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NURSING HOME CARE

How do I know if a loved one is being properly cared for in a Nursing Home?

If you suspect that a loved one or someone that you know is not receiving the proper care and treatment in a Nursing Home, it is important that you know the difference between what is proper and acceptable care and treatment, what is unacceptable care and treatment, and what is abuse. These are discussed below to help you answer your questions or concerns.

I) Proper and Acceptable Care and Treatment:

Nursing Homes are required to comply with the Code of Federal Regulations, (see below), in order to receive Medicare and Medicaid funding. In general, they must provide each Nursing Home resident the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with a comprehensive assessment and plan of care.

One of the most important regulations involves the quality of care that each resident receives. Section 483.25 states that each resident must receive the necessary treatment and services in order to maintain or to improve their Activities of Daily Living (ADL’s), which include eating, bathing, dressing and grooming, transferring and ambulating, toileting and using speech, language, or other functional communication systems, in order to maintain good nutrition grooming, and personal and oral hygiene.

I have summarized the rights and standards for the residents of Nursing Homes set by the Federal Regulations regarding the following important areas:

1. 1. Quality of Life (§483.15)The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality. This includes providing a clean bed and bath linens that are in good condition and a safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible;
   2. Quality of Care (§483.25)The facility must ensure that:
      1. residents receive proper treatment and assistive devices to maintain vision and hearing abilities;
      2. residents do not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable. Also, a resident having pressure sores must receive the necessary treatment and services to promote healing, prevent infection and prevent new sores from developing;
      3. a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible;
      4. a resident who enters the facility without a limited range of motion does not experience reduction in range of motion, unless the resident’s clinical condition demonstrates that a reduction in range of motion is unavoidable;
      5. each resident receives adequate supervision and assistance devices to prevent accidents;
      6. Maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident’s clinical condition demonstrates that this is not possible;
      7. each resident receives adequate supervision and assistive devices to prevent accidents;
      8. each resident must be provided with sufficient fluid intake to maintain proper hydration and health;
      9. residents with special needs receive proper treatment and care for the following special services:
         • Injections;
         • Parenteral and enteral fluids;
         • Colostomy, ureterostomy, or ileostomy care;
         • Tracheostomy care;
         • Tracheal suctioning;
         • Respiratory care;
         • Foot care; and
         • Prostheses.
   3. Nursing Services (§483.30)The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by each resident’s assessment and individual plan of care.
   4. Dietary Services (§483.35)The facility must provide each resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident.Each resident receives and the facility provides at least (3) three meals daily, at regular times comparable to normal mealtimes in the community.

       

   5. Physician Services (§483.40)The facility must ensure that The medical care of each resident is supervised by a physician.The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.
   6. Dental Services (§483.55)The facility must assist residents in obtaining routine and 24-hour emergency dental care
   7. Pharmacy Services (§483.60)The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.
   8. Infection Control (§483.65)The facility must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection.
   9. Physical Environment (§483.70)The facility must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel and the public.
      A long term care facility must install:

1. at least, battery-operated single station smoke alarms in accordance with the manufacturer’s recommendations in resident sleeping rooms and common areas;

2. an approved, supervised automatic sprinkler system

Bedrooms must:

1. accommodate no more than four residents;

2. measure at least 80 square feet per resident in multiple resident bedrooms, and at least 100 square feet in single resident rooms;

3. have direct access to an exit corridor;

4. be designed or equipped to assure full visual privacy for each resident;

Except in private rooms, in facilities initially certified after March 31, 1992, each bed must have:

1. ceiling suspended curtains, which extend around the bed to provide total visual privacy in combination with adjacent walls and curtains;

2. at least one window to the outside; and

3. a floor at or above grade level.
The facility must provide each resident with:

1. a separate bed of proper size and height;

2. a clean and comfortable mattress;

3. bedding appropriate for the weather and temperature.

As explained above, Nursing Homes are required to comply with the Code of Federal Regulations so that Nursing Home residents receive the necessary care and services for their physical, mental, and psychosocial well-being. The entire Code is below:

The Code of Federal Regulations

Title 42, Public Health, Part 483, of t he Code of Federal Regulations states the requirements for States and Long Term Care Facilities, and are listed below. To read the details of each regulation, simply click on the section number on the left side below:

§483.1

Basis and scope.

§483.5

Definitions.

§483.10

Resident rights.

§483.12

Admission, transfer and discharge rights.

§483.13

Resident behavior and facility practices.

§483.15

Quality of life.

§483.20

Resident assessment.

§483.25

Quality of care.

