Selecting a nursing home that will provide the care your relatives deserve requires research and leg work. This can help prevent the possibility of nursing home abuse and neglect.
Look for problems
Nursing homes should be transparent and answer questions about care. But these issues indicate problems and possible nursing home malpractice and neglect.
Staffing issues
According to a 2022 American Health Care Association report, 60 percent of 795 surveyed nursing home providers had worsening staffing issues since Jan. Almost 50 percent had high-level staffing shortfalls and 98 percent had problems hiring staff. Almost 61 percent of these providers restricted new admissions.
High staff turnover harms the continuity of care because fewer caregivers are familiar with their residents’ preferences and needs. This is especially difficult for residents with dementia who have problems expressing themselves.
Facilities perform better with lower turnover. The average turnover is 50 percent.
Having too many residents per caregiver also affects care. Around 20 years ago, the Centers for Medicare and Medicaid Services released a study recommending a daily minimum standard of 4.1 hours of total direct care for each resident to avoid placing them at risk. Direct care includes firsthand care, and services for older residents or patients having a disability.
Registered nurses
Registered nurses have more training and competency to provide better health care such as drug administration, inserting and management of intravenous catheters and developing patient care plans. Facilities staffed with more RNs had less significant pressure ulcers, hospitalizations, and urinary tract infections according to a review in in the July 2021 International Journal of Nursing Studies.
But licensed practical nurses, certified nursing assistants or CNAs generally comprise most staff. Many time, RNs are engaged in administrative work. Despite recommendations to have at least one RN on duty at all times, only six states impose this requirement.
Unclear ownership
Companies may divide ownership which makes it difficult to determine who actually owns the facility. Partial or nontransparent ownership can impact care.
Inadequate supplies
Shortages of mask, gowns, and gloves and other necessities harm infection control efforts and the staff’s ability to avoid virus contact with viruses and bacteria while providing direct care to patients. This also increases the risk of spreading organisms among residents. Some facilities have also experienced a shortage of bed linens.
Drug misuse
Families should ask attending physicians, nurses, or facility administrators about the medications they provide to residents with dementia and how antipsychotic medications are being used and their expected benefits. Obtain information on whether urinary tract infections and other health issues cause confusing or aggressive behavior.
Sometimes, nursing homes administer antipsychotic drugs that are approved for treatment of schizophrenia and bipolar disorder to residents with Alzheimer’s disease, or patients with dementia who have difficult to manage behavior. The FDA issued warnings about the use of Haldol and other anti-psychotic drugs for elderly patients with dementia-related psychosis.
This off label use of antipsychotic drugs has dropped since 2012. But data released in April 2022 indicates a slight increase.
Recurring complaints
Each state has an ombudsman program to improve care. Find out if these complaints are recurring:
- Inadequate discharge planning or improper eviction.
- Unanswered resident assistance requests.
- Negative staff attitudes and respect for residents.
- Medication administration problems.
- Roommate conflicts and other quality of life problems.
Sickness prevention
Multidrug resistant bacteria are present in about 25 percent of nursing home residents according to a 2017 systematic evidence review. These germs, such as the pneumonia causing bacteria Klebsiella, are resistant to widely used antibiotics.
Consistent handwashing and other basic infection measures help reduce the spread of these bacteria and other bacteria such as MRSA. Strong staff vaccination rates help prevent the spread of the flu and other pandemics to residents.
Hospital transfers
Decisions to send a resident to a hospital for care should be made carefully because it may be a long and bewildering experience. A nurse practitioner or registered nurse who oversees the patient’s direct care should assess their condition and then call the attending physician or nursing home resident direct who makes the transfer decision. Family members must be informed immediately.
Attorneys can help family members obtain information about patient care. They can also help assure that residents’’ rights are protected.
