Nursing Home Problems

What to Do if Things Go Wrong in a Nursing Home
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How to handle a common, nonthreatening nursing home problem

If you suspect or know of a problem with your family member or close friend's care, the first thing to do is spend some extra time just listening to her and encouraging her to talk the problem through with you.

It also helps if you know in advance what to keep an eye out for. Here are some problems that may arise, and what you can do to help:

  • Trouble adjusting to new living arrangements. Early days in a nursing home can be difficult and sometimes frightening, especially if she's getting used to not only a much smaller living space but also a new or worsening health condition. Even a small problem or irritation during the settling-in phase can feel overwhelming if she thinks she's going to have to live with the problem for the rest of her life.

What you can do: Hear her out, encourage her to try new things (like joining an on-site club or signing up for an activity), share a meal or two with her in the dining room, and help her focus on the positives. This may help her get her bearings and find her place in this new environment.

When specific gripes arise, you can take a more hands-on approach, helping to "shrink" a problem by getting to its source and finding a solution. Is that new roommate really "intolerable," or is the main problem that she keeps the TV on all day, making it impossible for your friend or relative to get the rest she needs? If you listen closely, a simple solution may present itself. Many nursing homes will give residents remote headsets for the TV, for example, but you may need to help her ask for a set -- and then help further by asking the roommate to wear it.

  • Not getting along with another resident. Moving from living alone or with a spouse to a group setting can be especially challenging if some residents are beginning to show signs of pre-dementia or other conditions that can cause aggression. Conflicts can arise, from small misunderstandings to full-fledged flare-ups.

Nan Hayes, president of RightSized Living, suggests that if a new resident is the target of aggression from a long-standing one, staff and family should also take time to evaluate the behavior of the target, who may unknowingly be contributing to the situation. For example, a disoriented new resident may wander into another resident's "space," which could create fear or anxiety and result in verbal abuse.

Family, friends, and staff can support new residents by making sure they're familiar with basic logistics and daily routines. Residents should understand procedures for reporting abuse within the home and feel comfortable sharing fears or concerns.

  • General boredom. A good nursing home will have a full calendar of activities to keep residents active and engaged -- but just because activities exist doesn't mean your friend or relative will automatically take advantage of them. When you come to visit, take note of whether she's habitually in her own room or bed rather than in a communal area engaged with other residents. Does she complain of loneliness or say that there's "nothing to do"?

What you can do: Simple shyness can keep older adults from taking advantage of the very group activities that would lift not only boredom but the social isolation that can contribute to declining health. Invite yourself along to an initial meeting of a club or activity group to help break the ice. If her health permits, take advantage of visits to go on a simple outing to a nearby restaurant or movie or to see old friends.


How to handle a potentially serious nursing-home problem

Sometimes an issue is more than a simple matter of your friend or relative getting adjusted to the home. Your help and intervention can be essential in such a situation.

  • Out-of-control aggression from another resident. Unfortunately, researchers have found that aggression and even violence among nursing home residents is much more common than is generally recognized. Researchers at a large urban nursing home documented 35 types of physical and verbal abuse, including screaming, pushing, punching, and fighting.

What you can do: For anything more than a simple slight, it's a good idea to involve staff to help check facts and determine the cause of the conflict. An experienced staff member should be familiar with the different personalities and able to help sort out misunderstandings.

When direct aggression or threatening behavior is involved, suggests Donna Quinn Robbins, CEO of Ultimate Moves, go directly to the administrator rather than to a nurse or nurse's aide, who may be too overwhelmed with daily responsibilities to provide the immediate intervention that's required. "Request a room change if the aggressor is a roommate, and keep up the pressure," Robbins advises. "The administrator is the key."

  • Problems with a staff member. It's hard to suddenly be dependent on strangers for basic care, so it's not uncommon for older adults to complain about their new caregivers initially. Whether or not these complaints are well founded, it's important to hear them out and try to help resolve them.

What you can do: After you've gotten the story from your friend or relative, try gently bringing the subject up with the caregiver -- not necessarily to point a finger but to figure out whether, together, you can come up with a solution. You know the resident best, so sometimes simply explaining a personality quirk or special need can help smooth a relationship.

Caregivers vary from one shift to another, so make sure you ask who is assigned to your loved one each time you visit or call, and make a point of getting to know the various caregivers.

If speaking to the immediate caregiver doesn't solve the problem, you may need to go up the chain of command to the charge nurse, then the director of nursing or the nursing home administrator. Exactly whom this will involve depends on how the particular nursing home is run and how its administration is structured, so it's a good idea to ask for a facility manual early on, before your friend or relative signs a contract and moves in (unless, of course, the move was made on an emergency basis).

Line staff, or those at the front desk, should also be able to answer your questions about the chain of command and steer you in the right direction if you have a serious concern.

