Nursing homes are among the health care facilities that are advocating for exemptions from legal liability during the pandemic. Some critics believe this will allow unsafe conditions and poor care to continue to exist.
One of the most vulnerable demographics for the coronavirus is the aging population. The elderly are not only more likely to get the illness, they are more susceptible to severe symptoms and at an increased risk of death, especially if they have an underlying health condition. Because most patients in nursing homes fit this description, it’s not surprising that there have been a number of deaths in these facilities related to COVID-19.
Nursing Home Concerns of COVID-19
Nursing homes have been worried about lawsuits which could result from these deaths, which is why they have attempted to protect themselves by getting immunity from lawsuits.
These facilities are seeking immunity because the situation is out of their control. They often face shortages on personal protective equipment and testing equipment.The guidelines continually change which also makes it difficult for these facilities to follow recommendations.
Experts with aging organizations are concerned about giving blanket immunity to facilities which are notorious for poor care and abuse. What makes the situation even worse is that family and friends are not able to see their loved ones in these facilities to ensure they are getting the best possible care. In many instances of neglect and abuse in nursing homes, the situation occurs because the patient is unable or afraid to say anything. They have no one to advocate for them. When nursing homes are called out on their substandard level of care, it often happens because someone who visited a loved one contacted authorities.
Several states have enacted temporary immunity for nursing homes during this time to protect the facilities from civil lawsuits. New York went even further and provided immunity to the facilities for criminal liability. It’s important to note that the temporary immunity doesn’t cover facilities or providers if there is willful misconduct or gross negligence.
Health inspections have shown that many facilities weren’t following requirements for safety and care to control infections even before the novel coronavirus was a factor. By granting temporary immunity, critics say it allows these facilities to do as much or as little as they want with no repercussions.
The temporary immunity only lasts as long as COVID-19 creates an emergency situation for the states and the country. However, there is no way at this point to know how long that will be. For those nursing homes that were already performing below standard, they aren’t being held to a higher standard to improve.
Nursing homes have been hit hard by the coronavirus with dozens of infections. While there are no solid numbers to know how many people have died in these facilities from the virus, some experts say it is over 10,000. With the latest information still saying a vaccine is at least a year away, concerns about the impact of COVID-19 for everyone still exist. For the elderly population, especially those in nursing homes, the situation is frightening.
Government Increases Scrutiny of Nursing Homes
Health inspectors are being sent by the Centers for Medicare & Medicaid Services to nursing homes as well as hospitals to check on the practices in place for infection control. The main attention is going to areas where the coronavirus has been identified.
More Attention on Infection Control
The increase in attention comes from the five deaths of residents at Life Care Center in Kirkland, Washington who had all been infected with the coronavirus. The inspectors would be looking at whether the correct protocols were in place and if the staff had followed the rules on infection control. This same facility had been cited in the past year for lapses in infection control, but the issues had been corrected, according to inspectors.
The inspectors will be looking at handwashing practices, whether staff are wearing gloves, how laundry is being handled and food preparation, among other things. While the leaders in the nursing home industry have said they support this plan, they also ask about dealing with possible shortages of critical supplies, including masks.
According to CMS, nursing homes have the ability to ban visitors to protect their residents. They can also screen each person who visits the facility to determine if they have traveled overseas recently and where.
Poor infection control is the number one reason for citations with nursing homes. Statistics show that over 9000 nursing homes have been cited in the past three years. These citations vary from basic hygiene to other preventative measures to control infection. Over one-third of those nursing homes have been cited more than once.
Many of the violations are considered lower level, which means they don’t come with fines. They also don’t impact the rating of the nursing home.
Infections in these facilities can be quite serious and often include extended hospital stays for recovery. Many don’t recover from the infections. For example, residents who have feeding tubes are at an increased risk of aspiration pneumonia and skin infections. While older people are more susceptible to these infections because their bodies can’t fight off disease as easily as someone younger, there are also concerns that staff members aren’t trained to monitor for these conditions, or they simply overlook indications of infection.
The Department of Justice Gets Involved
The US Department of Justice has created a task force to focus on substandard nursing home care. The areas of main priority include understaffing and poor infection control as well as neglect and abuse of residents. The DOJ plans to build training materials to assist law enforcement deal with the abuse and neglect of seniors in care.
The key areas of the nursing home plan for the CMS include:
- Stronger oversight
- Simpler reporting requirements
- Improved enforcement
- Improved quality measures
- Increased transparency
While the immediate focus is on infection control, the DOJ says it goes beyond that to failure of care for the residents. As part of the announcement of the new task force, the department cited such concerns as residents who develop pressure sores and those who cannot reach their food on trays, so they must go hungry.
