Neglected in plain sight: Signs that your elderly loved one is being neglected in a long term care facility and what you can do about it!

12 Jun Neglected in plain sight: Signs that your elderly loved one is being neglected in a long term care facility and what you can do about it!

The decision to place your loved one in long-term care is a very hard decision to make. One should consider the physical, emotional and social impact of the move. The thought of your loved one being mistreated or neglected can make you feel powerless. However, with access to resources and information, you can advocate for your loved one to have the best quality of care possible in a long-term care facility (LTCF) or nursing home.

When evaluating LTCF’s /nursing homes, you may have many questions like: What will they feed them? How will they take care of them? Will they be safe? Who are the staff members that will be providing care? Or How often will I be able to visit?

These are all reasonable questions that you should ask and have answers to before you admit your loved one to any facility. In fact, the answers to these questions and more are so vital to picking an appropriate facility that Medicare has developed a checklist to help you evaluate long-term care facilities. Make sure to look at multiple facilities at different times of the day. This gives you the opportunity to evaluate more within the facility. You may find that one facility is better at caring for the diseases or ailments that your loved one has than others. Visiting multiple facilities also allows you to compare the services and staff in order to gain a realistic perspective on the quality of care.

Quite frankly, I wish that I would have asked the above questions and used the checklist before agreeing to move my Godmother to a long-term care facility. In fact, my family did not review any other facilities for long-term care for our loved one. We simply met with the nursing leadership and administration at the rehabilitation facility where she was an inpatient and trusted their suggestion that she be moved to their long-term care unit instead of going home. I now believe that this was a mistake because we did not have any reference for the quality of care she received.

Over the course of 4 months after her arrival on the long-term care unit, she was diagnosed with Aspiration Pneumonia, Oral Thrush, two Urinary Tract Infections, a Stage 2 Decubitus Ulcer, a hand fracture from a fall, and loss of almost ten percent of her body weight. These are all clinical outcomes that are associated with neglect.

The above diagnoses are not readily visible to a visitor or non-healthcare provider. Therefore, your loved one could have visitors often and the visitors/family would not know that their loved one is being neglected. Nursing Home neglect is different from nursing home abuse in that neglect is a form of substandard care and breach of contract to deliver skilled nursing care that causes harm to the patient without mal-intent. Nursing home abuse implies that the caregiver intends to do harm.

Five Types of Nursing Home Neglect

1. Medical Neglect. This is when the facility fails to provide the appropriate medical attention to the resident for both preventative and acute services. This includes: monitoring blood sugar for diabetes and managing cognitive disorders such as Alzheimer’s and Parkinson’s disease.

SIGNS

1. Not taking blood sugar on schedule
2. Not assessing and managing bed sores.
3. Not notifying the family or power of attorney of changes in medical condition
4. Not transferring the resident to an acute care setting for treatment as appropriate.

2. Basic Needs Neglect. This is when the facility fails to provide the resources for the resident’s basic needs to be met. For example, the provision of proper food, clean linens, wash basins, a clean and safe environment.

SIGNS

1. Weight loss
2. Poor appetite
3. Dehydration
4. Dirty room and laundry
5. The foul odor of the patient room and hallways
6. Poor food options or no menu variety
7. Falls
8. Improper restraints
9. Leaving residents in soiled diapers
10. Call lights not working

3. Personal Hygiene Neglect.   This is when residents do not get proper assistance with brushing their teeth, showering or bathing, laundry or other personal grooming activities.

SIGNS

1. Oral infections
2. Gum disease
3. Foul body odor
4. Urinary Tract Infections
5. Bed sores

4. Social Neglect. This is when residents are ignored by staff or are left alone. This is especially crucial when your loved one is not mobile or has difficulty speaking.

SIGNS

1. Improper restraint
2. Isolation
3. The resident is left in public areas while sleep (ie. at the dining table).
4. The resident is left in soiled diapers in public areas.
5. Staff instructs residents to “go” in the diaper instead of taking them to the bathroom.

5. Emotional Neglect. This is when residents are yelled at by staff or punished for not following staff rules.

SIGNS

1. Behavioral changes- Resident is clingy, combative or withdrawn.
2. Loss of Appetite
3. Resident shows signs of fear around certain staff members.

What You Can Do.

1. Visit. When visiting observe your loved one’s behavior and speech for any changes. Residents whose family and friends visit are typically attended to better by staff.
   1. Ask the resident if they are eating.
   2. Monitor their weight. (Most facilities weigh residents once a month.)
   3. Observe the resident’s body odor
   4. Ask the staff to take the resident to the bathroom whenever you are there. (Staff should toilet immobile residents every two hours.)
   5. If you feel comfortable, look at the resident’s body for any bruises, blisters or sores. (Pay attention to the butt, hips, and elbows.)
   6. Visit at meal times to observe the meals and the environment in the dining hall.

2. Document. Write down the names of all staff members that are assigned to your loved one. Document any incidents or encounters that don’t look or feel right.
   1. Document Date and Time of incident
   2. Document who was involved
   3. Document what you observed from your loved one
   4. Email your concerns to the Director of Nursing, The Administrator and Unit Manager. In your email, request follow-up and an investigation.

3. Schedule meetings for updates. Most states require that nursing care plans are updated every 90 days. Family members should be invited to participate in the planning of care of their loved one. However, there may be changes in the resident’s status that require more frequent updates. Therefore, scheduling a conference call or in-person meeting bi-weekly with a standing agenda is recommended.   This call or meeting should last 15 to 30 minutes. The purpose of the meeting is to provide the family with updates on activities of daily living, changes in medical status, updates on progress in therapies, and any other concerns.

For more information on patient advocacy go to https://ncea.acl.gov/resources/docs/STOP-Poor-Care-Brochure-Print.pdf

4. Contact Local Long Term Care (LTC) Ombudsman. An LTC Ombudsman is a patient advocate for residents of nursing homes, board and care homes and assisted living facilities. The Ombudsman is a free community resource that is trained to resolve conflicts and advocate for families and patients who access long-term care. The federal Older Americans Act requires that every state have an Ombudsman program. For more information on the LTC Ombudsman program, go to http://ltcombudsman.org/about/about-ombudsman.

5. File a complaint with Local Department of Public Health. Every State has a Department of Public Health. Each department of Public health has a complaint filing process. Complaints can often be made by phone call, email or online. This is why it is important to document what you observe, so you can share details easily. For more information about filing complaints go to https://www.medicare.gov/claims-and-appeals/file-a-complaint/quality-of-care/complaints-about-quality-of-care-.html

Caring for your loved one can feel overwhelming and frustrating, especially when you don’t know what to do.  That is why I’ve shared these tips.  Over the past few months, while caring for my godmother, I could not help but think about all of the people who don’t have medical professionals in their family to interpret or advocate for them. My nursing background prepared me to be an advocate for my loved ones.  I believe that you too can advocate for those you love.  Feel free to send me a note or leave a comment below.  Stay tuned!  Next week, I’ll share tips on how to choose a healthcare provider for yourself and for your loved ones.