Nursing Home Abuse and Neglect - Essay Example

Nursing Home Abuse and Neglect I. Introduction: Nursing home abuse and neglect is most probably more frequent than reported. Nursing home residents are among the most vulnerable members of our society. This population is less able to report abuse or neglect due to medical problems such as dementia, stroke, and other disabling problems of old age. Nursing home residents may also underreport due to fear of retribution from caretakers. Caretakers are often abusive, or neglectful, because they believe they will not be caught. This paper addresses the issues of elder abuse and neglect within the nursing home population and proposes possible solutions. The most favored solution is the implementation of legislation that requires a combination of safeguards be put into place. These safeguards would include mandating screening of patients on a more frequent basis, an ombudsman program, and required training for all staff that includes consequences if caught being abusive or neglectful. The time from reporting abuse to the investigation of abuse by should be reduced from the standard of ten days to a standard of within 24 hours. II. The Problem: According to Dr. Terry Fulmer of New York University (Journal of American Geriatrics Society, Feb 2004) elder mistreatment is “the intentional actions that cause harm, or create a serious risk of harm, to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder”. Such mistreatment of elders in nursing homes is a significant problem in this country. Gone are the days when families quite naturally took on the responsibility of caring for the elderly. Most elderly in the country, who cannot care for themselves, are sent to nursing homes. Reports from across the country tell horrifying stories of those abused or neglected. In New Orleans, Louisiana a nursing home employee aged 19 raped a 92 year old woman (New Orleans City Business, 2004). Another nursing home resident had her leg amputated because of bedsores. After the amputation she died from the staff’s neglect. The staff did not turn her over as required to prevent bedsores on the other leg. An elderly man lost his testicles because of botched attempts to insert a catheter (New Orleans City Business, 2004). In her guest editorial to Nursing Homes Magazine (March 2005) Gloria Schramm tells the sad story of how her uncle was treated while he was in a nursing home. She recalls how he was miserable, had fallen from his chair because he was not properly restrained, and was unassisted at mealtimes when family was not there to assist him. She recalled how he waited long periods of time for simple things such as a drink of water, a diaper change, or help with repositioning himself in bed. The daily visits from family were critical to his recovery as the level of care he received otherwise was lacking. III. Background: Nursing homes were not always the answer in this country. Prior to World War II the poor and destitute elderly were sent to almshouses, or poor farms, which were known for their poor conditions and inadequate care. Some cities took responsibility for their poor and built, or renamed existing homes, to reflect the change in level of care. “In New York City, in 1903, the Charity Board renamed its public almshouse the Home for the Aged and Infirm. The city of Charleston followed suit in 1913, transforming their almshouse into the Charleston Home.” (Haber, 2007) After World War II legislation was put into place that somewhat funded nursing homes and nursing homes were built to act as long term care hospitals. Because of concern for those elderly in need women’s groups and religious groups established old age homes for the elderly. “As the founder of Boston's Home for Aged Women (1850), explained—a haven for those who were "bone of our bone, and flesh of our flesh" (Haber and Gratton, p. 130). Nursing homes today are funded by private insurance, Medicare, Medicaid, and any funds that the elderly person might have to contribute. IV. Possible Solutions: Although there is no fool proof way to ensure that the elderly are properly cared for, there are ways to provide some oversight so as to catch nursing homes that are abusive and neglectful. An ombudsman program at nursing homes may provide a way for patients to self-report abuse/neglect but self reporting requires that the patient be competent and not have dementia. Screening by doctors and nurses who come in contact with patients is another method of identifying abused or neglected nursing home patients. An oversight committee could provide a way for the nursing home to be monitored for negligent or abusive behavior. Nursing homes are regulated by state agencies and the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS). Both state and federal agencies provide oversight and reporting requirements. V. Recommended Solutions: As stated earlier, there is no perfect solution