§483.30

Nursing services.

§483.35

Dietary services.

§483.40

Physician services.

§483.45

Specialized rehabilitative services.

§483.55

Dental services.

§483.60

Pharmacy services.

§483.65

Infection control.

§483.70

Physical environment.

§483.75

Administration.

 

To receive free help and answers to questions, contact us directly anytime for an immediate and free consultation at 443-279-2027, you may also fill in the Contact box on the left side of this page, or email Ms. Miller directly.

You can also protect your case by reading my Free Medical Malpractice Fact Book.

 

What are the General Requirements of Nursing Homes Nursing Homes must meet certain general requirements in the following areas:

1) Proper Hygiene and Cleanliness:

Nursing Home residents must receive help with bathing, either taking a full bath or shower, and a shampoo as often as needed, but no less than once a week. If a resident is confined to bed because of illness , he or she should be given a daily bath and a full bath at least two times per week.

Residents should be provided assistance with shaving as needed and their hair should be brushed every day. Nursing Home staff should provide help before and after every meal with washing the resident’s hands, face and teeth and with toileting.

Whenever a resident becomes wet or soiled, they should receive assistance to be cleaned and their clothing and linens should be changed, washed and replaced with clean clothing and linens.

2) Proper Nutrition:

Resident’s should receive enough calories, protein and other nutrients to provide good nutrition. All foods should be served at the appropriate temperature. Nursing Home residents who need assistance with eating should receive help. Nursing Home staff should assist with opening packages and should provide special utensils if needed. Furthermore, residents should not be fed by feeding tubes, unless it is medically necessary.

Proper nutrition is important because poor nutrition and certain medical conditions may lead to the development of pressure sores, also known as bedsores (See #5 below). Without proper nutrition, especially vitamin C and zinc, which help to heal wounds, like bedsores, the body will not be able to heal, even with proper treatment for the sores.

3) Proper Hydration:

Each resident must receive fluids to prevent dehydration. Fresh water and drinking cups must be available to each resident and placed in a convenient location where it can easily be accessed, such as the resident’s table next to their bed. Extra attention should be provided during the Summer months to ensure that residents are consuming enough water in the heat in order to avoid dehydration.

4) Monitoring Vital Signs:

Nursing Home staff are required to take each resident’s pulse, blood pressure, temperature, respiration rate, and to weigh them when they are admitted to the Nursing Home and at least once a month, unless a Physician orders that this be done more frequently.

5) Attention to Circulation:

Nursing Home staff must watch residents who are confined to bed or sit in wheelchairs for extended periods of time, in order to make sure that residents do not develop pressure sores, also called bedsores or decubitus ulcers.

Residents confined to a bed or a wheelchair should have their position turned or changed, as often as necessary, if resident is uncomfortable, and at a minimum, every two (2) hours. Also, supportive pads and pillows, or special mattresses, should be provided if needed in order to relieve pressure on the skin so that proper circulation is maintained.

If a resident develops bedsores, it is important that they are given immediate treatment to heal the sores to prevent infection. These sores can be dangerous because it only takes having pressure on the skin for a period of time to develop the sores.

The sores develop when blood circulation is cut off to areas of skin and tissue, which causes the skin to breakdown and the tissue to die. This causes large and painful open sores, which can then become infected.

Once infected, bacteria can spread to the rest of the body. If this occurs, without timely and proper treatment, the infection can lead to the need for amputation. In other severe cases of infection, it may cause Sepsis. Sepsis occurs when the body releases chemicals to help fight the infection into the bloodstream, which causes inflammation throughout the body. The inflammation then creates blood clots that can prevent the needed oxygen and nutrients from reaching organs, which causes the organs to fail. Sepsis can progress to Septic Shock, which causes blood pressure to drop significantly and can lead to death. (Read more about bedsores ) {Derek, please link this to the Bedsores page}

In addition to making sure that residents do not develop bedsores, Nursing Home staff should also provide residents the needed care to prevent dry skin, itching or irritation.

Residents should also receive help on a daily basis with exercise, if possible, or walking, in order to maintain or improve the resident’s circulation, strength and use of their body.

6) Dressing:

Residents should be dressed each day in their own clean clothing and with the proper footwear so that they are comfortable. The nursing staff should ask the resident which clothing they would like to wear each day when they are dressed.

7) Toileting:

If the Nursing Home resident has control of his or her bladder and bowel and is not incontinent, he or she should receive help using the toilet, as often as is needed. Call buttons, which allow the resident to call for assistance, should be functioning properly at all times and should be answered promptly by the nursing staff.

