You can’t be a 24-hour caregiver for an elderly relative, but you want to know they’re safe and well cared for in a nursing home
None of us is getting any younger.
You might think about your golden years as far away, or maybe they’re in the not-too-distant future. And if they’re far off for you, perhaps you’re in the position of considering what eldercare looks like for your mom, dad, grandparent or some other older relative.
If you’ve made the decision (or plan to) that a loved one needs to live in a nursing home, you should feel comfortable with that choice. Most people aren’t able to provide 24/7 care for a family member, and in most situations, the person would have far better access to the services and care they need in a licensed facility.
But if you have a family member living in a nursing or assisted living facility, you want to be alert to the possibility that they might not be receiving the best possible care. Particularly today, when staffing shortages and increased regulations are making all areas of health care more difficult than they were a few years ago, there could be areas where your loved one’s care has fallen short.
Nursing home licensing and care
A nursing home is a facility that provides residential care for elderly or disabled people. These are sometimes called skilled nursing facilities (SNF), long-term care facilities or assisted living facilities. Most people who live in nursing homes don’t require hospital care, but they can’t be cared for at home. These facilities are staffed by nurses and aides who care for both the patients’ medical needs and their activities of daily living like feeding, bathing, dressing, toileting and other tasks.
Four required services in Alabama nursing homes
Alabama law requires that a nursing home must provide:
- Nursing care. Includes procedures or therapies administered by a registered nurse (RN) or licensed practical nurse (LPN), such as medication administration, injections or post-hospital care for conditions like strokes and heart attacks
- Personal care. Includes helping residents with walking, hygiene, eating, dressing, bathing, etc.
- Residential services. Includes general supervision in a protective environment, maintaining living areas and planning programs to meet social and emotional needs
- Medical care. Includes working with physicians to ensure that patients have prescriptions and care plans for treatment of chronic or acute conditions
There are also hundreds of state and federal regulations that govern long-term care. Generally, the more vulnerable a population is, the more regulation there is within the industry. Hospitals and other healthcare facilities, schools, transportation and similar industries are closely regulated for safety and health reasons.
The Older Americans Act of 1965
This federal legislation guarantees that each nursing home resident has a set of rights that a facility is required to respect. These rights include (but are not limited to):
- Right to a dignified existence
- Right to individual freedom of choice
- Right to privacy
- Right to voice grievances
- Right to protection of their money and property
- Right to manage their own finances
- Right to retain and use their personal possessions
- Right to visitors
- Right to be free from verbal, mental, sexual or physical abuse
- Right to self-administer drugs if it is safe to do so
- Right to be fully informed of their health status and participate in their care and treatment planning
To view additional rights afforded under the act, you can visit the Alabama Nursing Home Association website.
What is nursing home abuse?
Nursing home abuse can exist in a variety of ways, and it’s not always obvious when it’s happening.
Nursing home abuse includes:
- Physical abuse is any event or condition that causes physical injury or harm. It could be intentional, like aggressive handling. It can also be from neglect, such as a lack of physical care or overuse of restraints.
- Sexual abuse is unwanted sexual attention or exploitation. This also involves issues of consent. A patient who experiences dementia, Alzheimer’s Disease or other cognitive deficit that leaves them unable to know what’s happening or express their wishes is incapable of providing consent.
- Neglect can be either intentional or unintentional. Often, it happens when a facility is inadequately staffed to appropriately care for residents’ needs. Neglect includes failing to provide personal hygiene, food, clothing or water.
- Financial exploitation is when a caregiver takes advantage of a patient’s financial situation. This can mean stealing a resident’s personal property, but it could also be theft from a bank account, using the patient’s personal information to apply for credit or other types of identity theft for personal gain.
- Psychological or emotional abuse can be the most difficult to detect. A caregiver might yell, criticize, shame or humiliate a patient in a way that causes anxiety, upset or behavior changes.
- Resident-to-resident abuse happens, too. Not all abuse is at the hands of a caregiver. This is usually physical, psychological or sexual. It’s the caregiver’s responsibility to keep every patient safe and free from harm by other individuals, no matter who they are.
What are the signs of nursing home abuse?
If you are a frequent visitor to your loved one in a nursing home, you likely have a good sense of how they’re treated and whether things are going well. As you visit, you can also look at other residents to see if they seem healthy and well cared for too. Seeing residents engaged in activities and generally looking well-groomed and healthy is a big indicator of what happens “behind the scenes.”
While elderly people are susceptible to falls and might bruise easily or show other signs of physical injury, there are specific signs to look for that could indicate physical abuse.
