While we trust the staff members of nursing homes and assisted living facilities to care for our elderly loved ones and keep them safe, these institutions do not always uphold their missions. For a variety of reasons, most of which are preventable, nursing home residents are neglected and abused regularly in facilities throughout Illinois and across the country.
The Illinois Nursing Home Care Act defines abuse as “any physical or mental injury or sexual assault inflicted on a resident other than by accidental means in a facility.”
This abuse can be physical, including sexual abuse, or emotional, and can take many forms. Some examples include confining or isolating an individual for reasons that are not related to medical issues or withholding food, medication, therapy or other things necessary to a person’s health and well-being. Neglecting a nursing home resident’s needs may be a case of deliberate or unintentional neglect, where a caregiver is unaware of or does not understand a particular patient’s needs. Regardless of whether the neglect is intended or accidental, failure to provide a resident with appropriate nutrition, hydration, medicine, living arrangements or medical treatment constitutes neglect under Illinois law.
Abuse and neglect can result in many serious and tragic results for elderly people who depend on nursing home staff members to keep them healthy and safe. Some of the most common consequences of neglect are:
While the above consequences may be very different, they share some common causes. The most prevalent of these include:
- Failure to identify and monitor patients most at risk for choking, falling, dehydration or wandering
- Inadequate safety measures
- Insufficient staffing, especially for at-risk patients
- Improper or inadequate training for staff members
- Incomplete documentation and medical records
- Insufficient background and reference checks for staff members
Choking
The death rate from choking is higher among people aged 65 or older than for any other age group. Recent data indicate that over 2,000 people 65 and older die each year from choking on food in the United States. Human error causes the majority of these deaths in a nursing home or assisted living facilities.
Choking is most often caused by dysphagia, which is defined as difficulty or discomfort swallowing food, a condition that affects approximately 40% – 60% of institutionalized older adults. Certain neurological or nervous system disorders associated with aging, as well as some medical conditions, also increase the likelihood of experiencing dysphagia. These include multiple sclerosis, muscular dystrophy, Parkinson’s disease, neurological damage from strokes, brain damage or spinal injuries, Alzheimer’s disease, and certain types of cancers as well as some cancer treatments, such as radiation. In addition, aging causes the throat muscles to wear and increases the potential for other conditions that affect swallowing.
In a nursing home environment, some of the factors that may contribute to the risk of choking include:
- Untrained, unqualified or insufficient nursing home staff
- Disregarding a resident’s dietary plan
- Neglecting to update a resident’s dietary plan when health changes occur
- Leaving an at-risk resident to eat without necessary supervision
- Failing to perform a thorough oral evaluation upon admission, after illness or other health changes
- Inadequate supervision in the dining room or other areas where residents consume food and beverages
Nursing homes and assisted living facilities can help prevent choking incidents by implementing the following safety measures:
- Thorough oral assessment upon admission that includes physical examination and medical history
- Individualized eating plans for each patient with proper supervision and follow-up
- Reassessment when changes in a patient’s health occur
- Continuous monitoring of patient health and eating plan with complete documentation
Falls
Falls are the number one cause of injuries and subsequent deaths among older adults. According to the Centers for Disease Control and Prevention (CDC), more than one out of four older people falls each year and falling once doubles the chances of a subsequent fall. One out of every five individuals who fall (20%) suffers a serious injury such as broken bones, a hip fracture or a head injury, and most hip fractures (95%) are caused by falling. Falls are also the most common cause of traumatic brain injuries.
A variety of factors contributes to an individual’s risk of falling. Some of these factors, many of which are common to those living in nursing homes or assisted living facilities, include muscle weakness in the lower body, Vitamin D deficiency, walking and balance issues, medicines such as tranquilizers, sedatives or antidepressants, vision problems and foot pain. A higher number of risk factors increases the risk of falling.
Negligent Actions that Cause Residents to Fall
Most falls that occur in nursing homes are preventable. When a resident falls, it is often caused by one of the following reasons:
- Failure to complete a risk assessment for new residents or update risk assessments for existing residents when circumstances change
- Failure to identify at-risk residents in an easily recognizable way (Fall-risk bracelets, signs in the room, etc.)
- Failure to properly monitor at-risk residents when they are walking to the bathroom or through the hallways
- Inadequate fall prevention training for staff members
- Insufficient lighting
- Hazards such as loose rugs or misplaced furniture in residents’ rooms or common areas
- Failure to provide mats, bed rails or other assistive devices for at-risk patients
- Insufficient staff to properly supervise at-risk residents traveling within the facility
Preventative Measures
Most falls can be prevented by simple interventions by nursing home staff. These include:
- Risk assessments for new residents, with updates as health history and medical conditions change
- Staff training on fall prevention techniques
- Physical therapy or exercise classes for residents to help improve balance and overall strength
- Adequate lighting in residents’ rooms and hallways
- Availability of walkers, grab bars, handrails, hip pads and other adaptive equipment for residents who need assistance
- Evaluating a patient after a fall to determine the cause and initiate measures to prevent subsequent falls
Poor Nutrition
Malnutrition, the risk of which increases with age, is defined as poor nutrition resulting from an insufficient or poorly balanced diet, or from defective digestion or defective assimilation of food. Of the 1.7 million nursing home residents in the United States, 35%-85% are malnourished, and 30%-50% have substandard body weights.
