Articles Posted in Selecting a Nursing Home

The decision to place a loved one in a long-term care facility for the elderly can be a very difficult and emotionally demanding process. Both you and your loved one need to take an active role in the decision to maximize the health, safety and well-being of your loved one. Once you have narrowed down your search and thoroughly researched and toured the facility, you should consider the following set of guidelines put together by California Advocates for Nursing Home Reform to ensure your loved one receives the best possible care and treatment.

1. Support your loved one’s transition to the care facility. Open communication is extremely important while your loved one transitions to their new home. There may be feelings of loss or abandonment by the person being placed in the facility, as well as mirrored feelings of guilt or neglect by the person assuming responsibility for the placement. Therefore, it is important to openly discuss these feelings. Make sure your loved one receives a comprehensive assessment upon admission and be attentive to any changes in needs, behaviors, attitudes, and affections during the transition.

2. Make your visits count. Vary your visiting schedule by going on different days and at different times. This will ensure you are able to meet various members of the staff, and observe how your loved one interacts with other residents and staff members at different times of the day. Also, make a plan before each visit. Try to discover new things, meet new residents and staff members, explore new areas of the facility, plan special events outside of the facility, and bring with you important talking points and your loved one’s special interests.

If your loved one is suffering from dementia, you should be sure that any nursing home you may be considering is equipped to care for dementia patients, thus allowing for a more beneficial experience for the patient, not to mention a safer one.

Dementia is caused by damaged brain cells, which leads to a deterioration in cognitive abilities, including memory, speech, and

understanding. Numerous diseases lead to dementia, the most common being Alzheimer’s disease, which accounts for 70% of all dementia cases. Other diseases leading to dementia include Parkinson’s disease and vascular disease.

As a nursing home abuse and neglect lawyer, one of the most common questions is, “how do I choose the right nursing home for my loved one?” Unfortunately, there is rarely an easy answer to this question. However, there are some important guidelines listed below that I believe will assist you in selecting the most appropriate nursing home for you or your loved one.

Make a List:

Similar to any other big decision in life, there is no substitute for doing your homework and acquiring as much information as you can. Start by making a list of the nursing homes in a community close to relatives, friends, and/or people that will visit your loved one while in the nursing home. To obtain a list of nursing homes, you can contact your local California Department of Public Health District Office. Alternatively, California Advocates for Nursing Home Reform maintains an online nursing home guide that is very helpful.

It is an unfortunate fact that elder abuse is a common and growing problem in San Diego and throughout the United States. Abuse of the elderly can take many forms, ranging from neglect and abandonment to physical, verbal, financial, and even sexual abuse. Fortunately, professionals in health care are constantly working towards new breakthroughs in treatment and the prevention of abuse in the elderly population. It’s true that new research and techniques are changing the face of convalescent care every day.

As the population of elders in San Diego continues to grow, it’s also encouraging to see the elder abuse epidemic be drawn out of the shadows and into the light, so we can all learn to recognize symptoms of elder abuse, and report any suspicions. One such example of shining a light on elder abuse prevention will be coming to Southern California next month.

On September 15, 2016 the 2-day USC Judith D. Tamkin International Symposium on Elder Abuse will welcome “researchers, academics, physicians, nurses, and psychologists” to participate in a weekend committed to “Closing the Research Gaps and Moving the Field of Elder Abuse Forward.”

As the holidays approach, countless San Diego residents will share the seasonable spirit alongside their family, friends, and loved ones–many of which are elder and may reside in a nursing home. For others, the holidays offer a once-a-year opportunity to check in on the health and wellbeing of the loved elders in our lives.

The best way to ensure that your elderly friend or family member is safe, happy, and healthy is to equip your self with the appropriate facts and information. The Center for Elder Abuse has compiled a helpful fact sheet to review as you venture home for the holidays and spend time with your loved elders.

Here are a few tips, signs, and questions to consider that may help you determine whether the home aid, nurse, or nursing home staff is properly caring for your elderly loved one:

• Do you notice any significant changes in how he or she is spending money?

• Does your loved one seem afraid of or hesitant around his or her caregiver, roommate, or nursing home staff member?

• Does he or she appear thin, frail, overly tired, or have any unexplained cuts, bedsores, bruises, or injuries?

• Does your loved elder appear to have poor basic hygiene; are their hair or nails overgrown, do they appear unshowered; do they wear the same clothes over the course of several days?

• Does your loved one have easy access to their everyday assistance items–such as glasses, hearing aids, dental hygiene tools, walkers or wheelchairs, medications, etc.?

• Is there evidence–mail, e-mails, or phone messages–that indicates he or she has been the target of solicitations, aggressive telemarketers, online/by-mail contests, or other scams?

• Has he or she suddenly stopped participating in a long-time activity, club, or hobby they were once devoted to?

• Does your loved one appear lonely, depressed, or otherwise withdrawn or isolated from their friends, neighbors, and/or community?

