According to the National Center on Elder Abuse, one in 10 Americans over the age of 60 has suffered from mistreatment and abuse, which includes physical abuse, emotional abuse, and neglect. Despite the good intentions of most long-term care facilities abuse and neglect still occur. Federal and state laws provide protections for residents of long-term care facilities and define what constitutes a long-term care facility with most nursing homes, skilled nursing facilities, and in-patient rehabilitation centers falling within this definition.
Protecting our senior citizens and elderly loved ones is imperative. In this blog, we will:
- Outline the rights of residents in nursing homes and long-term care facilities;
- Define and provide examples of the different types of elder abuse and neglect;
- Identify warning signs and red flags to help recognize and prevent abuse and neglect;
- Identify resources to aid those faced with the tough decision to place a loved one in nursing or
long-term care; - Identify resources and avenues for advocacy when abuse or neglect is suspected;
- Outline possible legal remedies available for victims and their families.
Rights of Nursing Home and Long-Term Care Residents
The federal and state governments recognize that residents of nursing homes and long-term care facilities are isolated from the community and often lack the ability to fully assert their rights and needs. In response, numerous federal and state laws and regulations have been enacted to protect our aging and elderly loved ones. One such law is Georgia’s Bill of Rights for Residents of Long-Term Care Facilities, which not only defines the protected rights of residents but also the standard of care residents shall receive. These include, but are not limited to:
- The right to receive adequate and appropriate care, treatment, and services, which shall be provided with reasonable care and skill and with respect for the resident’s dignity and privacy;
- The right to choose their own physician;
- The right to participate in overall care planning and to be informed of substantial treatment or care plan changes;
- The right to refuse medical treatment, dietary restrictions, and medications;
- The right to have any significant change in the resident’s health status reported to persons of their choice within a reasonable time;
- The right to a complete and current explanation of the resident’s medical diagnosis, treatment, prognosis, and access to their medical records;
- The right to be free from actual or threatened physical or chemical restraint, isolation, or mobility restrictions;
- The right to exercise all rights, benefits, and privileges as a citizen, including the right to vote;
- The right to free exercise of religion;
- The right to personal choice;
- The right to retain personal property;
- The right to privacy; and
- The right to receive visitors.
This is not a comprehensive list and Medicare and Medicaid recipients are often entitled to additional protections under federal and state law. Skilled nursing facilities are required to provide a written description of these rights at the time of admission. Additional information regarding these federal rights can be found on Medicare’s website at www.medicare.gov.
Definition of Abuse and Examples
In Georgia, nursing home and long-term facility residents have the right to be free from abuse, which the law defines as, “any intentional or grossly negligent act or series of acts or intentional or grossly negligent omission to act which causes injury to a resident, including, but not limited to, assault or battery, failure to provide treatment or care, or sexual harassment of the resident.”1 Therefore, physical harm is not the only recognized form of abuse. Abuse also includes emotional harm, intentional violation of one’s rights, as well as neglect. Some common examples of the different types of abuse are as follows:
- Physical abuse: This may include hitting, slapping, pushing, pulling, or excessive use of force on a resident.
- Physical or chemical restraint: While hospitals are permitted to chemically and physically restrain patients for purposes of treatment and evaluation, nursing homes and long-term care facilities are required to provide residents with the least-restrictive homelike environment possible. Therefore, federal and state laws prohibit the use of chemical and physical restraint except in emergencies where the safety of the resident, or that of others, is at risk. Georgia law expressly states that “[i]n no event shall restraints, restrictions, or isolation be used for punishment, incentive, behavior conditioning or modification, or for the convenience of the facility.”2 Physical restraints include wrist restraints, ankle restraints, or any other device designed to restrict physical movement. Chemical restraint involves the use of medication to subdue a resident by making them drowsy or putting them to sleep. In nursing home and long-term care settings, chemical restraints are more common than physical. Anti-psychotic medications, such as Risperdal, Clozapine, Haldol, Seroquel, etc., are not only used as restraints but also frequently prescribed to treat diagnosed conditions, such as dementia and Alzheimer’s disease, which are common in older adults and elderly resident populations. This makes anti-psychotic medications readily available and accessible to facility staff. It also makes their use difficult to detect, especially in residents who have been prescribed such medications for daily use.
