Nursing Home Abuse

Neglect and outright mistreatment is common in nursing homes. Federal and state laws empower residents, family, and friends to do something about it.

Seventy-five million Baby Boomers have or will soon enter their golden years, and they are likely to live longer in retirement than their parents did. A large percentage of them will want or need residential care. That means a lot more nursing homes will be built, staffed, and filled with residents. Nursing homes can be a comfort to the elderly and to their loved ones—or they can be a hidden horror story for residents.

This article discusses nursing home abuse. For information about elder abuse laws, see Elder Abuse.

What is a "Nursing Home?"

Older people have a wide array of living arrangements to choose from, if they are fortunate enough to have the financial resources to choose. For example, an able-bodied, healthy older person may choose to live in senior cooperative housing where other older people live and where some meals and chores are shared. Others may choose an elderly housing facility in which they have an apartment and may live independently for the most part, but where some services are provided.

Some elders require a bit more care and need to live in an assisted living facility where help is provided for bathing, cooking, shopping, cleaning, and other daily needs. Still others, especially the infirm or disabled, may require greater (perhaps round-the-clock) attention. Those lacking the means to pay for private facilities may live in governmentally-subsidized senior housing. A "nursing home" is a facility where medical attention (such as administering medications and monitoring health needs), dietary needs, and recreational activities are provided. Nursing home residents receive full-time care.

Some nursing homes in the U.S. are privately run, with little or no governmental oversight. Some are funded by federal monies and subject to federal regulation. Some homes are staffed by people who are not trained either in health care or geriatrics. Many homes are understaffed, with residents left alone to suffer. The elderly residents often have complex physical and mental conditions that present a challenge to even trained caretakers.

Nursing Home Abuse

The abuse of elderly people includes physical, financial, emotional, or sexual abuse, as well as neglect or abandonment. Abuse in a nursing home or other residential care facility at times takes the form of malnutrition, dehydration, and bed sores resulting from extended periods in bed without being moved.

Nursing home abuse is a serious problem in the U.S., with 20 percent of homes being cited for sanitation, care, and other defects, according to"NURSING HOMES: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents," a 2007 report by the U.S. Government Accountability Office.This abuse takes many forms.

Inadequate medical care

Understaffing and inadequately trained staff are two chronic problems in nursing homes. These defects lead to many other issues for residents, including errors in the administration of medicines. Untrained staff may give a resident the wrong dosage, may fail to give the resident prescribed medication at all, or may give the resident the wrong medication. Where there is no relative or friend monitoring the resident, such errors may go undetected and can lead to complications or death.

Neglect or worse

Nursing home understaffinghas also led to neglect of frail residents unable to attend to their own basic needs. At times, neglect can rise to the level of a kind of torture, with the residents suffering bed sores from not being moved, malnutrition, dehydration, and other maladies. Residents may not be properly bathed or cleaned upon using toilet facilities, which can lead to life-threatening infections. Staph infections are a concern at any medical facility, and poor sanitation can increase the risk. The frail elderly are particularly susceptible to severe staph infections due to compromised immune systems.

Inadequate facilities

Some deficiencies are life-threatening, including poor or no fire prevention measures in facilities. The federal government did not require Medicare- and Medicaid-certified nursing homes to install automatic sprinkler systems until 2000, and then the regulations applied onlyto newly constructed facilities. It was not until 2008 that U.S. regulations required older nursing homes to install sprinkler systems; the government gave those facilities five years to comply. As of September 2013, over 1,100 nursing homes still lack full sprinkler systems and over one hundred have no sprinkler system at all, according to a report by the National Consumer Voice for Quality Long-Term Care.

Laws Governing Facilities

Under the federal Nursing Home Reform Act ("NHRA"), any nursing home receiving Medicare or Medicaid funding must meet certain standards. (42 U.S.C. § 1396g.) And, under the NHRA, all states that are home to such nursing homes must have a state agency devoted to developing and enforcing standards for the homes. The NHRA requires all Medicare- and Medicaid-certified nursing homes to "attain and maintain the highest practical mental and psychosocial well-being of each resident." (42 C.F.R. § 483.25.) However, the NHRA does not give a resident or his or her representative the right to file a lawsuit for violations of the law by a nursing home.

Some states, such as New Jersey and California, have laws governing nursing homes within the state and providing residents or their representatives with the right to file private lawsuits when a nursing home fails to meet the legal standards and the resident is harmed.

California and other states also have statutes that set out what features a skilled nursing facility must have and how it is to be established. However, a facility that houses elderly residents does not have to be run as a skilled nursing facility and does not have to comply with the rules for a skilled nursing facility.

Laws Governing Conduct of Staff

There have been many reports of nursing home residents being restrained or confined to their beds, either physically (with straps or belts), or pharmaceutically (with sedatives or other incapacitating drugs). It is a violation of federal law for a Medicare- or Medicaid-certified nursing home to restrain residents for the convenience of staff. (42 C.F.R. § 483.25(m).) Under U.S. regulations, every resident in a federally-funded nursing home has the right to freedom of movement unless restraint is needed for medical purposes.

Sexual abuse of residents by staff or other residents is also a problem in some homes. Sexual abuse of a nursing home resident violates state criminal laws against sexual assault and also may violate state elder abuse laws that provide for enhanced punishment. (For more information on sexual assault, including state-specific articles, see Sexual Battery.)

How to Report Suspected Abuse

The "Older Americans Act," signed into law by President Lyndon Johnson, sets up ombudsmen in every state to address reports of neglect, abuse, or other issues in nursing homes. If a staff member, a relative or friend of a resident, or anyone else suspects abuse or neglect at a nursing home, the state ombudsman is a good starting point to report the problem. To find the ombudsman for your state, visit the National Long-Term Care Ombudsman Resource Center (funded by the federal Administration on Aging), which provides training and support to each state's ombudsman. program.

Talk to a Lawyer

The retirement bulge of Baby Boomers has created a relatively new specialty in the law—elder law. If you suspect nursing home abuse in your community, talk to a lawyer who specializes in elder law to find out what to do.

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