Nursing Homes: A Frank Discussion
The government estimates that at least 70 percent of people over age 65 will require some long term care services at some point in their lives. For many, that long term care will be as a resident in a nursing home. This brief article will note some of what to look for in selecting a nursing home, some of what to watch for when visiting and care giving in the nursing home and some of what can be done if we suspect neglect.Many time the need to admit a patient to a nursing home occurs suddenly. Helpful information is immediately available at the Medicare Nursing Home Quality Compare website at http://www.medicare.gov/NHCCompare.
The Area Agencies on Aging assist people over age 50 and caregivers with community services including long term care choices. Nursing home recommendations from friends, physicians, clergy, and others with experience are helpful. One should consider the quality of life and the quality of care. Quality of life has to do essentially with dignity. Does the culture of the nursing home reflect a concern for honoring the individuality of the resident? How does the facility make certain that the environment is safe, clean and comfortable? Does the facility have the will and the means to provide for personal grooming and dress? How are visitation rights maintained and encouraged? Are provisions made both to provide a sense of personal privacy as well as opportunity for the resident to choose to participate in creative activities?
This is not only a matter of culture. The nursing home should be able to tell you the number of direct care staff it has on each shift, on weekends, and on holidays. Determine how long the Medical and Nursing Directors have been with the facility. An understaffed nursing home is stressful place for good people to work. A high turnover of personnel is common and alarming. A turnover of Medical or Nursing Directors may be an indictor of systemic problems.
There is a relationship between quality of life, quality of care issues and the staff to resident ratio. Does the nursing home have enough competent staff to answer call lights, turn the disabled resident to prevent sores, and attend to the dressing and toileting needs? Is there sufficient staff to provide the necessary security for the residents?Understaffing commonly results in preventable neglect such as medication errors, malnutrition, dehydration, pressure ulcers, falls and even physical assaults. Falls can result in immobilizing fractures and cause rapid decline in overall health and even death. Pressure ulcers result from leaving the resident in the same position without proper turning. These preventable sores cause pain, infection and sometimes serious overall deterioration.
Other signs of neglect may include unexplained weight loss, dehydration, unsatisfactory hygiene, improper dress and soiled bedding.Sometimes the best test of the level of care provided by the nursing home is as simple as the sniff test. If the facility has a strong offensive odor, it is likely understaffed and the residents are neglected.The residents or caregiver should get copies of the health inspection reports. The facility should have a report of the most recent state survey available for you to review. Insist on reading it.
If inquiries of the Medical Director are not satisfactory, a complaint may be filed with the Virginia Health Department. Information is available at http://www.vdh.virginia.gov/olc/complaint. Usually, an investigator will make an unannounced inspection of the family, review the medical records and interview the staff. The findings will be sent to you.Sometimes a family has no choice but to file a lawsuit against the facility. If the resident is competent, it can be filed in his name.Otherwise, it must be filed by the appointed guardian, power of attorney or in a death case, by the administrator of the estate. Generally, in Virginia the action must be broughtwithin two years of the injury. If the facility is government owned there are stringent notice of claim requirements which in some cases must be made within six months.The care of the elderly has changed dramatically and we owe a debt of gratitude to those dedicated individuals, doctors, nurses, CNAs and others who work for the aged. However, some nursing homes have become big, bottom line oriented, often multi-‐state businesses.
Our responsibilities as we grow older or as we provide care have not changed. Eachof us must insist that proper care be provided, that contracts be honored, and that negligent care not be tolerated.Duncan Garnett is a civil trial lawyer, partner at Patten, Wornon, Hatten & Diamonstein, L.C. and former President of the Virginia Trial Lawyers Association. He concentrates his practice on life-‐altering personal injury and wrongful death, and handles a wide variety of civil litigation.
Mr. Garnett can be reached at (757-223-4550)or dgarnett@pwhd.com
First published in The Oyster Pointer.
