Nursing Home Abuse Handbook

What is Nursing Home Abuse

Due to the influx of more elderly people from the Baby Boomer generation and the improvements in medicine that help keep people alive longer, more elderly individuals are in nursing homes than ever before. Unfortunately, this increase in nursing home patients also increases the likelihood that these patients may experience nursing home abuse. The National Center on Elder Abuse says that it is impossible to know how many people truly suffer from abuse at the hands of their caregivers. However, it says that in the most recent major study, approximately 10 percentof respondents said that they had been abused.
When a loved one is being abused, there are steps that you can take to protect him or her. The information in this handbook can help you identify abuse and take the steps necessary to protect your loved one.

Types of Abuse

Unfortunately, there are many types of abuse and mistreatment of elderly individuals. Abuse may take on one or more of the following forms:

Physical Abuse
Physical abuse is the non-accidental use of physical force that can result in pain, bodily injury or impairment.

It may include acts like the following:
·Hitting the patient
·Using an item to hit the patient
·Pushing the patient
·Pinching the patient
·Shaking the patient
·Burning the patient
·Overmedicating the patient
·Force-feeding the patient
·Misusing physical restraints
·Confining the patient
·Imposing physical punishment on the patient

Physical abuse is usually the easiest form of nursing home abuse to spot due to physical manifestations. However, patients often do not report it or cover it up because they are afraid of the consequences.

Common signs of physical abuse include:
·Unexplained physical injuries, including broken bones, bruises, welts, black eyes, sprains, cuts, lacerations or open wounds
·Restraint marks around the wrists and ankles
·Open wounds
·Multiple untreated injuries
·Broken glasses
·Laboratory results that show overmedicating or under-medicating
·Patient's reports of abuse
·Sudden request to spend more time with family
·Sudden change in the patient's behavior
·Isolation of the patient by caregiver

Sexual Abuse
Due to their vulnerability, elderly individuals are sometimes sexual targets. Sexual abuse is any type of non-consensual sexual contact. This definition expands to patients who do not have the capacity to give consent due to physical or mental health limitations.

Sexual abuse includes:
·Unwanted touching
·Coerced nudity
·Taking unwanted sexually explicit photographs
·Showing the elderly individual sexually-explicit
images or video
·Sexual assault or battery

Common signs of sexual abuse include:
·Bruising around the private areas
·Unexplained sexually transmitted diseases
·Vaginal or anal bleeding
·Torn or bloody clothing

Emotional Abuse
A caregiver may also emotionally abuse the patient by treating him or her in a manner that results in emotional pain, anguish or distress through verbal or nonverbal acts.

Examples of emotional abuse include:
·Making threats against the patient
·Yelling at the patient
·Humiliating or ridiculing the patient
·Insulting the patient
·Harassing the patient
·Infantilizing the patient
·Isolating the patient
·Ignoring the patient

Signs of emotional abuse include:
·Patient is emotionally upset or agitated
·Sudden change in personality, including being withdrawn and non-communicative
·Regressive behaviors, such as rocking, sucking or biting
·Patient is not permitted to interact with other patients during social activities

Financial Abuse
Financial abuse is the unauthorized use of an elderly individual's funds, assets or property.

Some examples of financial abuse include:
·Cashing unauthorized checks
·Misusing the patient's credit cards
·Stealing money, property or checks
·Forging the patient's signature
·Coercing or tricking the patient to sign a legal document such as power of attorney, a contract or a will
·Stealing the patient's identity
·Improperly using conservatorship or guardianship

Signs that financial abuse is occurring include:
·Unexplained withdrawals
·Unexplained transfers to someone outside the family
·Missing possessions
·Other sudden changes in bank account practices
·Significant change in credit
·Bills going unpaid or an account overdrafting when these problems did not previously occur
·An additional name on a patient's bank account
·Forged signatures on legal documents
·Abrupt changes in a will or other legal documents

Healthcare Abuse
Another form of elder abuse is healthcare abuse. This occurs when a nurse, doctor, care provider or other such individual commits any of the following acts:
·Charging for healthcare but not providing it
·Getting financial incentives to prescribe certain drugs and doing so when not necessary
·Overcharging for healthcare services
·Overmedicating the patient
·Making medical recommendations based on financial incentives
·Medicaid fraud

Signs of healthcare abuse include:
·Duplicate billings
·Lab reports of overmedication
·Inadequate care to the patient despite paying all medical bills in full
·Overcrowding in the nursing home
·High staff turnover rate
·Lack of proper training
·Low wages for caregivers
·Inadequate responses to healthcare questions

While neglect is different than abuse, it creates liability on the part of the nursing home. Neglect is the failure to provide the care necessary to the patient as required by his or her duties. This can include failing to provide the patient with necessities such as food, water, clean clothing, habitable conditions, medicine and personal safety.

