Although physical or sexual abuse of nursing home residents capture news headlines, most mistreatment stems from neglect.
That’s according to leading expert in geriatrics Dr. Terry Fulmer, president of the John A. Hartford Foundation, which provides grants to improve care for older adults. “Nobody should ever have to suffer from abuse, but neglect is more prevalent and more poorly understood,” she says.
“Abuse is usually assault and battery—someone slaps you or hits you—but the fact is you are more likely to live through that then through neglect,” says Fulmer. “If someone does not give you water, does not give you food and does not check a wound, you die. There is a tremendous mortality and morbidity associated with the syndrome of neglect.”
According to Dr. Fulmer, about 70 percent of cases screened for mistreatment of elderly people are due to neglect. Substandard care frequently occurs when nursing homes are understaffed or staff is not adequately trained. “If there’s neglect, there’s probably a staffing issue—the two go hand in hand,” says Brian Mahaney, a lawyer with an expertise in nursing home and long-term care abuse.
Nursing home residents often fail to report neglect because of cognitive difficulties or feelings of fear or embarrassment. “Patients don’t have much of a voice—to the extent that they are coherent and lucid and have a voice, they may be scared to death to tell anybody because they are 100 per cent at the mercy of the caregivers,” says Mahaney. “If I am 89 years old and wearing adult diapers and I can’t even feed myself, but I still have all my mental faculties, do I really want to rock the boat?”
Given the vulnerability of nursing home residents, it’s up to family members to look out for signs of sub-standard care. What follows are some key signs of nursing home neglect.
1. Pressure sores
A common sign of neglect in nursing home residents is pressure sores, which cause damage to skin and underlying tissue and can turn into ulcers and open wounds, in some cases leading to amputation. Bedridden residents are at risk for this condition, which develops when staff neglect to change their body position frequently enough. Pressure sores commonly form on the back of the head or neck, the shoulder blades, hips, backside, legs, ankles and feet. According to the Mayo Clinic, warning signs include unusual changes in skin color or texture, swelling and pus-like draining.
Changes in your aging loved one’s hygiene or appearance could also point to neglect. Is their hair unwashed? Do they wear the same rumpled, stained outfit day after day? Do you smell body odor? Alarm bells should go off if you smell feces or urine or see signs of urine burn (excoriated skin or lesions) or soiled bedding. Cleanliness should also extend to the nursing home itself—so take note of the condition of your parent’s room as well as the facility’s eating area and lounges.
3. Malnutrition and dehydration
Although nursing homes are obliged to provide nutritious food (this includes ground or pureed meals and/or help with feeding) a 2015 review of research estimates that 20 percent of residents in nursing homes experience malnutrition. Elders with late-stage dementia are especially susceptible, as they often have trouble swallowing and chewing. If your loved one has lost weight or leaves most of their food on their plate, report your concerns immediately to the nurse manager.
Also look out for dehydration, which can lead to major health problems. It’s easy for elderly people to get dehydrated as the perception of thirst diminishes with age. Signs of dehydration range from dry skin and mouth and cracked lips to vomiting, dizziness and confusion. It’s also a red flag if nursing home staff ignore residents who struggle to swallow water or hold a cup.
4. Muscle Contractures
Be wary of nursing homes that do not offer a physical activity program for residents. When people don’t exercise their joints or limbs or are inactive for long periods they are at risk for contractures, a freezing of a joint like an elbow, or a shortening or tightening of muscles. Contractures cause pain, restrict range of motion and decrease mobility. Elderly persons with this condition are also vulnerable to falls and pressure ulcers.
Take heed if your aging loved one complains about a long wait time when they call for assistance. Too long a wait might mean they try to get up from bed on their own, putting them at risk for falling, which can lead to hip fractures or death. According to the Centers for Disease Control and Prevention, up to 75 percent of nursing home residents fall each year, twice the rate of seniors who live elsewhere. In addition to understaffing, slippery floors, poor lighting or improper and incorrect walking aids can contribute to fall risk.
You should be on high alert if you find a loved one with dementia wandering alone in the halls as they can potentially wander off site, which could result in injury or death. You should also be concerned if the nursing home relies on physical restraints to prevent wandering--studies show that restraints are often ineffective and can even be harmful. Supervision of at-risk residents combined with an individualized care plan is the best method to deal with wandering.
Neglect can also occur when nursing home staff overmedicate residents or fail to notify caregivers about medication changes. Signs of overmedication (drowsiness, lethargy, confusion and dizziness) can lessen quality of life and lead to falls or other complications. If you suspect that your loved one is taking too many drugs (or the wrong drug), request a meeting with the nurse manager or staff physician where you can look at your loved one’s medical chart and ask pointed questions.
Once your loved one has moved into a nursing home, it’s crucial that you visit regularly, make a conscious effort to watch out for possible signs of neglect, and ask staff to explain anything you find out of the ordinary. (If they’re evasive about the answers, well, that’s another red flag.)
“I don’t know if the prevalence of neglect is changing, but I think people have a higher level of scrutiny, and I think that’s good,” says Fulmer. “Baby Boomers want quality care and they will be in asking very key questions-- I think people of my grandmother’s generation took what they got.”