ELDERLY ABUSE IN NURSING HOMES
Then, as if from a nightmare, the call comes in: the elderly loved one has fallen, developed a bedsore, or is rapidly deteriorating in the nursing home. While elder abuse in nursing home statistics suggest that nursing home abuse is quite common, no one ever wants to think it could happen to their own parent or spouse. This only makes the stress, guilt, and anxiety worse.
At Jerome Lindsay Salmi, our nursing home abuse lawyers have spent years carefully investigating serious allegations of nursing home neglect and medical malpractice. Over the years, here’s what we have learned about elder abuse in Illinois nursing homes.
Who Commits Most Elder Abuse?
Most elder abuse is committed by family members. In fact, the National Council on Aging suggests that as much as 60% of all elder abuse is perpetrated by members of the senior’s own family. The problem with statistics like this is they focus on elder abuse as a whole, including things like domestic violence and financial exploitation at home.
When it comes to actual neglect and abuse that occur in nursing homes, it can be much harder to find good statistics, largely due to the fact that most abuse and neglect go unreported. Residential care abuse is a different type of situation altogether. Somewhere between a statutory violation and a medical negligence situation, most allegations of nursing home abuse involve violations of state or federal regulations, while also constituting medical malpractice. Therefore, many lawyers fail to fully appreciate the elements of a nursing home abuse case that really matter when pursuing justice.
For these reasons, it can be quite difficult to appropriately classify each case in order to determine whether it qualifies as true nursing home abuse, medical negligence, or perhaps a different form of elder abuse, such as spousal abuse or domestic violence.
What Are Nursing Home Abuse and Neglect?
Abuse and neglect are common terms, but the law defines them very specifically. Under 210 ILCS 30/3, Illinois law defines “abuse” as any of the following that are inflicted on a resident for any reason other than by accident:
- Physical injuries
- Sexual abuse
- Mental injuries
Keep in mind that negligence is not the same as “an accident.” An accident is something unpreventable or unforeseeable. Negligence, on the other hand, is something preventable and foreseeable that is ignored or permitted to happen. Under the same Illinois law, “neglect” is defined as a specific failure on the part of the nursing home, which leads to physical or mental injuries or a deterioration in the elderly person’s physical or mental condition. This is usually caused by:
- A failure to provide adequate medical care
- A failure to provide adequate staffing
- A failure to provide for a resident’s personal care or well-being
Note that the injuries do not always have to be “physical,” but rather, they can also be mental injuries, such as fear, anguish, humiliation, or a loss of dignity.
Examples of Negligence in Nursing Homes
There are many ways that an aging nursing home resident in Illinois can suffer injuries at the hands of careless or otherwise inadequate nursing homes and their staff. Here three of the most common examples that tend to lead to serious harm.
# 1 – Nursing Home Falls
Fall rates in nursing homes tend to be worse when understaffed or where training is overlooked. Nursing homes often tell families that falls are unpreventable, but this is far from the truth. In fact, some of the leading authorities on nursing home fall prevention agree that the vast majority of falls that happen in healthcare environments are entirely predictable and thus preventable.
Consider the nursing home falls protocol for most facilities. In the 1990’s a nurse by the name of Janice Morse, Ph.D., R.N. wrote a groundbreaking book entitled, “Preventing Patient Falls.” The book established a standard of practice that would later lead to a second edition in 2008 and lead the way for a standardized method of predicting fall behavior in seniors. This is now known as the Morse Fall Scale, which is even used in major hospitals and by the U.S. Department of Veterans Affairs. According to Janice Morse, most falls are entirely predictable and therefore preventable with proper assessment and documentation.
When someone tells you that falls are unpreventable, remember that according to the leading authority on the subject, the majority of patient falls are completely preventable because they can be predicted well in advance. Plus, there are numerous measures available to nursing home staff to prevent falls. So, when someone tells you the fall was unpreventable, ask them what they actually did to prevent the fall.
- Why Falls Are Serious. A simple fracture may mean nothing more than a cast for a healthy, young, and otherwise young and active person. But for a vulnerable senior with medical problems, a single hip fracture could spell a deadly condition that will ultimately shorten their life and deprive family of those final years of their companionship.
- Repeated Falls and Fractures. A single hip fracture can cost well over $100,000 to repair surgically, and in some cases the costs can be far higher. This is unfair, and it is wrong to put that burden on the family or the taxpayers (through Medicare or Medicaid dollars). After all, if someone is in a nursing home, these events should not be happening.