Some examples of nursing home neglect and signs of neglect include:
·Bed sores
·Weight loss
·Unsuitable clothing for the weather
·Poor personal hygiene
·Failure to provide treatment for health problems
·No running water, improper wiring, fire hazards or no heat
·Dirty living conditions, including soiled bedding, smell of feces or urine, bed bugs, fleas or lice

Nursing home abuse and neglect are very serious matters and any reports from the patient regarding abuse should be taken seriously. Signs of nursing home abuse and neglect are often dismissed as signs of dementia or of the patient's frail nature. However, the rate of nursing abuse is alarming. Taking such reports seriously is the first step to helping stop future abuse.

Legal Claims

Nursing home abuse and neglect lawsuits may be based on intentional acts or unintentional acts in the case of neglect.

Legal claims may arise in the following situations:
·Patient falls and suffers physical injury
·Patient has untreated bed sores and pressure ulcers
·Patient was dehydrated or malnourished
·Patient was physically or sexually assaulted by caregiver
·Patient did not receive proper medical care from staff or nursing home
·Patient is over sedated
·Mistakes are made in patient's medication
·Property theft
·Development of STDs or urinary tract infection
·Lack of supervision
·Wrongful death

Basis for Legal Claims

The primary basis for a legal claim against the nursing home is the duty that it has to ensure adequate care of the elderly patient. This duty arises out of the contractual relationship and by virtue of the fact that the nursing home is receiving payment in exchange for providing such care.  Additionally, there are state and federal laws that regulate the level of care that nursing homes must provide.

If the nursing home receives payments through Medicare, it has a duty to ensure that:
·Patients are free of accident hazards as much as possible
·Patients receive adequate supervision and devices geared to prevent accidents

The basis for liability can arise out of a number of different scenarios, but some of the most common behaviors in which civil liability may arise are:

Negligent Hiring
Nursing homes must perform due diligence when hiring someone who will be in close proximity to a vulnerable population such as the elderly. Negligent hiring occurs when an employer fails to check into an employee's credentials or background and that employee later turns out to neglect or abuse the patient. Negligent training allegations are similar but focus more on the lack of providing necessary training to the employee after he or she was hired.

Negligent Supervision
Some nursing home abuse allegations arise from a claim that the nursing home did not hire enough staff or properly supervise staff, which contributed to the patient's injury.

Failing to Keep the Premises Safe
The nursing home has the duty to keep the home safe from any known hazards. Additionally, it has the duty to inspect the premises to uncover any unknown dangers and to quickly repairing these hazards. This can include the duty to prevent slips and falls, as well as prevent a scenario in which one patient can be a danger to another.

Failing to Maintain a Healthy Environment
Nursing homes may also be liable if the patient suffers from not living in a clean and sanitary home.

Failing to Provide Adequate Medical Treatment
Nursing homes do more than monitor a patient. They are also tasked with administering medication and medical treatment to patients. When this care falls below the accepted standard of care, a claim of medical malpractice may arise.

Evidence in Nursing Home Abuse Cases

One of the problems in nursing home abuse cases is that the victim is often a vulnerable or impressionable individual. He or she may be suffering from physical and mental conditions that impair his or her ability to remember and communicate.

While the patient's account is one important form of evidence, there are other objective forms of evidence that may help substantiate the case, such as:
·Medical reports - Medical records may show an ongoing history of physical signs of abuse or neglect.
·History of abuse - The nursing home may have been previously cited or sued due to abusing or neglecting other patients.
·Pictures of abuse - The patient, family or medical providers may have photographed the injuries.
·Medical testimony - A treating doctor or evaluating doctor may testify or provide testimony during a deposition that the patient's injuries are consistent with abuse.
·Surveillance footage - Abuse may be captured by surveillance in the nursing home itself, from a neighboring camera when the patient was in a public outing or in a bank camera if financial abuse was committed.
·Accounts by other patients - Another patient may have observed the patient's abuse or the routine practice of abuse in the home.
·Accounts by relatives - Loved ones may have observed the abuse or noticed some of the signs of abuse listed above.
·Financial and legal documents - If the patient was being financially abused, financial documents and legal documents may show evidence of this with forged signatures or the addition of a caregiver's name who should not be listed on the document.
·Admissions - A nursing home employee may have admitted to the abuse or seeing another person commit abuse.

Damages in Nursing Home Abuse Cases

Whether the abuse occurred on a recurrent basis or it was the result of one egregious incident that resulted in injuries, the victim has a right to damages. In the event that the patient died as a result of the abhorrent acts of the nursing home, the victim's family may be entitled to compensation through the pursuit of a wrongful death claim. The rules regarding who can file a wrongful death claim vary by each state. Some states require that the personal representative of the estate file the wrongful death case on behalf of the loved ones. The spouse and dependent children are usually allowed to benefit from such a case.

