Nursing Home Abuse and Neglect Alive and Well, but the Residents are not.

Virginia Department of Health and Department of Social Services, as well as the US Dept of Health and Human Services Agency for Health Care Research and Quality have regulations that are to be strictly followed by all residential facilities. All across the country egregious violations of these regulations are diminishing the quality of life, and in some cases causing the end of life, for many residents.

www.memberofthefamily.net has been strongly committed to improving quality of care and raising awareness about the safety and quality of homes across the country and has spent the last 12 years collecting, disseminating and distributing data on nursing home statistics and reports of violations. I encourage you to visit their site.

Below you will find my family’s story, told on my Grandmother’s behalf, in the hope of raising awareness about the seriousness of the violations that we are allowing to go on right under our noses and to one of our most vulnerable, needy and deserving populations; our elderly. Following the details of my Grandmother’s experience you will find an outline of specific regulations that were violated by Lake Prince Woods Skilled Care Center in Suffolk, VA followed by a list of references that may be helpful to you in being proactive in the care of your own loved ones and in demanding that our leaders address and correct these issues. I encourage you to reply to this post with your own stories, in honor or in memory of your loved ones, and to get involved and to make an impact. Our elderly are being silenced, we will not be.

My Grandmother was a vivacious, healthy and active 98 year old who had no serious health problems, shopped and visited away from the assisted living facility frequently and danced at social events within the facility on a weekly basis. She enjoyed quality care and active living within the walls of Lake Prince Woods Assisted Living. Approximately six weeks ago she had an obstruction in her bowel, resulting from scar tissue from an appendectomy 50 yrs earlier. The obstruction required an emergency surgery and left her with an ostomy that was supposed to have been reversed in 6 months. Once she came home from the hospital she went to the “skilled care” side of the home for what was supposed to be a couple of weeks until she learned to care for the bag and regained her strength. What we did not anticipate, based on the quality experience in the assisted living side of the home, was that the nurses would severely neglect her physical and emotional needs. The ostomy bag would routinely leak and nobody would change her and bell rings for help would go unanswered. The bag had to be changed several times a day, rather than the anticipated twice a week, because of the frequency of the leaks that stemmed from untrained staff fitting the bags and the bags not being drained in a timely and consistent manner. My mother, sister and I took shifts sitting at the home to visit Grandma and to ensure she was receiving care.  My Mom stayed all week, I came down every Friday-Sunday.  My sister visited before and after work.  I put in 25 or more hours on the weekends, Mom put in many more during the week. We had to do this to make sure they were doing basic things like giving her medicine. Grandma was so blessed to be fully mentally aware and would tell us which pills she had and had not received. Dosing records, weight records, food intake charts, etc were incomplete and what was there was illegible. One Friday I got there at 8pm, nobody had been in the room to check her since her dinner tray had been dropped off in the room at 5. She wasn’t supposed to be eating in the room, she was supposed to get up for every meal and go to the dining room, but she was not excited about that because she was fearful of the bag smelling/leaking, and the nurses didn’t encourage her to get up and go because they didn’t care and it was just as easy or easier for them if she sat in the bed to eat. She hadn’t seen anyone in three hrs, the dinner tray was still sitting there, her bag had leaked all over everywhere and soaked her bed sheets. I went to the nurses station and the nurse who was sitting there visiting with other staff said that she would get to it in a little while and she didn’t appreciate my acting as if she hadn’t done what she was supposed to do. I stood there. She looked at me. I said again, she is soaked and has been lying there for sometime, WHEN are you going to change her? She repeated in a nasty tone that she would do it when she got to it. At that point another nurse, not assigned to my Grandmother that night, volunteered to go with me and clean her up. Unbelievable. That’s just one in many stories, and most residents have experienced the same.  My sister found Grandma soiled around 6pm one evening and when she approached the nurse on duty she was told by the nurse that she was “on break” and would get to it later.  My Aunt and Uncle during one of their visits witnessed another resident wait over an hour after repeatedly buzzing for help to go to the bathroom.  In the four weeks that we were there, two of the residents had fallen while trying to go to the bathroom alone after not receiving responses to their calls for assistance.  Both were found, lying in the floor,  by family members who had come to see them.

Shortly after my Grandmother’s arrival to the “skilled care” side, the nutritionist at the home advised that she was dehydrated. Three days later a nurse practitioner examined my Grandmother at approximately 3pm (time uncertain because not documented) and ordered that she be immediately placed on IV fluids for dehydration. At around 1:00am the next morning she was started on fluids; 8 or more hours since they were ordered and days after the home’s nutritionist suspected dehydration. After receiving fluids she was in good spirits and physically stronger. Over the course of the 10 days following she again dehydrated. The last weekend before she died I kept telling the nurses I thought she was dehydrated and for them to call the doctor on call for the home. They passively refused by just ignoring my requests. Administrators were not on site because it was the weekend. On Sunday night when my Mother arrived several hours after I had left on my three hour journey back to Northern Virginia, my Mother insisted that the nurses call the ambulance to take her to the ER. The nurse told my Mom that they had called the ER and the ER was very busy. My Mom insisted and at that point the transport vehicle was called. My Grandma died early Monday morning (the following morning) from dehydration.

