When it comes to nursing home neglect, there are a ton of questions clients have but often find answers difficult to come by. Churchill Huston Law, LLC wants to arm you with the most accurate information available to help you understand whether a nursing home is mistreating your loved ones. To keep you informed, we’ve answered some of the most frequently asked questions about nursing homes and the way they deal with their clients.

1. Why does my loved one have bedsores?

According to the medical textbook Primary Care Geriatrics, “Pressure sores are graphic, ugly, smelly evidence of health care providers’ failure to take good enough care of the elderly.” Whether called bedsores, pressure wounds or decubitus ulcers, nursing home residents who suffer skin break down are at risk of infection and death. The minute you learn your family member is suffering from skin breakdown you must demand to see the area and do not be afraid to take pictures. It may be uncomfortable, but photographs are your best evidence.

Bedsores are caused by a combination of several well-known and understood factors, such as immobility, moisture, poor nutrition, limited sensory perception, and friction and shear. The easiest of these risk factors for family members to identify are immobility, moisture, usually from urine or feces, and inadequate nutrition.

Immobility is just what it sounds like. Is your loved one mostly in bed, a wheelchair or a recliner? If so they have limited mobility. People with limited mobility need to be turned and repositioned every two hours. This simple action relieves pressure on the bony prominences of the body and allows adequate blood flow. Without proper blood flow, the skin dies and breaks down. In addition to turning and positioning, there are a number of products for beds and chairs that reduce pressure. Demand them for your loved ones.

Moisture from being left in a urine soaked bed or brief or from being left in feces is another easily preventable situation that leads to bedsores. In addition to effects of moisture on the skin, think of soaking in a tub for too long, urine and feces are caustic substances which themselves cause damage to the skin. For those with existing skin breakdown, being left in urine and feces is a sure way to get an infected wound. Infections can affect the wounds ability to heal and can spread throughout the body.

Your body needs protein, vitamins, and minerals to stay healthy. When your body doesn’t get enough nutrition, it begins to fail. Bedsores are a common result of a nursing home’s failure to provide sufficient nutrition to residents. As soon as you notice your loved one losing weight, look out for bedsores.

Bedsores are described using a staging system from I to IV with IV being the most serious. It is easier to prevent bedsores than it is to heal one. If identified and treated in the first or second stage, bedsores heal easily. Stage III and IV wounds can take months or even years to heal if they can be healed at all. Wounds can cause infection of the blood, tissue, and bone which cause the body to fail and can result in death. It is imperative that you recognize the risks and demand the care your loved one needs, to prevent or heal bedsores.

2. Why is my loved one always thirsty when I visit?

Dehydration has been linked to numerous health and safety problems in nursing home residents. Dehydration increases the resident’s risk for falls, kidney failure, bedsores, swelling of the brain, shock, coma and even death. Getting your loved one enough fluid to meet their hydration needs is essential to their well being and required by federal law.

Dehydration is an easily preventable but potentially fatal medical condition that happens when nursing home residents do not get enough fluids. As a general rule, we need to drink about two liters of water, or eight – eight-ounce glasses of water a day to stay hydrated. Nursing home residents can become vulnerable to dehydration because of their medical conditions. It is imperative that the facility is aware of your family member’s hydration status.

What can you look for? Signs and symptoms of dehydration include a dry mouth or lips, a swollen tongue, fatigue, dizziness, and confusion. What should the nursing home be looking for? Fever, increased heart rate, and decreased blood pressure may also indicate someone is dehydrated. In addition to the clinical signs of dehydration, the nursing home can order laboratory tests of both blood and urine to determine if your loved one is dehydrated.

You have every right to demand that your loved one’s nursing home provides them with sufficient fluid intake to meet their daily needs. Dehydration is often just the tip of the iceberg when it comes to signs and symptoms of abuse and neglect. If the facility can’t give your loved one enough water, what else is being missed?

3. Why is my loved one losing weight?

Unintentional weight loss, lethargy, weakness, memory loss, and change in mental status are all warning signs that your loved one may be suffering from malnutrition. Malnutrition is a dangerous and potentially fatal condition that occurs when people do not get sufficient nutrients to meet their daily needs. If your loved one is in a nursing home, the failure to provide sufficient nutrition can be neglect and a violation of federal law.

Malnutrition increases your family member’s risk of bedsores, falls, depression, infection, and death. The elderly are often at increased risk for malnutrition because of their health condition, medications and natural changes in appetite associated with aging. The nursing home knows these risk factors and is required by federal law to provide care and services that enables your family member to attain or maintain the highest level of functioning of which they are able.

The elderly frequently need additional attention at mealtime to make sure they are getting enough to eat. This can be as simple as setting up their tray and as complex as a feeding tube. Often it’s the simple interventions that are most effective; offering snacks and supplements, healthier food choices, serving cold dishes cold and hot dishes hot. When a nursing home can’t take these basic steps to protect your loved one, it is often a sign of trouble to come.

4. Why does my loved one always seem so out of it when I visit?

Under federal law, a nursing home is not allowed to medicate residents, so they are easier for the staff to deal with. This practice is known as a chemical restraint. Too often the nursing home staff will provide residents with multiple powerful narcotics or mood altering medications because they don’t have enough staff to provide the care they promised. This conduct is illegal and extremely dangerous.