Nursing home residents with dementia, poor oral health, dysphagia (difficulty swallowing) or who take medications that irritate the stomach, are especially susceptible to malnutrition.
Malnourished residents require longer stays when hospitalized for acute illness, and they are five times more likely to die in the hospital than their well-nourished counterparts. Malnutrition also decreases the quality of life, something that is surely undeserved by people who should be enjoying their later years.
Preventable reasons people in nursing homes or assisted living facilities may suffer from malnutrition include:
- Failure to take complete medical history and perform a thorough evaluation that includes physical, cognitive, and psychosocial functioning
- Failure to develop an appropriate dietary plan for each resident based on
- Failure to educate staff on residents’ dietary needs and ability to eat independently
- Failure to provide supervision and assistance for residents who need help consuming food and beverages
- Failure to keep records of residents’ consumption of food and liquids and intervene when intake falls below established requirements
- Failure to provide opportunities for hydration throughout the day
- Failure to provide a variety of nutritious and appealing meals, snacks and beverages
- Inadequate staff training regarding proper nutrition and how to help residents eat an adequate and balanced diet
Malnutrition can result in a variety of other conditions that will further impair an elderly person’s health and quality of life; including infections, pressure ulcers (bed sores), anemia, hypotension (low blood pressure), confusion and impaired cognition, decreased wound healing, weakness, fatigue, apathy, and depression.
Wandering and Elopement
Supervision and security are two of the most important aspects of care in any nursing home or assisted living facility. If one or both of those elements are insufficient or lacking, it is likely that residents may engage in the harmful practice of wandering or elopement. Wandering, in a nursing home or other long-term care facility setting, is defined by The North American Nursing Diagnosis Association (NANDA) as “meandering, aimless, or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles.”
Simply put, it is when residents leave their rooms or other designated spaces and stray away from those who are supposed to be supervising them. Studies have estimated that up to 31% of nursing home residents wander at least once, including one in five people with dementia.
Wandering turns into elopement when a nursing home resident leaves the residence or property and cannot be found. Those who engage in elopement are distinguished by purposeful, overt, and often repeated attempts.
Inadequate supervision is the major reason why wandering and elopement occur.
While Illinois law mandates certain ratios of staff to residents, and guidelines are available from The Centers for Medicare and Medicaid Services (CMS), many nursing homes and assisted living facilities to fail to comply with these guidelines and requirements.
When there are not enough employees to keep an eye out for wandering residents, or the staff members who are available are not properly trained in wandering and elopement techniques, the results can be disastrous. Residents who wander away from their familiar surroundings, especially those with dementia, are likely to become confused and agitated when they find themselves in a strange place. These people are more likely to fall, experience a panic attack or suffer some other undesirable consequence. Residents who actually leave the premises are in even greater danger of getting lost, being hit by a motor vehicle or falling prey to a criminal element.
Other preventable causes of wandering and elopement are inadequate staff training and insufficient safety measures, such as alarm systems or lack of access to outside exit doors.
Death
Nursing home neglect and abuse sometimes result in the ultimate tragedy: the death of an elderly loved one. When this happens, the next of kin or personal representative of the deceased may be able to file a wrongful death lawsuit.
According to Illinois Wrongful Death Act, creates a cause of action for a deceased’s surviving spouse and next-of-kin.
The Nursing Home Care Act, 210 ILCS 45 (NHCA), states that owners and licensees of nursing homes “are liable to a resident for any intentional or negligent act or omission of their agents or employees which injures the resident”.
Wrongful death lawsuits must be filed no longer than two years after the death of the individual; however, the court has the discretion to waive this time limit if there are special circumstances that caused the delay in filing the claim. Under Illinois Law, the statute of limitations for wrongful death lawsuits is generally two years. That means the representative of a deceased person has two years after the date of death to file a lawsuit, or they will forever be barred from doing so. There are certain exceptions to the two-year statute of limitations. For example, the Discovery Rule found in Section 13-212(a) of the Illinois code of civil procedure (735 ILCS 5/13-212(a)) provides that within the four year statute of repose, any claim for malpractice against a health care provider must be filed within ten years of the date the representative knew, or through the exercise of reasonable diligence should have known, of the existence of the death for which damages are sought. There are also exceptions to the two-year statute of limitations (and four-year statute of repose) for causes of actions for minors.
In a nursing home or assisted living facility, a death can be caused by any number of factors.
- A resident could develop a fatal infection from untreated bed sores, or a fall that occurred due to inadequate supervision could have deadly results.
- Malnutrition caused by poor monitoring and failure to provide adequate food and liquids could result in a life-ending illness caused by a compromised immune system.
- An unsupervised resident who wanders away from the premises could be killed by a motor vehicle or die from exposure to the elements.
Regardless of the circumstances, if the death was caused by neglect or abuse on the part of the nursing home or facility, then the next of kin or representative has grounds for a wrongful death lawsuit.
If you believe your loved one is suffering (or has suffered) from deliberate or unwitting neglect and/or abuse in a nursing home or other assisted living facility, contact us immediately.
Our experienced and compassionate nursing home neglect and abuse lawyers are ready to help ensure your loved one’s future safety and obtain the benefits you and your family deserve. Contact us today for a free consultation.
Sources
https://www.illinois.gov/aging/ProtectionAdvocacy/Pages/What-is-abuse.aspx
http://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1225&ChapterID=21
https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
https://www.cdc.gov/media/releases/2016/p0922-older-adult-falls.html