The attitude of the staff at Lake Prince is “that’s too bad but we saw it coming, she lived a long life at 98.” Yes, she did live a long life, and she had no medical problems that would have suggested she should have died at that point. Dehydration is not an acceptable cause of death when one lives in a nursing facility. A month or so before my Grandmother’s death another woman was in a similar position at Lake Prince Woods Skilled Care, only there for a short time while rehabilitating. She was 69. After two weeks of living there she died from dehydration, bladder infection and bedsores.

According to Virginia Department of Health Regulation (12 VAC 5-371-10) abuse is defined as the “willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, or deprivation by an individual, including caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being to include verbal, sexual, physical or mental abuse.” Neglect is defined as “a failure to provide timely and consistent services, treatment or care to a resident or residents’ health safety or comfort, or a failure to provide timely and consistent goods and services necessary to avoid physical harm, mental anguish or mental illness.”

During the approximately 25 hours a week for four weeks that I spent in the nursing home with my Grandmother recently, I witnessed, complained about and verbally reported neglectful failures to provide for my Grandmother’s health, safety and comfort in a timely and consistent manner. I witnessed many other patients experience mental anguish and abuse that ranged from a refusal to assist with needs in a reasonable amount of time to verbal rants and chastising directed at residents at the hands of staff.

According to VA 5-371-150 each resident should receive a copy of Residents Rights and phone numbers and contact information for state personnel, to be used for the filing of complaints. This paperwork is also to include specific procedures by which the resident or family can file a grievance.

No such paperwork was provided, and a grievance form was only provided once the specific words “grievance form” were uttered which prevented them from avoiding the filing. Further, the form that was provided was for in-house complaint review.
Numerous meetings were held with the head nurse and the Director of the center, always with smiles and assurances that everything would be corrected. Fruitless.

At several points over the course of the last few weeks of Grandma’s life my Grandmother and my Mother advised me that we had to be very careful about our complaints and what we said because the message that was given to residents and families was not that they had a right to quality care, but that in the event that the home was dissatisfied with the complaints made by residents and/or families, the facility reserved the right to discharge the resident on 48 hours notice. Several other residents who I had the pleasure of getting to know during my time there told me the same thing- ‘I can’t say anything, I will be put out and I don’t have anywhere else to go.’

VA 5-371-180 Infection Control requires each facility to “establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to prevent the development and transmission of disease and infection.”

After one of the incidents in which my Grandmother was found soiled and lying in her own waste I stripped the soaked bed linens myself while the nursing assistant was cleaning my Grandmother. The waste had soaked through all blankets and sheets and was on the rubber mattress. As one of the nurses came to put new sheets on (the same nurse that told me she’d get to cleaning up Grandma when she could, while she continued to sit behind the desk doing nothing) I told her that the mattress needed to be cleaned because although it was now dry from the few minutes that had passed since I took the soiled sheets off, it was dirty. She ignored me and made the bed right in front of me without ever reaching for so much as a can of Lysol.

I could go on with other stories, but I want to hear from others. I want the state and nursing care facilities to get the point that enough is enough. Below please find specific legislative language that I will be asking our representatives to address. Please stand with me.

Legislation should be amended to include the following:

1) Procedure by which residents and/or family members can voice concerns and file formal complaints/requests for correction of care without the fear of retribution, either by means of maltreatment or displacement from the facility
2) Formal written procedures should be in place allowing each request that is made by a resident or family member to be documented and followed in order to avoid family requests for medicine, hydration treatment, special diets, and other standard routines being ignored or going unanswered.
3) Provision for the availability and use of in room cameras that can be installed and used by residents and residents’ family members to document and ensure proper care via internet access (viewing and recording), at the request of the resident or family members.
4) Requirements for the automatic reporting of incidents of deaths and subsequent investigation of deaths resulting from causes that suggest neglect such as dehydration and infections not associated with a preexisting medical condition.
5) Section VA 5-371-150 should be amended to require that a resident’s rights and complaint/grievance procedures be reviewed and explained to the resident and family members not just annually, but upon admission to the facility.
6) VAC 5-371-170 Quality Assessment and Assurance needs to be amended to require that internal quality assessment and assurance committees consist of at least two people who are current residents and of sound mind to actively participate or who are family members of current residents and should be attended by a representative of the state OLC (Office of Licensure and Certification).

Help me give voice to the elderly. Visit the following sites for useful information on the topic, and email me if you would like to become involved through petition signing, letter writing to our officials, volunteering at your local facility to be a friend to the residents, or if you are interested in helping to form a non-profit resident advocacy group. qualitycare4elderly@yahoo.com

www.memberofthefamily.net

http://www.dss.virginia.gov/facility/search/alf.cgi

http://www.hpm.umn.edu/nhregsPlus/state.html