If the resident does not have control of his or her and bladder and bowel, and is incontinent, he or she should receive care to help restore as much bladder and bowel control as possible. This care can include increasing the resident’s intake of fluids and helping the resident toilet on a regular schedule, or as needed.

Nursing staff who assist residents with toileting should be careful to ensure that the resident does not contract a Urinary Tract Infection (UTI) from improper wiping and cleaning of the resident.

Catheters should only be used if it is medically necessary. Residents who require a catheter must be given extra attention in order to prevent a Urinary Tract Infection (UTI).

Any resident who becomes wet or soiled should be promptly cleaned and their clothing, and linens, if necessary, should be changed right away.

8) Special Needs:

If a resident has any special needs, such as the need for Physical Therapy, Occupational Therapy, Speech Therapy, or has the need for services for their vision, hearing, respiratory care, has other needed services, or is in need of mental health treatment, the Nursing Homes staff must make the arrangements for theses special services for the residents.

 

To receive free help and answers to questions, contact us directly anytime for an immediate and free consultation at 443-279-2027, you may also fill in the Contact box on the left side of this page, or email Ms. Miller directly.

You can also protect your case by reading my Free Medical Malpractice Fact Book.

 

II) Improper Nursing Home Care and Treatment:

If the Nursing Home in which your loved one resides is not following any one of the standards or requirements in Section I above (Proper and Acceptable Care and Treatment), then he or she is receiving unacceptable care and treatment and you need to seek assistance immediately.

 

III) Nursing Home Abuse:

What is Nursing Home Abuse?

Elder abuse is any act of abuse when the victim is 65 years of age or older and is prohibited by law. The abuse may occur in a nursing home, an assisted living facility, a care facility or hospital.

Abuse is defined by law as “ the non-therapeutic infliction of physical pain or injury, or any persistent course of conduct intended to produce, or resulting in, mental or emotional distress.” The section of the law is found in the Annotated Code of Maryland below:

Annotated Code of Maryland

HEALTH – GENERAL
TITLE 19.  HEALTH CARE FACILITIES
SUBTITLE 3.  HOSPITALS AND RELATED INSTITUTIONS
PART VI.  RIGHTS OF INDIVIDUALS

Md. HEALTH-GENERAL Code Ann. § 19-347  (2011)

§ 19-347. Abuse prohibited

(a) Definitions. —

(1) In this section the following words have the meanings indicated.

(2) (i) “Abuse” means the non-therapeutic infliction of physical pain or injury, or any persistent course of conduct intended to produce or resulting in mental or emotional distress.

(ii) “Abuse” does not include the performance of an accepted medical procedure that a physician orders.

(3) “Law enforcement agency” means the Department of State Police or a police agency of a county or municipal corporation.

(b) Report of alleged abuse. —

(1) A person who believes that a resident of a related institution has been abused shall report promptly the alleged abuse to an appropriate law enforcement agency, the Secretary, or the Department of Aging.

(2) A report:

(i) May be oral or written; and

(ii) Shall contain as much information as the reporter is able to provide.

(3) The recipient of the report promptly shall notify:

(i) The other parties referred to in paragraph (1) of this subsection; and

(ii) Unless the administrator is the alleged abuser, the administrator of the related institution.

(c) Failure to make required report. — Any employee of a related institution who is required to report alleged abuse under subsection (b) of this section, and who fails to report the alleged abuse within 3 days after learning of the alleged abuse, is liable for a civil penalty of not more than $ 1,000.

(d) Investigation. —

(1) Unless otherwise provided, the law enforcement agency, with the assistance of the Secretary, shall:

(i) Investigate thoroughly each report of an alleged abuse; and

(ii) Attempt to insure the protection of the alleged victim.

(2) The investigation shall include:

(i) A determination of the nature, extent, and cause of the abuse;

(ii) The identity of the alleged abuser; and

(iii) Any other pertinent fact or matter.

(3) Within 10 working days after the completion of the investigation, the law enforcement agency shall submit a written report of its findings to:

(i) The State’s Attorney;

(ii) The Secretary;

(iii) The local ombudsman as designated by the Secretary of Aging;

(iv) Unless the administrator is the alleged abuser, the administrator of the related institution; and

(v) The Division of Licensing and Certification of the Department of Health and Mental Hygiene.

(e) Referral to Secretary by law enforcement agency. — The law enforcement agency:

(1) Shall refer to the Secretary for investigation reported instances of abuse involving any persistent course of conduct intended to produce or resulting in mental or emotional distress; and

(2) May refer to the Secretary for investigation reported instances of patient-to-patient abuse.