Overmedication of older people has been described as, “a public health crisis” by Jane Brody of the New York Times. Falls, bedsores, adverse drug interactions and death are but a few of the potentially cataclysmic results of overmedicating nursing home residents. The first signs and symptoms of overmedication can be subtle and include a lack of energy and confusion.

All too often we hear families tell us about the medication roller coaster experienced by their loved ones. This is particularly true when a resident is in and out of the hospital. As a resident’s responsible party you have every right to meet with the nursing home staff and doctor to discuss this. Don’t be afraid to speak up and even change physicians for your loved one if you have concerns or unanswered questions.

5. Why can't I find anyone to help care for my loved one when I need them?

Unanswered call bells, residents left sitting in urine or feces, falls, weight loss, bedsores, and unexplained injuries. These are a few of the warning signs that your loved one’s nursing home simply does not have enough staff to provide proper resident care. A nursing home is required to have sufficient staff to meet the needs of the residents. If they do not have enough staff, they are violating the law and endangering your loved one.

Each task to which your loved one is entitled, feeding assistance, turning and positioning, bathing, takes time. If there are not enough nurses and certified nursing assistants in the facility, then care suffers. Another dangerous consequence of understaffing is the effect it has on the caregivers themselves. Overworked healthcare providers become resentful and frustrated and can lead to poor care.

As more and more people recognize the dangerous effects of understaffing, there has been an increase in the number of resources to help you select an appropriate facility for your loved one. One of the first places to look to see how a nursing home is rated is the Medicare Nursing Home Compare website. You can look up any facility to see how they rank in areas such as staffing, quality measures, and overall rating.

6. Why did my loved one fall?

Falls in nursing homes place residents at risk for catastrophic injury and death. Falls can also result in traumatic brain injuries or broken bones. Residents who suffer brain injury and broken bones are placed at higher risk of developing bedsores and dying prematurely.

There are a number of factors that cause the elderly to fall. Taking multiple medications, suffering from degenerative joint disease, and natural changes associated with aging all increase the risk that your loved one may fall. The nursing home is aware of these risk factors and must provide accommodations to meet the needs of the residents and supervise them to prevent injury. If they do not, they have violated the law and neglected the resident.

If your loved one is a fall risk, there a number of measures the nursing home must utilize to reduce that risk. The nursing home can use fall mats, bed alarms, and chair alarms to name a few. In addition, the nursing home can appropriately staff the facility to make sure their residents are safe. The law requires these interventions, and you have every right to demand certified care for your family.

7. Why is my loved one always on antibiotics?

Urinary tract infections, C-Diff, Cellulitis, Sepsis, and MRSA, are infections suffered by a large number of nursing home residents. These infections place your loved one's health and well being at risk. In addition to fever and other more typical symptoms, infections in the elderly cause loss of appetite reduced ability to function, changes in mental status, falls, and increase the risk of bedsores.

In a nursing home, infections can spread from resident to resident if the facility fails to take the necessary precautions. If a nurse or CNA fails to wash their hands between patients, an infection can be transmitted. Infections can spread in a nursing home if bed linens are not handled appropriately or if sick residents are not isolated as needed. The risks for infection are numerous and varied.

Like most aspects of the nursing home industry, infection control is specifically regulated by the state and federal laws. The Centers for Disease Control have a website dedicated to informing nursing homes and their employees of the dangers of infection and how to prevent their spread.

If you see symptoms of infection in your loved one, you have every right to demand they receive appropriate medical attention, including a visit to the hospital. Don’t be afraid to speak up. You are the first and last line of defense for your loved ones.

8. How can I make medical decisions for my loved one?

A Power of Attorney is an important legal document which gives another person the ability and duty to act in the best interests of another. A Power of Attorney can permit another to act in a number of areas including healthcare decision making, retention of counsel, banking transactions, and real estate transactions to name a few. Before you make the difficult decision to entrust your loved one to the care of a nursing home, it is essential that a Power of Attorney be completed.

The purpose of a Power of Attorney is to avoid any confusion about who is authorized to act on behalf of the nursing home resident. If a problem arises with a resident’s care and the resident has not appointed power of attorney, the family’s ability to act to protect the resident can be limited. The facility may withhold medical or other pertinent information citing HIPAA. The last thing a family needs is a procedural roadblock to getting the best care possible for the resident.

Just as a Power of Attorney can expressly grant authority, it can explicitly limit authority. Nursing homes are increasingly asking family members to sign documents limiting their access to the courts. These documents are called Arbitration Clauses. In the context of a Power of Attorney, it is perfectly valid to withhold authority to enter into such agreements on behalf of the resident.

In special cases, a nursing home can have a third party appointed to act as a guardian for your family member. These situations can cause a great deal of anger, resentment, and stress. The first step in avoiding this is to have a valid Power of Attorney.

In Pennsylvania, a Power of Attorney can be obtained with the assistance of an attorney or by using a form available online. A Power of Attorney must be treated seriously. It both confers great authority and imposes greater responsibility. If you have any questions or concerns, call the Senior LAW HelpLine at 1-877-PA-SR LAW (1-877-727-7529).

If you have any more questions about the different abuses and difficulties that your loved ones might be going through in a nursing home, get in touch with the experts at Churchill Huston Law LLC. As the best nursing home neglect lawyer in Philadelphia, PA, we assist with Nursing Home Abuse, Neglect and Medical Negligence cases. I have been in this same line of work since 2004 and won many awards, cases and build quite a practice between then and now. To learn more about how we can help you, please click here or contact us by clicking here.