Articles Posted in Dehydration

Dehydration is a serious health risk, especially in elderly people.  Individuals over 65, who live alone or with their elderly partner, are at a higher risk of dehydration than other age groups because they may forget to stay hydrated or they are too tired to get a drink.  However, in a nursing home, dehydration should never happen and, in some situations, is an example of elderly abuse.

How Wide Spread Is This Issue?

One elderly person dying from dehydration in a nursing home is unforgivable.  People who live in nursing homes are there because they need help of varying degrees to survive.  One of the necessities of life is water.

Elder abuse typically refers to the knowing, intentional, or negligent act by a custodial care provider, caregiver, or any other person that causes harm to a vulnerable adult. In California, anyone aged 65 and older is protected by the Elder Abuse and Dependent Adult Civil Protection Act. The laws are designed to help prevent neglect and abuse to California seniors. Neglect falls within the definition of elder abuse, and unfortunately may have dire consequences to the victim.

In broadest terms, neglect is a type of elder abuse wherein a caregiver fails to provide the elder with basic needs including water, food, shelter, heat/air-conditioning, personal hygiene products and medical assistance. Failure to adequately move or reposition a bedridden elder, for example constitutes neglect, just as failing to keep elders properly nourished and hydrated constitutes neglect.

Neglect is particularly dangerous for elders, as it can lead to life-threatening consequences. Such consequences of neglect include:

Neglect is one of the most common forms of senior abuse in San Diego and around the country. According to the California Department of Public Health’s Nursing Home Residents’ Rights, malnutrition constitutes a form of neglect, and thus—elder abuse.

Nursing homes in San Diego have a legal responsibility to ensure that residents are properly nourished. Nursing home staff must monitor residents during mealtime to ensure that all residents are being properly fed. Likewise, failure to provide appropriately nutritious meals is a serious form of senior neglect.

Warning signs, symptoms, and indications that an elderly loved one in San Diego could be suffering from malnutrition as a result of a neglectful or abusive caregiver or nursing home staff member, include:

A diet made up of healthy foods is necessary to maintain health and well-being. It can also help reduce factors that can contribute to falls.

Some common conditions, which may lead to elders falling in a Southern California nursing home include:

  • Dehydration

Nursing homes in California have a responsibility to prevent malnutrition in resident elders, per the California Department of Public Health. In fact, failure by nursing home staff to monitor residents during mealtime, and/or failure to provide nutritious meals is a form of neglect.
Symptoms that an elder residing in a California nursing home may be suffering from malnutrition include:

*Weight loss
*Lack of Energy
*Slow recovery or healing from injuries or wounds

Elders may not receive proper nutrition for a variety of reasons including, a dislike of the food being served, improper temperature of food being served, difficulty in chewing due to oral or dental problems or pain, difficulty in swallowing, being forced to eat alone, or at a time when other residents aren’t eating. Elders suffering from anxiety, dementia, and depression may also reject meals, which can lead in time to malnutrition.

However, elders suffering from any of these conditions may be suffering from them due to neglect. For example, it is the responsibility of the nursing home to ensure that a resident elder does not have dental issues, or oral pain. Similarly, if an elder residing in a California nursing home is not getting the nutrition they need, because the food is bland, or cold, it is the responsibility of the nursing home to take steps to make the food taste better, by adding seasonings, serving the food at proper temperatures, or offering alternative meals.

As a resident of a California nursing home, elders are granted certain rights when it comes to their meals, and any nursing home who overlooks these steps may be found guilty of neglect. Neglect is a form of elder abuse and may be a civil or criminal offense in California. If you suspect that an elder you love is being neglected in any manner while residing in a California nursing home, report it to your local long-term care ombudsman. You may also want to contact an experienced, elder abuse attorney to discuss your concerns.
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Southern California elders – particularly those residing in nursing homes, or skilled nursing facilities – are unfortunately prone to developing life-threatening bedsores. Bedsores, which are also known as pressure ulcers, can lead to a host of health problems, particularly in elders whose health may already be compromised. Similarly, because many elders may be confined to a bed or wheelchair, their risk for developing these sores is increased.

According to the Mayo Clinic:
People are at risk of developing pressure sores if they have difficulty moving and are unable to easily change position while seated or in bed. Immobility may be due to:

•Generally poor health or weakness
•Injury or illness that requires bed rest or wheelchair use
•Recovery after surgery

However, more specific risk factors affecting elders which make them so susceptible to bedsores may include advanced age, which results in thinner, drier, less elastic skin, which is generally more fragile. Elders may also develop bedsores after significant weight loss, which can accompany a long-term illness. Poor nutrition and/or dehydration also make elders susceptible to developing dangerous bedsores. Illnesses such as diabetes, and vascular diseases may also lead to damaged skin tissue, making it easier for a bedsore to develop. Likewise, elders who suffer from bowel or bladder incontinence are also likely to develop bedsores if soiled clothing isn’t removed and replaced immediately.

Similarly, elders who are in a state of mental decline are typically more likely to develop dangerous bedsores. Those who have limited mental alertness may be unaware that sores are developing, leading them to progress into dangerous infections before being discovered. By the same token, any elder who has diminished sensory perception, such as those who are paralyzed, may also not discover bedsores until they have reached a dangerous stage.

The key to prevention (and treatment) of bedsores is to relieve pressure. This can be accomplished most effectively by repositioning an elder regularly, particularly once a bedsore has developed.