(f) Report of findings by Secretary. — Within 10 working days after the completion of an investigation under subsection (d) of this section, the Secretary shall submit a written report of its findings to:

(1) The State’s Attorney;

(2) The local ombudsman as designated by the Secretary of Aging; and

(3) Unless the administrator is the alleged abuser, the administrator of the related institution.

(g) Immunity from civil liability. — A person shall have the immunity from liability described under § 5-631 of the Courts and Judicial Proceedings Article for:

(1) Making a report under this section;

(2) Participating in an investigation arising out of a report under this section;

(3) Participating in a judicial proceeding arising out of a report under this section; or

(4) Participating in transferring, suspending, or terminating the employment of any individual who is believed to have abused or aided in abusing a resident under this section.

(h) Notice. —

(1) The Department shall provide each related institution with signs that set forth the reporting requirements under this section.

(2) The related institution shall post the signs conspicuously in the employee and public areas of the related institution.

 

To receive free help and answers to questions, contact us directly anytime for an immediate and free consultation at 443-279-2027, you may also fill in the Contact box on the left side of this page, or email Ms. Miller directly.

You can also protect your case by reading my Free Medical Malpractice Fact Book.

 

What Are The Types of Nursing Home Abuse?The types of Nursing Home abuse are listed below and the signs of abuse to look for are also described in detail in the next section:

a. Neglect – Refusal or failure to provide food, health care or physical care;

b. Physical Abuse – Inflicting, or threatening to inflict, physical pain or injury or committing an act of violence;

c. Emotional and Verbal Abuse – Inflicting mental distress or anguish through nonverbal acts, or verbally by using insulting, degrading, aggressive or threatening language;

d. Sexual Abuse – Any non-consensual contact that is sexual in nature;

e. Exploitation – wrongfully using or taking property, money, assets or resources without consent, or by using coercion, deception, duress, undue influence or false pretenses .

What Are The Signs of Nursing Home Abuse?a. How can I tell if a loved one is being neglected in a Nursing Home?The signs of Nursing Home neglect include:

• Malnutrition;
• Dehydration;
• Poor personal hygiene;
• Unsanitary and unclean clothing, bedding and conditions;
• Bed sores and infections;
• Lack of care for medical problems;
• Not providing necessary medication;
• Unsafe and hazardous conditions.

b. How can I tell if a loved one is being physically abused in a Nursing Home?The signs of Nursing Home physical abuse include:

• The presence of bruises, cuts, wounds, or welts
• Unexplained injuries
• Unreasonable physical restraint
• Confinement to a room
• Giving too much medication or psychotropic medication unauthorized by a physician
• The victim or another resident reports slapping, pushing, shaking, beating or other mistreatment.

c. How can I tell if a loved one is being emotionally or verbally abused in a Nursing Home? 

The signs of Nursing Home emotional or verbal abuse include: 

• The resident is agitated or emotionally upset
• Loss of Self Esteem
• The resident is withdrawn and quiet
• Unusual behavior such as rocking while sitting, biting and sucking their thumb
• Acting out toward others with anger, insults, threats, or the silent treatment
• Wanting to be isolated from other people

d. How can I tell if a loved one is being sexually abused in a Nursing Home?The signs of Nursing Home sexual abuse include:

• Fearful or angry reaction to a nursing home staff member, particularly during toileting, bathing and dressing of the resident
• Unexplained difficulty with walking or sitting
• Torn, stained, or bloody underclothing
• Bruises or redness around the elderly person’s inner thighs, breasts, genitals, buttocks, wrists or ankles
• Unexplained genital infection or sexually transmitted disease
  Vaginal or anal bleeding

• Presence of sperm, stained or bloody bed sheets

e . How can I tell if a loved one is being exploited in a Nursing Home?

The signs of Nursing Home exploitation include:

• Unexplained disappearance of money, property, or assets

• Unauthorized changes to a Will Power of Attorney, or other Legal or Financial documents
• Unexplained withdrawal of money from bank accounts or changes in bank accounts

• Receiving Delinquent Notices and unpaid bills despite the availability of adequate funds

• Unexplained r eduction of services and care provided
• Receiving excessive and unnecessary services

• The victim or another resident reports financial exploitation such as someone forging a signature or cashing a check without authorization

To receive free help and answers to questions, contact us directly anytime for an immediate and free consultation at 443-279-2027, you may also fill in the Contact box on the left side of this page, or email Ms. Miller directly.

You can also protect your case by reading my Free Medical Malpractice Fact Book.