- Visible bruises, scars or welts
- Unexplained broken bones, sprains or dislocations
- Broken eyeglasses
- Rope marks on wrists, ankles or other signs of restraint
- Failure to take medication properly
- Refusal of caregiver to allow you to be alone with your loved one
As previously discussed, abuse can be more than just physical harm. Here are some of the signs to watch out for with other kinds of abuse:
- Stained, bloody or torn undergarments
- Vaginal or anal bleeding that’s not related to a preexisting medical condition
- STDs or other genital infections
- Bruising or other marks near genitals or breasts
- Left alone in public (outside the facility or residence)
- Unusual weight loss or signs of dehydration
- Bedsores (which can lead to serious infections like sepsis)
- Unsafe living conditions like lack of heat or air conditioning, fire hazards or unclean water
- Dressed inappropriately for the temperature or weather conditions
- Unclean appearance
- Soiled bed linens, dirty clothes, bugs or other unclean or unsanitary conditions
- Exhibiting symptoms of dementia, including sucking their thumb, mumbling, rocking or other behaviors that are unusual for that individual
- Unable to leave the facility, make phone calls, send mail or have visitors
Sudden changes in financial status, such as withdrawals from your loved one’s bank account or an ATM, may indicate financial abuse.
Financial abuse can also be healthcare fraud. You might be able to spot this if your family member is:
- Receiving too much or too little medication
- Receiving poor care when services have been paid for in full
- Receiving duplicate bills for the same services, medications or assistive devices
Insufficient staff or staff that lacks adequate training can be signs of fraud as well.
How to prevent nursing home abuse
Document, document, document!
The most important thing you can do throughout the process is document every instance that you believe is abuse or neglect.
If you’re visiting in person and can take photos of marks on your family member’s body, unclean or unsanitary conditions or other evidence of improper practices, those will be helpful—as they say, a picture is worth a thousand words.
If you’re only able to visit with your loved one by phone, take notes of anything they say that sets off alarms in your head. Keep a close eye on their bank accounts and spending, and maintain an inventory of their belongings. Before you move your family member into a nursing home, make a list of anything they bring that has value, like jewelry or other items. If anything goes missing, you need to have it documented that it was there in the first place.
Any notes or photos should include dates, times and any specific staff members who were involved in the comments or incidents. The more detail you have, the better.
- Appoint a guardian. If you’re unable to visit regularly, contact a volunteer agency to see if you can find a helper who can visit your loved one regularly. A person who has family or friends “drop in” is less likely to suffer abuse.
- Review financial statements. If your loved one isn’t able to manage their own financial details, be sure that you or another trusted family member are regularly reviewing their financial statements. Even a fast monthly or quarterly skim of bank accounts, credit card bills and legal documents is enough to check for any unusual transactions or changes.
- Unannounced visits. If you’re able to visit, do so without the facility knowing ahead of time that you’re coming. They can’t require you to call ahead, though it’s reasonable to expect that you’d come during daytime or evening hours and not when residents are likely to be sleeping. It’s your family member—you have a right to visit whenever you want.
- Get to know the staff. If your family member has specific caregivers on certain shifts, get to know those people. A caregiver will feel more accountable when you know them by name and see their interactions or relationship with the person in their care.
Who is liable for Alabama nursing home abuse, and what can you do if it happens?
The person or entity that’s liable for the abuse would depend on the situation. It could be a specific staff member, but it’s more than likely that the management bears liability also. The employer is responsible for the acts of its employees.
A claim might be handled differently depending on whether the nursing home is privately run or government operated.
If a resident is abusive to another resident, it’s still the responsibility of the facility staff to prevent this from occurring. They are liable for the safety of each resident, regardless of how the injury happens.
How to file an Alabama nursing home complaint
If you need to make a complaint against an Alabama nursing facility, you can use the Alabama nursing home complaint form. This form permits you to make anonymous complaints if you’re not comfortable with adding your name.
You can also contact the Alabama ElderCare Hotline at 1-800-356-9596 or by email at [email protected].
If your complaint is against an assisted living facility, you can email [email protected] or call 1-866-873-0366.
However, filing a complaint can be a complicated and lengthy process. If you believe a loved one is experiencing abuse or neglect, you want action now. Particularly in the case of an elderly person who might be mentally or physically fragile, time is of the essence to get the care they need.
You can use the Enjuris law firm directory to find an Alabama nursing home abuse lawyer who can advocate for your loved one’s rights, help cut through the red tape to assist them in getting the care they deserve and help you have peace of mind.