- Emotional abuse: Emotional abuse can include verbal assaults, threats, intimidation, or isolation imposed by facility caregivers and other staff members.
- Neglect: Neglect most commonly occurs when a facility fails to provide adequate and appropriate care, treatment, and services or fails to provide them with reasonable care and skill. This can include failing to provide necessary assistance with daily hygienic activities, such as bathing, dressing, brushing teeth, hair brushing, etc. It can also include failing to provide adequate and proper hydration and nutrition and ignoring obvious needs or requests for medical attention.
When neglect results in a resident’s treatment and care plan not being followed, it can have serious consequences. Some common failures include failing to administer medications and treatments; failing to provide therapy and other rehabilitative services; failing to change wound dressings or bandages; and failing to assist and regularly reposition residents with limited mobility.
Warning Signs and Red Flags of Abuse and Neglect
Some residents are at a higher risk of abuse and neglect than others. Recognizing what makes a resident high risk and understanding the signs of elder abuse and neglect are the first steps toward prevention. Those at higher risk include residents with limited mobility, cognitive deficiencies, or behavioral issues, which are often associated with dementia and Alzheimer’s. Residents with mobility restrictions require additional assistance with activities of daily living, transfers, and simply moving about the facility. Those with significant mobility restrictions, especially those who are bedbound, require even more assistance as they need to be turned or repositioned at regular intervals, or reminded to do so, in order to relieve pressure and prevent the development or worsening of pressure ulcers (bedsores). Those with cognitive impairments or behavioral issues also require additional monitoring and assistance as they often have difficulty following instructions and may be prone to violence or outbursts.
Facilities are prohibited from accepting a patient unless they have properly trained staff in sufficient numbers to provide adequate and proper care. Unfortunately, most nursing homes and long-term care facilities are private, for-profit corporations that prioritize profits over people. With the goal of filling beds and keeping costs low, facilities become understaffed. This can also result in staff being inexperienced or poorly trained. Without adequate and properly trained staff, facilities are unable to provide adequate and sufficient care that meets professional standards of quality, especially to those requiring a higher degree of care and supervision.
Some red flags and warning signs of abuse and neglect include, but are not limited to:
- Poor hygiene. Unattended hygiene, such as deficient oral hygiene, unbrushed hair, smelly or dirty appearance, can be a sign of abuse or neglect, as well as dirty or unchanged clothing or bed linens.
- Concerning smell. In addition to poor hygiene, an unpleasant or offensive odor could indicate that your loved one isn’t receiving adequate incontinence or toileting assistance. It could also indicate something more ominous, such as neglect of adequate or consistent skin or wound care and new or worsening pressure ulcers (bedsores) or an infection.
- Suspicious bruising or injuries. Not all bruising and injuries indicate signs of abuse and neglect, especially in the elderly and those with various medical conditions. However, where bruising is severe, persistent, and/or unexplained, it could indicate abuse or neglect.
- Unexplained falls. Falls can be common among the elderly and those with limited mobility. However, if falls become consistent or severe, it may indicate that the resident isn’t receiving adequate assistance with activities of daily living or lacks supervision.
- New or worsening pressure ulcers (bedsores). The development of new pressure ulcers is preventable, and most pressure injuries or ulcers tend to heal with adequate and proper care and treatment. When they develop, or get substantially worse, even infected, this may indicate that the resident is not receiving adequate prevention and care via regular skin checks, consistent repositioning, use of pressure-relieving devices, and wound care.
- Physical or chemical restraints. As chemical restraints are most common, watch for signs of your loved one being “out of it,” overly drowsy or sleepy, or sleeping more than usual, especially when they are not easily aroused or awoken. Sudden prescription or dosing changes, especially with sedatives or antipsychotics, without a clear medical need or proper diagnosis, may be evidence of chemical restraint.
- Significant weight loss or dehydration. Significant weight loss and dehydration can be common in elderly residents, especially those with certain medical conditions. However, it can also be evidence of abuse or neglect, especially where drastic, consistent, and unexplained.
