Detecting Patient Abuse

Detecting abuse in nursing homes requires vigilance and it requires being a bit of a Sherlock Holmes sometimes. The tips below should help you spot abuse in the nursing home.

Physical Abuse

The most serious form of patient abuse in nursing home resident is physical abuse. Here are some classic indicators, derived from the medical literature, of physical abuse

Damage to skin integrity including:

	Cuts and lacerations
	Puncture wounds, particularly from fingernails, etc.
	Belt marks, or ligature marks (particularly around legs, feet, hands, or around the neck).
	Poor skin condition
	Poor skin hygeine
	Bruises, welts, discoloration

Look under clothing

Search for bruising under arms and near the neck.

Any injury incompatible with patient history

Any injury which has not been properly cared for (injuries are sometimes hidden on areas of the body normally covered by clothing)

Absence or loss of hair (absent chemotherapy or radiation therapy) and/or hemorrhaging below scalp

Dehydration and/or malnourished without illness-related cause

Loss of weight

Burns (chemical or thermal)

Soiled clothing or bed linen

Psychological or Emotional Abuse

Nursing home patients need to be cared for. That means more than just bathing, nutrition and hydration. It means taking a moment to calm a troubled mind, and answering gently when a patient doesn't know where they are. All too often, however, residents receive no such support. Or worse, the resident is actively abused emotionally by staff members who threaten, cajole, intimidate, or harass their elderly charges. Possible indicators of Psychological and Emotional Abuse include:

	Helplessness
	Hesitation to talk openly
	Implausible stories used to explain events ("I was bitten by a dog" when no dog exists at the facility).
	Confusion or disorientation unassociated with clinical condition
	Anger
	Fear of family, nursing home staff, or strangers
	Withdrawal
	Depression
	Denial
	Agitation

Neglect by Caregivers

Sometimes nurses and certified nurses assistants don't set out to abuse the elderly, they simply run out of time in a day to care adequately for all the elderly patients assigned to them. This results in neglect. Possible indicators of neglect by caregivers would include:

	Dirt, fecal/urine smell, or other health and safety hazards in elder's living envrionment.
	Rashes, sores, lice on elder
	Elder is inadequately clothed
	Elder is malnourished or dehydrated
	Elder has an untreated medical condition

One of the best ways to document neglect is to look at what the nursing home says it will do, and compare it to what it actually does. Every nursing home has forms that it must fill out to take care of patients. Please note, every family has access to medical records under 42 CFR 483.10 unless the resident, while competent, blocked that access.

Abuse Generally

Some aides and nurses, however, are more than just bad tempered or overworked. Some are simply evil people who believe they have the right to do with residents as they see fit. Possible indicators of abuse from the caregivers includes:

	The elder may not be given the opportunity to speak for him or herself, or see others, without the presence of the caregiver (suspected abuser)
	Attitudes of indifference or anger toward the dependent person, or the obvious absence of assistance
	Caregiver blames the elder for accidents (e.g. accusation that incontinence is a deliberate act)
	Aggressive behavior (threats, insults, harassment) by caregiver towared the elder
	Previous history of abuse to other patients or a criminal record
	Problems with alcohol or drugs
	Inappropriate display of affection by the caregiver
	Flirtations, coyness, etc as possible indicators of inaappropriate sexual relationship
	Conflicting accounts of incidents by staff.
	Unwillingness or reluctance by the caregiver to comply with service providers in planning for care
	Inappropriate or unwarrented defensiveness by the resident's caregiver

Sexual Abuse

Rape is not a sex crime -- its a crime of power. All too often the elderly are shockingly attacked in the beds that family members think are safe. Indicators of sexual abuse include:

	difficulty in walking or sitting without evidence of muscular-skeletal disease;
	bruising on the inner thighs;
	vaginal bleeding not associated with menses;
	presence of sperm in the vagina or anus;
	unexplained venereal disease or infection.

How To Report Abuse

If you find evidence that your nursing home resident may be abused, you need to report this information to the state agency responsible for investigating nursing home abuse. In Missouri that agency is the Missouri Department of Health and Senior Services. A call should be placed immediately upon discovering the abuse.

If there are witnesses to the fact that a particular aide or nurse caused harm to a patient, then that information should likewise be transmitted to local police agencies. Nurses, aides, and health care workers in nursing homes are subject to the same laws as others, and can be arrested and prosecuted for assaulting or battering elders.

How to Spot A Cover Up

Frequently when a nursing home is guilty of neglect or abuse, rather than admit the problem and deal with the negligence of its employees, the home will attempt to cover up the negligence. Examples of this include:

	Telling the family that the resident "died in her sleep" (usually indicates they don't know what happened to the resident).
	Telling the family that an autopsy is not required
	Placing clothing, towels, blankets, or other items of equipment or clothing in such a way as to obscure the results of physical injuries.
	Telling the family that clothing was soiled, and therefore not available (may indicate that there are bloodstains or similar evidence on the clothing).
	Telling the family that the patient fell from a bed (whenever signs of physical abuse are present).

When these things occur, press for answers and insist that any unusual injury be explained or reported to the Division of Aging or similar state agency. Do not accept "we don't know" for an answer. Homes have a duty to provide 24 hour a day protective oversight, and that means preventing accidents. However, frequently staffing is so short that they can't meet this requirement, and therefore cover up incidents of abuse and neglect in order to protect their license. Insist on speaking directly to caregivers when there is an injury; do not let administrators or nursing personnel whitewash an incident. Early investigation and thorough investigation frequently forces changes that result in better care.

When To Seek Legal Counsel & Take Additional Steps

Sometimes the abuse simply does not stop. Or worse, the neglect -- often a product of short staffing and poor working conditions and wages -- multiplies. If this happens the police and the state government may be unable to do enough to rectify the situation. In those situations the best recourse may be to see a private attorney. But you must act quickly!

In Missouri Chapter 198 of the Revised Statutes provides residents, and their families, with a powerful tool to force compliance with federal and state law. But to be effective, the resident, the former resident, or the estate of the former resident must make a formal complaint to the Attorney General's office within 180 days of the conduct giving rise to the cause of action. So if your family member is assaulted, neglected, abused, or emotionally damaged by conduct of a nursing home, a 180 day clock starts running on the day the assault or emotional abuse takes place. At the end of the 180 days the resident may have common-law rights to file an action, but the statutory right that provides for punitive damages is gone. For this reason it is imperative to act quickly. An attorney should be sought out as quickly as possible to permit an investigation and, if necessary, litigation.