Articles Posted in Signs of Elder Abuse

In recent years the Centers for Disease Control and Prevention has drawn attention to a source of increasing concern for nursing home residents: Candida auris, also known as C. auris, a fungus that causes “bloodstream infections and even death” in those it affects. Like many infections, C. auris infections are particularly dangerous for those who are already suffering from other conditions. Described by the CDC as “a serious global health threat,” C. auris poses a special risk for nursing home residents.

What makes C. auris so dangerous? A few things. The CDC notes that the fungus is frequently resistant to numerous antibiotic medications; that it is “difficult to identify with standard laboratory methods”; and that it is even prone to misidentification by laboratories without certain technology. This places elderly populations, especially those in nursing homes and other long-term care facilities, at heightened risk. A New York Times report published in September 2019 described a June 2019 study that found “patients and residents in long-term care settings have alarmingly high rates of drug-resistant colonization, which means they carry the germs on their skin or in their bodies, usually without knowing it, and can pass them invisibly to staff members, relatives or other patients.” The study in question “focused on Southern California,” finding that 85% of nursing home residents “harbored a drug-resistant germ.” The CDC has also found that the infection proliferates in long-term healthcare centers

The Times reported that 800 cases of C. auris infection have been identified in the US since the fungus was first reported here in 2015. In August 2019, the CDC updated that count to 806. That includes 388 confirmed cases in New York; 227 confirmed cases in Illinois; 137 confirmed cases in New Jersey; 24 confirmed cases in Florida; and five confirmed cases in California. The Times attributes C. auris’ easy spread through nursing homes to a few factors, in addition to the prevalence of nursing home patients on multiple antibiotics to which the infection has already developed a resistance. Nursing homes are frequently understaffed and under-resourced, according to the Times, and struggle to “enforce rigorous infection control.” They often cycle infected persons in and out of hospitals, putting those hospitals’ patients at risk of the infection too. One health expert told the Times, “You’ll never protect hospital patients until the nursing homes are forced to clean up.” Basic hygienic measures, such as “using disposable gowns and latex gloves,” are essential to combating the infection, yet often unfollowed by long-term care centers, according to the Times. Experts also attribute the infection’s spread in the US to healthcare economics “that push high-risk patients out of hospitals and into skilled nursing homes.” Under the US’s healthcare system, these experts told the Times, “nursing home facilities are reimbursed at a higher rate to care for these patients… providing an economic incentive for poorly staffed or equipped facilities to care for vulnerable patients.”

A recent study has found that a class of drugs known as anticholinergics may increase the risk of dementia in patients aged 55 years and older. Commonly used in antidepressants, antihistamines, and antimuscarinics, the drugs have long been associated with side effects like confusion and memory issues. The new study, published in JAMA Internal Medicine, suggests more powerful side effects than medical professionals have previously understood.

As a report by the New York Times explains, anticholinergics encompass a variety of medications. Examples include clozapine, an antipsychotic; diphenhydramine, an antihistamine used in Benadryl, among other products; paroxetine, an antidepressant; tizanidine, a muscle relaxant; and scopolamine, an anti-nausea medication. Anticholinergics owe their wide range of applications to their function in blocking acetylcholine, a neurotransmitter involved in nervous system functions like muscle regulation, respiratory activity, digestion, and the opening and contraction of blood vessels. “Older adults are more likely to be prescribed many of these medications,” the Times explained, “simply because they tend to have more health issues.”

The JAMA Internal Medicine study examined 58,769 patients who had been diagnosed with dementia, with 225,574 matched control patients. Researchers examined dementia patients’ medical records, scrutinizing what medications doctor prescribed them between eleven years and one year before they were diagnosed with dementia. The study took into account 56 separate anticholinergic drugs, accounting for the dosage patients were prescribed and the length they were prescribed the drugs in question. What researchers ultimately discovered was a 50% increase in the risk of dementia in patients “who used a strong anticholinergic drug daily for about three years within that 10-year period,” according to the Times. This risk was strongest in patients who used anticholinergics to treat depression, psychosis, epilepsy, and bladder regulation issues. The study also found a stronger association between anticholinergics and dementia in patients who received their dementia diagnoses before they reached 80 years of age, and in patients with vascular dementia in comparison to those with Alzheimer’s disease.

Making the transition from an independent life to living in a nursing home is rarely easy for an elderly person.  Fear, anger, anxiety, and many more emotions can make the anticipation of this lifestyle change dangerous.  What are the risk factors and methods of mitigation that can be used to prevent a tragedy?

Transitioning from Home to Nursing Home

The time period between when the decision is made to move to a nursing home and the actual move-in date is critical.  In some cases, the prospect of this lifestyle change is enough to make an elderly person consider suicide as an option.  Some of the reasons for this include:

Though much of the conversation around elder abuse is centered on nursing home malpractice, the leading issue many elders are currently facing is self-neglect. Self-neglect is defined by the National Adult Protective Services Association as, “an adult’s inability, due to physical or mental impairment or diminished capacity, to perform essential self-care…”, and is something that happens far too often within the older population worldwide. With many different factors to appreciate, it’s hard to always know exactly what to look for when trying to detect the symptoms of this epidemic.  

Who is most likely to experience self-neglect?

When having the conversation about self-neglect, it’s important to be aware of what some of the most vulnerable groups are. Though there has yet to be a study of adequate sample size and population diversity, researchers are already starting to see early trends of which demographics are more likely to have this problem.

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.