  • Signs or complaints of poor care, neglect, or abuse. Because many older adults were raised "not to make a fuss" and may not speak up for themselves for fear of alienating caregivers, it's important to ask questions that leave the door wide open to report serious problems. Instead of just asking "How are you?" from time to time, you may want to gently ask a more directive question, such as, "Is everything OK? Are there any problems I can help out with?"

Visible trouble signs to watch out for include frequent bedsores, unexplained weight loss, or older adults who spend long periods unattended in their beds or in wheelchairs in hallways or common areas.

What you can do: If you have reason to believe that a particular caregiver is neglectful or abusive, then ask that your friend or relative be moved or assigned to a different caregiver while the concern is investigated.

If a serious problem does arise, this is an area where she may really need you to advocate for her, rather than waiting to see what happens. So if you try to contact an administrator and don't get a response right away, don't hesitate to be insistent. They may be busy, but your loved one's health and happiness are at stake!

If at all possible, you'll also want to make frequent, unannounced visits to check on her well-being during a period when a serious concern has been raised. Or, if you live out of town, ask a close family friend or relative to do it.

If, after going up the chain of command, you still have serious concerns, you can contact your local or state long-term care ombudsperson and consider filing a complaint. Of course, if your concerns have reached this level, it may also be time to think about looking into a different nursing home.

Nell Bernstein

Nell Bernstein's writings have appeared on Salon. See full bio

almost 2 years, said...

Mother been living in her own shes76 years old she gotten thrown out if her place for failure not getting along with other tenants an having dementia. She has problems not getting along with people before going to a nursing home an also I'm her only daughter she curses me an other relatives to I been abuse so much by her since beginning but I forgave her I token her twice before out the nursing home to live into my household unfortunately she went back that's been years ago since now she has been now to this second nursing home she's not getting along with the residents roommates accusing the nurses of stealing her clothing an her roommate had to move out of the room she just moved into another nursing home two days had the room mate up 2 hours intimidating her because she made a bowel movement on herself an the smell also cursing the roommate out I just leave it up to the nursing home I cannot control my mother she not an easy person to get along with I already had her home along with my husband .kids an grandkids it didn't work out she don't belong out here in her own an that's what she mad at doctor saying she need 24/7 and her meds she has house keepers an nurses coming out when she was living on her own but was accusing nurses if taking meds housekeepers of taking her clothes man money an landlord of overcharging rent an cursing out the residents she at where she belongs I give it up to Jesus he will make a way amen

over 2 years, said...

I have a question my grandmother is in a rehab facility and they want to make her stay as a full time resident.I am perfectly fine to take care of her at my house but other family members are telling them to talk me out of it.They have threatned me that I cant take her home and the only thing she isn't doing right now is walking hat should I do?

about 3 years, said...

I am having issues with this nursing home still changing a number on my appt card and accussing me of stuff it is not right the state is here anyway but they have there morning meeting to find some way discharge me or get me into problems they gang up together

about 3 years, said...

My grandmother lives in independent living. She's 98 and has somebody with her 22 hrs a day. She can do just about everything herself but needs assistance. There are is no family near her. We brought in help because she doesn't want to go to assistant living or the nursing home and frankly I think she would just give up if she had to go to one of them. She has to wear braces on her legs and walks with a walker. The facility will not let the girls have a key to the place and there is usually nobody at the front desk to let them in. They want them to call up to my grandmother to let them in which means she either has to get out of bed (if she's in a sound sleep she gets confused) put her braces and shoes on and walk all the way to the buzzer or she has to get up and out of her chair which is a chore for her (and sometimes has her shoes off) Is there anyway we can make them give the girls a key??

over 3 years, said...

it's a shame I had to find a web-site for help since my 18 yr old in a place where he is being hurt .. so thank you for the help

about 4 years, said...