- Typical Fall Injuries. Fall related injuries can be extremely serious and even fatal. These tend to include:
- Fractures to the arms or wrists
- Hip fractures
- Head traumas
- Brain bleeds
- Broken tailbones
- Deep tissue injuries
#2 – Decubitus Pressure Ulcers
The second common injury in Illinois nursing homes tends to be bedsores. These painful wounds area also known as pressure ulcers, pressure injuries, or decubitus ulcers. Ultimately, they are all the same thing. They are tissue injuries that occur at a level beneath the skin. They lead to impairment of the tissue and even muscle fibers, which can result in open sores that develop fairly fast when left untreated. These are most common over bony areas of the body, such as:
- Back of the neck and ears
(See below illustration of the most common places for bedsores on the human body.)
What Makes Pressure Ulcers Deadly?
A pressure ulcer or “bed sore” is not to be taken lightly. If a loved one has developed a pressure ulcer, or you notice large, discolored patches of skin, get help immediately. This could be a very serious problem that can quickly lead to a deterioration in health and even death. Centers for Medicare and Medicaid Services (CMS) guidelines state that any time after October 2008, healthcare facilities are not paid for the treatment and repair of pressure ulcers that were not present on admission. In other words, the guidelines state that these are “never events,” meaning they should never occur in a healthcare setting, unless unpreventable. And therein lies the key.
When a loved one develops a pressure ulcer, the nursing home will immediately try to argue that the bedsore was unavoidable. In fact, some facilities and staff will even lie, hide the evidence, or try to claim that the injury was related to some sort of resident-induced injury. Facilities will go to great lengths to avoid calling it what it is – neglect. If they admit it, then they may not receive payment for all of the care that goes into treating the problem.
Bedsore Stages and Knowing What to Look For
There are generally 4 stages (plus the fifth stage being “unstageable”) of bedsore development. These are established by the National Pressure Ulcer Advisory Panel (NPUAP). They include the following:
Stage 1 – A closed skin injury that shows mild discoloration at the surface but is still intact. At this stage, the skin will appear like a diaper rash, but it is generally reversible through frequent assistance, repositioning, and good nutrition and hygiene.
Stage 2 – The blister forms. At this stage, the skin is usually starting to open or form blisters. It becomes very tender and can be extremely painful, especially when moving or transferring a person from one position to another. Healthcare staff often meet resistance when helping nursing home residents reposition at this stage, but it’s important to provide medical care even when uncomfortable.
Stage 3 – At this point, most wounds are very difficult to reverse. This does NOT mean the pressure ulcer is unpreventable. After all, it WAS preventable. Now it is so bad that the tissue will erode, leaving underlying fat tissue exposed. It may be bloody, deep red, and show signs of drainage. At this stage, the wound will usually be very wet, meaning it is highly exposed to infection, especially for residents who are incontinent and require frequent assistance with toileting.
Stage 4 – At this final stage, underlying bone, muscle, tendons, and even joints may be visible. Tissue can be black or flaky, and the resident will almost always have an infection by now. It is very hard to reverse a bedsore once it gets this far along. In depositions, some actual nursing home physicians have even testified that it is far better to treat a wound early than to let it get worse. An ounce of prevention is truly worth a pound of cure.
Unstageable Wounds – At this point, the wound is so badly separated from the healthy skin and the wound bed and edges are so badly deteriorated that staff can no longer get accurate measurements of depth and width. So, it becomes unstageable.
When inspecting a loved one at a nursing home, look for these three things:
- Bandages to bony parts of the body. If there is a bandage, it is likely hiding a pressure ulcer, skin tear, or some other injury.
- Foul Odor. If you smell something akin to rotting meat or a foul odor that does not seem familiar, it may be a wound.
- You are asked to leave while staff “reposition” your loved one. Unless your loved one asks you to leave, there is really no medical reason why nursing home staff would need you to leave the room in order to move or reposition a bed-bound resident. If your loved one is cognitively intact, they get to make the choice about who is around. If they have dementia and you are their agent, it’s not up to the nursing home to decide whether you stay, unless there is some clear medical reason for leaving (operating an x-ray machine, no room, sanitary environment, etc.)
#3 – Infections
Finally, infections are one of the biggest killers in nursing homes. Between weak immune systems, poor nursing home care, and staff not providing ample hygiene services, there are a lot of ways that residents can develop deadly infections. Here are a handful of the most common infections that claim residents’ lives each year in Illinois.