Nursing homes are often under-staffed in an effort to maximize profits or because they are underfunded.  With the number of elderly people requiring care increasing at a record pace, some institutions use prescription drugs to make their residents more “manageable”.  Legal and ethical issues notwithstanding, the health implications of the use of chemical restraints are terrifying.

What Is a Chemical Restraint?

Put simply, a chemical restraint is when someone’s movement or actions are restricted through pharmaceutical intervention.  Types of drugs used as chemical restraints are:

Nearly 70% of elder abuse victims are women, according to the Bureau of Justice Statistics. It is worth noting that the population of elder women is much larger than the population of elderly men in the United States, however, that does not make these alarming statistics any less disturbing.

Why are women the victims of elder abuse more often than men? There are a few reasons most experts tend to agree upon.

  1. Elderly females may be seen as easier targets for physical, financial, emotional, or even sexual abuse.

For many Californians the time comes when their loved elderly parent or family member may need some help within their home. Whether they need help with meal preparation, personal health and hygiene, or just some help around the home and with errands, finding the right person to care for your elder can be stressful.

Types of in-home caregivers for elders may range from a weekly housekeeper to a certified nursing assistant, or skilled care worker. The range of services provided may be cleaning the home, dispensing medication, helping the elder with transportation, or home care workers may help with personal care such as bathing, and monitoring overall health.

Once you determine the type of care your loved elder needs, there are many places to find compassionate, qualified in-home caregivers. Consider beginning your search by asking for referrals from friends and family, or from a doctor specializing in senior care. You can also check job postings such as those found in the newspaper, or online on sites including www.Caring.com.

Understaffing nursing homes is incredibly dangerous to adults over 65 residing in long-term care facilities such as Southern California nursing homes. That’s precisely why specific laws and regulations are in place which mandate proper staffing at long-term care facilities.

Under California law, “The facility shall employ an adequate number of qualified personnel to carry out all of the functions of the facility” Health & Safety Code § 1599.1(a). Moreover, Health & Safety Code §1276.5-1276.65 mandates that nursing homes must provide a minimum of 3.2 nursing hours per patient per day.

Unfortunately, many facilities choose to ignore the California law. Even worse, the understaffing of nursing homes has been directly correlated to abuse and neglect of elders. Indeed, understaffing in California nursing homes leads to substandard care over and over again. Substandard care in nursing homes then leads to illness, injury, and too often, death.

Elders being admitted to a long-term care facility, such as a Southern California nursing home, are granted certain rights. These rights are protected by regulations on both the State and Federal level. Specifically, these rights are guaranteed by the California Code of Regulations, the California Health and Safety Codes, the California Welfare & Institutions Code, and the Code of Federal Regulations. All California elders entering into a nursing home are granted these rights by law.

Unfortunately, this does not mean their rights are protected and upheld by the facility and staff members. It is important that anyone considering placing an elder into a long-term care facility understands these rights. Rights are granted on pre-admission, while in residence, and transfer and discharge basis.

Pre-Admission Rights
As a potential resident of a long-term care facility, such as a California nursing home, residents’ rights are granted before being admitted. Each potential resident has the right to:

•Visit the facility
•Review the license and certification of the facility
•Review the admission agreement
•Inquire into cost of care, optional services and coverage provided by Medicare or Medi-Cal
•Be informed of all rights in a language that is understandable to the resident
•Be informed of the nursing home’s rules and regulations
•Review all contracts thoroughly before signing
•Be made aware of what basic services are included in cost, and what services are optional
•Be made aware of right to apply for Medicare or Medi-Cal, and be granted assistance in applying for this coverage
•Refuse to have a cosigner
•Refuse to provide a deposit, if you are the beneficiary of Medi-Cal or Medicare
•Refuse to delay rights to receive Medicare or Medi-Cal
•Refuse to sign an arbitration agreement
•Receive the Patient’s Bill of Rights

In-Residence Rights
Federal and State laws further guarantee residents of California nursing homes certain rights while living in the facility, including:

•The right to be treated with respect and dignity
•The right to privacy during treatment
•The right to privacy during personal care
•The right to choose your personal physician
•The right to participate in one’s own treatment planning and decision making
•The right to receive care to ensure proper personal hygiene
•The right to reside in a clean, sanitary facility
•The right to receive proper nutrition in quality and quantity as per physician’s recommendations
•The right to manage your own financial affairs
•The right to refuse care/treatment
•The right to make advance directives including power of attorney, DNR
•The right to voice grievances and/or suggest policy changes to the facility without fear of repercussions
•The right to make and receive phone calls privately
•The right to privacy in visits from family members and friends
•The right to be completely free from abuse, chemical restraints and physical restraints that are not medically required to treat patient’s symptoms
•The right to a monthly itemized bill
•The right to 30 days’ notice of increase in facility rates

Transfer & Discharge Rights

Elders being discharged or transferred from one facility to another, or to return to a private residence are also granted rights under California and Federal laws. Nursing home residents transferring, or being discharged are granted the following rights:

•The right to voluntary discharge without notice
•The right to refuse involuntary transfer except in an emergency
•The right to receive a refund of security deposit within 14 days of account being closed
•The right to remain in the nursing home if insurance transfers from private pay to Medicare or Medi-Cal
•The right to remain in the nursing home if nursing home withdraws from Medicare or Medi-cal
•The right to have a bed held for 7 days if resident is transferred to a hospital

The State of California and the United States Federal Government guarantees these rights and more to all residents of Southern California nursing homes. If these rights are being in any way restricted, or violated, it is time to speak with an elder abuse attorney about your next course of action.
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