Nursing Home Abuse Caught on Camera
A woman from North Carolina was concerned about the care her mother was receiving in a nursing home. Using a hidden camera, she caught video of staff engaging in abusive conduct towards her mother.
Most Abuse Goes Unreported
One day after the camera was installed, the video captured abuse. The first episode was verbal abuse where the attendant yelled at her mother during a change. It then became physical when the assistant moved the woman across the bed in a violent way. The patient cried out in pain.
The daughter took the camera to the director of the nursing home who fired the employees immediately. However, the assistant district attorney failed to file charges against the employees, which means they can find another job in a different nursing home because there are no records of the abuse.
According to a report from the Centers for Medicare and Medicaid Services, one in five emergency room visits for residents from nursing homes are from abuse. Most of the time, the nursing home doesn’t report the abuse to law enforcement or the proper government agency.
A second report was generated that included reviews of more than 34,000 Medicare claims. After reviewing those claims, it was found that almost 90 percent could be linked to possible abuse or neglect.
What Happens with Abuse
Some of the most common types of injuries from abuse or neglect include the following:
- Head injuries
- Severe infections
- Bruises and cuts
- Bedsores in the later stages
One of the reasons it can be difficult to detect abuse in a nursing home is because the elderly are more prone to injury from other situations. For instance, they may fall and break a bone or get a bruise. They may not eat well or drink and become dehydrated. However, repeated incidents of injury, especially when not documented, are signs of possible abuse.
Patients often deny abuse because they are afraid of the repercussions since they must live in the nursing home. They may become quiet and withdrawn, seem upset or fearful.
Another form of abuse is keeping the patient sedated beyond what the doctor prescribed. The person may spend much of their time sleeping, so staff members don’t have to tend to them as often. If the patient seems groggy or is sleeping a great deal more than what seems normal, it should cause you to question what is going on.
You may be unable to get information from your elderly loved one about the abuse. However, you can report it to the authorities if you suspect abuse or neglect has occurred. It’s important to remove the person from the living environment as quickly as possible. You can also contact local authorities to have the nursing facility investigated.
Removal to a new facility should cause a change in the patient. They may now feel more secure in opening up about what happened if they are able. You will also likely notice improvement in their health and a reduction in injuries in the new environment.
New Tool Alerts Consumers to Nursing Home Abuse
A new icon was added to the Nursing Home Compare website to alert consumers to potential abuse issues within specific nursing homes. The change will make it easier for consumers to find information about the quality of care in these facilities.
Strides Being Made for Protection of Elderly
The Nursing Home Compare website provides valuable information on nursing homes, including whether it meets federal standards and the levels of staffing at the facility. It provides data on quality performance as well. However, finding out about citations for abuse had required multiple steps. This new tool reduces the effort so consumers can be more informed.
The icon became visible in October and will be included on facilities that have been cited for neglect and exploitation along with abuse in the past year. It also shows where residents may have been harmed by abuse in the past two years. The icons will be updated on a monthly basis to allow for more recent information and to prevent nursing homes from being flagged unnecessarily.
Defining and Recognizing Elder Abuse
Statistics show that elder abuse and neglect may occur in one per 20 facilities around the nation. The Centers for Disease Control and Prevention (CDC) provides a definition for elder abuse. According to the website, it is an intentional act that results in the risk of harm to an elderly person or older adult, which is defined as a person at least 60 years old. It may also be a failure to act in their best interests or to provide safety. The abuse may happen by a caregiver or someone else in charge of the well-being of the elder. The elderly person doesn’t have to be harmed, only at a risk for harm.
The CDC categorizes elder abuse in the following ways:
- Physical abuse – force used which causes pain, injury, impairment, illness or death. It may include choking, hitting, biting, scratching, beating, pushing, kicking or pinching, among other acts.
- Sexual abuse – unwanted or forced touching of private areas or sexual acts.
- Emotional abuse – name-calling, insulting, threatening, isolation, and control.
- Financial abuse – improper use of a person’s finances and may include depriving them of access to their own belongings and assets.
- Neglect – failure to prevent harm from an elder or provide basic care.
While abuse often happens to those who are incapable of defending themselves because of mental or physical health problems, it can happen to healthy people as well. Patients with dementia or those with limited mobility are at a greater risk, but so are those who have been abused in the past. Patients who are isolated and have no social support or family are also at an increased risk.
A lack of supervision and oversight by administration often leads to an increased risk for elder abuse in facilities. Staffing issues as well as negative attitudes towards the residents by staff members may contribute as well.
The new alert icon for the NHC website will be a valuable tool to help families and other caregivers determine the best facilities for their elderly loved ones. However, it’s only as effective as the reports being made. If anyone suspects abuse of their elderly loved on in a center, they should report their suspicions to have an investigation conducted.
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