Signs To Look For
There are several different types of nursing home abuse, each
of which has certain signs to watch out for. They include:
- Physical abuse is generally characterized by unexplained
injuries including bruises, fractures, sprains, open wounds,
internal bleeding, and more. In many cases, these injuries are
caused when the patient is hit, slapped, kicked, or otherwise
physically violated. However, malnutrition and medication
under- and overdoses may also be signs of physical abuse.
- Verbal, mental, and/or emotional abuse is marked by severe
emotional anguish and agitation, withdrawal, and
non-responsiveness and is often brought on by repeated
insults, humiliation, threats, intimidation, harassment, and
- Sexual abuse includes any inappropriate touching or sexual
contact, rape, and forced nudity among other things. Signs of
sexual abuse include unexplained genital infections, bruising
around the breasts or genitalia, torn or bloodied
underclothing, and more.
- Exploitation occurs when a nursing home resident’s
personal funds, property, or assets are illegally or
improperly used. Missing personal effects and/or checks,
sudden changes in a will or other financial documents, and
unpaid bills may all be signs of exploitation.
NURSING HOME NEGLECT AND ABUSE
Many complex factors lie at the root of negligence in nursing
homes, but in the end, it may be a matter of numbers. Medicaid
pays for the care of more than 65% of patients in nursing homes
nationwide, with the federal government paying 60% of the costs,
and the states paying the remainder. But the gap between
Medicaid payments and the actual cost of maintaining a patient
in a nursing home is estimated at about $10 per patient, per
day, on average. Consequently, staff recruitment, retention, and
development compete with corporate profits for scarce resources.
Patient neglect and abuse is the end result.
Staffing Shortages Lead to Negligence in Nursing Homes
Staff burnout due to high patient loads and excessive
overtime is considered by many experts to be the primary cause
of abuse and negligence in nursing homes.
In 2002, the U.S. Department of Health reported to Congress
that 9 out of 10 nursing homes have inadequate staffing levels,
estimating that understaffed facilities would need to increase
their workforces by 50 percent to reach levels required for good
Why is it so hard to adequately staff a nursing home? Nurse
aides in long-term care facilities are paid low, even
poverty-level wages to do work that is demanding, unpleasant,
and frustrating and often requires mandatory overtime and double
With patient loads of 20, 30, or even 40 patients per aide
and high levels of care required by each patient, aides cannot
keep up with the demand—changing and making beds, transferring
patients from bed to chair, bathing, dressing, turning, feeding,
and hydrating patients, assisting with bathroom needs and
emptying bedpans. In addition, caregivers are at higher risk for
on-the-job injuries than steelworkers or coal miners, according
to the Occupational and Safety Health Administration (OSHA).
It's not difficult to see why nursing home negligence is
becoming more widespread.
The American Health Care Association claims that 107,000
additional health care workers would be needed to provide
acceptable levels of care for patients in nursing homes in the
United States—a need that will continue to rise with the graying
of the population.
Insufficient Background Checks
Most states require background checks for some nursing home
employees, but no state requires national background checks, and
caregivers with a record of nursing home negligence or abuse in
one state may be hired unwittingly by a facility in another
In addition, no checks are required for support staff, such
as maintenance workers, and caregivers are often allowed to
begin work before background checks are complete.
Inadequate Staff Training
Federal law requires 75 hours of training for nurse aides,
and while some states may require more, that training still may
be inadequate. Training in caring for patients with dementia and
other serious illnesses may be particularly lacking, even though
these cases pose the greatest challenge for the caregiver.
With staff turnover rates varying by region from 49 percent
to 143 percent annually for nurse aides and from 28 percent to
59 percent for registered nurses, retaining a trained and
qualified staff is a monumental challenge.
Limited Negligence Investigation Resources
By federal mandate, each state has a long-term care ombudsman
program to identify and investigate complaints of nursing home
negligence. The power of these programs is limited, however, and
often vulnerable to political pressure.
Many of the volunteers in ombudsman programs eventually quit
out of frustration at their inability to effect change, and many
paid staff have been thwarted in their attempts to speak out
when their position is at odds with the agenda of local or state
Predictable timing of periodic mandatory inspections by state
or local agencies may further hamper enforcement efforts. If a
facility is aware of an impending visit by inspectors, they may
temporarily clean up problems to avoid penalties and fines
imposed for nursing home negligence.
Signs of Nursing Home Abuse
* Unexplained injuries or bruises
* Over or under medication
* Visible cuts, bruises, or welts
* Rapid weight loss or weight gain
* Dehydration, malnutrition, and bedsores
* Unsanitary living conditions
* Broken bones
* Sudden death
The law limits the amount of time after a patient incurs an
injury to file suit. The amount of time varies based on the
theory of liability and the state in which the patient files the
suit. One should consult with a lawyer as soon as practicable
for advise as to you rights.