to end the problem of abuse and neglect in nursing homes. There are ways to monitor and catch abuse and neglect. Surprise inspections by state and federal agencies may curb abuse. The Louisiana Medicaid Fraud Control Unit of the Louisiana Department of Health and Hospitals coordinate with other state and federal agencies to catch and prosecute abuse and neglect cases such as the cases listed above (New Orleans City Business, 2004). Definitions of ‘mistreatment and neglect’ need to be added to state and federal legislation so that it is well understood what is, and is not, mistreatment. Doctors and nurses must be required to screen all elderly patients for abuse and neglect. If abuse or neglect is detected the patient must be moved to an abuse shelter program, or hospital, and not be returned to the nursing home unless the abuse or neglect is unfounded. All nursing home residents need to be screened at least once a month for abuse or neglect. Lastly, the reporting to response time should be changed from 10 days to 24 hours. State and Federal agencies need to investigate abuse and neglect immediately because a lot can happen in a ten day period. The situation and evidence may no longer be present after the longer report to response time. VI. Conclusion: Nursing home abuse and neglect is a significant problem in the United States. It is not limited to certain states or regions but is found country wide. The United States has come a long way from the terrible conditions of poor houses and alms-houses. Our most vulnerable population is no longer warehoused in deplorable conditions. But, the incidents of abuse and neglect reported and substantiated show that there is still room for improvement. By implementing new legislation that requires more oversight, screening, and investigation of possible abuse or neglect the United States can curb the amount of abuse or neglect that takes place. Those who work in nursing homes need to be educated as to the consequences of perpetrating abuse and neglect. Those caught need to be punished to the fullest extent of the law. No Exceptions! References Fulmer, Terry. Progress in Geriatrics. Progress in Elder Abuse Screening and assessment Instruments. Journal of the American Geriatrics Society; Feb 2004, Vol. 52 Issue 2, p297-304, 8p. Retrieved September 24, 2007 from http://search.ebscohost.com/login.aspx?direct=true&db=aph&an=11979124&site=ehost-live Haber, C. Nursing Homes: History. Medicine Encyclopedia, Aging Healthy Vol. 3. Retrieved 09/23/2007 from http://medicine.jrank.org/ HABER, C., and GRATTON, B. Old Age and the Search for Security. New York: Cambridge University Press, 1994. New Orleans City Business. 2004. Horrifying nursing home abuse justifies surprise state probes. November 01, 2004, Vol. 25 Issue 18, p24-24 1/3p Retrieved September 24, 2007 from http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=14970593&site=ehost-live Schramm, Gloria. Lessons Learned from my Uncle Lou. Nursing Homes: Long Term Care Management; March 2005 Vol. 54 Issue 3, p8-11, 3p, 1c Retrieved September 24, 2007 from http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=16473119&site=ehost-live PROGRESS IN GERIATRICS GUEST editorialBY GLORIA SCHRAMM Lessons learned from my Uncle Lou decade or two ago, I remember reading about stare crack- .K)Wii.s ;ind sceinj; television magazine exposes on nursing homes kir engaging in patient abuse and neglect. The homes mentioned were cited for sanitary violations, as well as tor applying bed scraps and other restraints, apparently more for the convenience of their paltry-size staffs than for patient protection. Just before admitting a beloved uncle to a local care center, though, I thought that things had improved for che better. My 97-year-old Uncle Lou had weakened and fallen at home. After a brief hospital stay, he was released to the only nursing home that had room and wnuld accept his insurance, as he was in need of physical therapy to help strengthen his atrophied limbs before returning home. Here was a man who had emigrated from Italy early last century, worked hard, owned his own barbershop, was well known and loved in the comnuinity, and finally retired after having traveled [he world with my aunt. He is the last surviving member of a large Italian family. After my father died. Uncle Lou told me to consider him as my "make-believe" father. At the nursing home I visited him nightly, gave him his favorite protein drink, and tucked him in. Hewas now mostly bedridden when noE sitting up in a wheelchair. He had been in the facility only 20 days, but he was miserable. Every night he shook his head and pleaded with me to "get me out of here!" He complained that he buzzed continuously lor service but waited endlessly for small deeds like a drink of water, a diaper change, or to be repositioned in his bed lor comfort from tow back pain. In addition, since he could not lift his hands or arms