Potential damages in a personal injury lawsuit include:
·Medical expenses
·Rehabilitation expenses
·Funeral expenses
·Violations of the patient's dignity
·Pain and suffering
·Punitive damages

Contact a Nursing Home Abuse Lawyer

If you have an elderly loved one who has been abused or neglected in a nursing home where you believed he or she would receive proper care, it is important that you discuss your case with a nursing home abuse lawyer. Nursing home abuse cases are one form of personal injury cases. 

Look for a lawyer who has experience in this area of the law so that he or she is familiar with typical claims, the evidentiary burden and the standard of care that the nursing home is required to provide. Statutes of limitations limit how much time you have to act and still be able to recover. 

Filing a lawsuit can help you recover financial compensation. Additionally, a lawsuit can help bring awareness to abuse or neglect that is occurring in order to prevent other elderly patients from having to suffer the same treatment.


Know Your Rights!

Articles About Nursing Home Abuse

  • What Are the Signs of Nursing Home Abuse?
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  • What You Need to Know About Nursing Home Arbitration Agreements
    When you get to the nursing home and meet with the administration, they will ask you to sign a stack of roughly two dozen documents. These documents cover a range of subjects, including your legal rights in the event your loved one is harmed under the facility’s care. This form is known as the arbitration agreement, and you may have come across them in other situations throughout your life. An arbitration agreement generally waives your rights to a jury trial and to sue the other party.
  • Facts About Nursing Home Neglect
    Although you've entrusted your loved one to the care of a nursing home you are suspicious about what's going on behind the curtain. What is nursing home neglect? What can you do if you think something is going wrong?
  • DOJ Sues Pennsylvania Nursing Home Chain Under The False Claims Act Alleging Grossly Substandard Care
    In June 2022, the U.S. Department of Justice (DOJ) filed a civil suit under the federal False Claims Act against a chain of nursing homes in Pennsylvania and Ohio. The Complaint alleges that American Health Foundation (AHF) and three of its nursing homes provided grossly substandard care for which Medicare and Medicaid should not have paid. According to the complaint, AHF leadership was aware for years that the conditions at its facilities fell short of the standards required by the Nursing Home Reform Act (NHRA), but failed to remedy these violations and focused solely on profitability. In fact, the DOJ’s complaint alleges that AHF amassed over $16 million which they invested in stocks, and not in necessary staff and supplies to improve the quality of care to their patients.
  • With the Growth of Elder Law Comes Statutes and Rules of Interest for All Practitioners in Colorado
    With our population living longer due to advancements in medical care and technology coupled with the baby boomer generation getting older, we are in the middle of the “Silver Tsunami” of aging in America. As a direct result, Elder Law as a practice discipline has grown exponentially over the past 10 years. And the need for skilled practitioners in the area has grown even more dramatically.
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    When you are involved in a car or motorcycle accident, it can be an experience that is rather disorienting. As a result, it can be difficult to think clearly and focus on what needs to be done immediately following the collision. However, what you do during this time can be crucial, as the well-being of yourself and others can depend on it. Experts recommend that the following actions be taken after a motorcycle or car accident. It might be helpful to print off a checklist and store it in an easily accessible place, such as your glove compartment, to ensure that you complete all the steps.
  • Nursing Home Wandering and Elopement Lawsuits
    Lawsuits against nursing homes can be filed when a resident wanders, or elopes, from the facility. Wander can be a safe and healthy behavior when it involves wandering through the hallways to reduce stress, for exercise, or for activity. In fact, many residents are encouraged to wander inside the nursing home for those purposes.
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    Did you know that distracted driving remains one of the leading causes of car accidents in Illinois and nationwide? Even with all the information out there about how dangerous distracted driving is, people still choose to use their phones and do other distracting things behind the wheel.
  • Fundamental Components of a Wrongful Death Case in Rhode Island
    The unexpected and tragic loss of a loved one, in addition to causing grief and pain, can also lead to tremendous financial strain for families, particularly if they’ve lost a primary wage earner or breadwinner. When the death was caused by someone else’s negligence or wrongdoing, families in Rhode Island may be able to file a wrongful death lawsuit, which is a civil lawsuit, seeking compensation for their losses.
  • Nursing Home Neglect Cases for Bed Sores
    Our aging population has resulted in a significant increase in the number of skilled nursing home residents. A major issue with elderly patients is the risk of developing bed sores, or decubitus ulcers. These are almost always preventable with proper attention, care, and implementation of basic nursing protocol.

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