- Lack of appropriate response, or failure to intervene. While the above-referenced red flags and warning signs may not be, in themselves, cause for concern, a facility’s reaction is. When reports or inquiries are made, the facility should not only express care and concern but should intervene to ensure any emergent medical care or treatment needs are met and that any necessary adjustments to the care or treatment plan are made and implemented in a timely manner.
Ultimately, if you have an elderly or aging loved one in nursing or long-term care, being present and involved is the best method of prevention. Residents with regular visitors who are involved in their daily care are less likely to become victims of abuse and neglect. However, it is understandable that career, family, and other commitments may make daily visits difficult or impossible. If that is the case, consider a coordinated visiting schedule between yourself and others. Telephone calls and visits via Facetime and Zoom are also great ways to stay involved. If you develop a coordinated visiting schedule, consider sharing it with your loved one, even placing a calendar on the wall of their room, which is a great reminder of how much they are loved, and cared for, and gives them something to look forward to. If a visiting schedule is shared or posted, consider pop-in, and unannounced visits as well, as the likelihood of unannounced visitors is just as important as regular visitors when it comes to prevention.
Communication between visitors and family members is also of vital importance. Establish a group chat, email thread, shared calendar, online journal, application, or other means for visitors to share updates in real-time. Maintaining a pleasant, respectful, and cooperative demeanor with facility staff and management is also necessary to ensure their cooperation and timely receipt of updates and requested information. Fostering relationships with those providing daily care to your loved one is a great way to establish a direct line of communication with the facility. It often results in more frequent or detailed updates regarding your loved one and their daily care.
Resources for Those Considering Nursing or Long-Term Care
If you are searching for a nursing or long-term care facility, Medicare.gov’s facility search tool is an invaluable resource. This search tool not only allows you to identify facilities in your area but also compare them based on rankings of overall quality, staffing, inspection results, etc.
For Georgia residents, inspection reports and the results of recent surveys for all facilities can be found through the Georgia Department of Community Health. This transparency is essential in monitoring facility performance and ensuring compliance with care standards. Georgia’s Department of Adult Protective Services is also a useful resource for information and reporting instances of elder abuse, neglect, and exploitation.
Resources where Abuse and Neglect is Suspected
If you believe a loved one is a victim of elder abuse or neglect, it is imperative that your concerns are addressed quickly and transparently. Visit our nursing home abuse attorneys page to contact us for more information. Here are some other options for reporting and oversight where abuse or neglect is suspected:
- Internal reporting: Start with speaking to the facility staff, nursing directors, or upper management about your concerns.
- Request a care plan review: Request a review of the resident’s care plan and records to ensure they are receiving adequate and appropriate care. If your loved one has a primary care doctor or other trusted physician prior to entering the facility, schedule an appointment to review their care plan with them. If something is missing, the provider may be willing to write an order for any necessary changes or additions.
- External reporting: For unresolved issues, or to report abuse and neglect, contact the Georgia Department of Community Health through their Facility Licensure Complaint Page or directly report an incident using their online form.
- Document the event and its reporting: Suspicions of abuse and/or neglect should not only be reported but also documented. In fact, documentation is a good practice anytime a red flag or warning sign is spotted. Document by writing down or noting the specifics regarding the occurrence, including, but not limited to: the date and time of the event, or its discovery; all specifics relative thereto; the names of any nursing staff or other employees who may have witnessed the event or have knowledge of it and a brief description of what you believe they may know and why; to whom the event was reported and when; and the outcome of the report. You should also document the event through photographs and videos, where applicable.
Possible Legal Remedies Abuse and neglect have the propensity to cause significant injury and lasting impacts to not just the victims, but their families and loved ones as well. In addition to the inevitable pain, suffering, emotional distress, and financial impact of an injury, elderly victims may also experience a loss of mobility, a decline in overall health, and even death. Georgia law provides civil remedies for victims and their families and financial compensation may be recoverable. In the event of a significant injury, resulting in an impact on overall health, mobility, or even death, our law firm may be able to help. Our firm is committed to protecting the rights and well-being of the elderly and advocating for justice in cases of abuse and neglect. Call 866-982-5295 or contact us for a free case evaluation.
