As the U.S. population ages, nursing homes have become the primary residence for many of our elders. Elder abuse in nursing homes across the country has become a serious and tragic issue that is increasing each year, with neglect being one of the most common forms of this type of abuse. It should be noted that abuse and neglect are not exactly the same. Abuse implies a willful act intended to harm another, while neglect involves a breach of duty by the nursing home to those under its care, often in the form of inadequate, substandard care that causes harm to its residents.
An astonishing 95% of nursing home residents have stated that they had been neglected or seen another resident neglected. Worse yet, in one study over 50% of nursing home staff admitted to mistreating older patients, with two-thirds of those incidents involving neglect.1 Compounding this problem is when residents are unable or unwilling to communicate with family members about what they’re going through, either because of physical or mental infirmities, or because they fear retaliation from nursing home staff members.
However, there are signs of nursing home neglect you can watch for in order to protect your elderly loved ones. It should be noted that neglect can take many forms, and while no single factor is definitive, neglect may very well be occurring if more than one of the following signs are present:
Issues with Personal Hygiene
Elderly nursing home residents often need help with their basic personal hygiene needs. Nursing home staff should be providing this assistance, including help with bathing, laundry, brushing of teeth, doing hair and clipping nails. When nursing homes are understaffed, or the staff is poorly trained, residents are left to rely on themselves to complete these regular self-care tasks, resulting in an unkempt appearance and poor personal hygiene.
Unsanitary Living Conditions
Nursing homes should be free of dirt and debris, pests, mold, etc. Residents should be provided with fresh bedding and towels, and their rooms and living areas should be clean and well-maintained. What’s more, federal law requires nursing homes to “establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment . . . and to help prevent the development and transmission of disease and infection.” Serious health issues can easily arise when these standards are not met.
Nursing homes should have good lighting, floors that aren’t slippery, safe mobility equipment (wheelchairs, walkers, etc.) and safe furnishings in the residents’ rooms. Failing to provide a safe environment can lead to accidents and falls, the consequences of which are more serious for the elderly. While a younger person can sustain a fall with minimal harm, the same fall for an older adult often results in sprains and bone fractures.
Malnutrition, defined as receiving too much or too little nutrients for basic health, occurs in up to of 85% of American nursing home residents.2 Residents are often completely reliant on staff for their meals, and malnutrition happens when staff are not offering enough food to residents and/or are not overseeing their residents’ proper nutrient consumption. All nursing homes should have the equipment and skilled staff needed to screen residents to ensure they are receiving proper nutrition. Too often they fail to do so, which negatively affects the elder’s physical, mental and emotional health. Some signs of malnutrition include: weight loss, canker sores, red or glassy eyes, fatigue, yellowing skin, white fingernails, and bed sores.
Residents in poorly managed or staffed nursing homes often suffer from dehydration because drinks are not being provided in a timely manner. In fact, dehydration is the most common type of neglect elders living in nursing homes experience. Some elderly people may not display a strong thirst drive, and therefore need regular supervision of their fluid intake to ensure they’re getting enough water. Other elders, because of disability or language barriers, may not be able to communicate that they are thirsty and what type of fluids they prefer. Dehydration in the elderly can cause or complicate serious risks to their health, including brain swelling, seizures, kidney failure and coma. A resident may be dehydrated if they show signs such as thirst, having dry, papery skin, or decreased urine output/urination frequency. Symptoms of more serious, late-stage dehydration include confusion, irritability, inability to sweat, sunken eyes and cheeks, low blood pressure, delirium and rapid breathing.
Loss of, or Lack of Mobility
A good nursing home should have programs and policies to help keep their residents mobile. Regular movement helps maintain muscle mass and mobility, and can greatly help with balance and circulation issues. If your loved one has lost some or all of their mobility, it may be because they are left sitting or lying in bed for long periods of time. Bedsores and other infections can also develop when elders are not given the opportunity for regular movement.
Also called pressure ulcers, bedsores are injuries to the skin and underlying soft tissue caused by prolonged pressure on the skin. They most commonly develop on areas of the skin that cover bony areas of the body, such as the heels, ankles, hips and the tailbone, and can be difficult to treat. The elderly in nursing homes develop bedsores when they are confined to beds or chairs for long periods without the opportunity, or needed assistance, to regularly move. Individuals with spinal cord injuries, paralysis or other neurological disorders need to be moved frequently to prevent these sores. Dehydration and malnutrition, discussed above, make the formation of bedsores more likely as the resident loses weight (and thus the fatty tissue that protects them from sores) and their skin becomes thin and papery. Bedsores often become infected.
Many nursing home residents need help taking care of themselves and moving about. A nursing home’s staff should be there to help. If they aren’t, patients will often try to do these things themselves, and acts as simple as getting out of bed or walking unassisted down a hallway can result in falls and injuries such as cuts, bruises, sprains and bone fractures. More troubling are signs of bruises or irritation on the resident’s wrists or ankles, which can indicate that the person has been restrained to a bed or wheelchair.
Normally, the human body’s response to an infection is to fight it off. But when the body over-responds to an infection, immune system chemicals in the bloodstream cause inflammation throughout the entire body. This can lead to damage to multiple organ systems. The elderly are at high risk for developing sepsis, and it is the most common reason for the hospitalization of nursing home residents. Any type of infection can lead to sepsis, but the most likely for the elderly in nursing homes are pneumonia, urinary tract infections, and bedsores. Sepsis can occur in nursing homes when the facility is not following state and federal guidelines with regard to infection control measures.
Infections in nursing homes are common. Those most frequently encountered in the nursing home setting are MRSA (a type of skin infection that is often introduced through breathing tubes, catheters, and other methods that allow access to the bloodstream), urinary tract infections (caused in nursing homes by the use of catheters as well as by dehydration), pneumonia, influenza, food poisoning caused by a staph infection, and infections arising from bedsores. Nursing homes infections often arise out of a failure of the facility to have proper infection control programs in place, as well as poor resident hygiene care.
If a nursing home resident shows fear or apprehension toward caregivers, is reluctant to interact with staff members, or displays anger or resentment toward
them, they may be suffering from neglect. Emotional neglect can also involve ignoring the resident, socially isolating the resident, and constant unkind treatment by staff. Ongoing neglect of this type can cause depression, and residents may begin to withdraw from friends and family members as a result.