A few days ago, a jury in Mobile reached a $7 million verdict against a facility over the sexual assault of one of its patients. The article discussing the case paints a disturbing picture of a facility that failed to monitor its own residents. Another fact from the article also stood out — The facility failed to report the assault for 24 hours after the incident. The article does not tell us why the facility waited or what finally prompted the report. Some facilities wait to see if the incident can be covered up.
When I think of nursing home cover-ups, my thoughts always return to a case many years ago. An elderly nursing home resident in Huntsville was severely attacked by fire ants in her bed over the course of several nights. The attacks were only discovered by the family when the resident’s daughter arrived early one morning to a horrible scene. The facility’s CNAs had her mother in the shower washing ants from her. The bed was covered with a mound of swarming ants.
We recently investigated a case where an Alabama nursing home tried to cover-up serious bedsores suffered by the resident. The nursing home neglected to note the bedsores in its own records and later tried to blame them on a hospital where the resident had spent a couple days for other treatment. Unfortunately for the nursing home, the hospital took extensive photographs and measurements upon the admission. So, there was no denying that the bedsores occurred in the nursing home.
In another of our recent cases, a resident fell and fractured his hip. The incident was never reported. Mysteriously, key records for the time frame at issue even disappeared. Fortunately, we were able to investigate the incident and obtain justice for the family.
Do nursing homes fail to report incidences of abuse or neglect? Yes. A prior Federal government investigation found that close to half of the allegations of abuse / neglect and subsequent investigations were not reported.
On an individual level, a resident and his family deserve better. Families trust these facilities to watch and keep safe their elderly loved ones. On a larger level, we need a system that accurately tracks abuse and neglect so the worst offending facilities can be shut down. What are some of the tactics used by nursing homes to keep from reporting incidents of abuse or neglect?
Failing To Document The Resident’s Condition
I listed this tactic first for a reason. Many nursing homes neglect to adequately chart patient care. In the industry, they often refer to their practice as “charting by exception.” In other words, nursing home administrators and staff claim they only chart when something important out of the patient’s normal, occurs.
The problem is that many important things are missed by caregivers. When you start asking individual caregivers about a resident’s “normal” they usually cannot tell you. How can you chart exceptions when you don’t even know the normal? You can’t. Charting by exception is often an excuse for understaffed facilities who don’t have the employees to provide adequate care or keep adequate records.
When a nursing home’s charting is incomplete or fails to document many activities, it becomes easier for the facility to hide events. Caregivers simply don’t chart them. If asked, the same caregivers claim they saw nothing abnormal since nothing was charted.
Claiming Ignorance About Injuries
It’s easy to see how a practice of charting by unclear or undefined exceptions allows nursing home employees to neglect their duty to document injuries. The nursing home can then easily claim ignorance or try to shift blame. I’ve seen nursing homes claim injuries were “self-inflicted” or “occurred elsewhere” while the resident was at the hospital for care.
Think of the fire ant attack case I mentioned at the beginning of this post. In that case, the daughter had observed rashes on her mother on previous days. Yet, the assisted living facility claimed ignorance. Would the facility have continued claiming ignorance if the daughter had not arrived early and caught staff in the process of their clean-up??? I think we all know the answer to that question.
Manipulating The Medical Chart
It’s easy to manipulate a medical chart when you only “chart by exception” but cannot define the baseline or the exception! I mentioned a bed sore case at the beginning of this post. In that situation, it was easy for the CNAs to simply chart day-after-day that the patient’s skin condition appeared fine. It was easy for the CNA to chart day-after-day that the resident was moved to avoid sores. It was only when he went to the hospital for another matter that the injuries were discovered. At the hospital, emergency room staff became startled by the extent of the injuries and took immediate photographs.
Intimidating The Patient
It’s difficult to imagine trusted caregivers trying to intimidate an elderly resident. Nobody wants to think that such bad behavior could occur. But, it does. While intimidation tactics can include outright threats or physical force, they often involve other conduct. Intimidation can include withholding food, social activities, or other things.
Injury And Incident Reporting Is A Real Problem. Be Watchful If You Have Elderly Loved Ones In A Nursing Facility
If you have a family member in a nursing facility, be watchful. Stay involved in your family member’s care. Be present as often as you can.
If you see any signs of injury, immediately seek medical care for your loved one. Photograph any injuries. Report any suspected abuse or neglect. Make sure you know the caregivers over your loved one.
Across Alabama, nursing homes are severely understaffed. Proper care is a serious issue impacting many families. With too few caregivers and almost no oversight by our state government, some nursing homes choose to not report injuries or problems. Our elderly loved ones deserve better.