Nursing Home Negligence News

The law defines negligence as the failure to exercise the degree of care considered reasonable under the circumstances, resulting in an unintended injury to another party. There are many reasons why a nursing home may be found to be negligent against its residents. Even though there are over 6 million elderly and disabled individuals receiving care in over 16,000 nursing and rehabilitation centers today, the number of neglect cases seen in America today remains uncomfortably high. Unfortunately, these cases most often go unnoticed by the public, except when one extreme case is brought to the light by the media.

A good example is the media attention that was focused on nursing homes in New Orleans after Hurricane Katrina hit. Mable and Salvador Magano, Sr., were charged with 34 counts of negligent homicide in September 2005 for leaving their residents to drown in the wake of the hurricane. While this is an extreme example of nursing home negligence, for every one incidence such as this, there are thousands more that slip under the cracks and remain unaccounted for.

The best way to prevent nursing home negligence is to be able to recognize the signs and act upon the actions of those responsible. Nursing home staff know that the state and federal government will take actions upon them if violations of law are found, so one would think they would implement stricter controls for their staff and operations. New laws to regulate the nursing home industry are always up for consideration, though the first step in fighting the problem is to know exactly where the problem lies.

Medical and physical neglect are at the top of the list of nursing home infractions. Criminal negligence is also often present, and some instances include physical abuse and assault, as well as battery and unnecessary restraint. All of these actions fail to comply with the care requirements for nursing homes as outlined in the U.S. Code of Federal Regulations at 42 CRF § 483, which very thoroughly describes the conditions under which residents should be living.

Neglect of the medical type can include failure to care for existing medical problems, to protect from health and safety hazards, and to prevent malnutrition, dehydration, and injuries such as bedsores and fractures. Incidences of medical neglect can include failure to provide residents with the appropriate medication at the required time, inadequately staffed physicians to deal with medical emergencies, and failure to monitor for hazardous situations. One prime example of this is a nursing home staff member in California who decided to light matches for candles near open oxygen containers. Thankfully, the staff member was terminated.

Physical neglect can take the form of failure to assist in personal hygiene, or in the provision of food, clothing, or shelter. Unsanitary and unclean conditions also amount to failure to comply with § 483.15, which in part requires nursing homes to "care for its residents in…an environment that promotes maintenance or enhancement of each resident's quality of life." Some instances of physical neglect may include prolonging a resident's exposure to urine and feces, failure to timely provide clean bedding and clothing, and allowing a resident to remain unwashed after exposure to bodily fluids. This type of neglect can easily lead to bedsores, infections, and malnutrition, which is why medical and physical neglect often go hand-in-hand.

Neglect may also be viewed from a criminal standpoint. Abuses such as battery, assault, rape and sexual assaults are unfortunately something that can and does occur in the nursing home industry. Although these examples may be a bit extreme, there are other incidences that may occur that would also be considered actionable under § 483 and the criminal code. For instance, using unnecessary physical restraint, purposely prolonging residents' access to food or water, and overmedicating are all infractions that underscore the importance of closely regulating nursing homes in order to provide the best possible care for the elderly and disabled.

Probably two of the most common types of nursing home negligence include pressure ulcers, commonly known as bedsores, and malnutrition. Many people think these two ailments are a natural part of aging, and perhaps that is why so many instances of this type of neglect go unreported. However, it is important to remember that nursing homes are required by § 483.25 to prevent and properly treat pressures sores, and to prevent malnutrition (including dehydration) by maintaining proper nutrition and water levels. These ailments are in no way normal, and any evidence of negligence on the part of the nursing home staff should be dealt with immediately to prevent the residents care from deteriorating.

Pressure sores are caused by prolonged pressure on the skin, usually on a location where the skin rubs close to the bone such as the ankles, elbows, and the tailbone. While pressure sores can be as mild as a pink discoloration of the skin that will return to normal shortly after the pressure is relieved, they can deteriorate without proper care. Extreme cases may result in a blackening of the skin that develops into a deep wound that has the potential to affect nearby bone and internal organs. An untreated bedsore will take on the characteristics of a severe burn wound, which can be life threatening.

Besides pressure, these ulcers can be caused by excess friction between the skin and another surface like sheets, clothing, or braces. Weight loss, dehydration and malnutrition are all contributing factors to pressure ulcers, which could explain why these top instances of negligence often are seen together.

Pressure ulcers are best prevented by frequently changing the residents' position in order to distribute weight at the pressure points equally. When the sores do appear, immediate management of them is warranted. The area must be kept clean, with any dead tissue being removed. Some wounds may even require surgery and bandaging to avoid becoming infected. Increased nutrition is also important to help speed healing.

The other most common nursing home negligence is malnutrition, with the inclusion of dehydration. Failure to provide adequate nutrition can make the residents prone to infections, confusion, and decreased immunity to bacteria and viruses. Considering that the elderly and disabled may already be at a high risk for these problems, the issue of proper nutrition is important. When nursing homes fail to hydrate their residents adequately, they are exposing them to possible urinary, kidney or neurological conditions. Malnutrition and dehydration can be costly for a nursing home facility to treat, and since these conditions are easily preventable, it would make sense for facilities to monitor the dietary intake of their residents closely.

Some instances of malnutrition or dehydration may not be entirely preventable by nursing home staff. Physical causes of these conditions may be a result of illnesses, mouth or swallowing disorders, or other disorders that may inhibit the absorption of vitamins and minerals. However, this can be counteracted by hiring staff who are not only educated about recognizing malnutrition, but about the proper ways to feed residents as well.

Though negligence in nursing homes is rampant, nobody knows exactly how many residents are actually affected. For every few cases reported, there are hundreds more that go unnoticed or unreported. The key to recognizing that a nursing home may be caring for its residents inadequately as defined by § 483 is to know the warning signs of negligence. These include increased numbers of resident illnesses and accidental deaths, as well as the appearance that residents are being improperly subdued by overmedication and unnecessary restraint. A simple conversation with a nursing home resident sitting in the halls or lying in their bed may provide some clues as to how well they are being cared for.

As the definition of negligence states, these problems may be unintentional consequences of nursing home staff behaviors and actions. Because of overcrowding nursing homes coupled with a lack of adequately trained and well-paid staff, many residents are being faced with improper care and a poorly followed action plan for the care they should be receiving. Although unintentional, these actions are still negligent, and actionable against the nursing home facility. In the event of criminal negligence, such as the case in New Orleans, action by authorities goes far beyond fines and sanctions, but calls for jail time and cessation of operation of the business.