• Are your loved one’s pets nourished, clean, and cared for?

As our elderly friends and family continue to age, it is essential that loved ones take an active role in ensuring their care does not fall to the wayside. Whether your loved one lives alone, in a nursing home, or with the help of a home aid–be sure to ask these questions during your holiday visits this year.

If you suspect an elder residing in the San Diego area is the victim of a senior scam, negligence, nursing home abuse, or other forms of elder abuse, contact an experienced elder abuse attorney and discover the recourse available to you.
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Psychological abuse, also referred to as emotional abuse, can be difficult to notice at first glance. The damage often reveals itself in the form of changed behavior, as opposed to physical bruises and marks. It’s important to know that abuse can happen anywhere the elderly person resides, even in a nursing home or other long-term care facility, and can be sustained by any type of caregiver (paid, unpaid; professional, amateur). The National Center on Elder Abuse (NCEA), directed by the U.S. Administration on Aging, states, “most cases of elder abuse are perpetrated by known and trusted others, particularly family members (including children, spouses, and others).”

Examples of psychological abuse by caregivers, friends, or even family:

• Screaming or yelling;

According to a recent study conducted by Cornell University, 1 in 5 nursing home residents suffer abuse at the hands of their fellow residents. The study is the first of its kind in collecting data on resident-to-resident abuse. The behaviors observed in the study include physical and sexual violence, verbal aggression and hostility, invasions of privacy, and other negative and inappropriate interactions.

Using data gathered from more than 2000 nursing home residents across ten different facilities, researchers determined that those that perpetrated these abusive behaviors were often cognitively impaired, but more mobile than their fellow residents. Over a four-week period, Cornell researchers observed and interviewed elder residents, and distilled statistical data from reports and questionnaires completed by staff:

• 16% of nursing home residents have been victims of verbal abuse from other residents, including instances of swearing and yelling.
• 10.5% of elderly nursing home patients report invasive behavior from other residents, such as un-permitted room entry and rifling through the personal possessions of others.
• 6% have suffered from physical abuse, like hitting, kicking, and/or biting.
• 1.3% reported sexual abuse, including indecent exposure, inappropriate contact, and efforts to exact sexual favors.

Presenting at the Gerontological Society of America’s Annual Scientific Meeting in 2014, Dr. Karl Pillemer noted that resident-on-resident abuse is “widespread and common in everyday nursing home life,” and that elderly residents suffering from conditions like dementia may act out with “verbally or physically aggressive behavior,” resulting in “arguments, shouting matches, and pushing and shoving, particularly in such close, crowded quarters.”

A particularly troubling aspect of this study is the lack of action on the part of nursing home staff. Across the country, including in San Diego and the surrounding Southern California area, elders suffer frequent abuse of all kinds from their fellow nursing home residents, and staff reports only a fraction of these altercations. Police are sometimes called to handle instances of theft or assault between residents, but many elderly nursing home residents lack a personal advocate to ensure that justice is delivered and their best interests are served.

If you suspect that your loved one in the San Diego or Southern California area is suffering from elder abuse, either from fellow residents in his/her nursing home or from nursing home staff, take action. Get in contact with a trusted professional who can assess your case and ensure that no abuse is ever repeated. Have your concerns addressed and resolved by a knowledgeable and experienced San Diego nursing home abuse attorney.
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According to multiple sources, including the Center for Medicare Advocacy, for-profit nursing homes are far more likely to provide insufficient quality of care for residents than non-profit nursing homes.

The Center for Medicare Advocacy’s website, which sites numerous studies, showed:

“Extensive research finds that the type of nursing home ownership and sponsorship affects the quality of care that facilities provide to their residents.”

More specifically, the research concluded in 2011, via the first-ever analysis of the ten largest for-profit nursing home chains, reported between 2003 and 2008, “facilities owned by the top ten for-profit chains had:

• The lowest staffing levels;
• The highest number of deficiencies identified by public regulatory agencies; and
• The highest number of deficiencies causing harm or jeopardy to residents.”

In fact, after more than 80 studies were reviewed and analyzed, comparing the quality of care in for-profit and not-for-profit nursing facilities. Results conclusively showed not-for-profit facilities had better outcomes on four key measures of quality:

• More or higher quality staffing;
• Lower prevalence of pressure ulcers;
• Lower prevalence of restraints; and
• Fewer government-cited deficiencies.

When it comes to choosing a California nursing home for your loved elder, it is vital that you research the facility thoroughly. Understaffing in nursing homes is incredibly dangerous to California elders residing in long-term care facilities. That is precisely why specific laws and regulations have been put in place which mandate proper staffing of long-term care facilities.

Under California law, “The facility shall employ an adequate number of qualified personnel to carry out all of the functions of the facility,” Health & Safety Code § 1599.1(a). Moreover, Health & Safety Code §1276.5-1276.65 mandates nursing homes must provide a minimum of 3.2 nursing hours per patient per day.

