
In this article we will outline what we know about malnutrition and dehydration in nursing homes around the State of Georgia. We’ll tell you the signs to look for, and then we’ll give you some suggestions about what to do when neglect occurs. We’ll offer help as to how to go about proving that neglect is happening to your patient. Finally, we’ll let you know how lawyers and judges go about setting a value for the injuries that follow when the standard of care suffers.
Unfortunately, the symptoms of malnutrition and dehydration can mirror the stages of the natural aging process. This is why individualized care by well-trained nursing staff members who know the patients is critical to identifying and treating these conditions.
With age, some changes are to be expected. Many elderly patients experience decreased thirst sensation which leads to decreased fluid intake. Many illnesses including Parkinson’s disease, dementia, stroke and other neurological disorders can affect the patient’s ability to swallow. This difficulty, dysphasia, requires more and better supervision at meals and snack time. These same patients often lack the motor skills to be able to actually feed themselves, so when staff cannot help, they can remain unfed.
Many times the medications taken by a patient for other conditions will also have an effect on appetite. Some medications have a diuretic component that compounds the problem. It is up to the nursing staff to watch for these signals and take steps to correct them. But with patient overloads, these steps may not always take place.
To make matters worse, there is a 93 percent employee turnover in nursing homes. This makes for inconsistent care from day to day. This is where family members must become involved.
Sadly, it is up to the family members to remain vigilent when a loved one is in a nursing home. Changes in the way your patient looks and behaves may be the first signs of neglect. Some other signs of malnutrition and dehydration are listed below.
- A noticeable weight loss
- Weakness of muscles
- Fatigue and apathy
- Frequent infections
- Slow healing of even small wounds and cuts.
- Irritability and dizziness
- Dry skin, hair, and brittle nails
- Long term constipation or persistent diarrhea
- Menstruation may become irregular or could stop completely in pre-menopausal women
Some signs of dehydration are:
- Reduced urine output, increasingly darker colour and stronger odor
- Dry mouth
- Cracked lips
- Dry eyes
- Lethargy and increased sleepiness
- Inability to concentrate
- Irritability and agitation
- Worsening constipation
- Sunken eyes
- Unexpected reduction in wound drainage
- Reduced skin elasticity
As you can probably see, under-nutrition is linked to infections, pressure ulcers, anemia, hypotension, confusion, impaired cognition, and hip fractures that don’t heal well. These patients become apathetic, weak and depressed. Eventually they can become bed-bound which makes healing even more difficult. Compared with well-nourished residents, the malnourished and/or dehydrated patients have a five-fold greater risk of mortality.
It is estimated that even when doctors order nutritional supplements in response to patient weight loss, only 2% of the residents consumed the supplements.
In a report commissioned by The Commonwealth Fund, a healthcare watchdog organization, study co-author Jeanie Kayser-Jones said, “The extent of malnutrition and dehydration in some American nursing homes is comparable to that found in many poor, developing countries where inadequate food intake is compounded by repeated infections,” Kayser-Jones is a professor of physiological nursing in the School of Nursing, and professor of medical anthropology in the School of Medicine, at the University of California, San Francisco.
“Malnutrition, dehydration, and weight loss in nursing homes constitute one of the largest silent epidemics in this country,” Commonwealth Fund President Karen Davis also stated.
And yet, the silent epidemic continues. Our researchers discovered that finding recent data on nursing home malnutrition is very difficult. Most of the studies done on this subject are nearly 20-years-old. As the population ages, the problem grows even though these conditions are preventable.
In a perfect world, you could rely upon nursing staff and ombudspeople to look out for the best interest of your nursing home resident. As the paragraphs above disclose, we live in a world that is far from perfect. Of all the nursing homes in Georgia, 40 percent get ratings of two stars or less. Therefore, it falls almost entirely upon you to document the condition of your loved one on a very regular basis and make official complaints whenever you spot a problem.
Keep a notebook with you when you visit the nursing home. Take pictures of the patient with date and time stamps using your cell phone. Your notes should include information about the condition of the patient’s skin and hair, how wounds or bedsores are healing, and the overall demeanor of the patient. Each of these things will be important if the situation does not improve and you must take the matter into a Georgia courtroom.
In theory, if the nursing staff and administration see that you are concerned they should step up to the plate and give your loved-one the extra care and encouragement necessary to normalize their nutritional deficits. If you complain and no improvement occurs, you may be faced with the decision of moving your loved one to a different facility. Sadly, though, the statistics prove that such a change might not improve the care, but will, instead, disrupt and agitate your patient.
When you make verbal complaints with nursing staff, follow up with a letter to the administration outlining the facts. Keep a copy of all communications for your file. This is a very powerful clue to the nursing home that you will not tolerate neglect – care may instantly improve.
If you observe continuing symptoms of nutritional neglect that does not improve when you bring it to the attention of the staff and administration, it’s probably time to consult an attorney.
It would be refreshing if powerful people fixed a problem right away without being ordered to do so by a court of law, but that rarely happens. It is an unfortunate fact that sometimes the only way we can get the full attention of corporate wrong-doers is by making them pay for their negligence in financial ways.
Unfortunately, as we see in many lawsuits brought against big corporations, sometimes the power of the purse drives the decisions to improve or to ignore the problems that exist. In a very real way, your attention to the care of your loved-one can work to help all the other patients in the facility by setting an example. We see it as something of a public service.
The suffering your loved one has endured can be turned into a positive channel by informing the rest of society that problem of neglect and abuse continue to exist. Every improvement in this national crisis is a welcome one.
Some cases can be settled without a lawsuit. Others require litigation. Once you file a lawsuit against a nursing home, there will be a period of ‘discovery’ during which lawyers will work to gather all the facts and confirm the observations of witnesses. There may be depositions, and costs for expert witnesses. These costs will be factored into the settlement.
Once this discovery is complete, the lawyers will discuss what compensation is adequate to the patient. If the lawyers cannot come to a satisfactory settlement, it may fall to the judge and the jury to set an appropriate award.
Nursing home neglect and abuse can be very detailed and complicated matters. You need an attorney who deals daily with this kind of problem. A lawyer who practices in any field of law other than personal injury will probably not have the expertise to win your case in court.
Rest assured the corporate attorneys that work for the nursing home will do everything possible to disprove your allegations. Particularly if there is any question about whether or not your loved-one’s condition could be caused by the normal aging process – and such questions are guaranteed to come up – you will need a legal team that already knows the answers. You need somebody who faces those kinds of questions every single day.
At the Millar Law Firm, we take only personal injury cases. Our law firm is dedicated to finding justice for those who have been injured as a result of the negligence of others. We face corporate and insurance company lawyers in court on a daily basis. We are well trained and battle hardened. We are ready to fight the good fight on behalf of your nursing home resident. Not every lawyer is similarly equipped.
We also offer a free case evaluation. Because we are so familiar with the symptoms and consequences of nursing home neglect, we can look at your facts and evaluate what the outcome might be. It is our privilege to advise potential clients about how they should proceed in order to achieve the best result for their loved ones.
The legal staff at Millar Law Firm is standing by to help you make positive changes in your nursing home patient’s daily care. Call us today.