For elders residing in a Southern California nursing home, inspection of the skin should be a routine part of care. Unfortunately, all too often patients suffer from bedsores due to neglect or lack of an appropriate care plan implemented in the California nursing home. If you have found a bedsore on an elder you know, a doctor needs to be notified immediately. Bedsores can often be resolved with appropriate detection and treatment.

While many long-term care facilities in California provide excellent care, others subject their patients to many forms of neglect or elder abuse. The California Welfare & Institutions Code §15610.57, addresses “neglect” in part by stating it is “the negligent failure to exercise the degree of care a reasonable person would have exercised had they had the care and custody of an elderly person.” This would include the failure to protect that elder from dehydration, bedsores, falls, other injuries caused by safety or health hazards and any type of injury that does not fit the explanation provided by the staff.
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By law, the staff members employed by California nursing homes are required to report health changes observed in the elders residing in their facilities. Unfortunately, all too often these changes are unreported. The change in condition of a resident may not be reported for a variety of reasons, including fear that the nursing home be may fined for understaffing, or neglecting California elders residing within the facility. In other cases, a resident who has experienced a rapid deterioration in condition, may indicate that isolation, neglect, or even abuse is occurring within a facility.

Failure to report changes in condition to an elder’s doctor and family members is a violation of the law.
Changes in an elder’s condition which must be reported may include, but is not limited to:

• Cracked lips, or sores in and around the mouth
• Noticeably dry skin
• Eyes which appear sunken in
• Disorientation/Confusion
• Fever and/or thirst
• Rapid weight loss
• Bed sores
• Broken bones

Elders residing within California nursing homes are granted certain rights. If they are violated, resulting in a change of condition, a crime may have been committed. It is important that all staff working in nursing homes in California report these changes in the condition of elderly residents in order to prevent serious health problems, injury, or even death to residents.

If you notice changes in the condition of your loved one while residing in a nursing home in California, report your concerns immediately. In Southern California and San Diego, you may consider reporting your suspicions to:

• Your loved one’s doctor.
• Long-Term Care Ombudsman Program. They provide a 24/7 Crisis Complaint Hotline at 800-231-4024.
• Adult Protective Services (APS). In San Diego County, you may contact: San Diego County Aging and Independent Services (858) 495-5660, or the Eldercare Locator help line at 1-800-677-1116.
• Your Department of Public Health Licensing Office.
• Local Law Enforcement, including the Police, Sheriff, and District Attorney’s office. The San Diego County Sheriff’s department can be reached at (858) 565-5200. The San Diego County District Attorney may be reached at 619-531-4040.

All elders in California nursing homes have the right to quality care and attention, regardless of their age or health. If those rights are denied, abuse must be reported. For tips on reporting suspected neglect and/or abuse in a California nursing home, the Justice Department has a helpful citizen’s guide that can be found at the following website:
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Residents of California nursing homes have the right to quality food while residing in any type of long term care facility. When a nursing home fails to provide quality food and beverages, elderly residents run the risk of becoming malnourished or dehydrated, which can lead to a whole host of medical complications. However, making sure that elderly residents receive enough food and water/beverages is the bare minimum that a nursing home must provide for its residents.

In addition to providing enough to eat and drink, here is a partial list of reasonable expectations (AKA Care Standards) that are granted residents of California nursing homes:

*Three meals a day at regular times with no more than 14 hours passing between meals.

Malnutrition and dehydration are alarmingly prevalent in California nursing homes and long-term care facilities. Malnutrition and dehydration in elders can result in serious physical harm to the elder. If you have a loved elder who resides in a nursing home in Southern California, be sure to look for symptoms of malnutrition and dehydration when you visit. Common signs of malnutrition and dehydration in elders include:

•Rapid weight loss
•Cracked lips, or sores in and around the mouth
•Noticeably dry skin
•Eyes which appear sunken
•Fever and/or thirst

It is important that any indication of malnutrition or dehydration be reported, and rectified immediately, due to serious medical conditions that can develop as the result of dehydration or malnutrition, including:

•Increased likelihood of falling due to weakness
•Increased likelihood of fractures caused by fall due to bone weakness
•Onset of bedsores, which may become life threatening
•Onset of anemia
•Bladder or Urinary Tract Infections (UTI)
•Malfunctioning of kidney (leading to renal failure)
•Fluid loss (diarrhea, fever)

In many instances, nursing homes in Southern California are so dangerously understaffed that nurses are unable to complete daily tasks such as delivering meals to their elderly residents’ bedsides. In many California nursing homes, staff and other health care professionals are not sufficiently trained to identify the symptoms.

The risk of malnutrition is especially acute for elders who are incapable of feeding themselves. In an understaffed nursing home, the time required to feed these patients is too costly, and trays of food are sometimes delivered to a patient’s bedside, only to remain untouched because a staff member is unable to personally feed the patient.

Likewise, it does not take much for an elder to become dehydrated. Brief periods with no water, rooms with slightly elevated temperatures, and increases in body temperature can lead to dehydration. Additionally, elderly residents of Southern California nursing homes are often prescribed diuretic medications, such as those for heart disease, kidney disease, and liver disease, requiring that more fluids be added to their daily intake to prevent dehydration. Elders may also lose their ability to identify when they are thirsty, and thus are unable to alert a nurse of their need for water.
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