Elderly Diabetics Face Many Obstacles in Skilled-Nursing Facilities

By Gary N. Stern, Esq.
Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP

In 1992, the California Legislature recognized the need to expand the remedies available to the elderly victims of nursing home neglect and abuse. The result was The Elder Abuse and Dependent Adult Civil Protection Act. This important law resulted in a nationwide explosion of consumer-driven litigation designed to hold nursing homes accountable for their reckless neglect of the elderly.
 
Many skilled-nursing facilities (SNFs) and other extended-care facilities often claim that they are not at fault for an elderly person’s decline under their care. Their position is that the decline was part of the natural progression of whatever disease process the elder had when he or she arrived at the facility.

However, SNFs do not only exist to maintain the elderly at the condition they were in at admission. Pursuant to federal and state statutes and regulations, SNFs must assist their patients to “attain or maintain the highest practicable physical, mental and psychosocial well-being.”

Such care is particularly vital when it comes to the elderly who have diabetes. Managing the disease is not an easy task for any patient, but with the aged, the complexities increase substantially.

The Centers for Disease Control reports the following statistics regarding diabetes and the elderly:

  • At least 12 percent of the population over the age of 70 has been diagnosed with diabetes.
  • Approximately 11 percent of those over 60 have undiagnosed diabetes. 
  • An older person with the disease is twice as likely to be admitted to a nursing facility as one without it.
  • Diabetics have a higher rate of several geriatric syndromes, including depression, cognitive problems, urinary incontinence, falls and injuries, and persistent pain.
  • Diabetics are at higher risk for developing pressure ulcers than elders the same age.

Because diabetic patients admitted to SNFs warrant, but seldom get, high-risk-patient status, there is a high probability their care won’t be managed according to well-known expert recommendations.

For instance, a RAND-UCLA study published in the June 2003 New England Journal of Medicine found that only 45 percent of diabetic patients received guideline-recommended care. One might think that care would be more intensive in a SNF compared to an ambulatory-care setting, but the fact is that physicians visit SNF patients infrequently. The result can be not only a poorer quality of life for the diabetic elderly but also a high rate of unnecessary and medically costly complications developing or progressing in this setting.

Proper care of the elderly diabetic in a SNF boils down to:

  • Designating the elderly diabetic as a high-risk patient from the time of admission;
  • Identifying each patient’s specific risk profile;
  • Focused management of the risks identified;
  • Careful monitoring, and
  • Appropriate documentation and follow-up.

Even in those patients where a diabetic complication did not have its onset at an SNF, rational nursing and medical management strategies are available to mitigate its impact. It is the responsibility of the facility to deal aggressively with those complications.

An SNF is often the place where a critical life decision for the patient is to be made: can the patient eventually go home, or be placed in a long-term care facility? Contrary to the arguments used by nursing facilities in elder abuse cases, many complications need not be a “natural progression of the disease.” Such facilities need to be held accountable for meeting accepted standards of care of our elderly diabetics.

The Elder Abuse Act enables the families of elderly loved ones to hold elder care institutions to a standard that will improve the lives of our older citizens and decrease the unnecessary expenses that society incurs as a result of failures of medical and nursing management.

There is sufficient information available to allow better management of the aged; there is much that can be done to improve their quality of life in and out of medical facilities.

(The law firm of Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LPP is educated and familiar with cases involving elderly abuse. If you would like to contact an attorney about your case, please contact us at 213-739-7000 or click here to learn more.)

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