my father who is 95,96 in july,has been in the nursing home for over two years due to stroke and has aphasia but his mind is totally in tact..everything..memory and ability to understand and read,which my mother and i were told is rare..he walks witha walker or cane and is in awesome shape for a 96 year old fact his stroke came about because he fell and hit his head,NOT from bad health.his health before the stroke was excellent and people were amazed that he was still working on his car and even shopping for hours at a time in department stores and could walk nearly as fast as me at full speed..i'm 59 and power walk a couple miles a day ..he retired at 92 years 94 the doc said he'll live to be 100 with no problem!he fell at 3am in the restroom ,hit (gashed)his headand that caused his dad's problems lay in the fact he can't pronounce words and has to be fed with tube to stomach..he has expressed very emotionally that he desires to come home ,that he misses us as family as wants to do things like before,to spend his time with us,play his cd's and watch his movies,play cards and he wants to go on as he was before he had his stroke,living a normal (as possible)family life mother and i were told over a year ago that because his mind is in tact and because he wants to come home, because he only needs to be connected to the machine temporarily with the option of either night or day ,and that all he needs is to be dressed daily and bathed and fed and diaper changed a couple times daily,that he can come home when my mother,who is 89, is shown what to do and how to care for him.that medicare or medicaid would cover the costs of things he needs like wheelchair,walkers,etc..his social worker led us on for 7 months,telling us that she had gotten the ball rolling./she made an appointment with us after 7 months to show me and my mother how to maintain his machine and discuss what we'd need to know in order to bring him home.we kept the appointment by driving to the nursing home to find that the social worker we're to meet was not working there mom and i discussed with the staff that we were there to keep an appoinment she'd made just a week prior.they claimed her last day was just after her phone call to us sometime earlier in the week..we also found that nobody,not even the home administrator was aware of the fact that my mom and i were trying to get my dad home and that this social worker was helping us..turns out she'd never done a thing to get anything done..she'd never started the paperwork or anything.never contacted medicare,nothing..she spoke to nobody about his coming home,she just led us on for 7 months..this is absurd..and it gets absurder..i discussed with the administrator how unhappy we are that this occured!! 7 months of being led on by this social worker when she was doing absolutely nothing at all!! So this adminsrator vowed that HE would get the ball rolling for us,contact medicaid,my dad's dr,find out what would be covered by insurance and so mother and i had no choice but to rely on him..that was now two months ago..he made an appointment two weeks ago with my my mother and i to disuss this again and show us how to maintain his machine and have a nurse show us what to do and explain certain things,etc...he wound up canceling the meeting at the last minute and rescheduled it for today tuesday june17th 2014..he called and canceled it again today..two months now AFTER the initial meeing with him..btw,at the initial meeting we had with him,he claimed that when social workers questioned my mother seperately from me,they felt as though she was too concerned that she shouldn't take care of my by saying ,they questioned her seperately from me, i have to assume they thought i was bullying her in to the decision?when he told us this, my mother and i both were confused and she calmy told him that she has no idea why they would have thought that!..but once we were in the car on the way home she let me know how infuriated she was at his statement.we now feel we're being led on and why we don't know but we're discussing whether or not we should hire an attorney father is so emotionally drained from being promised over and over for year that he's on his way mother and i are at wits end..especially now that we just found out that this administrator that canceled this appointment today is leaving the nursing home and they now have a new we now have to go through all of this all over again with a new administrator??should my mother and i now seriously consider an attorney to get this done? Even if they attempt to use my mothers age against her,they can't use mine..i'm 59 and am healthy as a horse.Let me point out that his original social worker ,did everyhing she could to tell my mother that she didn't believe my mother could handle my father and that she'd have to watch him like one would watch a toddler that's loose,running around the room..truth is my father sits and watches tv and if at home would be playing his cd's,his movies,or we'd be playing cards,etc..over 90% of his time would be doing normal things he always did..i don't believe this social worker understood or even cared that my father's mind is totally in tact..she spoke as if he 's a child that gets into stuff mother and i know better..we've had him home to visit many times,we visit him frequently ,he writes stuff down that my mother and i understand..all he does at the nursing home is sit,wheel around and watch tv and lay down ..the nurses don't even bother wih him most of the day except to feed him,change a couple diapers.yeah a real wild toddler my arse.//his mind and memory is totally in tact.i'ts time for him to come home./

almost 6 years, said...

If a person has Alzheimers Disease many of the things you suggest just don't apply. A person with Alzheimers disease can't communicate if something is going on that is just not right.

over 6 years, said...

Hello 'ticket', You may search for similar questions that have already been asked and answered by the Community at If you are still searching for answers, you may ask a question of your own at Hope this information is helpful to you!

over 6 years, said...

the article was helpful. I want my Mom to come and live with me, in my house. But the sister who thinks she can punish my Mom my by making her stay there with the help of this nursing home, with an invalid power of attorney. Please help!!!!!!!

over 7 years, said...

There are patient advocates available at no cost if this problem persists. Know all of your available resources because patients have the right to protection and privacy while living in a long term care facility.

over 7 years, said...

This article was somewhat helpful. My mother had to be admitted to the nursing home under emergency conditions, so I selected the one she is in based on research done some years ago when my father was about to need care. The facility is one of the better ones in the area, with regard to the care given the patients, general cleanliness, etc. My problem is with three of the patients near my mother's room who like to roam, and have been found in, or trying to enter, other patient's rooms. The one I found in Mom's room was twice her size, and could easily harm her if she were so inclined. This is a big issue for me, since Mom can no longer call for help herself. The nurses were apologetic, but in my mind, that is insufficient. I went to the front desk and inquired what protocol the facility had in place to insure patient safety and privacy, to the extent that that is possible. I was met with a fairly blank expression from a member of the administrative staff, and when I pressed on for a serious answer, was told that they had security cameras. Still not what I want to hear. I will now follow up with the administrator.