The U.S. Census Bureau estimates that by 2050, 20 percent of the U.S. population will be 65 or over. In 2010, the United States had 5.8 million seniors over the age of 85. By 2050, this number will skyrocket to 19 million.
So, what does this mean for America’s aging population? Inevitably, we’ll see a rise in long-term care (LTC) facilities, such as nursing homes, assisted living facilities (ALFs) and LTC hospitals. There are a number of state and federal regulations in place to protect vulnerable seniors from elder abuse and neglect in these facilities. Unfortunately, not all facilities play by the rules.
For many, nursing home abuse and neglect evokes horrifying images of physical abuse by a caretaker. It’s important to note that physical abuse only accounts for a small percentage of nursing home abuse and neglect cases. The National Center on Elder Abuse (NCEA) considers “failures by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm” elder abuse and neglect. According to the NCEA, recent studies estimate that only one in 14 cases of elder abuse ever comes to the attention of authorities. An NCEA research brief cites the following statistics:
• During 2008, 3.2 million Americans resided in nursing homes;
• More than 900,000 Americans resided in ALFs in 2008;
• Nearly one in three U.S. nursing homes were cited for violations of standards;
• Ninety-five percent of residents sampled stated that either they’d been neglected or they witnessed nursing home staff neglect another resident; and,
• More than 50 percent of nursing home staff admitted to mistreating, neglecting or abusing nursing home residents in the prior year.
Combating this epidemic requires constant vigilance on the part of family members, friends and, yes, advisors. Evidence of any of the following could be a sign of elder abuse:
Bedsores (decubitus ulcers). These wounds commonly develop on a patient’s backside and/or heels due to unrelieved pressure. If a nursing home resident is unable to reposition their body in bed, the nurses must move and reposition the resident to relieve the pressure. Failure to do this is neglect and can result in bedsores. The Center for Medicare and Medicaid Services has deemed pressure sores to be a “never event” in health care (that is, an adverse event that’s unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability) and usually preventable.
Falls. Nursing home falls occur frequently and can be lethal. Of the 1.6 million residents in U.S. nursing home facilities, approximately half fall annually. One in three of those who fall will do so two or more times in one year. For an elderly resident, a fall can be catastrophic. One in every 10 residents who falls has a serious related injury, and about 65,000 patients suffer a hip fracture each year from falls. Not all falls can be prevented, but it’s incumbent on the facility to assess fall risk and have a plan in place to prevent falls. Facility falls are also “never events.”
Unexplained bruising and fractures. Bumps, bruises and fractures can indicate abuse and neglect in non-verbal residents, like those suffering from Alzheimer’s or dementia. A serious fracture in a bedbound, non-ambulatory patient may indicate a physical assault or an attempt to conceal the dropping of the patient during a transfer. LTC facilities need to investigate unexplained injuries in non-verbal residents.
Medication errors. One of the largest profit centers for nursing homes is the in-house pharmacy. Residents are often required to fill prescriptions using the nursing home pharmacy in lieu of their preferred outside pharmacy. Unfortunately, the proper medication names and dosages aren’t always transferred along with the resident. For obvious reasons, medication errors can cause grave injury or wrongful death.
Sexual abuse. Sexual abuse is a nearly inconceivable, yet persistent type of assault in LTC facilities. The overwhelming majority of elder sexual abuse victims live in nursing homes (71 percent of victims reside in nursing homes). Eighty-one percent of the time, the perpetrator is the caregiver. A nursing home staff member must immediately report any complaint of sexual abuse made by a vulnerable resident, and the nursing home must investigate it.
Malnutrition and dehydration. Most LTC residents require assistance with their activities of daily living, which include eating and drinking. Some residents’ conditions prevent them from verbalizing their need for food and water and tragically, these basic needs can be withheld. Resident dehydration and malnutrition represent the most widespread neglect injuries in LTC facilities. It’s estimated that approximately one third of U.S. nursing home residents are either malnourished or dehydrated at any given time. Malnutrition presents in patients with weight loss, dry lips, a reddened mouth, muscular problems, cognitive impairment and yellowing skin.
Wrongful death. If an LTC facility resident dies due to injuries from neglect or abuse, the decedent’s estate and survivors can bring a wrongful death claim. These claims are generally statutory in nature, and available damages vary by venue.
The Administration on Aging created a useful, prioritized list outlining what you should do if you suspect elder abuse:
• If the resident is in immediate danger, call 911 and get them emergency medical help.
• Contact the local Adult Protective Services state agency. If you’re unable to locate the proper agency, call 1-800-677-1116 for a free ElderCare Locator.
• Contact the resident’s outside doctor who’s unaffiliated with the potentially at-fault facility.
• Contact law enforcement if the suspected abuse is criminal in nature.
• Contact an elder abuse attorney to investigate the potential claim and advise your clients on their potential options.
This is an adapted and abbreviated version of the author's original article in the July issue of Trusts & Estates.