An Overview Of Nursing Home Abuse

1. Are Nursing Homes Required to Have Certain Numbers of Staff?

Under federal law, Medicare and Medicaid certified nursing homes must have a registered nurse on duty seven days per week, for at least eight hours per day. A licensed nurse (either an RN or an LPN) must be on duty 24 hours per day. However, there is no required minimum number of nurse’s aides who must be on duty at any given time. The nursing aides are the staff members who provide the majority of the routine day-to-day care. However, licensed nursing homes are required to “provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident.” Additionally, nursing homes are required to provide at least 75 hours of training for all nursing aides before they can begin working with residents.

2. Can physical or chemical restraints be used on a patient?

Using chemical or physical restraints on a nursing home patient is only allowed when a physician orders them in order to protect the resident. It may only be used with the approval of the resident or his/her representative. Under federal law, nursing homes may not use any form of restraints as a means of convenience for the facility, or as a method of punishment (Code of Federal Regulations, 483.13(a).

By definition, a restraint is “any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body.”

Instead of using restraint devices on patients, nursing home staff should help to re-direct patients who may have a habit of wandering. If this is not successful, then staff should use different devices, such as bed and chair alarms, to alert them when a patient moves from the spot they were originally occupying, in order to help the facility keep tabs on the residents’ whereabouts.

3. What are the ‘stages’ of bed sores?

Hospitals and nursing home facilities utilize a four-stage scale to diagnose, monitor, and treat bed sores, which are also known as pressure sores or ulcers. This categorization is done in order to make the process uniform across all facilities and patients.

Bed sores are classified based upon their level of severity – they can be categorized from Stage 1 to 4. Here is the breakdown of each stage of pressure sores set forth by the professional organization The National Pressure Ulcer Advisory Panel.

Stage I – In the early stages, a bed sore may appear as a red patch on the skin that may hurt or itch. It will usually feel warm and firm to the touch. These wounds are typically superficial, and will disappear soon after the pressure or tension is relieved.

Stage II – At this stage, skin loss will have already taken place, either in the outermost layer of skin (called the epidermis) or the skin’s deepest layer (the dermis), or sometimes both. Stage II sores are open wounds that resemble an abrasion or blister. The surrounding tissue may appear red or purple. If treated in a timely manner, sores in this stage can heal quickly.

Stage III – Wounds in this stage are deep and crater-like. When a bed sore reaches this stage, it has affected all of the skin’s layers, and has destroyed or damaged the muscle and affected tissue.

Stage IV – Stage 4 wounds are the most serious and advanced of them all. By this time, large-scale skin loss has taken place, along with damage to bone, muscles, joints, and tendons. These wounds are extremely difficult to treat, and sometimes cause fatal infections in the body.

Sometimes, a pressure sore may be classified as “unstageable.” Bed sores in this category are typically very advanced wounds, where the skin, muscle, and bone are all deeply affected.

4. Who is at risk for bedsores in a nursing home?

Patients in hospitals, nursing homes, and other medical facilities are at an especially high risk for contracting pressure sores. Patients in wheelchairs are also likely to develop bed sores on their shoulder blades, spines, tailbones, and buttocks. It is less common to develop bed sores on the backs of arms and legs, although it can still occur. Patients who are bed-bound also tend to develop bed sores on the backs and sides of their heads, shoulders, hip bones, ears, tailbones or lower back, knees, ankles, heels, and toes.

5. What Are Signs of Nursing Home Abuse?

Sadly, nursing home residents across the country at times endure physical, mental and/or sexual abuse. Unfortunately, some of the most commonly abused nursing home patients include those who are mentally and/or physically disabled, and do not have the capabilities to fight off or report the abuser. Below are some common warning signs that may indicate that nursing home abuse has occurred. If a loved one has suffered any of the following conditions, then further investigation is warranted.

• Unexplained cuts, bruises, sprains, burns, or fractures
• Nursing home staff refusing to allow visitors to see resident or delays in allowing visitors to see resident
• Bed sores/pressure ulcers
• Unaccounted for large withdrawals from bank accounts or changes in banking practices
• Frozen joints
• Loss of appetite
• Bloody clothing
• Staff not allowing resident to be alone with visitor
• Unexplained vaginal or anal bleeding
• Resident being kept in an over-medicated state for prolonged periods of time
• Unexplained venereal disease or genital infections
• Sudden changes in behavior
• Loss of resident’s possessions

6. Who Regulates Nursing Homes and How do they Regulate Them?

Across the United States, nursing homes are typically regulated by both the Department of Health, which is a state agency, and the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS), which are federal agencies. Each agency has its own rules and regulations in order to control all aspects of nursing home operations, including: staffing, resident care, medical equipment, and policies and procedures.

Since nursing homes legally must comply with federal and state regulations, officials from both agencies conduct routine inspections of the facilities in order to ensure that these nursing homes are in compliance with the regulations. These unannounced inspections are also known as ‘surveys,’ and are typically done at least once per year. If a facility has a history of violations or has received a complaint about resident care, then these surveys may take place more frequently.

After one of these inspections are conducted, a report describing the facility’s compliance with agency regulations is filled out. If a rule has been broken but it does not pose an immediate threat to resident safety, then the administrators of the nursing home will have the chance to review the findings, and draft and propose what is called a “plan of correction.” However, if the discovered violations do cause a potential threat to patient safety, then the agency has the right to impose a multitude of penalties, which may include; monetary fines, suspension of new patient admissions, license suspension, and removing facility supervisors from their position.

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