Feb 5, 2010

Nursing homes are a vital and necessary part of the health care provider system. There are many fine nursing homes with staff that do the work of angels. This article should in no way serve to tarnish the good work of those institutions or their staff. However, there are good and bad professionals in every vocation. The end result of choosing the wrong nursing home is that your loved one's well-being could be put in jeopardy.

This article is written from the perspective of a legal practitioner who has too often seen the outcome of bad nursing homes and the injuries and deaths that they can cause. I will attempt to provide a general checklist of red flags to watch for as you or your family choose a facility to care for a loved one. This checklist is by no means exhaustive and is certainly not scientific. These red flags come from documentation and experiences of many of our clients and is offered in the hope that it might serve to spare even one patient from experiencing the ravages of such outrageous professional misconduct.

As a matter of background, nursing home negligence can be broken down into categories. However, every single case I have ever seen of negligence or abuse in the nursing home environment, at its core, comes down to intentional economic decisions made at the institutional level. To that end, when the lawyer for the nursing home wants to suggest that mistakes in care were simply unavoidable, unforeseen accidents, our usual response, which can be proven by carefully procured documents and discovery is "NO, this patient was neglected (or even abused) based on economic choices made by the CFO, the Director and even the board."

The basis of negligence in these cases always seems to center around either poor individual staff hiring or simply an administrative decision to hire far fewer staff members than would be reasonable. Either way, at the heart of nearly every abusive or neglectful encounter in a nursing home negligence case is the "almighty dollar."

Thinking for a minute in terms of a pure business profit model: Profits are a derivative of maximizing capital input (more money coming in), while minimizing capital output (less money spent on overhead). In most businesses there is nothing wrong with maximizing profit.

However, capital input, in a nursing home setting is a product of filling more beds with patients (warehousing more patients). Reducing overhead (capital output), in a nursing home setting, is largely limited to efforts to contain costs associated with employees (either by quantity or quality) or by cost containment efforts regarding expenditures related to food or medication. These business profit enhancement efforts naturally compromise the quality of patient care. We recommend you watch for the signs that such efforts are compromising patient care in relation to your loved one at one of these facilities. The general assumption of this article is that when you initially visited the facility and met the Director, you felt confident (enough) in your decision such that you moved your loved one to that facility.

Now, you visit regularly, and want to keep your eyes wide open to the possibility that the economy or a change in business philosophy is not compromising your loved one's care. The following 10 Red Flags should be carefully considered and watched for in determining whether such abuse or neglect is, or might be, on the horizon.

A) MAJOR RED FLAGS - You Have a Huge Problem Right Now!

Universally, a classic sign of neglect is the occurrence of pressure ulcers, sometimes referred to as bed sores.

This is a byproduct of a bed-confined patient who is not being moved and altered in their position sufficiently to maintain proper blood circulation. These can be deadly and are often the first step toward gangrene and the need for amputations.

This is the single most common complaint we hear about from our nursing home neglect clients, and these are always (at least so far as we have ever seen) strong supporting evidence of patient neglect. Simply stated, there is no tolerable level of pressure ulceration on a patient.

You should have serious concern for your loved one's continued safety if occasions of pressure ulcers are occurring at the facility. The time to act on these circumstances is IMMEDIATELY. Absent the strangest of circumstances, patients should relocate out of such an institution, without delay. In our experience, bed sores are the result of extreme and outrageous neglect.

RED FLAG #2: Dehydration:
If pressure ulcers are the most common initial complaint we hear about in nursing home neglect cases, certainly a close second is dehydration of patients. Often times this results in renal (kidney) failure, which can be deadly.

RED FLAG #3: Patient Complaints Increasing:
You can't please all the people all the time. However, if you are noticing either your loved one or other patients more vocally complaining about staff, food, hygiene, etc, do not simply overlook the possibility that circumstances at this institution are changing for the worse.

B) MODERATE RED FLAGS - You Might Have a Problem in the Future, Keep a Watchful Eye:

RED FLAG #4: Fewer Staff:
If you recall that in months or years past that on your visits there used to be a larger amount of staff present than now, this could be the makings of a problem. Fewer staff means less people to take care of patients and consequently, more opportunities for neglect, or even abuse, to occur.

RED FLAG #5: Increase in Staff Turnover:
Like in any business, if you start noticing that they cannot keep good people employed for any duration, there might be a good reason for that.

Employee turnover in the nursing home industry is a problem globally. However, if it seems more a problem recently in your loved one's nursing home, stay diligent in watching for other red flags. Staff turnover means new and often times less trained staff working with patients. It can also reflect economic cost-saving decisions by management that you need to be on notice of and ready to act upon.

RED FLAG #6: Quality of Staff Appears to be Reducing:If caring and thoughtful professionals seem to be being replaced by what appears to be less caring, less considerate professionals, there may be something brewing. This could very well be based on an institutional decision to cost contain and replace higher paid workers with lower paid workers. In these circumstances, nearly always it is the patient care that is most compromised.

RED FLAG #7: Morale of Staff Appears to be Declining:
If you are noticing more sour faces, less smiles and less pleasantries with staff, it may not just be a coincidence. Staff cutbacks, increased responsibilities and less money make for a less pleasant workplace and certainly increase the odds that patient care will suffer.

RED FLAG #8: Patient Group and Individual Activities Lessen:
If your recent visits have left you wondering why it seems that there are less activities for the patients to do than in previous times, again, this may very well be a sign.

Outgoing staff members who organize events, outings or activities in these nursing homes often make the difference in the quality of life for these patients. If that seems to be less present, again this might reflect efforts to generally cutback on overhead, staffing or the quality of staff being hired and needs to be carefully watched.

RED FLAG #9: Decreased Food Quality:
There are certain challenges to nursing home cooking including dietary considerations of patients, reduced sodium use, etc. However, if you have a recollection that meals there were at one point surprisingly good, and suddenly seem surprisingly bad, that could be a sign of cost containment efforts which might be cause for major concern. The idea being, if they are cutting back on food quality or preparation efforts, what else might they be cutting back on?

RED FLAGS #10: Declining Cleanliness and Hygiene Standards:
Cleanliness and hygiene at a nursing home are critical to patient well being. Staffing quality and quantity are clearly the most vital considerations that reflect whether steps are being taken to maintain these health standards.

If your recent visits have caused you concern about cleanliness or hygiene issues, that could be a sign of economically-motivated changes in staffing that you need to confirm are not affecting patient care.

While certainly one or two isolated red flags here or there can be explained, persistent and reoccurring red flags should most assuredly cause you concern. At Anderson Hemmat we have experienced attorneys who can meet with you to discuss the Red Flags that you may have noticed at your loved one's nursing home. Please call us today for a free consultation.


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