Nursing Home Abuse & Neglect

Wandering

While poorly defined, the problem includes excessive ambulation and excess movement. There are five behavioral patterns associated with wandering in persons with dementia. These are tactile wandering, environmentally cued wandering, reminiscent wandering, recreational wandering, and agitated purposeful wandering.

At a minimum, a nursing home must identify residents at risk for wandering. They must also develop a care plan that addresses the wandering, develop a program for preventing wandering, and keep the facility safe from accidents as well as modify the environment to discourage wandering Finally, there must be a comprehensive plan in place that is facility-wide to mobilize staff to look for a missing resident.

Daily Care

Proper nutrition is a basic necessity for the health and well-being of young and old alike. Poor nutrition causes involuntary weight loss, dehydration, pressure sores, and reduced quality of life. With weight loss and dehydration comes a vulnerability to disease, pressure sores, decreased mobility, and increased mortality rates.

The elderly require at least 1.5 liters of fluids per day. Pressure sores require treatment which includes adequate calories, protein, fluids, vitamins and minerals, and intervention. A facility is required to provide “sufficient fluid intake to maintain proper hydration and health.” 42 C.F.R. § 483.25(I)(j).

In addition, facilities are required by law to ensure that a resident does not develop pressure sores unless they are clinically inevitable and that a resident that has pressure sores receives adequate treatment to promote healing and adequate safeguards to prevent new sores from developing. 42 C.F.R. § 483.25(c).

Falls

A fall is defined as a sudden, uncontrolled, unintentional, non-purposeful downward displacement of the body to the floor /ground or another object. A facility is required to:

• Ensure that the environment is as free as possible from accident hazards
• Ensure that each resident is provided with supervision and assistance, as well as fall prevention devices, to prevent falls. 42 C.F.R. § 483.25(h). Falls may be caused by many factors. These factors include medication or physical limitations, as well as extrinsic factors such as defects in the facility structure. A higher rate of falls and fall-related injuries occur among nursing home residents, especially for those residents with dementia. While not all falls result in injury, some result in fatal injuries. Because of the seriousness of falls, nursing homes are required to conduct a fall assessment for each resident and provide a plan for each resident to prevent such an event.

Medication Error

The law requires that drugs be administered in accordance with the written orders of the attending physician. They must be given to the proper patient at the appropriate time, in the correct dosage, and via the proper route.

Obviously, medication errors can cause numerous types of injuries, but they may also affect the patient’s control of their own faculties causing them to fall, be unable to eat or drink, or perform other necessary daily functions. Unfortunately, medications are often inappropriately used as a patient restraint.