Unfortunately, many facilities choose to ignore this California law. Even worse, understaffing at nursing homes have been directly correlated to abuse, neglect, and substandard care of elders. Before selecting a nursing home for your loved elder ask plenty of questions, and conduct your due diligence. A checklist of questions you should ask about the Southern California nursing home you’re considering for your loved elder can be found here.

If you believe that someone you know has been abused while residing in a California Nursing Home, contact an award-winning elder abuse attorney today.
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Perhaps in response to the revelation that the California Department of Public Health has been negligent in investigating claims of elder abuse occurring in nursing homes and assisted living facilities across the state, Governor Jerry Brown’s proposed fiscal budget includes the addition of roughly 260 positions in the Licensing & Certification Division of the California Department of Public Health.

A statement issued by the California Advocates for Nursing Home Reform (CANHR) in response to the proposed budget reads:

“According to the Department’s Budget
Change Proposals, the Department is requesting the new positions primarily because its prior methodology for assessing its staffing needs failed to consider that inspectors were needed to investigate its vast backlog of complaints or to finish complaint investigations and write reports after onsite visits were conducted.”

Unfortunately, even given the influx of a proposed $30 Million, and the addition of hundreds of jobs, CANHR also said that it is expected to take an additional four years for all pending investigations to be completed. Their statement further said:

“In other words, the Department allowed thousands of complaints involving nursing home abuse and neglect to languish for years because its leaders could not competently perform the most basic assessment of its staffing needs. Some of these failed leaders remain at the Department and should be replaced by qualified and competent managers before it is awarded any more money.

CANHR calls on Governor Brown to swiftly appoint a new leadership team at the Department of Public Health. The new leaders should have the qualifications, experience, and will to build the Licensing & Certification Division into a premier consumer protection agency that will protect the interests of nursing home residents and patients of other health facilities throughout California.”

If you suspect that an elder is being abused, it is vital to report your concerns immediately. Under California law elder abuse can be both a criminal and civil offense. The state of California has taken a firm stance and zero tolerance policy towards elder abuse in any capacity. As part of their mission to encourage all Californians to report suspected elder abuse, the state has created The Citizen’s Guide To Preventing and Reporting Elder Abuse, which can be viewed in its entirety here. You should report suspicions of elder abuse to:

• Local Law Enforcement, including the Police, Sheriff, and District Attorney’s office. The San Diego County Sheriff’s Department can be reached at (858) 565-5200. The San Diego County District Attorney may be reached at 619-531-4040.
• Long-Term Care Ombudsman Program provides a 24/7 Crisis Complaint Hotline at 800-231-4024.
• Adult Protective Services (APS). In San Diego County, you may contact: San Diego County Aging and Independent Services (858) 495-5660.
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The numbers of low income elderly and/or disabled Californians who are choosing to stay in their homes rather than reside in institutions, including nursing homes, is on the rise due in part to the availability of a program called In-Home Supportive Services (IHSS).

IHSS is a program in California which pays caregivers to help low-income elderly and disabled persons in their own homes, rather than placing the elder in a nursing home. While it may sound like a terrific option for elders who do not want to live in a residential facility, such as a nursing home, the IHSS program is not without its own problems.

Low income elderly or disabled persons are almost unanimously responsible for hiring, training and supervising their own caregivers, even though the caregivers are paid by the state. Most caregivers are family members or acquaintances of the elder, but many are not. Moreover, no formal training is required of caregivers, nor is there any regulated oversight in place to ensure that the IHSS caregiver is performing the duties they are being paid to perform. Some argue that this limited oversight puts elders at greater risk for abuse including financial abuse and/or neglect.

Signs that an elder is being abused by a caregiver include:

•Bruises, pressure marks, broken bones, scrapes, cuts, burns
•Withdrawal from normal activities
•Depression
•Weight loss
•Anxiety
•Bedsores
•Poor hygiene
•Arguments or strained relationships between the caregiver and elderly person

If you or someone you love is over 65, or disabled and needs in-home help, it is crucial to choose the caregiver carefully. Helpful tips for hiring a care worker have been provided by AARP here. You can also learn more about the IHSS program by visiting the California State Department of Social Services website.

If you suspect that an elder you know is being abused in their own home, or in a facility such as a California nursing home, it is imperative that you speak up.

You may consider contacting:

•Your loved one’s doctor.
•Long-Term Care Ombudsman Program. They provide a 24/7 Crisis Complaint Hotline at 800-231-4024.
•Adult Protective Services (APS). In San Diego County, you may contact: San Diego County Aging and Independent Services (858) 495-5660, or the Eldercare Locator help line at 1-800-677-1116.
•Your Department of Public Health Licensing Office.
•Local Law Enforcement, including the Police, Sheriff, and District Attorney’s office. The San Diego County Sheriff’s Department can be reached at (858) 565-5200. The San Diego County District Attorney may be reached at 619-531-4040.
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