to feed himself when seated in a wheelchair in the dining room, he often went unassisted and skipped a meal if my auiu was not there or he wasn't fortunate enough to find a merciful aide to feed him. On his first day in the facility, he had slid out ofhis chair onto the floor, sustaininga bruise to his arm. Staff had failed to place a lap bar to secure him in. "I never in my life!" wailed my feisty uncle. "The newspapers are gonna hear about this!" Our biggest challenge came on a Sunday evening around 9 p.m. His daughter, my cousin, who livedout of town, had already gone 8 • MARCH 2005 WWW.NURSINGHOMESMAGAZINE.COM home, as did my aunt, after spending all day with him. When I arrived at the tacility, my uncle was already in bed. However. I noticed he had no protective bed bar raised on the side ofhis bed to prevent him from falling out onto the hard tiled floor. 1 wanted him to have one, and so did he. When I asked the nurse and aide at the nearest nursing station to please provide one immediately. I was informed that my 87-year-old aunt would have to sign foione. Since it was late and she lives some 30 miles away, I offered as the next nearest relative to sign for one right then and there. I was told, though, that our requests were inadequate, that there was a new state law, a ridiculous "blanket rtile," and they would get in trouble for violating it. This new state law considered a bar provided without writren permission by (in this case) a spouse to be an "abusive restraint." I asked them if it would be better if my uncle suffered a fractured skull. It was abusive, 1 said, not to give him a bed bar and added I wouldn't leave that night utitH he got one. 1 had waited 20 minutes when a nurse came and said the doctor on call was telephoned and had given the OK. btit had added that if my uncle attempted to "hurl himself over the bar," his injuries would be worse than ifhe merely fell out of bed. Obviously, that doctor had not seen my frail, weak uncle. This could have been attended to earlier. In fact, 1 believe the question of something as basic as the need for a bed bar should be raised at the point of admission. Loved ones often cannot think clearly In the throes of emotional and financial upheaval and the major life change that comes with having to place one's spouse in a nursing home. Thank God my uncle was lucid and had all his faculties in sharp working order, to be able to speak for himself. Many of the aides and nurses had a sense of warmt h and humor and seemed to care when dealing with him. But some of the others seemed apathetic, overworked, or just not visibly or audibly present on the premises. For example, on another night while visiting my uncle, I heard a man shout for help several times, 1 went out into the empty hall to investigate and called out, "Is there anyone working here?" 1 saw a door ajar as he continued to call I'or help and, peering inside, I saw a burly, heavyset, crippled man sitting on a commode and fast becoming impatient. I pleaded with him to stay put while I found help, and he promised he'd wait. Fearingfor his safety, and not sure 1 would be able to lift him by myseU, I proceeded down the hall to the nursing station and found it deserted. Amazingly, /was left in charge. At that point. 1 could have ransacked the joint, rifled through medications, or done anything else I wanted to do. Desperate for help, I picked up the phone ar the desk, buzzed the switchboard, identified myself, reported the incident and our location, and said, "Send a nurse tjuickly!" A few minutes passed before someone in white made her way slowly down the corridor from the other wing and said she'd send the aide on the floor there to help him. By that point, the man had found the wherewithal to help himself off the commode and into his wheelchair without falling and injuring himself. Then, help arrived. I suppose at only $ 140/day (the average price in my area for nursing homestays paid by patients and/or their health insurance plans) f^icilities such as this one cannot afford to hire more staff members to ensure against these breaches of safety and security or, better yet, hire more of the right kind of staff. If I had been a surprise "spotter" or srate auditor, though, heads would have rolled tbat night. I am.i proponent ofexemplary customer service, especially when peoples' lives, psyche,s,andphysical well-being are at stake. A nursing home is not a department store, but neither should it seem like a warehouse or waiting room. Although I didn't find evidence of the kinds of neglect spotlighted on TV exposes, 1 still found the level of service wanting. It means that the federal government might have to start giving priority to humane causes—including the needs of those in the final phase of life—instead of cutting human service GUEST editorial programs. And taxpaying citizens might have to start caring enough to lobby for sweeping reforms in