Articles Posted in Signs of Elder Abuse

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Dehydration is a serious health risk, especially in elderly people.  Individuals over 65, who live alone or with their elderly partner, are at a higher risk of dehydration than other age groups because they may forget to stay hydrated or they are too tired to get a drink.  However, in a nursing home, dehydration should never happen and, in some situations, is an example of elderly abuse.

How Wide Spread Is This Issue?

One elderly person dying from dehydration in a nursing home is unforgivable.  People who live in nursing homes are there because they need help of varying degrees to survive.  One of the necessities of life is water.

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Nursing homes are often under-staffed in an effort to maximize profits or because they are underfunded.  With the number of elderly people requiring care increasing at a record pace, some institutions use prescription drugs to make their residents more “manageable”.  Legal and ethical issues notwithstanding, the health implications of the use of chemical restraints are terrifying.

What Is a Chemical Restraint?

Put simply, a chemical restraint is when someone’s movement or actions are restricted through pharmaceutical intervention.  Types of drugs used as chemical restraints are:

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One of the largest generations in American history is beginning to transition into the elderly stage of human life.  In this stage, many people become less independent and, as a result, require assisted living and clinical care.  As aging individuals become dependents, they tend to lose their mobility.  Pressure ulcers are a direct result of the inability of a person to reposition their body unassisted.  In nursing homes and hospitals, elderly people are too often neglected and the price they pay can be severe.

Pressure Ulcers and Their Stages

Pressure ulcers (often referred to as bedsores, decubitus ulcers, and pressure sores) are a form of breakdown of the skin caused by prolonged and unalleviated pressure, incontinence, dirty or untidy bedsheets, and more.  Typically, they form in areas such as the heels, hips, buttocks, tailbone, shoulder blades, and elbows.  They are categorized based on severity:

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It is no secret that many people have difficulty asking others for help. Elders living in Southern California are no different. Even though physical and mental capabilities may start to diminish with aging, it is still not easy for many seniors to let others know they are struggling.

That is why it is up to all of us to keep an eye on aging family members or friends. Here is a list of warning signs that a senior you love may need help from family members or professionals.

  1. Abnormal or repeated phone calls If your grandmother, mother, father, or other elder family members begin making phone calls to you repeatedly, or at peculiar times of day, it may indicate confusion. It may also be a sign of memory loss, or could indicate that the elder is feeling lonely or depressed. If you notice these types of calls, try scheduling set calls with your loved one every day to see if they stick to those times and calls. If they don’t, it may be indicative of cognitive decline.
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Nearly 70% of elder abuse victims are women, according to the Bureau of Justice Statistics. It is worth noting that the population of elder women is much larger than the population of elderly men in the United States, however, that does not make these alarming statistics any less disturbing.

Why are women the victims of elder abuse more often than men? There are a few reasons most experts tend to agree upon.

  1. Elderly females may be seen as easier targets for physical, financial, emotional, or even sexual abuse.
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For many Californians the time comes when their loved elderly parent or family member may need some help within their home. Whether they need help with meal preparation, personal health and hygiene, or just some help around the home and with errands, finding the right person to care for your elder can be stressful.

Types of in-home caregivers for elders may range from a weekly housekeeper to a certified nursing assistant, or skilled care worker. The range of services provided may be cleaning the home, dispensing medication, helping the elder with transportation, or home care workers may help with personal care such as bathing, and monitoring overall health.

Once you determine the type of care your loved elder needs, there are many places to find compassionate, qualified in-home caregivers. Consider beginning your search by asking for referrals from friends and family, or from a doctor specializing in senior care. You can also check job postings such as those found in the newspaper, or online on sites including www.Caring.com.

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Understaffing nursing homes is incredibly dangerous to adults over 65 residing in long-term care facilities such as Southern California nursing homes. That’s precisely why specific laws and regulations are in place which mandate proper staffing at 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 that nursing homes must provide a minimum of 3.2 nursing hours per patient per day.

Unfortunately, many facilities choose to ignore the California law. Even worse, the understaffing of nursing homes has been directly correlated to abuse and neglect of elders. Indeed, understaffing in California nursing homes leads to substandard care over and over again. Substandard care in nursing homes then leads to illness, injury, and too often, death.

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Elders being admitted to a long-term care facility, such as a Southern California nursing home, are granted certain rights. These rights are protected by regulations on both the State and Federal level. Specifically, these rights are guaranteed by the California Code of Regulations, the California Health and Safety Codes, the California Welfare & Institutions Code, and the Code of Federal Regulations. All California elders entering into a nursing home are granted these rights by law.

Unfortunately, this does not mean their rights are protected and upheld by the facility and staff members. It is important that anyone considering placing an elder into a long-term care facility understands these rights. Rights are granted on pre-admission, while in residence, and transfer and discharge basis.

