Elder Abuse: How to Detect It and What to Do About It
Gary N. Stern

With the ever expanding life expectancy of our population, elder abuse becomes a more common occurrence. Despite good intentions, nursing homes, residential care facilities and retirement homes do not always provide the necessary care and supervision. People who have a family member in such a facility need to know what to look for and what to do when they see signs of abuse or neglect. Of particular concern are board and care facilities and assisted living facilities (what are formally called "residential care facilities for the elderly") that take in elders who need more advanced care. This is often seen in the case of Alzheimer's patients. Residential care facilities are not licensed health care providers and often lack adequate safeguards and personnel to determine when a resident is deteriorating and thus requires a higher level of care. Abuse and neglect also occur in skilled nursing facilities despite the fact that nursing homes are heavily regulated by both California and federal law.

Identifying Signs of Neglect

Family members need to frequently check on their loved one to make sure he/she is comfortable and not in daily pain. Elderly people, because of their disabilities, are at high risk for bedsores, also known as decubitus ulcers. To prevent them, nursing homes are required by federal and state law to turn the resident at least every two hours. If this is not done, bedsores may develop in the tailbone area where they are not visible. This is one possibility to consider if there are increasing reports of pain from a nursing home resident.

Other consequences of neglect are malnutrition or dehydration. If a resident has dryness around the lips, it may be an indication that he/she is not getting the necessary nutrition or hydration. Elderly people often eat a special diet, such as soft food if they have difficulty chewing. When caregivers neglect to read the dietary orders in the chart, they may provide the resident with an inappropriate diet. As a result, the individual does not eat and soon develops dehydration and malnutrition.

These are just a few signs of neglect that families can look for. In general, whether the resident is at a nursing home or another type of facility, keep a watchful eye out for any change in condition.

The underlying reasons for neglect and abuse in elder care facilities:

A primary reason for elder neglect and abuse is facility understaffing. In nursing homes, the Certified Nurse Assistants (CNAs) who are rendering the day-to-day care have a difficult job. They are generally minimum wage earners with very little training who are asked to care for 10-12 people on a shift. They run around from person to person to turn them and clean them up if they are incontinent. Overworked and poorly prepared for the challenges of the task, they occasionally lose patience and hit residents or move them roughly.

In many instances, however, the CNAs are the heroes who are doing the best they can under very difficult circumstances. The real villains often are the corporate owners and CEOs who take the money that should go into patient care and spend it on themselves. Although throughout the country a certain number of nursing hours is required per day, per resident, many facilities do not even come close to providing that level of care.

Getting Help

According to federal and state regulations, each nursing home in California is required to have a family counsel or residents' counsel. Further, there must be a written plan of care for each resident. If there is a problem, residents or family members can complain directly to the counsel and request a meeting. A practical suggestion is to ask to have the plan of care reviewed with the director of nurses or the nutrition supervisor to make sure it is up to date.

If the resident or family member receives no satisfaction from the counsel or the facility administration, another option is to contact the local elder care ombudsman. In California, just about every community or region has an ombudsman whose sole job it is to intervene on behalf of family members who are concerned about the care of their loved ones in a nursing home.

Under the California Penal Code, elder abuse is a felony and can be prosecuted when there is evidence that it was done intentionally. In any clear case of abuse, immediately contact Adult Protective Services, which will contact the police. Los Angeles County has a very active Adult Protective Services unit, as well as an elder care unit within the LAPD. They prosecute cases of physical abuse of the elderly, as well as gross and pervasive neglect in a facility.

Attorneys specializing in elder abuse can educate families on their options. In 1992, the Legislature expanded the rights of the elderly to pursue civil litigation, providing lawyers with an incentive to take on these types of cases.

Choosing the Best Care

Many senior citizens prefer to live in their own homes, and it is usually the case that family members want the same type of care for their mother or father. Unfortunately, in-home health care is expensive and often a nursing home is the only avenue open to a senior and her family. When it becomes necessary to move an elder to a facility or to change facilities, a helpful web site is Nursing Home Compare hosted by the Department of Health and Human Services, www.medicare.gov/nhcompare. Here, you can look up nursing homes certified by Medicare and Medicaid/Medical and view their quality ratings, staffing data, inspection reports and past citations. There is also information on alternatives to nursing homes and a checklist for evaluating facilities. It is a convenient and reliable way to shop for the best home away from home for your loved one.

Sidebar: Three Levels of Care

The highest level of care, just below the hospital, are "skilled nursing facilities," formerly called "nursing homes." Licensed by the California Department of Health Care Services, these are 24-hour care facilities whose nurses and staff are certified. A somewhat lower level of care is provided by "residential care facilities for the elderly" (RCFE's), formerly known as "board and care homes." These are licensed by the California Department of Social Services. Their residents can perform basic activities of daily living, such as dressing and feeding themselves. If they need help with medication, a staff member is responsible for providing it.

The lowest level of care is provided at retirement homes or assisted living facilities. Here residents are able to care for themselves, but are provided with certain housekeeping services.

California also has many hybrid facilities, where multiple levels of care are available under one roof. A person can enter such a facility at its board and care level and then 10 years later move to the skilled nursing wing of the facility.