nursing home care, and then put their money where their mouths are. I would think any politician sponsoring reform legislation would get a heavily favorable vote, li only because of the sheer numbers of aging people, not to mention the growing number of midlife baby boomers with aging parents who need to know that their loved ones are appropriately cared for and not living in fear or in danger of neglect or abuse. Surely 1 am one taxpayer who would be willing to pay that price. Money or not, how does one guarantee a strong work erhic or a caring heart in those workers who are caring for our aged parents or ourselves? Perhaps, with state aid. there should be more stringent evaluation and surveillance systems and immediate firing practices in place for slackers and those who otherwise don't make the grade. And perhaps there should be "blackl ists" that sped fy incidents, dates, and times of those who are unfit to be in the caring profession at all. I bet the quality of care would improve—and quickly! 1 recognize that it is hard work to serve other people. But the needs of elderly patients, no matter how exasperating, should be paramount and met with a sense of urgency by all staff all the time. And it should be a joy for them to serve. Uncle Lou did get his wish to go home just in time For Christmas and, as it happened, two months before he passed away. During his nursing home stay, which seemed like a prison sentence to him, he had been attended to a bit quicker once my aunt, cousin, and I made our presence repeatedly visible and asserted ourselves on his behalf. I advise people with loved ones in a nursing home to show their faces as often as possible ro ensure (heir loved ones get what they want and need. Meanwhile, one doesn't need an advanced medical or administrative degree to conceive ot or implement improvements in nursing home attitude and level of care. Just a little caring and generosity of spirit would go far in changing the inuch-maligned and dreaded image of the nursing home. • Gloria Schramm resides in North Bellmore, New York. Access to her recent e-book, Soul on Fire: Encounter With Mother Teresa, is available at www.1chapter.com/details.ctm?TableName=Commentar)es&BooklD=41. To send your comments to the author and editors, please e - mail schrammO3O5@ nursingtiomesmagazine. com. Guest Editorials cover the spectrum of longterm care. Do you have thoughts you'd like to share? e-mail rpeck@en.coni NEW ORLEANS CITYBUSINESS • NOVEMBER 1, 2004 CIT\BUSINESS Horrifying nursing home abuse justifies surprise state probes THE HORROR STORIES regarding nursing home physical abuses are mind-numbing: • A 19-year old employee at a Lafeyette Parish nui^ing home admits raping a 92-year-old woman suffering from dementia. • An elderly woman with bedsores on her leg is forced to have her leg amputated and eventually dies three weeks later hecause the staff at the nursing home &iled to turn her over as their duties required. The nursing home staff continued to record they were routinely turning the woman over in bed to prevent bedsores from forming even after her leg had heen lost. • An elderly man loses his testicles after the nursing home staff botches repeated catheter insertions. There are many, many more such horrifying stories. Kris Wartelle, spokeswoman for the attorney general's office, said; "This is a huge problem. We've gotten some really bad cases that would make your hair stand on end." Those in need of nursing home care comprise our most vulnerable and fiagile population sector. They need and deserve better care and tourer legal enforcement a^unst those who would prey upon them. The number of abuse, neglect and exploitation complaints received by the Louisiana attorney general's office reached 1,373 in 2003 and was already up to 1,294 through Septemher of this year. It's not just Louisiana's problem. A 2001 report prepared by the House of Representatives' Special hivestigations Division found 5,283 U.S. nursing homes — neariy one-tliird of all U.S. nursing homes — were dted for abuse violations between 1999 and 2001. In more than 1,600 of those nursing homes, the abuses were serious enough to place the readents in immediatejeopardy of death or serious injury. The nursing home abuse epidemic prompted state Attorney General Chailes C. Foti Jr. to establish Operation Safeguard, which will coordinate surprise inspections conducted by the Medicaid fTORTAT.S Fraud Control Unit, Louisiana Department of Health and Hospitals and crmiinal investigators with state and federal agencies. Some nursing home operators have grown defensive about their operations, claiming the press is blowing the abuses out of proportion. This is a ridiculous assertion. Just one abuse case is egregious and we have thousands here in this state alone every year. If anything, the press hasn't done enough to highlight this insidious problem. Leaving the human element aside for a moment, the state is also attempting to tout itself as a retirement community. Cleaning the nursing home abuse epidemic up is not only the r i ^ t and moral thing to do, it could help achieve the goal of becoming a national retirement destination. George Canipagna, chief investigator for die Medicaid Fraud Control Unit, said inspections would hegin soon. They can't hegin soon enough.