Pre-Admission Rights
As a potential resident of a long-term care facility, such as a California nursing home, residents’ rights are granted before being admitted. Each potential resident has the right to:

•Visit the facility
•Review the license and certification of the facility
•Review the admission agreement
•Inquire into cost of care, optional services and coverage provided by Medicare or Medi-Cal
•Be informed of all rights in a language that is understandable to the resident
•Be informed of the nursing home’s rules and regulations
•Review all contracts thoroughly before signing
•Be made aware of what basic services are included in cost, and what services are optional
•Be made aware of right to apply for Medicare or Medi-Cal, and be granted assistance in applying for this coverage
•Refuse to have a cosigner
•Refuse to provide a deposit, if you are the beneficiary of Medi-Cal or Medicare
•Refuse to delay rights to receive Medicare or Medi-Cal
•Refuse to sign an arbitration agreement
•Receive the Patient’s Bill of Rights

In-Residence Rights
Federal and State laws further guarantee residents of California nursing homes certain rights while living in the facility, including:

•The right to be treated with respect and dignity
•The right to privacy during treatment
•The right to privacy during personal care
•The right to choose your personal physician
•The right to participate in one’s own treatment planning and decision making
•The right to receive care to ensure proper personal hygiene
•The right to reside in a clean, sanitary facility
•The right to receive proper nutrition in quality and quantity as per physician’s recommendations
•The right to manage your own financial affairs
•The right to refuse care/treatment
•The right to make advance directives including power of attorney, DNR
•The right to voice grievances and/or suggest policy changes to the facility without fear of repercussions
•The right to make and receive phone calls privately
•The right to privacy in visits from family members and friends
•The right to be completely free from abuse, chemical restraints and physical restraints that are not medically required to treat patient’s symptoms
•The right to a monthly itemized bill
•The right to 30 days’ notice of increase in facility rates

Transfer & Discharge Rights

Elders being discharged or transferred from one facility to another, or to return to a private residence are also granted rights under California and Federal laws. Nursing home residents transferring, or being discharged are granted the following rights:

•The right to voluntary discharge without notice
•The right to refuse involuntary transfer except in an emergency
•The right to receive a refund of security deposit within 14 days of account being closed
•The right to remain in the nursing home if insurance transfers from private pay to Medicare or Medi-Cal
•The right to remain in the nursing home if nursing home withdraws from Medicare or Medi-cal
•The right to have a bed held for 7 days if resident is transferred to a hospital

The State of California and the United States Federal Government guarantees these rights and more to all residents of Southern California nursing homes. If these rights are being in any way restricted, or violated, it is time to speak with an elder abuse attorney about your next course of action.
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Southern California elders – particularly those residing in nursing homes, or skilled nursing facilities – are unfortunately prone to developing life-threatening bedsores. Bedsores, which are also known as pressure ulcers, can lead to a host of health problems, particularly in elders whose health may already be compromised. Similarly, because many elders may be confined to a bed or wheelchair, their risk for developing these sores is increased.

According to the Mayo Clinic:
People are at risk of developing pressure sores if they have difficulty moving and are unable to easily change position while seated or in bed. Immobility may be due to:

•Generally poor health or weakness
•Paralysis
•Injury or illness that requires bed rest or wheelchair use
•Recovery after surgery
•Sedation
•Coma

However, more specific risk factors affecting elders which make them so susceptible to bedsores may include advanced age, which results in thinner, drier, less elastic skin, which is generally more fragile. Elders may also develop bedsores after significant weight loss, which can accompany a long-term illness. Poor nutrition and/or dehydration also make elders susceptible to developing dangerous bedsores. Illnesses such as diabetes, and vascular diseases may also lead to damaged skin tissue, making it easier for a bedsore to develop. Likewise, elders who suffer from bowel or bladder incontinence are also likely to develop bedsores if soiled clothing isn’t removed and replaced immediately.

Similarly, elders who are in a state of mental decline are typically more likely to develop dangerous bedsores. Those who have limited mental alertness may be unaware that sores are developing, leading them to progress into dangerous infections before being discovered. By the same token, any elder who has diminished sensory perception, such as those who are paralyzed, may also not discover bedsores until they have reached a dangerous stage.

The key to prevention (and treatment) of bedsores is to relieve pressure. This can be accomplished most effectively by repositioning an elder regularly, particularly once a bedsore has developed.

For elders residing in a Southern California nursing home, inspection of the skin should be a routine part of care. Unfortunately, all too often patients suffer from bedsores due to neglect or lack of an appropriate care plan implemented in the California nursing home. If you have found a bedsore on an elder you know, a doctor needs to be notified immediately. Bedsores can often be resolved with appropriate detection and treatment.

While many long-term care facilities in California provide excellent care, others subject their patients to many forms of neglect or elder abuse. The California Welfare & Institutions Code §15610.57, addresses “neglect” in part by stating it is “the negligent failure to exercise the degree of care a reasonable person would have exercised had they had the care and custody of an elderly person.” This would include the failure to protect that elder from dehydration, bedsores, falls, other injuries caused by safety or health hazards and any type of injury that does not fit the explanation provided by the staff.
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Isolation is a form of Elder Abuse in California, per California Penal Code §15610.43. Elder abuse is a violation of the rights of elders by those charged with caring for them in facilities, such as California nursing homes. California nursing homes are required to provide reasonable care, and any intent to do otherwise constitutes a criminal action.

Elder Isolation may include:

*Any intentional actions, which prevent an elder resident from making or receiving phone calls, or having contact with family and friends outside of their residential, nursing facility.
*Any intentional actions which prevent the elder resident from speaking with their physicians, their attorneys, law enforcement or even members of their religious organization.
*Actions such as placing an elder in a locked room, or restraining them in another capacity without their consent.
*Confinement of an elder (which can also be deemed false imprisonment).

Elders are often isolated by nursing home staff as a way of dominating and/or instilling fear in the elder resident. The consequences that the elder may experience as the result can be traumatic. Elders who have been isolated often experience depression, anxiety, stress, and fear. In the worst cases, the lasting effects of isolation may result in suicide or death.
If you suspect that a loved elder may be experiencing intentional acts of isolation while in a his or her nursing home, speak up. Often elders who are being victimized in any way feel helpless to do anything about the abuse, for fear of repercussions.

If you suspect an elder you know is being abused in any capacity while residing in a California nursing home, report it to the following agencies immediately:
• 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. 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.
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