- Pneumonia – Pneumonia happens when the lungs become inflamed and infected, sometimes filling with fluid, puss, or other infectious materials. Rare among the general public, these infections are a concern for people with limited mobility. Something like a hip fracture can quickly lead to lack of mobility and ultimately pneumonia.
- Clostridium difficile (C-Diff) – C-diff is most common when a person has built up a resistance to antibiotics after long-term use of certain powerful drugs. This is why it is important for elderly nursing home residents to receive appropriate dietary and hydration services, as well as good infection control. It’s much better to prevent infections than be forced to treat them long term. C-diff causes loose stools and can be fatal.
- Methicillin-resistant Staphylococcus aureus (MRSA) – This is not your ordinary Staph infection. It is often caused by open sores or wounds, and in time it can be fatal. MRSA (pronounced “Mersa”) is very hard to treat, because by its nature it is resistant to drug therapies.
- Sepsis – Of all the infections nursing home residents can acquire, Sepsis is the most serious immediate threat in many cases. This is because it is an infection of the blood. Once an infection has gotten into a person’s blood, it can claim a life within days or even hours. It often forms as a result of a bedsore that is untreated.
How Illinois Law Protects Nursing Home Residents and Their Families
Unlike some other states, Illinois law is very specific about protecting elderly nursing home residents. The Illinois Nursing Home Care Act is a statutory scheme that allows private attorneys to act as a sort of “private attorney general,” in order to prosecute negligent nursing homes through a civil action. Here’s how it works.
The State of Illinois performs about 1,300 annual inspections of facilities each year, and then they have to respond to upwards of 6,000 complaints of abuse and neglect annually, according to the Illinois Department of Public Health’s own website. The problem is there are only about 200 investigators statewide. They are supplemented by a volunteer ombudsman at times, but there is frankly no way for the state to fully enforce the complex rules and rights that are established by the law. Thus, the law was written to allow residents and surviving family members (in cases where the resident dies) the opportunity to hire a private attorney to pursue justice on their behalf. Through this type of lawsuit, negligent and poorly run facilities and their owners can be held accountable for the harm they cause, and it relieves the state of the burden of hiring hundreds of attorneys to do the work.
A Southern Illinois Nursing Home Neglect Lawyer Can Help
Jerome, Lindsay & Salmi, LLP never charges upfront fees to clients. The same is true of nursing home abuse cases. Most nursing home cases take about 6 months to investigate prior to filing a lawsuit, and our office covers all of the out-of-pocket expenses for most cases. Once the case is thoroughly investigated, the records and evidence are shared with confidential experts who are industry-leading physicians and nurses who are trained to spot abuse and neglect and render opinions. Once they have reviewed the case and helped to form the basis for a lawsuit, the case is filed in court.
On average, most nursing home abuse cases will take several years to resolve. Of course, there are many factors that can expedite or delay the outcome. As such, it’s important to discuss all concerns with an attorney early on in the process. A lawyer will handle the majority of the daily litigation tasks, including:
- Court filings
- Court appearances
- Negotiations with defendants
- Negotiations with insurance claims handlers
- Trial preparation
What You Do as a Plaintiff in a Nursing Home Case
There are generally only two times during a case where you, as the injured resident or authorized representative, will need to be directly involved in a proceeding. These are:
- The initial consultation
- Answering questions and being available to discuss the case periodically
- Answering written questions
- Occasionally signing paperwork
- Answer questions at a deposition, and
- Appear at trial.
Keep in mind that over the course of several years, a plaintiff’s tasks will actually be relatively minor and sporadic. With a good lawyer in charge of the case, you should be able to go on about your life and let the attorney handle the vast majority of the work.
Contact an Experienced Nursing Home Injury Lawyer
At Jerome, Lindsay & Salmi, LLP, we are devoted to protecting the rights of injured people throughout southern Illinois, including clients all over the state. We’ve handled cases for clients as far away as Chicago and Harrisburg and just about everywhere in between. From our office in Fairview Heights, Illinois, we make time to meet with clients in person, in their homes, or even in the nursing home. We can arrange a video conference or schedule a time to have an attorney come meet with you in your own neighborhood. You won’t pay a penny for the time or the consultation, and our attorneys do not bill by the hour. We take as long as needed to get a clear understanding of what happened.
So, if you have a close relative who is suffering from injuries or abuse in an Illinois nursing home, or you have recently lost a loved one due to neglect, poor medical care, malpractice, or physical abuse, call Jerome, Lindsay & Salmi, LLP today.