* The MNA was among the organizations invited to testify at hearings held at a Waltham senior center by the Joint Committee on Health Care regarding the issue of abuse and neglect of nursing home patients in Massachusetts. The hearings were held in the wake of an increase in the number of reports of elder abuse and neglect by the state DPH, which documented more than 12,000 complaints of poor care last year. MNA executive director Julie Pinkham delivered the testimony, which included an extensive summary of recent research detailing the link between declining quality and safety of care in nursing homes and poor RN staffing, excessive turnover of all nursing staff and poor pay and working conditions, particularly for nurses’ aides. Pinkham highlighted the following statements as taken from a 2001 study conducted by researchers associated with the John F. Kennedy School of Government: • “Strong evidence supports the relationship between increases in nurse staffing ratios and avoidance of critical quality of care problems.” • “The rate of turnover among nursing staff in long-term care institutions is extremely high, averaging 100 percent for certified nursing assistants and 66 percent for registered and licensed nurses.” • “A 1999 General Accounting Office (GAO) report noted that each year, more than one fourth of nursing homes had deficiencies that either caused actual harm to residents or placed them at risk of death or serious injury.” Pinkham also pointed to a report by the Institute of Medicine in 2003, which found that nine in 10 nursing homes in America were understaffed, and that this understaffing was causing a rapid decline in the quality of care for nursing home residents. “Here in Massachusetts, our nursing home industry is providing a level of poor care in line with these national findings,” she told the committee. “We have received reports from nurses and patients of staffing levels in nursing homes in our state that leave one nurse responsible for as many as 40 to 60 patients at a time. We have received hundreds of complaints of poor care, serious accidents, terrible neglect and patient abuse as a result of these conditions.” Pinkham added, “As with the hospital industry, the nursing home industry has failed to provide nurses and nurses’ aides with the support and resources they need to practice their profession and to deliver the care patients deserve.” In both cases, the MNA told the committee that legislation to regulate staffing levels was needed. But Pinkham cautioned that while in the hospital industry, RN-to-patient ratios alone would solve the problems of quality and safety in that setting, in the long-term care sector the problems are more complex. “While salary issues are not a primary issue of concern in hospitals, they are in nursing homes. There is a real danger that if you pass ratio legislation for long-term care without providing the funding base necessary to recruit and retain staff to fill those positions, you will not solve the crisis we now face.” She pointed out that the issue of adequate pay, particularly for nurses’ aides, as well as for LPNs and RNs is of paramount importance to this issue. “We have nurses’ aides being paid poverty wages, working under horrendous conditions, which is a recipe for the ludicrous turnover rate they are now experiencing,” Pinkham stated. Therefore, solving the crisis in longterm care requires a more comprehensive approach. The MNA made the following recommendations to address the problem: • Significant increases in state and federal funding for long-term care, that includes direct-wage pass throughs to guarantee a living wage for nurses’ aides, and a competitive wage for LPNs and RNs. • Other supports for direct care workers, including welfare-to-work training programs, child care and transportation supports are also necessary. • We also need to ensure all these workers have greater access to union organizing and collective bargaining so that they can have the leverage to negotiate for fair wages and benefits, and to have a protected voice in advocating for working conditions to ensure adequate care. “Finally, as a society and a culture we need to recognize the value of care giving and to provide funding and resources to encourage those in our society to enter and stay in this important field of work. We also need to provide those who need this type of care with a system that works  one that is focused on treating the elderly and those with chronic conditions with dignity and respect,” Pinkham concluded. N Read More